Caries risk in patients with thalassaemia major

Treatment of dental and orthodontic complications in thalassaemia

BACKGROUND

Thalassaemia is a quantitative abnormality of haemoglobin caused by mutations in genes controlling production of alpha or beta globins. Abnormally unpaired globin chains cause membrane damage and cell death within organ systems and destruction of erythroid precursors in the bone marrow, leading to haemolytic anaemia. The life-long management of the general health effects of thalassaemia is highly challenging, and failure to deal with dental and orthodontic complications exacerbates the public health, financial and personal burden of the condition. There is a lack of evidence-based guidelines to help care seekers and providers manage such dental and orthodontic complications. This review aimed to evaluate the available evidence on methods for treating dental and orthodontic complications in people with thalassaemia to inform future recommendations. This is an update of a Cochrane Review first published in 2019.

OBJECTIVES

To assess different methods for treating dental and orthodontic complications in people with thalassaemia.

SEARCH METHODS

We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Haemoglobinopathies Trials Register in September 2022, and we searched nine online databases and trials registries in January 2022. We searched the reference lists of relevant articles and reviews and contacted haematologists, experts in fields of dentistry, organisations, pharmaceutical companies and researchers working in this field.

SELECTION CRITERIA

We searched for published or unpublished randomised controlled trials (RCTs) that evaluated treatment of dental and orthodontic complications in individuals diagnosed with thalassaemia, irrespective of phenotype, severity, age, sex and ethnic origin.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened the 37,242 titles retrieved by the search. After deduplication, we identified two potentially relevant RCTs. On assessing their eligibility against our inclusion and exclusion criteria, we excluded one and included the other.

MAIN RESULTS

We included one parallel-design RCT conducted in Saudi Arabia and involving 29 participants (19 males, 10 females) with thalassaemia. It aimed to assess the effectiveness of photodynamic therapy as an adjuvant to conventional full-mouth ultrasonic scaling for the treatment of gingivitis. The average age of participants was around 23 years. There is very low-certainty evidence from this trial that full-mouth ultrasonic scaling plus photodynamic therapy compared to full-mouth ultrasonic scaling alone may improve gingival index score and bleeding on probing after 12 weeks in people with thalassaemia. We found no studies that assessed other interventions for the various dental or orthodontic complications of thalassaemia.

AUTHORS' CONCLUSIONS

Although the included study showed greater reduction in gingivitis in the group treated with full-mouth ultrasonic scaling plus photodynamic therapy, the evidence is of very low certainty. The study had unclear risk of bias, a short follow-up period and no data on safety or adverse effects. We cannot make definitive recommendations for clinical practice based on the limited evidence of a single trial. Future studies will very likely affect the conclusions of this review. This review highlights the need for high-quality RCTs that investigate the effectiveness of various treatment modalities for dental and orthodontic complications in people with thalassaemia. It is crucial that future trials assess adverse effects of interventions.

Investigation of the Wetting Properties of Thalassemia Patients' Blood Samples on Grade 5 Titanium Implant Surfaces: A Pilot Study

Background and Objectives: Beta-thalassemia (BT) has a high prevalence in Mediterranean, Southeast Asian, and African countries. Studies stated that thalassemia is an endemic disease that causes significant health problems in Cyprus. This study aimed to measure the contact angle between the implant and blood samples from BT major patients and healthy individuals to compare the contact angles and wettability of Grade 5 titanium implant surfaces. Materials and Methods: Grade 5 titanium discs that were 10 mm in diameter were used since they mimic the surface of dental implants. Following receiving informed consent, blood samples were taken from the patients’ index fingers in each group with lancet needles and a photo of the contact angle between the blood samples and the titanium surface was taken; the collected blood was transferred to a titanium disc with a medical pipette. ImageJ software with a specific contact angle plugin was used for the contact angle measurements. Results: Theta-mean, theta-circular, and theta-ellipse values were compared between all groups, and no significant difference was found (p > 0.05). Conclusions: In this study, it was hypothesized that the patients’ rheological property of decreased deformability would affect the wettability of implant surfaces in vitro; however, no such finding was reached in this study. Since in-depth studies associated with dental implant success in BTM patients are absent in the literature and Cyprus is one of the Mediterranean countries with a high prevalence of BTM, this study was conducted to enrich the literature. While some systemic diseases may affect the contact angle between the implant surface and blood, it can be concluded that this condition was not present for BTM patients in our study. Last but not least, we emphasize that this experiment was done on a single surface type and the results can be totally different when using other surface types.

