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Article: Dental Clearance needed for Joint Replacements DR. JERRY GORDON
People who are scheduled for total joint replacement are required to get a dental clearance prior to their surgery. The reason is that any untreated dental infection arising from the teeth or gums can cause bacteria to lodge in the newly placed artificial joint, compromising the healing and successful outcome of the operation.

The need for artificial joints, including total hip and knee replacement, are often caused by chronic ailments such as osteoarthritis. Artificial joints are also required when damage occurs due to trauma or fractures that will not completely heal over time. People who are scheduled for total joint replacement are required to get a dental clearance prior to their surgery. The reason is that any untreated dental infection arising from the teeth or gums can cause bacteria to lodge in the newly placed artificial joint, compromising the healing and successful outcome of the operation.

In most cases, I suggest that the person who requires total joint replacement see their dentist at least two months prior to surgery, receive a dental cleaning, and a full mouth series of x-rays (about 18 x-rays in most cases). After I have completed my clinical examination, I will evaluate the x-rays. The following conditions must be treated for a person to receive a dental clearance for joint replacement therapy: dental cavities, gum disease, abscessed teeth, fractured teeth or fillings, loose teeth, and most oral pathology found on the soft tissues of the mouth. Treating these conditions either cures the existing infection, or greatly reduces the likelihood an infection will occur in the future.

Some dental conditions may not need to be treated to be cleared for total joint replacement surgery. Small chips confined to the enamel of the teeth, deep stains, and mild areas of hypocalcification or "white spots" on teeth may not need to be treated prior to joint replacement surgery because the risk of infection to the joint is remote. These areas can be treated after the surgery has been completed. In most cases, it is advisable to delay cosmetic dental treatment such as tooth whitening, white fillings, and porcelain veneers until after the artificial joint has healed. Major dental treatment, including fixed bridgework (a series of joined caps or crowns), and dental implants should also be postponed several months after the total hip or knee replacement has been completed.

To prevent infection, antibiotics are routinely given prior to dental treatment for the first two years after joint replacement. Antibiotics may be required for longer than two years for those who have had an artificial joint replaced in the past, have had artificial joint infections in the past or have an unstable artificial joint, have severe rheumatoid arthritis, are on steroid therapy, or have diseases or take medications that suppress the immune system. People who have poor dental hygiene, gum disease, and other untreated dental infections put themselves at possible risk of infecting their artificial joints. Regular dental examinations and cleanings at least twice a year and good oral hygiene are of vital importance to prevent potential problems with artificial joints and to maintain optimum dental health.

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Dr. Gordon is the dental columnist for the Bucks County Courier Times. He has published more than 300 articles since 1998. He is a recognized dental expert for Dr. Oz.

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