Prevention Of Total Hip and Knee Arthroplasty Periprosthetic Joint Infection inPatients Undergoing Dental Procedures

Publication Date: November 18, 2024
Last Updated: December 2, 2024

Summary of Recommendations

Prophylactic Systemic Antibiotic Use Before Dental Procedure (Hip/Knee Patients)

Routine use of a systemic prophylactic antibiotic prior to a dental procedure in patients with a hip or knee replacement may not reduce the risk of a subsequent periprosthetic joint infection. (L)
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Dental Screening Prior To Hip or Knee Arthroplasty

Implementation of a dental screening in patients before a hip or knee replacement may not reduce the risk of subsequent periprosthetic joint infection. (L)
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Antiseptic/Antimicrobial Treatment

In the absence of reliable evidence, it is the opinion of the workgroup that the use of an oral topical antiseptic wash is not necessary before a dental procedure in patients with a hip or knee replacement. (C)
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Delay Vs. No Delay of Arthroplasty After a Dental Procedure

In the absence of reliable evidence, it is the opinion of the workgroup that the decision to delay a hip or knee replacement surgery is based on the risk of transient bacteremia, the occurrence of an invasive surgical procedure, or treatment of an active dental infection. (C)
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Delay vs. No Delay of Dental Procedure After a Hip/Knee Arthroplasty

In the absence of reliable evidence, it is the opinion of the workgroup that the decision to delay a dental procedure after hip or knee replacement surgery is based on the risk of transient bacteremia, the occurrence of an invasive surgical procedure, or treatment of an active dental infection. (C)
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Suggested Time Intervals Needed Between Dental Procedures and TJA Surgery

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Dental Procedure Group Considerations Minimum Time Before TJA Minimum Time After TJA
Dental examination without probing dental radiograph or cone beam CT imaging, denture adjustment procedures, clear orthodontic aligner (invisible braces) adjustment procedures, occlusal guard or bite splint adjustment Not considered invasive dental procedures. No possibility of manipulation of gingiva. Same day Same day
Oral hygiene procedures including dental cleaning, dental prophylaxis using a rubber cup and handpiece [without scaling] or periodontal probing (without SRP) 1 day 3 months
Orthodontic procedures including banding or debanding orthodontic fixes or removable appliances, archwire adjustment, orthodontic mini-implant removal, orthodontic separate placement 1 day 3 months
Other non-invasive procedures including suture removal, anesthetic injection, crown and bridge placement, dental restorative procedures, rubber dam clamp or matrix band wedge between teeth, impression taking, endodontic treatment (root canal therapy) Impressions may be taken digitally (no risk) or with intraoral impression material use in a tray (minimal risk) 1 day 3 months
Scaling and/or root planing (SRP) with manual (hand instruments) or ultrasonic scaler 1 day 3 months
Dental Extractions including single, multiple, impacted third molar With or without bone graft or platelet-rich fibrin material for socket augmentation 1 week 3 months
Oral Surgery (including dental implant surgery, periodontal surgery, cleft palate surgery, piezoelectric surgery, osteosynthesis plate removal) 3 weeks 3 months
Treatment of Active Dental Infection Antibiotics and oral surgery (e.g. extraction) or endodontic treatment (e.g. root canal therapy) 3 weeks after resolution of active infection Same day

Recommendation Grading

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.

Overview

Title

Prevention Of Total Hip and Knee Arthroplasty Periprosthetic Joint Infection inPatients Undergoing Dental Procedures

Authoring Organizations

American Academy of Orthopaedic Surgeons

American Association of Hip and Knee Surgeons

Publication Month/Year

November 18, 2024

Last Updated Month/Year

December 2, 2024

Document Type

Guideline

Country of Publication

US

Document Objectives

This clinical practice guideline is based on a systematic review of published studies examining the influence of dental care and procedures on outcomes after total joint arthroplasty (TJA) as well as strategies to mitigate potential risks associated with dental care and procedures in patients with a TJA. It provides recommendations that will help practitioners to integrate the current evidence and clinical practice, and it highlights gaps in the literature in need of future research. This guideline is intended to be used by appropriately trained physicians and dentists considering prevention of total hip and knee arthroplasty periprosthetic joint infection in patients undergoing dental procedures. The recommendations are a guide for physicians and dentists that should not be interpreted as a standard of care. It also serves as an information resource for developers and applied users of clinical practice guidelines.

Target Patient Population

Patients who are scheduled to undergo TJA as well as those who have a TJA and are seeking dental care

Target Provider Population

All clinicians, including orthopedic surgeons as well as dental providers, considering prevention of total hip and knee arthroplasty periprosthetic joint infection in patients undergoing dental procedure

Health Care Settings

Ambulatory, Outpatient, Operating and recovery room

Intended Users

Dentist, nurse, nurse practitioner, physician, physician assistant, surgical technologist

Scope

Management, Prevention

Keywords

infection prevention, dental procedures, Total Hip and Knee Arthroplasty, Periprosthetic Joint Infection

Source Citation

American Academy of Orthopaedic Surgeons The Prevention Of Total Hip and Knee Arthroplasty Periprosthetic Joint Infection in Patients Undergoing Dental Procedures Evidence-Based Clinical Practice Guideline. aaos.org/dentalppxcpg Published 11/18/24