CONSENSUS RECOMMENDATION The literature review did not identify any studies meeting inclusion criteria that evaluated topical antiseptic wash prior to a dental procedure for patients with a hip or knee replacement. The consensus recommendation stems from low quality data that has evaluated the impact of chlorhexidine mouthwash prophylaxis on bacteremia following dental procedures (Brown, 1998; Duvall, 2013; Lockhart, 1996; Maharaj, 2012; Tuna, 2012). The results of these studies indicate that chlorhexidine wash prophylaxis does not significantly reduce the level of bacteriemia following dental procedures. As a result, oral topical antiseptic wash is not recommended before a dental procedure in patients with a hip or knee replacement for the purpose of reducing the risk of periprosthetic joint infection (PJI).
Benefits/Harms of Implementation
Given that the data does not support the use of chlorhexidine washes, there is limited harm of implementing this recommendation. Potential benefits are the reduced patient and societal costs by not utilizing this practice.
Outcome Importance
Periprosthetic joint infection is a devastating complication after total joint arthroplasty associated with increased morbidity and mortality. Fortunately, rates of PJI are reported as low as 1%. The prevention of PJI is important but interventions should be implemented when evidence exists to guide the clinician.
Cost Effectiveness/Resource Utilization
This recommendation does not support the use of chlorhexidine wash, which will improve cost-effectiveness and resource utilization.
Acceptability
Because of the lack of demonstrated harm and historical practices of oral, topical antiseptic washes, clinicians might be less willing to accept the guidelines and change practice.
Feasibility
Fortunately, adopting the guidelines is not resource-intensive or reliant on special needs. Therefore, it would be highly feasible to implement the guidelines with greater clinician acceptance.
Future Research
Continued research with larger studies to examine the effectiveness of oral topical antiseptic wash prior to dental procedures on PJI risk for patient with a hip or knee arthroplasty are necessary to provide better understanding regarding the use of an oral topical antiseptic wash.