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Investigation of the Long-Term Antibacterial Properties of Titanium by Two-Step Micro-Arc Oxidation Treatment. COATINGS 2021. [DOI: 10.3390/coatings11070798] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Recently, biofilm formation caused by bacterial adhesion and colonization has been recognized as the major cause of failure in orthopedic and dental implant surgeries. In this study, a customized micro-arc oxidation (MAO) treatment technique was developed to obtain desirable antibacterial properties on Ti surfaces. The two-step MAO treatment was applied in the fabrication of specimens with Ag and with/without Zn in their surface oxide layer. In order to simulate practical usage, surface analyses and immersion tests were performed to evaluate the incorporation of Ag and Zn into the resulting oxide layer and ion release behavior, respectively. Additionally, the antibacterial properties of the specimens after long-term immersion in physiological saline were evaluated using Gram-negative facultative anaerobic bacteria. The MAO-treated specimens containing Ag and Zn exhibited excellent antibacterial properties against Escherichia coli, which were sustained even after 6 months of immersion in physiological saline to simulate practical usage. Moreover, the Ag ions released from the surface oxide indicate the antibacterial properties of the specimen in the early stage, while the release of the corrosion products of Zn demonstrates its antibacterial properties in the later stage.
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Young JR, Bannon AL, Anoushiravani AA, Posner AD, Adams CT, DiCaprio MR. Oral health implications in total hip and knee arthroplasty patients: A review. J Orthop 2021; 24:126-130. [PMID: 33679037 PMCID: PMC7930502 DOI: 10.1016/j.jor.2021.02.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 02/14/2021] [Indexed: 12/19/2022] Open
Abstract
Over the past two decades, oral health has emerged as a health care priority. Historically, patients greater than 65 years of age, the economically disadvantaged, members of racial or ethnic minority groups, or the disabled or home bound have experienced significant barriers to routine dental care. The connection between oral health care and periprosthetic joint infections (PJI) continues to be of importance to the orthopedic surgeon, as such infections are significantly morbid and costly. This review aims to introduce the importance of oral health as a small but crucial portion of an arthroplasty patient's overall perioperative management.
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Affiliation(s)
- Joseph R. Young
- Division of Orthopaedic Surgery, Albany Medical Center, Albany, NY, USA
| | - Annika L. Bannon
- Department of Family Medicine, Albany Medical Center, Albany, NY, USA
| | | | - Andrew D. Posner
- Division of Orthopaedic Surgery, Albany Medical Center, Albany, NY, USA
| | - Curtis T. Adams
- Division of Orthopaedic Surgery, Albany Medical Center, Albany, NY, USA
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Danilkowicz RM, Lachiewicz AM, Lorenzana DJ, Barton KD, Lachiewicz PF. Prosthetic Joint Infection After Dental Work: Is the Correct Prophylaxis Being Prescribed? A Systematic Review. Arthroplast Today 2021; 7:69-75. [PMID: 33521200 PMCID: PMC7818599 DOI: 10.1016/j.artd.2020.11.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/12/2020] [Accepted: 11/11/2020] [Indexed: 02/02/2023] Open
Abstract
Background Prosthetic joint infection (PJI) of total hip (THA) or total knee arthroplasty (TKA) after dental procedures is uncommon, and antibiotic prophylaxis remains controversial. For high-risk patients, the American Academy of Orthopedic Surgeons recommends amoxicillin prophylaxis. However, no systematic review of the literature of PJIs associated with dental procedures explores if amoxicillin is suitable for the reported organisms. Methods A librarian-assisted search of the major databases (PubMed, Medline, Embase, Scopus) identified 954 articles. Only case reports, case series, and reviews with patient level data were included. After exclusions, 79 articles were fully reviewed. Results Forty-four PJIs after dental procedures were identified, 22 in primary THA, 20 in primary TKA, one in revision THA, and one in a hip resurfacing procedure. Antibiotic prophylaxis was documented for 5 patients. The dental procedure was invasive in 35 (79.5%). Comorbidities were present in 17 patients (38.7%). The organisms reported were Streptococcus spp. in 44%, other aerobic gram-positives in 27%, anaerobic gram-positives in 18%, and gram-negative organisms in 11%. An estimated 46% of organisms may be resistant to amoxicillin. The outcomes of treatment were reported for 35 patients (79.5%). Twenty-seven patients (61.4%) had no clinical signs of PJI at the final follow-up visit. Conclusions Lower extremity PJI associated with dental procedures is often caused by organisms unlikely to be prevented with amoxicillin. Additional studies are warranted to determine the choice and efficacy of antibiotic prophylaxis to prevent dental-associated PJI in the highest risk patients. Insufficient data exist to recommend the optimal treatment for patients with PJI in THA and TKA associated with dental procedures.
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Affiliation(s)
| | - Anne M Lachiewicz
- Division of Infectious Diseases, University of North Carolina-Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | | | - Karen D Barton
- Duke University Medical Center Library & Archives, Durham, NC, USA
| | - Paul F Lachiewicz
- Department of Orthopedic Surgery, Duke University, Durham, NC, USA.,Durham Veteran's Administration Medical Center, Durham, NC, USA
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Shimabukuro M, Tsutsumi H, Tsutsumi Y, Manaka T, Chen P, Ashida M, Ishikawa K, Katayama H, Hanawa T. Enhancement of antibacterial property of titanium by two-step micro arc oxidation treatment. Dent Mater J 2020; 40:592-598. [PMID: 33361664 DOI: 10.4012/dmj.2020-188] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
A customized micro arc oxidation (MAO) treatment technique was developed to obtain desirable antibacterial properties on titanium surfaces. The two-step MAO treatment was applied to fabricate a specimen containing both Ag and Zn in its surface oxide layer. Surface analyses and metal-ion release tests were performed to evaluate the presence of Ag and Zn and the ion release behavior for simulating practical usage, respectively. Additionally, the antibacterial properties of the specimens were also evaluated using gram-negative facultative anaerobic bacteria. The MAO-treated specimens containing both Ag and Zn showed excellent antibacterial properties against Escherichia coli, and the properties were sustained even after 28 days of immersion in physiological saline to simulate the living environment.
