title: Dental procedures and subsequent prosthetic joint infections: findings from the Medicare Current Beneficiary Survey.
abstract: BACKGROUND
  The publication of the 2009 American Academy of Orthopedic Surgeons' (AAOS') guidelines for antibiotic prophylaxis after joint replacement (arthroplasty) has renewed debate concerning appropriate prophylaxis for dental patients. The authors examined an administrative data set to assess whether dental procedures were associated with prosthetic joint infections (PJIs).
  
  
  METHODS
  Using data for the years 1997 through 2006 from the Medicare Current Beneficiary Survey (MCBS), the authors identified participants who had undergone total joint arthroplasty and those who had experienced a PJI. They explored associations between dental procedures and subsequent PJIs by using time-to-event analyses (N = 1,000). A nested case-control study included case participants who had had PJIs (n = 42) and matched control participants who had had total arthroplasty but had no PJIs (n = 126). The authors calculated hazard ratios (HRs) and odds ratios (ORs).
  
  
  RESULTS
  Control participants (people without PJIs) were more likely than were case participants (those with PJIs) to have undergone an invasive dental procedure, though this trend was not statistically significant in either the time-to-event analysis (HR = 0.78; 95 percent confidence interval [CI], 0.18-3.39) or the case-control analysis (OR = 0.56; 95 percent CI, 0.18-1.74). Only four of 42 case participants had undergone an invasive dental procedure in the 90 days before the infection occurred. Consideration of all dental procedures yielded similar results.
  
  
  CONCLUSIONS
  Dental procedures were not associated significantly with subsequent risk for PJIs, although this study's power was somewhat low. The clinical importance of prophylactic antibiotics in dentistry for patients who have undergone joint arthroplasty, therefore, may be questioned.
  
  
  CONCLUSIONS
  These results support the view that the 2009 AAOS Information Statement on antibiotic prophylaxis for people with prosthetic joints should be reconsidered for patients in that population who are receiving oral health care.
authors: Department of Developmental and Surgical Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN 55455, USA. skaar003@umn.edu
authors: Daniel D
authors: DD
authors: Skaar
authors: Heidi
authors: H
authors: O'Connor
authors: James S
authors: JS
authors: Hodges
authors: Bryan S
authors: BS
authors: Michalowicz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data; D019643:Arthroplasty, Replacement / Q000706:statistics & numerical data*; D016470:Bacteremia / Q000453:epidemiology; D016022:Case-Control Studies; D002908:Chronic Disease; D015331:Cohort Studies; D003729:Dental Care / Q000706:statistics & numerical data*; D003777:Dental Prophylaxis / Q000706:statistics & numerical data; D004522:Educational Status; D005260:Female; D006304:Health Status; D006801:Humans; D007182:Income; D008297:Male; D017533:Marital Status; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D016016:Proportional Hazards Models; D016459:Prosthesis-Related Infections / Q000453:epidemiology*; D012307:Risk Factors; D012390:Root Canal Therapy / Q000706:statistics & numerical data; D013997:Time Factors; D014081:Tooth Extraction / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology