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Dental Tribune Middle East & Africa Edition | 5/2016 37 Frequent dental scaling might reduce infection risk after knee replacement ByDTI TAINAN, Taiwan: Oral bacteria that enter and spread through the blood- stream have been found to cause about 10 per cent of peri-prosthetic joint infections after total knee ar- throplasty (TKA). Therefore, TKA patients are often advised to pay special attention to their oral health. A team of Asian researchers has now found that frequent dental scaling might reduce the risk of infection afterTKA. For patients with end-stage osteoar- thritis, TKA is a common treatment to improve function and reduce knee pain. However, in some cases, patients contract subsequent peri- prosthetic joint infections. With a risk of about 2 per cent, these infec- tions are the most frequent com- plication after TKA and may lead to functional loss, revision surgery and increasedmortality. In about one tenth of all cases, TKA infections are caused by oral bacte- ria that enter the bloodstream and cause transient bacteraemia, the temporary presence of bacteria in the blood. Oral bacteraemia may occur because of dental treatments, such as extractions or dental scaling, but also as a result of daily oral care, including toothbrushing and floss- ing. The condition has been found to occur more frequently in patients with poor oral health. Dental plaque accumulation and gingival inflam- mation in particular are thought to significantly increase the prevalence ofbacteraemiaaftertoothbrushing. Regular dental scaling to remove plaque and calculus contributes to maintaining oral health and is pro- vided by many dentists as part of routine dental care. Therefore, the researchers from National Cheng Kung University in Tainan hypoth- esisedthatitmightbeapossibleway to reduce the risk of peri-prosthetic infection in TKA patients. In their study, the scientists investigated the association between the frequency of dental scaling and the risk of peri- prosthetic joint infection, using data from Taiwan’s National Health In- surance Research Database, which contains data on 99 per cent of the country’spopulation. The researchers analysed 1,291 pa- tients who had undergone TKA be- tween1999and2002andneededre- vision surgery within five years after the initial operation owing to a peri- prosthetic infection. They compared these cases to a control group of age- and sex-matched TKA patients who had not had any peri-prosthetic infection. The scientists found that the pa- tients in the infection group had un- dergone less frequent dental scaling within the three-year period before their endoprostheses had to be re- moved.Ofthesepatients,73.1percent had not visited a dental clinic during that time to have dental check-ups and scaling, compared with 67.8 per centinthecontrolgroup.Only7.1per cent of the patients with a peri-pros- thetic infection underwent regular dentalscaling,whereas10percentof thepatientsinthecontrolgroupdid. Statistical analysis showed that pa- tients who had received dental scal- ing one to four times during the three-year period had a 16 per cent lower risk of infection than patients who had not undergone the dental procedure. For patients who had seen the dentist five to six times for dentalscaling,theriskwas31percent lower. The researchers concluded that regular dental scaling might re- duce the risk of peri-prosthetic joint infection in TKA patients, as it can improve oral health and thereby reduce the risk of transient bacte- raemia caused by oral bacteria. How- ever, further research is required to confirmthisconnection,theystated. The study, titled “Frequent dental scaling is associated with a reduced risk of periprosthetic infection fol- lowing total knee arthroplasty: A na- tionwide population-based nested case–control study”, was published online in the PLOS ONE journal on 23June. "Forpatientswithend-stage osteoarthritis,TKAis acommontreatment toimprovefunctionand reducekneepain." news Dental Tribune Middle East & Africa Edition | 5/201637