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Affiliation(s)
- Masaya Shimabukuro
- Department of Biomaterials, Faculty of Dental Science, Kyushu University.,Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU)
| | - Harumi Tsutsumi
- Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University (TMDU)
| | - Yusuke Tsutsumi
- Research Center for Structural Materials, National Institute for Materials Science (NIMS)
| | - Tomoyo Manaka
- Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU)
| | - Peng Chen
- Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University (TMDU)
| | - Maki Ashida
- Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University (TMDU)
| | - Kunio Ishikawa
- Department of Biomaterials, Faculty of Dental Science, Kyushu University
| | - Hideki Katayama
- Research Center for Structural Materials, National Institute for Materials Science (NIMS)
| | - Takao Hanawa
- Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University (TMDU)
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Chemical and Biological Roles of Zinc in a Porous Titanium Dioxide Layer Formed by Micro-Arc Oxidation. COATINGS 2019. [DOI: 10.3390/coatings9110705] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This study investigated the time transient effect of zinc (Zn) in the porous titanium dioxide formed by micro-arc oxidation (MAO) treatment routinely performed for Zn-containing electrolytes. The aim of our analysis was to understand the changes in both the chemical and biological properties of Zn in physiological saline. The morphology of the Zn-incorporated MAO surface did not change, and a small amount of Zn ions were released at early stages of incubation in saline. We observed a decrease in Zn concentration in the oxide layer because its release and chemical state (Zn2+ compound to ZnO) changed over time during incubation in saline. In addition, the antibacterial property of the Zn-incorporated MAO surface developed at late periods after the incubation process over a course of 28 days. Furthermore, osteogenic cells were able to proliferate and were calcified on the specimens with Zn. The changes related to Zn in saline had non-toxic effects on the osteogenic cells. In conclusion, the time transient effect of Zn in a porous titanium dioxide layer was beneficial to realize dual functions, namely the antibacterial property and osteogenic cell compatibility. Our study suggests the importance of the chemical state changes of Zn to control its chemical and biological properties.
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Balato G, Ascione T, Iorio P, De Franco C, De Matteo V, D'Addona A, Tammaro N, Pellegrino A. Knee septic arthritis caused by α-hemolytic Streptococcus in a patient with a recent history of knee arthroscopy: a case report. BMC Infect Dis 2019; 19:887. [PMID: 31651256 PMCID: PMC6814035 DOI: 10.1186/s12879-019-4556-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 10/10/2019] [Indexed: 12/02/2022] Open
Abstract
Background Arthroscopic partial meniscectomy is a common procedure in orthopedic practice. Infections are uncommon complications of this procedure with an incidence rate of 0,01% - 3,4%. Staphylococcus spp are the predominant causative agents in such cases. We present a case of knee septic arthritis caused by α-hemolytic Streptococcus. Case presentation A 22-year-old woman diagnosed with obesity (body mass index [BMI] 35 kg/m2) but with no other major comorbidities underwent an arthroscopic selective meniscectomy with administration of intravenous cefazolin for antibiotic prophylaxis. After an uneventful period of 2 months, the patient returned with pain, fever and a discharging sinus at the site of anterolateral arthroscopic portal. Blood tests and magnetic resonance imaging revealed osteomyelitis involving the tibial plate. Cultures of synovial fluid obtained from the knee and a pharyngeal swab yielded α-hemolytic Streptococcus. Five days later, the patient underwent arthroscopic debridement with partial synovectomy. Intraoperative specimens yielded α-hemolytic Streptococcus. The patient received intravenous piperacillin/tazobactam, followed by an associative regimen of amoxicillin and clindamycin with clinical, laboratory and instrumental evidence of symptom resolution. Conclusion The incidence of knee septic arthritis after arthroscopic partial meniscectomy is 0.01–3.4%. This infection is usually caused by Staphylococcus spp. and in rare cases by commensal bacteria, such as α-hemolytic streptococci, secondary to transient bacteremia. Screening of the colonized area is important to prevent possible transient bacteremia. Diagnosis is based on isolation of the causative organisms from synovial fluid cultures, and treatment comprises arthroscopic debridement with individualized systemic antibiotic therapy based on the results of an antibiogram.
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Affiliation(s)
- Giovanni Balato
- Unit of Orthopaedic Surgery, Department of Public Health, School of Medicine, Federico II University, Naples, Italy.
| | - Tiziana Ascione
- Department of Infectious Diseases, D. Cotugno Hospital, AORN Dei Colli, Naples, Italy
| | - Paolino Iorio
- Unit of Orthopaedic Surgery, Department of Public Health, School of Medicine, Federico II University, Naples, Italy
| | - Cristiano De Franco
- Unit of Orthopaedic Surgery, Department of Public Health, School of Medicine, Federico II University, Naples, Italy
| | - Vincenzo De Matteo
- Unit of Orthopaedic Surgery, Department of Public Health, School of Medicine, Federico II University, Naples, Italy
| | - Alessio D'Addona
- Unit of Orthopaedic Surgery, Department of Public Health, School of Medicine, Federico II University, Naples, Italy
| | - Nicola Tammaro
- Department of Orthopedics, Traumatology, Plastic-Reconstructive and Rehabilitation, School of Medicine, Luigi Vanvitelli University, Naples, Italy
| | - Achille Pellegrino
- Unit of Orthopedics and Traumatology, S.G. Moscati Hospital, CE, Aversa, Italy
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Dental assessment prior to orthopedic surgery: A systematic review. Orthop Traumatol Surg Res 2019; 105:761-772. [PMID: 31060914 DOI: 10.1016/j.otsr.2019.02.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 02/13/2019] [Accepted: 02/14/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND To reduce the risk of infection after orthopedic surgery, patients are asked to undergo preoperative assessments in various medical domains. However, to our knowledge, there has been no systematic review to evaluate the performance of a preoperative dental assessment before orthopedic surgery. We focus on two questions as follows: (1) is there a link between the presence of preoperative dental assessment and orthopedic infections?; (2) is the probability of an orthopedic infection increased in the presence of dental risk factors and comorbidities? PATIENTS AND METHODS Databases including PubMed, the Cochrane Library databases and Google Scholar were searched for English-language articles until November 2018. The inclusion criteria were descriptions of infections of joint prostheses and dental infections, and potential dental origins of pathogenic infections. Studies dealing with oral assessments performed before orthopedic surgery were included. RESULTS Based on eligibility criteria, 12 case series, 4 case-control studies and 12 cohort studies were included. In case-controls, prosthesis infection was presumably associated with a dental abscess in 6/224 of cases (2.9%). In cohort studies, exposure was defined as "any dental assessment or dental treatment performed before surgery". Even if only 4 cohort studies provide this information exposure, it would seem that the presence of an infectious complication is less frequent if the preoperative examination has been performed. Dental treatment given before surgery was mainly for scaling-polishing in 78/205 (38%), extraction in 49/205 of cases (24%) and restorative work in 37/205 (18%). DISCUSSION The literature review was made complex by the substantial heterogeneity among included studies. Although there is no formal evidence for or against preoperative dental assessment, it is advisable to perform this with the aim of maintaining favorable oral hygiene and thus reduce the risk factors. LEVEL OF EVIDENCE Level III, systematic review.