Implications of β-thalassemia on oral health status in patients: A cross-sectional study

Background:

β-Thalassemia is a chronic disease of autosomal recessive origin that is identified by the presence of a severe form of anemia. This hematological disease has been shown to directly influence a person’s physical as well as psychological well-being along with their families.

Aim:

This study aimed to find an association between dental health status and oral health-related quality of life (QoL) among children who have been diagnosed with β-thalassemia.

Materials and Methods:

This prospective cross-sectional study was carried out in the dental outpatient department; blood bank and pediatric outpatient departments that were associated with the primary institute. All study participants were age-ranged from 3 to 15 years. Informed written consent was obtained from caregivers or parents of all the study participants. This study was conducted for a total duration of 1 year (from June 2020 to June 2021). All study participants were categorized into two groups: (a) Group I (n = 150) comprised children who were diagnosed with β-thalassemia and (b) Group II (n = 150) comprised normal controls. Exclusion criteria in the study included children suffering from any systemic disease that predisposes them to dental caries or periodontal diseases. The intra-oral examination was performed using Decayed-Missing-Filled Teeth Index (DMFT/dmft Index) and Oral Hygiene Index-Simplified (OHI-S). Assessment of QoL was done by using the “Child Perceptions Questionnaire for children.” Collected data were recorded in Microsoft Excel workbook, 2007. Statistical comparison between both the groups was performed by using statistical tools such as the Chi-square test, Fisher’s exact test, independent t-test, and Mann–Whitney U test. The probability values lesser than 0.05 were considered to be statistically significant.

Results:

Maxillofacial findings—rodent facies, saddle nose, lip incompetence, pale oral mucosa, anterior open-bite, lower anterior teeth crowding, and maxillary anterior teeth spacing or crowding—were seen. Class II malocclusion was present in significant numbers of subjects. On comparing dmft/DMFT scores, no significance was observed while on comparing OHI-S index, statistical significance was seen. A statistically significant difference in the QoL was noted between thalassemic children and the control group.

Conclusion:

Thalassemic children showed a significant association between dental health and QoL.

The power of three-dimensional printing technology in functional restoration of rare maxillomandibular deformity due to genetic disorder: a case report

Background

Thalassemia is an inherited autosomal recessive blood disorder causing abnormal formation of hemoglobin, known as a syndrome of anemia with microcytic erythrocytes. It is the most common genetic disorder worldwide, with a high prevalence among individuals of Mediterranean descent. The state of homozygosity of the beta-globin mutated gene is known as beta-thalassemia major, and these patients require regular blood transfusions and iron chelation therapy for survival. The rapid loss of red blood cells among affected individuals activates compensatory mechanisms of excessive medullary and extramedullary hematopoiesis, leading to severe skeletal bone deformity.

Case presentation

We present the case of a 39-year-old Bedouin male, diagnosed with beta-thalassemia major at infancy, with diagnosed homozygosity for the intervening sequence 2-1 (guanine > adenine) mutation. Since early infancy, he started receiving blood transfusions with a gradual increase in treatment frequency through adulthood due to the severe clinical progression of the disease. He was referred to the oral and maxillofacial surgery department at Galilee Medical Center to evaluate his facial deformity in the upper jaw and treat his severe periodontal disease. The patient presented maxillary overgrowth, and severe dental deformity resulted in progressive disfigurement and difficulty chewing, swallowing, and speaking. To address the challenge of surgical treatment, we utilized the advantage of three-dimensional planning and printing technology to simulate the optimal result. Resection of maxillary bone overgrowth and insertion of custom-made subperiosteal implants were followed by rehabilitation of both jaws to the patients' satisfaction at 3-year follow-up.

