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Dentists, physicians provide statements on co-treatment of prosthetic joint patients

April 10, 2015

By Craig Palmer


Co-treatment: Dr. John Reitz, 2d from left at an April 1 meeting of dentists and physicians, was instrumental in year-long multi-disciplinary discussions on co-treatment of prosthetic joint patients that culminated in the meeting and development of an orthopedic dental clearance document posted by the Berks County Dental Society; Karen Miller, senior fellow of meeting sponsor Berks County Community Foundation is to the left of Dr. Reitz; Adam Feldman, M.D., cardiologist; Eric Elgin, M.D. cardiologist; Steven Longenecker, M.D., orthopedic surgeon, and Deb Powell, M.D., infectious disease, Reading Hospital.

Berks County Community Foundation photo

Reading, Pa. — Berks County dentists and physicians met April 1 to discuss collaborative patient care to minimize risks associated with prosthetic joint infections.

The document created from that meeting of 44 dentists, orthopedic surgeons, infectious disease physicians and cardiologists and posted at the Berks County Dental Society website represents local medical-dental responses to recently updated guidelines on the use of prophylactic antibiotics in patients with prosthetic joints who are undergoing dental procedures as described in the January Journal of the American Dental Association and reported at ADA.org.

“It all started one year ago with a conversation between an orthopedic surgeon from the Reading Hospital and myself,” Dr. John Reitz said in describing the ensuing discussions for the ADA News. “We discussed the ambiguity of the 2012 report entitled ‘Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures: Evidence-based Guideline and Evidence Report.’ We set out to establish our own guidelines that would be acceptable for both the dentists and orthopedic surgeons of the area.”

The American Academy of Orthopaedic Surgeons and the American Dental Association developed and published the 2012 report. A 2014 panel convened by the ADA Council on Scientific Affairs developed an evidence-based clinical practice guideline intended to clarify the 2012 report and published an updated clinical recommendation in the January JADA.

“The 2014 ADA report also suggests that dentists and orthopedic surgeons work together to minimize risks associated with prosthetic joint infections, which is what we did locally when we had the one-year discussion that culminated in the April 1 meeting,” said Dr. Reitz.

The document posted by the Berks County Dental Society includes these physician and dentist statements and a dental evaluation form: Antibiotic Prophylaxis for Dental and Medical Treatment of Patients with Prosthetic Joints, Dental Evaluation for Patients Prior to Prosthetic Joint Surgery and Total Joint Replacement Dental Evaluation Request.

“I believe the document we created is a great reference document for stimulating conversations in other communities and to get agreement on co-treatment of patients,” said Dr. John Reitz, who initiated local discussions on management of patients with prosthetic joints and “had a large part in writing the clearance document.” Dr. Reitz represents the Berks County Dental Society on an oral health access to care initiative organized by the Berks County Community Foundation.

“I think the dental evaluation document is a great document because,” said Dr. Reitz:

  • ”It goes beyond just a yes or no for dental clearance. It allows the dentist to categorize a mouth in terms of degree of dental disease severity. The surgeon can then make the final decision as to whether the oral condition poses a risk for surgery. The dentists didn’t want to be liable for giving dental clearance for joint surgery.
  •  ”It encourages the orthopedic surgeon to request a dental evaluation prior to prosthetic joint surgery from the patient’s general dentist, not just the oral surgeon on staff at the hospital.
  • ”It clearly outlines to the dentist what dental conditions correspond to the risk category. In essence, tooth decay is not a risk factor for orthopedic surgery. So the intent of the document is not to give dentists authority to do full mouth reconstruction so the patient can have a hip replacement.”

Dr. Reitz said the dental evaluation form, sometimes called a clearance form, was co-developed by the orthopedic surgeons and the dental society. The physicians’ statement posted at the Berks County Dental Society website is under review by the surgeons, he said. But the clearance form “won’t change.”