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General Assembly, Prevention, Host Related Local: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S3-S12. [PMID: 30352771 DOI: 10.1016/j.arth.2018.09.049] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Mirzashahi B, Tonkaboni A, Chehrassan M, Doosti R, Kharazifard MJ. The role of poor oral health in surgical site infection following elective spinal surgery. Musculoskelet Surg 2018; 103:167-171. [PMID: 30269297 DOI: 10.1007/s12306-018-0568-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 09/20/2018] [Indexed: 12/17/2022]
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVES To describe oral health and hygiene as a risk factor for surgical site infection (SSI). METHODS This cross-sectional study was conducted on patients over 18 years of age who were candidates for elective spinal surgery. The exclusion criteria were immunodeficiency, history of cancer, history of previous infection at the surgical site, cutaneous diseases and long-term use of corticosteroids. Questionnaires were filled out for patients via an interview in order to collect the demographic data of patients. Oral and dental examinations were performed using DMFT (D: decayed, M: missing, F: filled, T: total) and PUFA (P: pulp, U: ulcer, F: fistula, A: abscess) indices. Data were analyzed using Fisher's exact test and Mann-Whitney test. RESULTS A total of 78 patients were evaluated. There were 59 females (75.6%) and 19 males (24.6%). Eight patients were positive for SSI. Teeth caries (P = 0.016) and periodontal disease (P = 0.049) were significantly correlated with SSI. No significant association was noted between PUFA and SSI (P > 0.05). Sixty-five patients (83.3%) had a history of dental infection before surgery. Fifty% of patients being positive for SSI had a history of dental abscess (P = 0.023). CONCLUSIONS A significant association exists between SSI and caries, gingivitis/periodontitis and history of dental abscess.
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Affiliation(s)
- B Mirzashahi
- Joint Reconstruction Research Center (JRRC), Orthopedic Department of Imam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - A Tonkaboni
- School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - M Chehrassan
- Ayatollah Moosavi Hospital, Zanjan University of Medical Science, Zanjan, Iran.
| | - R Doosti
- School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - M J Kharazifard
- School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
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Abstract
Despite numerous guidelines, joint interprofessional collaboration, and years of data collection, the use of antibiotic prophylaxis before dental procedures remains controversial. There continues to be disagreement on indications, justification, and outcome of the use of various antibiotic prophylaxis regiments. This is complicated by the lack of data demonstrating any positive or negative impact on the care of patients. The dental community has distanced itself from a leadership role in this conversation, based on multiple concerns including fear of litigation, lack of clear pathophysiology, and unclear cause-effect relationship.
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Affiliation(s)
- Mehran Hossaini-zadeh
- Oral and Maxillofacial Surgery, Temple University Kornberg School of Dentistry, 3223 North Broad Street, Philadelphia, PA 19140, USA.
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11
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Modifiable risk factors and preoperative optimization of the primary total arthroplasty patient. CURRENT ORTHOPAEDIC PRACTICE 2017. [DOI: 10.1097/bco.0000000000000505] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Prosthetic Joint Infection Following Invasive Dental Procedures and Antibiotic Prophylaxis in Patients With Hip or Knee Arthroplasty. Infect Control Hosp Epidemiol 2016; 38:154-161. [DOI: 10.1017/ice.2016.248] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVESWe aimed to clarify whether invasive dental treatment is associated with increased risk of prosthetic joint infection (PJI) and whether prophylactic antibiotics may lower the infection risk remain unclear.DESIGNRetrospective cohort study.PARTICIPANTSAll Taiwanese residents (N=255,568) who underwent total knee or hip arthroplasty between January 1, 1997, and November 30, 2009, were screened.METHODSThe dental cohort consisted of 57,066 patients who received dental treatment and were individually matched 1:1 with the nondental cohort by age, sex, propensity score, and index date. The dental cohort was further divided by the use or nonuse of prophylactic antibiotics. The antibiotic and nonantibiotic subcohorts comprised 6,513 matched pairs.RESULTSPJI occurred in 328 patients (0.57%) in the dental subcohort and 348 patients (0.61%) in the nondental subcohort, with no between-cohort difference in the 1-year cumulative incidence (0.6% in both, P=.3). Multivariate-adjusted Cox regression revealed no association between dental procedures and PJI. Furthermore, PJI occurred in 13 patients (0.2%) in the antibiotic subcohort and 12 patients (0.18%) in the nonantibiotic subcohorts (P=.8). Multivariate-adjusted analyses confirmed that there was no association between the incidence of PJI and prophylactic antibiotics.CONCLUSIONSThe risk of PJI is not increased following dental procedure in patients with hip or knee replacement and is unaffected by antibiotic prophylaxis.Infect Control Hosp Epidemiol. 2017;38:154–161
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Sonohata M, Kitajima M, Kawano S, Mawatari M. Acute Hematogenous Infection of Revision Total Hip Arthroplasty by Oral Bacteria in a Patient without a History of Dental Procedures: Case Report. Open Orthop J 2014; 8:56-9. [PMID: 24741380 PMCID: PMC3988493 DOI: 10.2174/1874325001408010056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 03/10/2014] [Accepted: 03/29/2014] [Indexed: 11/25/2022] Open
Abstract
The risk of periprosthetic joint infection from hematogenous bacterial seeding is increased in patients undergoing
dental procedures that facilitate the development of bacteremia. We herein report the case of a patient without a history of dental procedures who suffered from an acute metastatic
infection of a hip prosthesis by the oral bacterium Streptococcus mutans 18 months after undergoing revision total hip
arthroplasty. The patient was successfully treated by two-stage revision surgery. It is important to realize that the efficacy of antibiotic prophylaxis against joint infections has not yet been convincingly
proven. As a result, optimal dental hygiene and regular dental visits may be more important than antibiotic prophylaxis for
maintaining joint health. Therefore, orthopedic surgeons should educate patients with joint prostheses about good oral
health.