Conclusions

The ongoing implementation of state-of-the-art technologies such as virtual reality and three-dimensional printing has become a prominent component in surgical toolsets. Comprehensive case simulation and accurate planning before surgery will improve surgical results and patient satisfaction. This approach is highly advocated when approaching a case of rare maxillofacial deformity associated with either genetic or orphan diseases.

Evaluation the oral hygiene conditions, oral Candida colonization and salivary Streptococcus mutans and Lactobacilli density in a group of β-thalassemic children and adolescence

BACKGROUND

In this study, the prevalence and distribution of dental caries and oral hygiene conditions in a group of patients with β-TM are evaluated and the results compared to age-and gender-matched healthy patients. In addition, oral candida colonization and the density of Streptococcus mutans (S.mutans) and Lactobacilli in the total saliva are assessed.

MATERIAL AND METHODS

This study involved 59 β-TM patients between 6-16 years old (mean:11.59±3.22), who applied to the Department of Pedodontics, Faculty of Dentistry, Akdeniz University, with ongoing follow-up, treatment and regular blood transfusions. All enrolled patients were diagnosed with β-TM by the Department of Pediatric Hematology and Oncology, Faculty of Medicine, Akdeniz University. As a control group, age-and gender-matched healthy 50 patients were included to the study.

RESULTS

Plaque ( p=0.001), DMFT ( p=0.009) and DMFS ( p=0.039) indices were significantly higher in the β-TM patients, whereas, the oral hygiene status was significantly lower ( p=0.004). Saliva buffering capacity average was insignificantly but slightly more in β-TM patients( p=0.131). While S.mutans values were significantly higher in the β-TM patients ( p=0.002), no significant difference was found in the Lactobacillus ( p=0.131) and Candida values ( p=0.33).

CONCLUSIONS

DMFT, DMFS, Plaque and oral hygiene indices and S.mutans values were found significantly different in β-TM patients than healthy, control group patients, in this study.

Treatment of dental and orthodontic complications in thalassaemia

BACKGROUND

Thalassaemia is a quantitative abnormality of haemoglobin caused by mutations in genes controlling production of alpha or beta globins. Abnormally unpaired globin chains cause haemolytic anaemia by causing membrane damage and cell death within organ systems and destruction of erythroid precursors in the bone marrow. The life-long management of the general health effects of thalassaemia in affected individuals is a highly challenging issue in and of itself; and failure to deal with dental and orthodontic complications in people with thalassaemia exacerbates the public health, financial and personal burden posed by the condition. There exists a lack of evidence-based guidelines for care-seekers and providers to best deal with such dental and orthodontic complications in thalassaemia, which this review seeks to address.

OBJECTIVES

The main objective of this review was to assess different methods to treat dental and orthodontic complications in people with thalassaemia.

SEARCH METHODS

We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Haemoglobinopathies Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. We searched the reference lists of relevant articles and reviews.Date of last search: 01 August 2019.We also searched nine online databases (PubMed, Google Scholar, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, Literature in the Health Sciences in Latin America and the Caribbean database, African Index Medicus, Index Medicus for South East Asia Region, Index Medicus for the Eastern Mediterranean Region, Indexing of Indian Medical Journals). We searched the reference lists of relevant articles and reviews and contacted haematologists, experts in fields of dentistry, organizations, pharmaceutical companies and researchers working in this field.Date of last search: 22 July 2019.

SELECTION CRITERIA

We searched for published or unpublished randomised controlled trials for treatment of dental and orthodontic complications in individuals diagnosed with thalassaemia, irrespective of phenotype, severity, age, gender and ethnic origin.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened 35,202 titles from search results. We identified four unique randomised controlled trials, of which one seemed potentially relevant. Based on closer inspection, the trial was found not to be eligible for inclusion.

MAIN RESULTS

We did not find any relevant trials for inclusion in the review.

