Brenner Joseph D, Atallah Marina, Yatsonsky David, Casabianca Andrew, Hanna Maged
College of Medicine and Life Sciences, The University of Toledo, Toledo, USA.
Orthopedic Surgery, The University of Toledo Medical Center, Toledo, USA.
Cureus. 2024 Jul 2;16(7):e63696. doi: 10.7759/cureus.63696. eCollection 2024 Jul.
Bacteria can enter the bloodstream through simple actions such as brushing teeth, flossing, and even chewing food, increasing the chance of hematogenous seeding of prosthetic joints. Antibiotics before dental work in patients with orthopedic hardware is a topic of debate because of concerns for antibiotic resistance. Patients with dentures theoretically avoid this risk due to the lack of teeth and their maintenance. Most periprosthetic joint infections (PJIs) that occur in the first six months after surgery are due to wound infection, whereas late PJIs are more commonly caused by hematogenous seeding.
Charts from patients who received primary total joint arthroplasty were interrogated for the condition of their teeth at the time of operation. If the patient had a PJI, the time from surgery and the organism responsible were noted. Multivariate linear regressions were performed for statistical analysis to compare rates of dental status, infection, comorbidities, and demographics.
From the 1,500 charts reviewed, patients with teeth and edentulous had similar rates of comorbidities. PJI patients had higher rates of chronic kidney disease than patients who did not have the infection. The overall rate of infections in patients with teeth was 2.14%, close to the national average. The rate of infection in patients without teeth was 0.78%. Patients with teeth have a higher rate of infection one month or longer from surgery than edentulous patients.
There was an increased infection rate in patients with teeth at six months and greater since the primary total joint arthroplasty. The organisms responsible for many of the PJIs are commonly found in the mouth of humans. Having teeth is a potential risk factor for late PJI.
细菌可通过刷牙、使用牙线甚至咀嚼食物等简单行为进入血液，增加人工关节血源性播散的几率。由于担心抗生素耐药性，骨科植入物患者在牙科治疗前使用抗生素一直是一个有争议的话题。理论上，佩戴假牙的患者因没有牙齿及其维护而可避免这种风险。大多数人工关节周围感染（PJI）发生在手术后的头六个月，是由伤口感染引起的，而晚期PJI更常见的原因是血源性播散。
查阅接受初次全关节置换术患者的病历，了解其手术时的牙齿状况。如果患者发生PJI，则记录手术时间和致病微生物。进行多变量线性回归分析以比较牙齿状况、感染、合并症和人口统计学的发生率。
在审查的1500份病历中，有牙患者和无牙患者的合并症发生率相似。PJI患者的慢性肾病发生率高于未发生感染的患者。有牙患者的总体感染率为2.14%，接近全国平均水平。无牙患者的感染率为0.78%。有牙患者在手术后一个月或更长时间的感染率高于无牙患者。
初次全关节置换术后六个月及更长时间，有牙患者的感染率增加。许多PJI的致病微生物常见于人类口腔中。有牙是晚期PJI的一个潜在危险因素。