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Affiliation(s)
- Motoki Sonohata
- Department of Orthopedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan
| | - Masaru Kitajima
- Department of Orthopedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan
| | - Syunsuke Kawano
- Department of Orthopedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan
| | - Masaaki Mawatari
- Department of Orthopedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan
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Gryskiewicz J. Dual-plane breast augmentation for minimal ptosis pseudoptosis (the "in-between" patient). Aesthet Surg J 2013; 33:43-65. [PMID: 23277619 DOI: 10.1177/1090820x12469534] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Dual-plane breast augmentation (DPBA) can be an effective technique for treating patients with ptotic breasts who fall somewhere in between the traditional requirements for breast augmentation versus a more extensive augmentation-mastopexy. OBJECTIVES The author outlines indications for DPBA, describes the technique, and presents outcomes data from patients receiving gel or saline implants in an effort to clarify the advantages of DPBA compared with breast augmentation with or without mastopexy. METHODS This 8-year retrospective comparative study reviewed the results of saline implants placed with a DPBA technique in a single surgeon's practice during the final 4 years of the FDA moratorium (phase 1) compared with both gel and saline implants placed during the 4 years after the moratorium was lifted (phase 2). Patients were consecutive. The entire patient cohort (n = 1999 for primary BA; 3998 implants) was assessed for outcomes. RESULTS Of the entire cohort, 24.2% were followed for over 1 year; 23.5% of the 256 DPBA patients were followed for over 1 year. Mean (SD) age was 33.6 (8.7) years. The difference in revision rates between BA versus DPBA was 4.6% (95% confidence interval [CI], 0.7-8.5). CONCLUSION The DPBA approach is most likely suited for patients with minimal ptosis who fall into a "gray area" between normal anatomy (treated with a traditional BA) and frank ptosis (which would require mastopexy). Knowledge of this approach will allow surgeons to more effectively treat patients who present with unique "in-between" anatomy not addressed by ordinary BA and avoid more extensive mastopexy scars. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Joe Gryskiewicz
- University of Minnesota Academic Health Center, School of Dentistry Cleft Palate/Craniofacial Clinics, Minneapolis, Minnesota, USA.
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16
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Legout L, Beltrand E, Migaud H, Senneville E. Antibiotic prophylaxis to reduce the risk of joint implant contamination during dental surgery seems unnecessary. Orthop Traumatol Surg Res 2012; 98:910-4. [PMID: 23158782 DOI: 10.1016/j.otsr.2012.07.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 07/09/2012] [Accepted: 07/11/2012] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Joint implant infection rates range between 0.5% and 3%. Contamination may be hematogenous, originating in oro-dental infection and, as in endocarditis, antibiotic prophylaxis has been recommended to cover oro-dental surgery in immunodepressed patients with joint implants less than 2 years old, despite the lack of any formal proof of efficacy. In this context, the cost and side effects of such prophylaxis raise the question of its real utility. MATERIALS AND METHODS A search of Pubmed was performed using the following keywords: prosthetic joint infection, dental procedure, antibiotic prophylaxis, hematogenous infection, dental infection, bacteremia, and endocarditis. Six hundred and fifty articles were retrieved, 68 of which were analyzed in terms of orthopedic prosthetic infection and/or endocarditis and oro-dental prophylaxis, as relevant to the following questions: frequency and intensity of bacteremia of oro-dental origin, frequency of prosthetic joint infection secondary to dental surgery, and objective efficacy of antibiotic prophylaxis in dental surgery in patients with joint implants. RESULTS Bacteremia of oro-dental origin is more frequently associated with everyday activities such as mastication than with tooth extraction. Isolated cases of prosthetic contamination from dental infection have been reported, but epidemiological studies in joint implant bearers found that absence of antibiotic prophylaxis during oro-dental surgery did not increase the rate of prosthetic infection. The analysis was not able to answer the question of the efficacy of dental antibiotic prophylaxis in immunodepressed patients; however, oro-dental hygiene and regular dental treatment reduce the risk of prosthetic infection by 30%. DISCUSSION AND CONCLUSION The present update is in agreement with the conclusions of ANSM expert group, which advised against antibiotic prophylaxis in oro-dental surgery in implant bearers, regardless of implant duration or comorbidity: the associated costs and risks are disproportional to efficacy. LEVEL OF EVIDENCE AND TYPE OF STUDY: Level V; expert opinion.
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Affiliation(s)
- L Legout
- Lille Nord-de-France University, Lille, France.
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Barrington JW, Barrington TA. What is the true incidence of dental pathology in the total joint arthroplasty population? J Arthroplasty 2011; 26:88-91. [PMID: 21723698 DOI: 10.1016/j.arth.2011.03.036] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Accepted: 03/23/2011] [Indexed: 02/01/2023] Open
Abstract
One million total joint arthroplasties (TJAs) are performed annually in the United States. The incidence of oral disease has not been documented in this population. To understand the scope of disease, a descriptive longitudinal population-based study sought to define the true incidence of dental pathology in the TJA population. One hundred consecutive TJA patients from a dedicated arthroplasty practice were sent for dental clearance, including oral examination, cleaning, radiographs, and treatment of active decay. The incidence of pathology was documented. Of 10 patients, 23 (23%) were treated before being cleared for arthroplasty. Sixty-six procedures were performed--2.9 problems per patient. No patient developed TJA infection. Routine preoperative dental clearance revealed 23% incidence of pathology, and no patient developed TJA infection.
