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Dental hygiene in maintaining a healthy joint replacement: a survey of Canadian total joint replacement patients

Wood, Thomas J. MD; Petruccelli, Danielle MLIS, MSc; Piccirillo, Liz RN; Staibano, Phillip BSc(Hons); Winemaker, Mitch MD, FRCSC; de Beer, Justin MD, FRCSC

doi: 10.1097/BCO.0000000000000410

Background: Dental procedures and their role in prosthetic joint infections remain controversial. Recent literature shows that total joint replacement in patients with good oral hygiene are less like to develop an prosthetic joint infection. The purpose of this study was to assess dental hygiene practices and knowledge of its importance in maintaining joint health among patients who have had a total joint replacement, and to understand, based on patient report, the extent to which current clinical practice guidelines have been adopted into everyday practice.

Methods: A cross-sectional survey study of dental hygiene practices was conducted on patients who have had total joint replacement presenting for their 6 wk postoperative follow-up. We hypothesized that patients would have good dental hygiene habits, but limited knowledge of oral hygiene and prosthetic joint infection risk. Responses were analyzed using descriptive statistics and benchmarked against population data from the Oral Health Module of the Canadian Health Measures Survey (CHMS).

Results: The study cohort included 453 patients (mean age 65.9±9.9 yr) with total joint replacements. Our findings demonstrated that although 86% had a cleaning within 12 mo, 5% did not visit a dentist. While 95% brush and 46% floss daily, 4% did not brush and 21% did not floss which is comparable to CHMS population data. Only 49% had been informed of dental hygiene in reducing prosthetic joint infection risk.

Conclusions: Patients who have had total joint replacement practice good dental hygiene overall; however, communication regarding its importance in preventing prosthetic joint infection remains inconsistent. Healthcare practitioners must uniformly educate patients who have total joint replacement on the importance of good dental hygiene in maintaining joint health.

aDivision of Orthopedic Surgery, McMaster University, Hamilton, Ontario, Canada

bComplex Care and Orthopedics Program, Hamilton Health Sciences, Hamilton, Ontario, Canada

cHamilton Arthroplasty Group, Hamilton Health Sciences Juravinski Hospital, Hamilton, Ontario, Canada

dDepartment of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada

Financial Disclosure: Drs. Winemaker and de Beer have received payment for lectures and travel from Stryker Canada for activities outside this work. The other authors have no disclosures. The authors report no conflicts of interest related to this work.

Correspondence to Danielle Petruccelli, MLIS, MSc, Hamilton Arthroplasty Group Hamilton Health Sciences Juravinski Hospital Hamilton, Ontario, Canada Tel: +905-527-4322 ext. 42296; fax: +905-389-5617; e-mail:

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