Dental clearance before knee or hip replacement or heart surgery

The uncontrolled dental infections might cause bacteriemia which might result in joint implant infection or endocarditis. To mitigate the risks, general dental clearance is needed before scheduling the joint or heart surgery. During the dental clearance, the goal is to control the active infection to reach a healthy level. Patients do not need full mouth restoration or veneers to restore the function or esthetics just for the purpose of dental clearance. 

Based on our training, experiences, and the references

1) ADA guidelines "Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures- Executive Summary on the AAOS/ADA Clinical Practice Guideline"

2) Frey, C et. al World J Orthop. 2019 Dec 18; 10(12): 416–42. Impact of dental clearance on total joint arthroplasty: A systematic review.

3) Berks County Dental Society: Orthopedic clearance at https://berkscountydental.org/orthopedic-clearance

Prosthodontist Dr. Qing, Endodontist Dr. Yang, and Oral Medicine specialist Dr. Idahosi recommended the following procedures for the dental clearance.

1) Comprehensive exam

2) Periodontal exam

3) FMX if not taken within 3 years.

4) full mouth debridement if no regular tooth cleaning.

5) Treatment to control active dental infection including periodontitis, oral mucosa active bacterial or viral infections, Pulpitis or periapical periodontitis, gross decay, loosen crowns or restorations.

Author

Hai Qing HAI QING, DMD, Ph.D., Board Cert Prosthodontist Private practice at New Britain, PA 18901 Adjunct clinical assistant professor teaching Advanced Prosthodontics Program at Upenn Dental Medicine.