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Affiliation(s)
- John W Barrington
- Texas Center for Joint Replacement, 5940 W. Parker Rd, #100, Plano, TX 75093, USA
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Mercuri LG, Psutka D. Perioperative, postoperative, and prophylactic use of antibiotics in alloplastic total temporomandibular joint replacement surgery: a survey and preliminary guidelines. J Oral Maxillofac Surg 2011; 69:2106-11. [PMID: 21470752 DOI: 10.1016/j.joms.2011.01.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Accepted: 01/04/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE In 2009, the American Academy Of Orthopedic Surgeons recommended lifelong prophylaxis after orthopedic total joint replacement (TJR) before these patients undergo dental, aerodigestive, genitourinary (GU), and gastrointestinal (GI) procedures. Because oral and maxillofacial surgeons worldwide are implanting alloplastic total temporomandibular joint replacements (TMJ TJRs), it appeared reasonable to survey these surgeons to obtain data that might shed some light, not only on this issue, but also to obtain some data to begin to develop preliminary guidelines for the peri- and postoperative use of antibiotics for TMJ TJR using these results and the orthopedic data. MATERIALS AND METHODS A total of 35 surgeons worldwide, members of either the TMJ Concepts or Biomet Microfixation online networks were e-mailed a standard questionnaire surveying their perioperative, postoperative, and prophylactic use of antibiotics for their TMJ TJR cases. RESULTS Of the 35 surgeons, 26 (74.2%) from 8 different countries responded. A total of 2,476 cases (3,368 joints) were retrospectively surveyed. Of the responding surgeons, 96.2% used, in order of frequency, cefazolin, clindamycin, cephalosporin, or penicillin-based antibiotics in the perioperative period and continued their use for a mean of 7 days (range 5 to 14) postoperatively. Also, 46.2% soaked the TJR components either in the perioperative antibiotic or in vancomycin, poviodine, gentamycin, or peroxide before implantation. In addition, 61.5% irrigated the wounds after device implantation with bacitracin, vancomycin, poviodine, peroxide, or the perioperative antibiotic. These surgeons reported that 51 joints (1.51%) had become infected within a mean of 6 months (range 2 weeks to 12 years) postoperatively. A total of 32 devices (0.95%) required removal and/or replacement. In cases in which the organisms were isolated, the organisms commonly associated with biofilm infection of TJR devices, Staphylococcus aureus, S epidermidis, Peptostreptococcus, and Pseudamonas aeruginosa, were cultured. In only 1 joint (0.003%) was there a suggestion of an association with an invasive dental/aerodigestive, GU/GI procedure. Regarding prophylaxis after TMJ TJRs and before dental/aerodigestive, GU, or GI procedures, 53.8% of the respondents reported that they provided prophylaxis. Of these, 1 recommended doing this for 6 months and 4 for 2 years, such as has been the American Dental Association/American Academy of Orthopedic Surgeons recommendation since 2003; and 9 reported they believe these TMJ TJR patients should have lifetime antibiotic prophylaxis before invasive dental/aerodigestive, GU, or GI procedures. CONCLUSION The evidence provided from the present small study survey and a review of the orthopedic data could provide the opportunity to develop guidelines for the preoperative, intraoperative, and postoperative antibiotic management for TMJ TJRs and spur additional research into this important area of patient management.
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Kotzé MJ. Prosthetic joint infection, dental treatment and antibiotic prophylaxis. Orthop Rev (Pavia) 2009; 1:e7. [PMID: 21808671 PMCID: PMC3143964 DOI: 10.4081/or.2009.e7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Revised: 05/04/2009] [Accepted: 05/22/2009] [Indexed: 11/23/2022] Open
Abstract
Current international and national prophylactic antibiotic regimens have been analyzed in respect of the prevention of bacteremia after dental and surgical procedures and, therefore, of joint prosthesis infection. This information was used to formulate guidelines for the Department of Maxillofacial and Oral Surgery. Publications since 2003 were used in this research. In addition, recommendations of accredited institutions and associations were examined. These included the guidelines of the American Dental Association in association with the American Academy of Orthopaedic Surgeons (2003), the American Heart Association (2007), the Working Party of the British Society for Antimicrobial Chemotherapy (2006) and the Australian Dental Guidelines (2005). No guidelines published by any institution in South Africa were found. The general rationale for the use of antibiotic prophylaxis for surgical (including dental) interventions is that those procedures may result in a bacteremia that may cause infection in joint prostheses. Antibiotics, however, should therefore be administered to susceptible patients, e.g. immunocompromised patients, prior to the development of bacteremia. The guidelines recommended for use in South Africa are based solely on those used outside South Africa. South Africa is regarded as a developing country with its own population and demographic characteristics. Eleven percent of our population is infected with HIV, and a specific guideline for prophylactic antibiotic treatment is, therefore, essential.
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Affiliation(s)
- Marthinus J Kotzé
- Department Maxillofacial and Oral Surgery, School of Dentistry, University of Pretoria, South Africa
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Uçkay I, Pittet D, Bernard L, Lew D, Perrier A, Peter R. Antibiotic prophylaxis before invasive dental procedures in patients with arthroplasties of the hip and knee. ACTA ACUST UNITED AC 2008; 90:833-8. [DOI: 10.1302/0301-620x.90b7.20359] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
More than a million hip replacements are carried out each year worldwide, and the number of other artificial joints inserted is also rising, so that infections associated with arthroplasties have become more common. However, there is a paucity of literature on infections due to haematogenous seeding following dental procedures. We reviewed the published literature to establish the current knowledge on this problem and to determine the evidence for routine antibiotic prophylaxis prior to a dental procedure. We found that antimicrobial prophylaxis before dental interventions in patients with artificial joints lacks evidence-based information and thus cannot be universally recommended.
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Affiliation(s)
- I. Uçkay
- University of Geneva Hospitals and Faculty of Medicine, 24 Rue Micheli-du-Crest, 1211 Geneva 14, Switzerland
| | - D. Pittet
- University of Geneva Hospitals and Faculty of Medicine, 24 Rue Micheli-du-Crest, 1211 Geneva 14, Switzerland
| | - L. Bernard
- Raymond Poincaré University Hospital, 104 Boulevard Raymond Poincaré, 92380 Garches, France
| | - D. Lew
- University of Geneva Hospitals and Faculty of Medicine, 24 Rue Micheli-du-Crest, 1211 Geneva 14, Switzerland
| | - A. Perrier
- University of Geneva Hospitals and Faculty of Medicine, 24 Rue Micheli-du-Crest, 1211 Geneva 14, Switzerland
| | - R. Peter
- University of Geneva Hospitals and Faculty of Medicine, 24 Rue Micheli-du-Crest, 1211 Geneva 14, Switzerland
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BELL SYDNEYM, GATUS BARRIEJ, SHEPHERD BRUCED. ANTIBIOTIC PROPHYLAXIS FOR THE PREVENTION OF LATE INFECTIONS OF PROSTHETIC JOINTS. ACTA ACUST UNITED AC 2008. [DOI: 10.1111/ans.1990.60.3.177] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- SYDNEY M. BELL
- Department of Microbiology, Prince of Wales Hospital, Randwick
| | - BARRIE J. GATUS
- Department of Microbiology, Prince of Wales Hospital, Randwick
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Bauer T, Maman L, Matha C, Mamoudy P. Soins bucco-dentaires et prothèses articulaires. ACTA ACUST UNITED AC 2007; 93:607-18. [DOI: 10.1016/s0035-1040(07)92685-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Boyd D, Li H, Tanner DA, Towler MR, Wall JG. The antibacterial effects of zinc ion migration from zinc-based glass polyalkenoate cements. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2006; 17:489-94. [PMID: 16691345 DOI: 10.1007/s10856-006-8930-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2005] [Accepted: 08/03/2005] [Indexed: 05/09/2023]
Abstract
Zinc-based glass polyalkenoate cements have been synthesised and their potential use in orthopaedic applications investigated. Zinc ions were released from the materials in a rapid burst over the first 24 h after synthesis, with the release rate falling below detectable levels after 7 days. Cement-implanted bone samples were prepared and the released zinc was shown, using energy dispersive X-ray analysis, to penetrate from the cement into the adjacent bone by up to 40 microm. Finally, the cements exhibited antibacterial activity against Streptococcus mutans and Actinomyces viscosus that reflected the pattern of zinc release, with the inhibition of growth greatest shortly after cement synthesis and little or no inhibition measureable after 30 days.
