American Academy for Oral Systemic Health
Connect Newsletter, Jan 2012
Planning Joint Replacement Surgery? Check-in With Your Dentist First
By Lisa Marie Samaha, DDS, FAGD Thu, Jan 19, 2012
Joint replacement surgery is a commonly performed surgery today. Alarmingly, seven percent of all joint replacement
surgeries are revision procedures, meaning the surgeries have to be repeated. More and more, joint infections are
becoming recognized as being one of the complicating factors in joint surgery failures, and new information is pointing to
the systemic spread of periodontal bacteria through the bloodstream. Physicians and surgeons should work closely with
dentists and dental hygienists to certify that periodontal disease is dealt with prior to joint replacement surgery, and vice
versa.
Anyone considering a joint replacement should plan on a visit to a qualified dentist,
beforehand. If at all possible, they should make sure their mouth is free of gum disease
before they schedule for that new hip or knee. Otherwise, there is a risk the new joint will
become infected.
It is commonly accepted in medicine that bacteria and infection in the mouth does not
remain in the mouth, but spreads throughout the entire body. With periodontal disease, the
bacteria that cause the disease travel from the infected gums, through the bloodstream, to
every tissue in the body. Not only is this bacteria linked to heart attack, stroke, high blood
pressure, diabetes, Alzheimer’s, lung and kidney disease, cancers and other disease states,
it is very dangerous for those undergoing surgical procedures. There is no place in the body that is protected from the
invasion of aggressive and injurious periodontal bacteria. Additionally, infection anywhere in the body compromises the
entire immune system.
Joint disease currently affects more than 20 million people in the United States. More than 1 million total joint
replacements are performed every year, according to the American Academy of Orthopaedic Surgeons. With thousands of
revision procedures performed, determining risk factors is prudent before surgeries are performed. Deep infections of the
joint replacements usually result in the failure of the new joint and create the need for extensive revisions, the AAOS says.
This concern is nothing new to medicine. In a 1994 article published in the British Medical Journal, Wirral University
Teaching Hospital in Great Britain reported that the mouth was a principal source of bacterial infection in patients’
prosthetic joints.
When a joint surgery becomes infected, both patient and physician question, “Why?” Commonly, the surgical procedure
went smoothly. However, the patient feels warmth around the joint. There is continued pain and swelling with the joint
remaining in a chronic state of infection. Oftentimes, retreatment is necessary.
Infection caused by dental disease, (typically periodontal infection), can be prevented if surgery is postponed until dental
clearance is confirmed by a dentist skilled in a proper pre-surgical evaluation.
Without a comprehensive dental screening, there’s no way to confirm whether periodontal disease is present. In some
people with very advanced levels of periodontal disease, the condition may be obvious—inflamed, bleeding gums tell the
story. But even life-threatening levels of gum disease can remain an invisible health risk. Alarmingly, people with dental
disease often have no symptoms until the disease is in its moderate to advanced stages.The effects of the bacterial
infection are not necessarily visible on the outside of the gums, but hidden on the inside surface, adjacent to the root of the
tooth. People typically have no idea they have the disease, yet it is rampant in our society.
Of all American adults, 75% have periodontal disease, according to the American Academy of Periodontology. A
significant number of this population also seeks joint replacements. If current trends continue, 1.4 million knee
replacements and nearly 600,000 hip replacements will be performed in 2015. By the year 2030, the total number of hip
and knee replacements combined is expected to exceed 4 million, according to The Kaiser Permanente National Joint
Replacement Registry.
The American Academy of Orthopaedic Surgeons and the American Dental Association recommend that people requiring
joint replacement surgery receive a dental clearance prior to joint replacement surgery.
At the Perio Arts Institute, a nationally recognized teaching center in Newport News, Virginia, seminars are provided on
every aspect of the oral/systemic link. Physicians, dentists and their teams learn what they need to know about the critical
relationship between oral disease and overall health. At Port Warwick Dental Arts, a comprehensive general dental
practice, in-depth diagnosis and treatment for patients who are preparing for or who have already received joint
replacement surgery is provided.
Although the message is starting to spread, only a small percentage of those who seek dental care have actually received a
dental clearance beforehand. Often, Port Warwick Dental Arts, a joint problem occurs, the patient then begins to have
dental pain or swelling, and then calls for an appointment. Other times, an upcoming joint replacement for a new patient is
determined when the in-depth medical history that is part of our comprehensive new patient examination.
When the orthopedic surgeon is informed that our mutual patient has a serious level of periodontal disease, the surgeon is
appreciative and always postpones the surgery, unless it is an emergency procedure.
Orthopedic surgeons typically follow the recommendations of the AAOP and have their patients take antibiotics prior to
future dental appointments. It is important for anyone who has had joint replacement surgery to inform their dentist so he
or she can collaborate with their physician on the appropriateness of antibiotic pre-medication prior to dental care.
There are several options, surgical and non-surgical, for treating periodontal disease, depending on the nature of the
disease. The Perio Arts Institute and Port Warwick Dental Arts has developed a leading-edge, nationally recognized
protocol for diagnosing and treating periodontal disease non-surgically. Surgical intervention is reserved and available for
the most advanced cases.
By postponing joint replacement and seeking a dental examination and treatment first, individuals will have both a
healthier mouth and improved recovery from joint surgery. Since the body’s immune system is not compromised by
dental infection, patients’ healing will be swifter, more uneventful and more predictable. Most critically, their risk for
serious joint infection is minimized, post-surgically.
By Lisa Marie Samaha DDS, FAGD
Dr. Lisa Marie Samaha graduated from the Medical College of Virginia School of Dentistry, Virginia
Commonwealth University, and has been in private general dental practice in Newport News since 1982.
Internationally published, she is also the Founder and Director of the Perio Arts Institute which has two
divisions: Perio Arts Research and PerioPassion! Seminars which are fully AGD PACE approved for
advanced periodontal education. Her focus is to work closely with physicians to coordinate the best
healthcare for patients and to help establish a new standard of care in dentistry by bridging the gap
between dentistry and medicine and providing her patients with true, integrated dental health care.
www.perioartsinstitute.com