Impact of dental clearance on total joint arthroplasty: A systematic review

Table 1 PubMed and Scopus search results

Search	Hits
PubMed search results
Arthroplasty and dental and clearance	5
Arthroplasty and dental and hygiene	21
Sourced from citations	0
Scopus search results
Arthroplasty and dental and clearance	5
Arthroplasty and dental and hygiene	18
Sourced from citations	1

Table 2 Quality assessment based on downs and black questionnaire

	Adamkiewicz et al[12]	Tokarski et al[13]	Vuorinen et al[14]	Wood et al[15]	Barrington et al[16]	Lampley et al[17]	Tai et al[18]	Sonn et al[19]
Q1	1	1	1	1	1	1	1	1
Q2	1	1	1	1	0	1	1	1
Q3	1	1	1	1	0	1	1	1
Q4	1	1	1	1	1	1	1	1
Q5	1	2	2	2	1	1	2	1
Q6	1	1	1	1	1	1	1	1
Q7	1	1	1	0	0	1	1	1
Q8	1	1	1	1	0	1	1	1
Q9	1	1	1	1	1	1	1	1
Q10	1	1	1	0	0	1	1	1
Q11	1	1	1	1	1	1	1	1
Q12	1	0	0	0	1	0	1	1
Q13	1	1	1	1	1	1	1	1
Q14	0	0	0	0	0	0	0	0
Q15	0	0	0	0	0	0	0	0
Q16	1	1	1	1	1	1	1	1
Q17	1	1	1	1	1	1	1	1
Q18	1	1	1	0	0	1	1	1
Q19	1	1	1	1	1	1	1	1
Q20	1	1	1	1	1	1	1	1
Q21	1	1	1	1	1	1	1	1
Q22	1	1	1	1	1	1	1	1
Q23	0	0	0	0	0	0	0	0
Q24	0	0	0	0	0	0	0	0
Q25	0	1	1	1	0	0	1	1
Q26	1	1	1	1	1	1	1	1
Q27	0	0	0	0	0	0	0	0
Total	21	22	22	19	15	20	23	22

Table 3 Risk factors and epidemiology of total joint arthroplasty patients

Author	Model	n	Methods	Results	Conclusion
Adamkiewicz et al[12]	Patients at a tertiary University Hospital in Poland	228	Patients admitted for elective TJA received dental evaluation along with standard preoperative workup	Clinically significant periodontal disease was detected in 28.5% of patients	Periodontal disease is prevalent in patients undergoing TJA
Tokarski et al[13]	Patients at a tertiary care center in the United States	300	Patients answered a dental hygiene questionnaire then received dental evaluations and necessary interventions	12% failed dental clearance. Patients with one or more of: Narcotic use, tobacco use, or last dentist visit over one year ago, had a 22% risk of failure compared to 6% for patients with no risk factors	It may be reasonable to only screen high risk patients for dental pathology
Vuorinen et al[14]	Patients at a public, tertiary care hospital in Finland	731	Patients filled out a prospective dental health questionnaire and underwent a dental examination and necessary interventions	29.4% of patients failed dental clearance. 5.1% of patients had severe periodontitis. Tobacco use and root canal were risk factors. Regular dental examination was a preventive factor	The inspection and treatment of dental pathology is important prior to elective TJA
Wood et al[15]	Patients at a large academic center in Canada	453	Patients answered a dental hygiene survey at their 6 wk post-operative appointment	76% of patients had a cleaning within 12 mo. 5% did not visit a dentist. 49% were informed of the impact of dental hygiene in reducing PJI	Patients generally have good oral hygiene, but patient education is inconsistent

PJI: Periprosthetic joint infection; TJA: Total joint arthroplasty.

Table 4 Impact of dental clearance on infection

Author	Model	n	Methods	Results	Impact of clearance
Barrington et al[16]	Patients at a metropolitan, tertiary arthroplasty practice in the United States	100	Patients obtained dental clearance, cleaning, and dental interventions. On POD 1 or POD 2, patients were interviewed	23% were not cleared due to dental decay and were treated. There were no periprosthetic infections within 90 d. One in four patients had dental pathology	It is difficult to draw a definitive conclusion
Lampley et al[17]	Elective TJA and hip fracture patients in a tertiary arthroplasty practice in the United States	519	Patients obtained dental clearance, cleaning, and interventions. On POD 1 or POD 2, patients were interviewed	Early postoperative infection rate was significantly lower in the clearance group. Only one infection had a possible dental source	Dental clearance and interventions did not reduce early postoperative infection
Tai et al[18]	Patients s/p resection arthroplasty and uninfected TKA controls from the Taiwanese NHIRD	6295	Patients with removal of infected TKA were matched with TKA patients without infections from the NHIRD and retrospectively analyzed	Compared to patients who did not receive scaling, those who received scaling once and 5-6 times in the previous three years had 20% and 31% less risk of TKA infection, respectively	Dental scaling was associated with lower risk of infection
Sonn et al[19]	Elective TJA patients at an unspecified location	2457	The data for a consecutive TJA patients was retrospectively analyzed	There were no significant associations between complication and dental evaluation or extraction	Dental evaluation +/- extraction did not improve complication rates

POD: Post op day; NHIRD: National health insurance research database; TKA: Total knee arthroplasty; TJA: Total joint arthroplasty.