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Affiliation(s)
- D Boyd
- Research Scholar, Materials & Surface Science Institute, University of Limerick, National Technological Park, Limerick, Ireland
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25
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Abstract
Success in the treatment of infected orthopedic prosthesis requires the best surgical approach in combination with prolonged optimum targeted antimicrobial therapy. In choosing the surgical option, one must consider the type of infection, condition of the bone stock and soft tissue, the virulence and antimicrobial susceptibility of the pathogen, the general health and projected longevity of the patient, and the experience of the surgeon. If surgery is not possible, an alternative is long-term oral antimicrobial suppression to maintain a functioning prosthesis. Treatment must be individualized for a specific infection in a specific patient.
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Affiliation(s)
- Irene G Sia
- Division of Infectious Diseases, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
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Steingruber I, Bach CM, Czermak B, Nogler M, Wimmer C. Infection of a total hip arthroplasty with Prevotella loeschii. Clin Orthop Relat Res 2004:222-4. [PMID: 15043121 DOI: 10.1097/00003086-200401000-00038] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Infection is a serious complication of total hip replacement. It has been proposed that 6% of all infections after total hip arthroplasty may be of dental origin through hematogenous spread. However, no conclusive evidence that the mouth is a definitive source for infection of a total hip replacement has been reported. In the current case, Prevotella loeschii, a pigmented bacteroides species was identified in a total hip replacement. Prevotella loeschii is an organism which exclusively inhabits the dental region. Hematogenous spread of Prevotella loeschii may occur after penetration of the mucosal barrier in cases of endodontic or periodontic lesions, pericoronitis, or complications of tooth extraction. The involvement of Prevotella loescheii in an infection in a patient who had a total hip arthroplasty is strong evidence for the mechanism of a hematogenous infection from a dental source.
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Affiliation(s)
- I Steingruber
- Department of Radiology, University of Innsbruck, Austria.
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Abstract
BACKGROUND AND OVERVIEW In 1997, the American Dental Association and the American Academy of Orthopaedic Surgeons convened an expert panel of dentists, orthopaedic surgeons and infectious disease specialists and published their first Advisory Statement on Antibiotic Prophylaxis for Dental Patients with Prosthetic Joints. This represented the first time that national health organizations had gone on record on this topic. This 2003 advisory statement is the first periodic update of the 1997 statement. In addition, the organizations have created a new patient handout (included at the end of the statement) that dentists may share with their patients. The 1997 Advisory Statement has been well-used by dentists and orthopaedic surgeons. Following their standard protocols for periodic review of existing advisory statements, the ADA and AAOS and their expert consultants recently reviewed the 1997 statement. CONCLUSIONS AND CLINICAL IMPLICATIONS The 2003 statement includes some modifications of the classification of patients at potential risk and of the incidence stratification of bacteremic dental procedures, but no changes in terms of suggested antibiotics and antibiotic regimens. The statement concludes that antibiotic prophylaxis is not indicated for dental patients with pins, plates or screws, nor is it routinely indicated for most dental patients with total joint replacements. However, it is advisable to consider premedication in a small number of patients who may be at potential increased risk of experiencing hematogenous total joint infection.
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29
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Abstract
This article documents the late infection of a total knee replacement in a haemophiliac following a dental procedure. It underlines the need for reconsideration of the current British guidelines regarding antibiotic prophylaxis for dental procedures in patients with total joint replacement.
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Affiliation(s)
- L M Nadlacan
- University Department of Orthopaedic Surgery, Oxford Road, Manchester M13 9WL, UK.
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30
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Kaar TK, Bogoch ER, Devlin HR. Acute metastatic infection of a revision total hip arthroplasty with oral bacteria after noninvasive dental treatment. J Arthroplasty 2000; 15:675-8. [PMID: 10960009 DOI: 10.1054/arth.2000.4331] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The risk of hematogenous bacterial infection of a total joint prosthesis is currently considered to be greatest in the 2 years after arthroplasty or when the patient is chronically ill or immunocompromised, for dental treatments that are considered invasive, with a higher incidence of bacteremia. We report the case of a healthy man who had undergone revision hip arthroplasty 11 months previously and who developed acute signs of infection of the hip prosthesis with an oral organism 30 hours after supragingival dental cleaning, performed with the specific intention to be noninvasive, without antibiotic prophylaxis.
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Affiliation(s)
- T K Kaar
- Division of Orthopaedic Surgery, St. Michael's Hospital, University of Toronto, Ontario, Canada
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31
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Abstract
REVIEW The focal infection theory was prominent in the medical literature during the early 1900s and curtailed the progress of endodontics. This theory proposed that microorganisms, or their toxins, arising from a focus of circumscribed infection within a tissue could disseminate systemically, resulting in the initiation or exacerbation of systemic illness or the damage of a distant tissue site. For example, during the focal infection era rheumatoid arthritis (RA) was identified as having a close relationship with dental health. The theory was eventually discredited because there was only anecdotal evidence to support its claims and few scientifically controlled studies. There has been a renewed interest in the influence that foci of infection within the oral tissues may have on general health. Some current research suggests a possible relationship between dental health and cardiovascular disease and published case reports have cited dental sources as causes for several systemic illnesses. Improved laboratory procedures employing sophisticated molecular biological techniques and enhanced culturing techniques have allowed researchers to confirm that bacteria recovered from the peripheral blood during root canal treatment originated in the root canal. It has been suggested that the bacteraemia, or the associated bacterial endotoxins, subsequent to root canal treatment, may cause potential systemic complications. Further research is required, however, using current sampling and laboratory methods from scientifically controlled population groups to determine if a significant relationship between general health and periradicular infection exists.
