Intellectual Disability:

 An umbrella term describing disorders that:

o Are usually present at birth - onset prior to age of 18
o Negatively affect
 intellectual functioning (learning, problem solving, decision-making)
and
 adaptive functioning (every day social and communication skills)
 Further information required regarding specific type of ID
o Down’s Syndrome
o Fetal Alcohol Syndrome
o Fragile X Syndrome

http://dental.washington.edu/wp-content/media/sp_need_pdfs/Down-Adult.pdf

https://www.nidcr.nih.gov/sites/default/files/2017-09/practical-oral-care-intellectual-care.pdf

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6986941/#:~:text=Mouth%20breathing%2C
%20caused%20by%20an,disease%2C%20caries%20and%20impacted%20teeth.

Mouth Breathing:

 Constant mouth breathing alters the pH of the saliva, removing some of its antibacterial
effect and we become more susceptible to tooth decay
THI:

 The damaged bone and cartilage is removed and replaced with prosthetic components
 Osteoarthritis causes loss of joint cartilage in the hip. Damage to the cartilage and bones
limits movement and may cause pain. People with severe pain from a degenerative joint
disease may not be able to do normal activities that involve bending at the hip.
 Hip replacement may also be used to treat certain hip fractures. A fracture is an injury often
from a fall. Pain from a fracture is severe. Walking or even moving the leg causes pain.
 Spread of oral bacteria into the bloodstream (bacteremia) from oral microorganisms can
occur after invasive dental procedures and can potentially lead to infection of a hip or knee
prosthesis.
 patients with prosthetic joint implants, a January 2015 ADA clinical practice guideline, based
on a 2014 systematic review states, “In general, for patients with prosthetic joint implants,
prophylactic antibiotics are not recommended prior to dental procedures to prevent
prosthetic joint infection
 According to the ADA Chairside Guide, for patients with a history of complications associated
with their joint replacement surgery who are undergoing dental procedures that include
gingival manipulation or mucosal incision, prophylactic antibiotics should only be considered
after consultation with the patient and orthopedic surgeon; in cases where antibiotics are
deemed necessary, it is most appropriate that the orthopedic surgeon recommend the
appropriate antibiotic regimen and, when reasonable, write the prescription
 It has been suggested that antibiotics might only be needed in “higher risk” situations such
as major dental procedures (an extraction or a root canal), in the immunocompromised host
or in those with poor oral hygiene.
o Higher risk dental treatment: Discuss with your orthopaedic surgeon. Antibiotic
prophylaxis likely to be recommended prior to dental procedure:
o (I) At risk (immunocompromised) patients:
 Diabetics (particularly those with insulin-dependent diabetics
 Patients taking corticosteroid medication (eg for asthma or skin problems)
 Patients with rheumatoid arthritis
 Patients taking immunosuppressive medications (eg organ transplant or
cancer patients)
 Patients with previous history of prosthetic infection.
 (II) High risk procedures: eg dental abscess, root canal procedures
 ADA: although surgical procedures can result in incidental bacteraemia, there is a low risk of
seeding of the joint prosthesis and subsequent infection. Accumulated evidence supports;
neither the indication for prophylaxis nor the choice of antibiotics regimen is altered by the
presence of a joint prosthesis
o This is true even for procedures that commonly cause bacteraemia
 Surgical Ab Prophy to prevent surgical site infection – only for OMFS procedures

 Non-infected dental problem not causing pain: Delay non-urgent and non-infected
dental procedures until 3-6 months after joint replacement
 Dental abscess (infection): Proceed with urgent and aggressive dental treatment to
clear the abscess. Treat the cause of the abscess. Treatment should occur under
antibiotic coverage (see below)
  Treatment of dental pain: Provide emergency dental treatment for pain. Antibiotics
(see below) are recommended if a medium or high risk dental procedure is to be
performed

https://journals.sagepub.com/doi/full/10.1177/1120700019883244

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5045463/#:~:text=Surgeons%20generally
%20recommend%20patients%20wait,is%20required%20at%20this%20time.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6123982/

https://www.allinahealth.org/health-conditions-and-treatments/health-library/patient-
education/total-hip-replacement/surgery-and-beyond/medicines-that-may-be-used-during-your-
recovery-after-surgery

Periprosthetic bone resorption following THA was a well-known phenomenon [5]. It may increase
late-occurring periprosthetic fractures [6]. Moreover, bone resorption may decrease the primary
stability of the implant and lead to progressive implant loosening [7], which was considered as the
most common reason for revision

Osteoporosis have 3 major potential complications in total hip arthroplasty: perioperative fracture,
an increased risk of periprosthetic fracture, and late aseptic loosening.

Incidence of osteoarthritis is constantly increasing with raising life expectancy. This aging process
also has led to an increasing number of patients with osteoporosis who need hip replacement for
osteoarthritis