This dental care case takes place in Connecticut and involves a 60-year-old female with a past medical history of alcoholism. She underwent a total hip replacement which developed an infection. The patient presented to her dentist and required a tooth extraction. Her past medical history (total hip replacement, infection and alcoholism) had been noted by the treating dentist. Following the extraction, the patient experienced significant pain and complained of puss and discharge from the extraction site. The patient notified the dentist on numerous occasions but no antibiotics were offered or prescribed. The patient then followed up again to suggest that an infection had developed at the extraction site; again, the dentist failed to ask the patient to come for a check up or prescribe antibiotics. After a week, the patient presented to another dentist who identified the infection and prescribed antibiotics. Unfortunately, the infection had spread to the knee replacement and the patient consequently required a revision knee replacement surgery. The patient developed a host of complications stemming from the failure to prescribe antibiotics following the extraction.
Question(s) For Expert Witness
1). Do you routinely perform tooth extraction?
2). If so, have you routinely extracted teeth from patients who've had significant orthopedic surgery (i.e. total hip replacements) in the past?
3). Are there additional measures to be taken in this instance, to ensure the prevention of infection in an at risk patient?
4). Have you ever had a patient develop the outcome described?
Expert Witness Response E-001522
Pre and post-op antibiotics are required for patients who have undergone a total hip replacement. There is an editorial in the Journal of Orthopedics that states that it should be the treatment of choice. I am an active practitioner and require antibiotics pre and post-operatively, especially for total hip replacement patients. I routinely treat total hip replacement patients with this condition. I have not experienced a similar outcome because of my proclivity for antibiotic coverage.