歯周病治療による菌血症と人工関節感染

抄録

 Bacteremia occurs through the translocation of oral bacteria from subgingival biofilms into the systemic circulation following daily oral hygiene activities and dental procedures. Bacteremia is caused more frequently in the treatment of periodontal disease than in other dental procedures. Periodontal treatment involves mechanical debridement, which consists of plaque control, scaling and root planing, and periodontal surgery. The debridement of bacterial biofilms in close proximity to the ulcerated epithelium of the gingival sulcus or periodontal pocket may lead to bacteremia. Therefore, it is essential to maintain oral hygiene and periodontal health in order to decrease the risk of bacteremia.

 It has long been debated by the American Academy of Orthopaedic Surgeons (AAOS) and the American Dental Association (ADA) whether or not the risk of prosthetic joint infection (PJI) is related to bacteremia after professional dental treatments. Currently, there is strong evidence of such an association. In addition, the indirect evidence obtained from multiple moderate-strength studies suggests that the use of prophylactic antibiotics reduces the incidence of post-dental procedure bacteremia. However, there have been no studies regarding the relationship between bacteremia and PJI.

 In summary, it is necessary to consider the risk of dental procedure-induced bacteremia and patient characteristics when prescribing prophylactic antibiotics for patients with prosthetic joints who are undergoing dental procedures. It may be particularly beneficial for these patients to maintain good oral hygiene.