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Affiliation(s)
- C A Murray
- University of Glasgow Dental School, Glasgow, UK
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32
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Abstract
The treatment of the infected total hip replacement remains expensive, leads to a long difficult course for the patient, and frequently results in a suboptimal functional outcome. Various treatment techniques are available, and may be suitable for the more straightforward case. These include one-stage exchange arthroplasty, two-stage exchange arthroplasty, resection arthroplasty, and debridement and irrigation. The complex infected total hip replacement encompasses numerous host and organism factors. These include unusual or multiple organisms, diagnostic difficulties, bone loss, immunocompromise, and reinfection. In the authors' experience, the problem of the complex infected hip replacement is best addressed using the prosthesis of antibiotic-loaded acrylic cement approach. This interval arthroplasty is a modular, custom-made, immediate fit, antibiotic selective, temporary spacer system that allows the surgeon to reconstruct even the most deficient bone stock safely and effectively using two-stage exchange arthroplasty. It affords the patient rapid pain relief, allows them to mobilize quickly while successfully eradicating infection in 96% of hips with severe bone loss, and sets an appropriate soft tissue environment for a relatively straightforward second stage procedure. The prosthesis of antibiotic-loaded acrylic cement system affords the benefits of two-stage exchange without the functional disadvantages of an excision arthroplasty particularly when the proximal femur is severely deficient. It allows flexibility for the interval period and the type of fixation used, and the potential for allograft reconstruction at the final stage.
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Affiliation(s)
- F S Haddad
- Division of Reconstructive Orthopaedics, University of British Columbia, Vancouver, Canada
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34
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Advisory statement. Antibiotic prophylaxis for dental patients with total joint replacements. American Dental Association; American Academy of Orthopaedic Surgeons. J Am Dent Assoc 1997; 128:1004-8. [PMID: 9231605 DOI: 10.14219/jada.archive.1997.0307] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
An expert panel of dentists, orthopaedic surgeons and infectious disease specialists convened by the American Dental Association and the American Academy of Orthopaedic Surgeons, or AAOS, performed a thorough review of all available data to determine the need for antibiotic prophylaxis to prevent hematogenous prosthetic joint infections in dental patients who have undergone total joint arthroplasties. The result is this report, which has been adopted by both organizations as an advisory statement. The panel's conclusion: Antibiotic prophylaxis is not indicated for dental patients with pins, plates and screws, nor is it routinely indicated for most dental patients with total joint replacements. However, it is advisable to consider premedication in a small number of patients who may be at potential increased risk of hematogenous total joint infection.
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35
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Affiliation(s)
- H N Newman
- Department of Periodontology, Eastman Dental Institute and Hospital, London, England
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36
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Bridgeman A, Wiesenfeld D, Newland S. Anatomical considerations in the diagnosis and management of acute maxillofacial bacterial infections. Aust Dent J 1996; 41:238-45. [PMID: 8870277 DOI: 10.1111/j.1834-7819.1996.tb04866.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
General dentists are frequently called upon to manage maxillofacial infections. Such infections are usually well localized in their initial stages but can spread to become severe and potentially life-threatening. This paper discusses the anatomical basis of the spread of these infections and techniques relevant to the rational management of these serious conditions.
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37
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Affiliation(s)
- T J Pallasch
- Pharmacology Section, School of Dentistry, University of Southern California, Los Angeles, USA
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38
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Bartzokas CA, Johnson R, Jane M, Martin MV, Pearce PK, Saw Y. Relation between mouth and haematogenous infection in total joint replacements. BMJ (CLINICAL RESEARCH ED.) 1994; 309:506-8. [PMID: 8086903 PMCID: PMC2542714 DOI: 10.1136/bmj.309.6953.506] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To investigate the source of infections associated with orthopaedic prostheses. DESIGN Analysis of four infections of prosthetic joints with case records; minimum inhibitory and minimum bactericidal concentrations and sodium dodecylsulphate polyacrylamide gel electrophoresis of the cell wall polypeptides of the Streptococcus sanguis isolates from the mouth and infected prostheses; examination of the patients' mouths for periodontal disease and caries. SUBJECTS Four adults (three men) aged 58-83. RESULTS For each patient the strain of S sanguis isolated from the mouth was indistinguishable from that isolated from the prosthesis. All patients had severe periodontal disease and caries. CONCLUSIONS The mouth was probably the source of bacterial infection in the prosthetic joints of these patients; the route of infection was possibly haematogenous. Incipient oral infection should be treated before joint replacement, and oral health should be maintained indefinitely.
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39
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Shrout MK, Scarbrough F, Powell BJ. Dental care and the prosthetic joint patient: a survey of orthopedic surgeons and general dentists. J Am Dent Assoc 1994; 125:429-36. [PMID: 8176078 DOI: 10.14219/jada.archive.1994.0047] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Orthopedic surgery and general dentistry residency program directors were surveyed about treatment considerations for dental patients with prosthetic joints. The majority believed dental diseases can affect joint prostheses and thought orthopedic surgeons should be consulted before dental treatment. Both groups recommended antibiotic prophylaxis for these patients.
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Affiliation(s)
- M K Shrout
- Oral Diagnosis and Patient Services, School of Dentistry, Medical College of Georgia, Augusta 30912-1241
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40
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Kurzweil PR, Spencer CW. Infection of a total knee arthroplasty following percutaneous transluminal coronary angioplasty. Orthopedics 1993; 16:909-10. [PMID: 8415276 DOI: 10.3928/0147-7447-19930801-11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- P R Kurzweil
- Southern California Center for Sports Medicine, Long Beach 90806
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41
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42
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Field EA, Martin MV. Prophylactic antibiotics for patients with artificial joints undergoing oral and dental surgery: necessary or not? Br J Oral Maxillofac Surg 1991; 29:341-6. [PMID: 1742268 DOI: 10.1016/0266-4356(91)90124-n] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Prophylactic antibiotic cover for certain oral and dental procedures for patients with artificial joints is a controversial issue. This paper examines the evidence supporting the use of antibiotic cover and concludes that routinely, for the majority of patients with artificial joints, it is not justified. Certain medically compromised patients with artificial joints have a slightly increased risk of infection and, under these circumstances, antibiotic prophylaxis may be justified. The antibiotic recommended for this group is cephradine or in the case of penicillin allergy, clindamycin. Preoperative dental fitness is mandatory for all patients who are to receive artificial joints. This information will be of interest to the oral and maxillofacial surgeon in his own clinical practice, and when giving advice to local general dental practitioners.
