Can Oral Bacteria Cause a Joint Replacement to Fail?

Researchers at Case Western Reserve University may have found a potential link between gum disease and joint health, with particular implications for failing joint replacements. Working collaboratively, dental, orthopedic and arthritis specialists tested the DNA in synovial fluid in 36 patients with both native and replacement joints. Some samples showed the presence of oral bacteria in the fluid, which the scientists suggest could be contributing to aseptic loosening or excessive wear in joint replacement patients when no infection is present.

The study was designed to test whether there is “bacterial spread from the oral cavity to the joints,” and enrolled patients were diagnosed with either rheumatoid arthritis (11 of 36 patients) or osteoarthritis (25 of 36 patients). Eight patients with OA and one patient with RA had failed artificial joints. Of the 36 patients, five (14%) were shown to have bacteria in their joints. Of these five patients, two were diagnosed with periodontitis and had identical bacterial clones in both the synovial fluid and the dental plaque samples. This suggests that bacteria is able to travel from the mouth to the joints via the bloodstream.

Though the results were modest, the study’s authors say that this confirms a pathway for oral bacteria between the mouth and joints. This adds to the body of literature showing the relationship between dental disease and other conditions, including heart disease and stroke. Further, they recommend that patients with arthritis or failed prosthetic joints be examined for the presence of periodontal diseases and be treated accordingly and suggest that appropriate treatment of periodontal disease may help prevent joint replacements. The study was published in the Journal of Clinical Rheumatology.

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