Department of Orthopedics and Traumatology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Department of Virology, University of Helsinki, Helsinki, Finland.
Scand J Surg. 2019 Dec;108(4):338-342. doi: 10.1177/1457496918816911. Epub 2018 Dec 2.
To prevent severe prosthetic joint infections, a dental examination is usually recommended prior to arthroplasty, even sometimes regarded resource- and time-consuming. The aim of this study was to determine whether a risk factor-based algorithm could be created to send only selected patients for dental clearance.
A prospective study of 952 patients scheduled for elective arthroplasty was performed. Patients filled out a questionnaire regarding potential risk factors for dental infections, and dentists documented patients' oral health and interventions performed (data available for 731 patients).
Of the patients, 215 (29.4%) failed dental clearance; a total of 432 teeth were extracted, 32 patients (4.4%) required root canal treatment, and 37 patients (5.1%) had severe periodontitis. Independent risk factors for failure were history of root canal treatment (odds ratio: 2.282, 95% confidence interval: 1.346-3.869, p = 0.020), use of tobacco products (odds ratio: 1.704, 95% confidence interval: 1.033-2.810, p = 0.037), dental visit indicated by oral symptoms within 3 months (odds ratio: 1.828, 95% confidence interval: 1.183-2.827, p = 0.007), or visit to a dentist within 6 months (odds ratio: 1.538, 95% confidence interval: 1.063-2.224, p = 0.022). Regular dental examination was a preventive factor (odds ratio: 0.519, 95% confidence interval: 0.349-0.773, p = 0.001). However, based on the examined risk factors, no sufficiently large group of patients at lesser risk for dental infections could be identified.
Because of the high need for dental care revealed by our unselected patient population, the inspection and treatment of dental pathology of all patients are important interventions prior to elective arthroplasty.
为了预防严重的人工关节感染，通常建议在关节置换术前进行牙科检查，即使有时被认为是资源和时间的浪费。本研究旨在确定是否可以创建一种基于风险因素的算法，仅将选定的患者送去进行牙科清除。
对 952 名计划接受择期关节置换术的患者进行了前瞻性研究。患者填写了一份关于潜在牙科感染风险因素的问卷，牙医记录了患者的口腔健康状况和所进行的干预措施（731 名患者的数据可用）。
952 名患者中有 215 名（29.4%）未能通过牙科清除；共拔除 432 颗牙齿，32 名患者（4.4%）需要根管治疗，37 名患者（5.1%）患有严重牙周炎。失败的独立危险因素包括根管治疗史（比值比：2.282，95%置信区间：1.346-3.869，p=0.020）、使用烟草制品（比值比：1.704，95%置信区间：1.033-2.810，p=0.037）、口腔症状在 3 个月内就诊（比值比：1.828，95%置信区间：1.183-2.827，p=0.007）或在 6 个月内看牙医（比值比：1.538，95%置信区间：1.063-2.224，p=0.022）。定期牙科检查是一个预防因素（比值比：0.519，95%置信区间：0.349-0.773，p=0.001）。然而，根据所检查的风险因素，无法确定一个风险较小的足够大的患者群体。
由于我们的未选择患者群体中显示出对牙科护理的高需求，因此在进行择期关节置换术前，对所有患者的牙科病理进行检查和治疗是重要的干预措施。
