An Orthopedic Surgeon’s Dental Examination: Reducing Unnecessary Delays in Joint Replacement Surgery for Marginalized Patients in a Safety Net Hospital System

• Published in: Arthroplasty today Vol. 12; pp. 76 - 81
• Main Authors: Tye, Erik Y., Taylor, Adam J., Kay, Robert D., Bryman, Jason A., Andrawis, John P., Runner, Robert P.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2021; Elsevier
• Subjects: Dental screening; Marginalized patients; Original Research; Preoperative dental clearance; Safety net hospital; Total joint arthroplasty; Dental screening; Total joint arthroplasty; Marginalized patients; Preoperative dental clearance; Safety net hospital
• ISSN: 2352-3441; 2352-3441
• DOI: 10.1016/j.artd.2021.10.001

Selective dental clearance before total joint arthroplasty (TJA) has been proposed; however, effective strategies of carrying out this practice are lacking. This study aims to determine the positive predictive value (PPV) of a novel oral examination performed by an orthopedic surgeon to better direct limited resources for marginalized patients in a safety net hospital system. A retrospective review was conducted on 105 consecutive patients who had an oral examination performed by a single surgeon before elective TJA. Patients who screened negative proceeded to surgery without further formal dental clearance. Patients who screened positive underwent formal examination/intervention by a dentist before surgery. The rate of correct referral that resulted in patients undergoing an oral surgical intervention was determined. Complications during a minimum 90-day postoperative follow-up period were collected and compared. Thirty patients (28.6%) screened positive while 75 patients (71.4%) screened negative and proceeded to surgery without referral. The PPV of the screening test was high, with 73.3% of patients receiving a major surgical oral intervention before TJA. Patients sent for formal referral required 89.1 more days to receive their surgery than those that screened negative (54.9 days ± 4.24 vs 144.0 days ± 82.4, P < .001). An orthopedic surgeon’s oral examination demonstrates a high PPV to identify high-risk patients in need of an oral surgical intervention before TJA. This provides a unique solution regarding over-referral for preoperative dental clearance and avoids delays for marginalized patients considering elective TJA in a safety net hospital system.