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Affiliation(s)
- E A Field
- Department of Clinical Dental Sciences, University of Liverpool
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43
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Blackburn WD, Alarcón GS. Prosthetic joint infections. A role for prophylaxis. ARTHRITIS AND RHEUMATISM 1991; 34:110-7. [PMID: 1984767 DOI: 10.1002/art.1780340118] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- W D Blackburn
- Department of Medicine, University of Alabama, Birmingham 35294
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44
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Jacobson JJ, Schweitzer S, DePorter DJ, Lee JJ. Antibiotic prophylaxis for dental patients with joint prostheses? A decision analysis. Int J Technol Assess Health Care 1990; 6:569-87. [PMID: 2150670 DOI: 10.1017/s0266462300004220] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A decision analysis was performed to assess the risks, costs, and effects of no prophylaxis, oral penicillin, and cephalexin regimens currently being debated for dental patients at risk for late prosthetic joint infection (LPJI). The analysis suggests that there is a very small risk of LPJI (29.3 cases per 10(6) dental visits), which is outweighed by a greater risk of death with an oral penicillin strategy than with a "no prophylaxis" strategy (2.31:1.93). An oral cephalosporin appears to spare life and limb but does so at an extremely high cost. Over $500,000 must be spent to spare one year of life, while $480,000 needs to be spent to prevent one case of LPJI. Some individual dental patients may still be at a much greater risk for LPJI than others. However, from the evidence to date, routine predental antibiotic prophylaxis for all prosthetic joint patients is a very expensive preventive strategy and is not cost-effective. However, clinical experience suggests that antibiotic prophylaxis may be appropriate in some situations.
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Abstract
Osseointegration or bony anchorage of oral implants was first described by Brånemark and coworkers. This type of connection between the titanium oxide layer and the bone gives stable long-term results for the implants in function. Fibrous tissue interphase between implant and bone will allow mobility which will gradually increase and cause implant failure. The microbiota around stable versus failing implants seem to parallel the patterns around healthy versus diseased natural teeth. Infections most often develop around failing implants. This may create mostly localized, but sometimes even widespread serious infection problems. Metastatic infectious problems related to endo-prosthesis replacing joints and cardiovascular structures are briefly discussed in connection with bacteremia caused by oral infections in general and surgical procedures.
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Affiliation(s)
- H R Haanaes
- Det Odontologiska Fakultetet, Universitet i Oslo, Norway
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46
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Ballard C, Mowers RM, Millares M. Antibiotic prophylaxis in dental procedures. DICP : THE ANNALS OF PHARMACOTHERAPY 1990; 24:41-3. [PMID: 2301189 DOI: 10.1177/106002809002400109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- C Ballard
- School of Pharmacy, University of California, San Francisco
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47
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Tsevat J, Durand-Zaleski I, Pauker SG. Cost-effectiveness of antibiotic prophylaxis for dental procedures in patients with artificial joints. Am J Public Health 1989; 79:739-43. [PMID: 2499200 PMCID: PMC1349634 DOI: 10.2105/ajph.79.6.739] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
We performed a cost-effectiveness analysis to evaluate whether patients with artificial joints should take penicillin, erythromycin, or no antibiotics before dental procedures. We modeled the risk of anaphylaxis from penicillin, the risks and consequences of an artificial joint infection, and the actual variable costs of hospitalization and antibiotics. Penicillin prophylaxis is slightly less expensive than erythromycin prophylaxis but is both more expensive and less effective than no prophylaxis. Erythromycin prophylaxis, the most effective, is the most expensive strategy. The marginal cost effectiveness of erythromycin prophylaxis compared to no prophylaxis is $12,900 per quality-adjusted year of life saved. Sensitivity analysis demonstrates that the risk of developing a joint infection is the key parameter in the analysis. Based on our estimated risk of developing a joint infection, the cost-effectiveness of antibiotic prophylaxis with erythromycin compares favorably with other medical interventions. Thus, until a definitive study to quantify the risk is conducted, patients with artificial joints should take prophylactic erythromycin when they undergo dental procedures.
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Affiliation(s)
- J Tsevat
- Department of Medicine, Tufts University School of Medicine, Boston, MA 02111
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48
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Cioffi GA, Terezhalmy GT, Taybos GM. Total joint replacement: a consideration for antimicrobial prophylaxis. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1988; 66:124-9. [PMID: 2970053 DOI: 10.1016/0030-4220(88)90079-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Infection is the principal and most devastating complication of total joint replacement, resulting in long periods of hospitalization, staggering costs, loss of the implant, disastrous physical impairment, and even death. Staphylococcus aureus and Staphylococcus epidermidis account for more than 50% of late infections. Animal studies have shown that joint implants are at a high risk of becoming infected via a metastatic hematogenous route during transient bacteremias. Because cephalosporins have been established as the perioperative and intraoperative agents of choice to prevent infections related to total joint replacement, oral cephalosporins are the drugs of choice to minimize the potential for the metastatic infection of prosthetic joints associated with transient dental bacteremias. Clindamycin is preferred for patients who are allergic to the cephalosporins or who may have a cross-allergy between penicillin and the cephalosporins.
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Affiliation(s)
- G A Cioffi
- Oral Medicine Department, Naval Dental Clinic, Jacksonville, Fla
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Nery EB, Meister F, Ellinger RF, Eslami A, McNamara TJ. Prevalence of medical problems in periodontal patients obtained from three different populations. J Periodontol 1987; 58:564-8. [PMID: 3476724 DOI: 10.1902/jop.1987.58.8.564] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Data from three different sources of periodontal patients were collected and examined to find if there was a significant difference between these groups relative to the prevalence of medical problems. Data were evaluated to show if age and sex were significantly related to the existence of medical problems and to determine which problems were the most prevalent. A total of 581 periodontal patients' records were obtained. Results of the evaluation showed that the private office group had 27.6% medical problems, the academic dental center had 46.3%, and the hospital dental clinic had 74.1%. Cardiovascular disease was the most prevalent medical problem in all groups and orthopedic disease or injury was second. Within each group, sex was not significantly related to the presence of a medical problem. Age was a highly significant factor, with the prevalence of medical problems increasing with advancing age.
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Abstract
The percentage of elderly persons retaining natural teeth is increasing. Although many of these individuals cannot be convinced to see a dentist regularly, they are generally seen by a physician or nurse relatively frequently. The physician or nurse can provide a vital service for these patients by performing oral screening examinations. A technique is described for accomplishing this.
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