Go easy with the dental floss.
Dental Floss Infects Knee Replacement

A Minnesota woman flossed so energetically, and forcefully that her gums bled and she passed a serious infection to the five year old joint replacement in her knee.
According to Ala Dababneh, M.D., at the Mayo Clinic, where the patient was treated, the woman sought help when her right knee became swollen and painful, and she started experiencing chills. Doctors diagnosed a serious infection in her replaced knee.
Blood tests revealed the infection to be a bacterium called Streptococcus gordonii which is generally found in the mouth. When the patient explained that she often flossed until her gums bled the mystery was solved.
Dababneh suspects that the bacterium probably entered the patient’s bloodstream through her injured gums and then traveled to her knee, where it established itself.
To treat the infection, the medical team opened up the woman’s knee, flushed out as much of the infection as they could and then prescribed antibiotics. The patient made a complete recovery but will have to continue taking antibiotics. Dababneh explained that because implants do not have an immune system to keep them safe, they are more vulnerable to infections,
“It’s a rare event. I don’t want people to worry that just flossing is going to cause them an infection in their prosthetic joint, ” Dababneh said in an interview in Live Science.

Discussion
This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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