AUTHORS' CONCLUSIONS

We were unable to draw any conclusions due to the lack of available data and trials. This review highlights the need for conducting and appropriate reporting, of high-quality randomised controlled trials investigating the effectiveness of various treatment modalities for dental and orthodontic complications in people with thalassaemia.

Comparative Evaluation of BMI, Dental Age, Salivary Alkaline Phosphatase Levels, and Oral Health Status in Children with β Thalassemia Major

PURPOSE

Thalassemia poses clear systemic and oral health problems. Clinicians must be aware of various dental treatment needs in these patients. This study was undertaken to assess body mass index (BMI), dental age, salivary alkaline phosphatase levels, malocclusion, and treatment needs in children with β thalassemia major.

MATERIALS AND METHODS

A total of 100 children within the age group of 2-15 years (50 thalassemic and 50 healthy controls) were included. Dental age, oral health status, malocclusion, and intervention urgency index was recorded. Unstimulated whole saliva samples were collected to assess the salivary alkaline phosphatase levels. The recorded data were statistically analyzed.

RESULTS

A significantly greater number of thalassemia children were found to be in the underweight category. A significantly high OHI-S scores and low gingival index scores were observed in thalassemia children. Salivary alkaline phosphatase levels were significantly low in thalassemia children compared to the control group. Intervention urgency index scores were significantly high in thalassemia group of children.

CONCLUSION

Thalassemia children had low BMI, gingival index scores, salivary alkaline phosphatase levels and higher prevalence of malocclusion, and high OHI-S index scores compared to the healthy control group. Intervention urgency index scores revealed greater dental treatment needs in children with thalassemia.

HOW TO CITE THIS ARTICLE

Rani ST, Reddy ER, et al. Comparative Evaluation of BMI, Dental Age, Salivary Alkaline Phosphatase Levels, and Oral Health Status in Children with β Thalassemia Major. Int J Clin Pediatr Dent 2019;12(4):303-306.

Oral manifestations and dentofacial anomalies in β-thalassemia major children in Dubai (UAE)

AIMS

The purpose of this study was to identify special oral and dentofacial manifestations of β-thalassemia major (ΒTM) in Emarati children in Dubai (UAE).

MATERIALS AND METHODS

A total of 38 (ΒTM) and 76 healthy Emirati children were recruited. An oral examination was conducted to determine dmft/DMFT indices, Simplified Oral Hygiene Index, occlusal anomalies, dentofacial, and soft-tissue abnormalities.

RESULTS

ΒTM children had significantly higher DMFT compared to the healthy controls (p-value, 0.017). The Met Need Index (MNI) and the Restorative Index (RI) were lower in the ΒTM group but without statistical significance. Calculus Index (CI) was found to be significantly higher in ΒTM children (p-value, 0.002). The proportion of gingivitis was significantly lower in the ΒTM group (p-value, 0.009). ΒTM children had significantly higher proportion of retained primary teeth (p-value, 0.001) and gingival pigmentation compared with healthy controls (p-value, 0.001). BTM children did not have any statistically significant difference in the Angle molar classiication compared to the control. Interestigly, a significantly higher proportion of transverse cross bite was found in the control subjects compared to the BTM group (p-value, 0.004).

CONCLUSIONS

Significantly higher DMFT, retained primary teeth, gingival pigmentation, and CI was found in the BTM group compared to the controls while significantly lower gingivitis index and transverse cross bite was seen in the BTM group.

Sociodemographic profile and oral health status of thalassemic patients attending the National Thalassaemia Centre, Kurunegala, Sri Lanka

AIM

The aim of the present study was to investigate the sociodemographic profile and oral health status (Decayed, Missing, Filled Teeth [DMFT] and periodontal health) of thalassemic patients compared to healthy individuals.

METHODS

The data were collected by means of an interviewer-administered, pretested, and validated questionnaire, followed by oral examination. Patients attending the outpatient department, who were age and sex matched, but without any diagnosed or suspected long-term illnesses, were considered for the control group. Both groups were compared in terms of facial profile, skeletal pattern, facial angles, DMFT, and periodontal health (plaque index, bleeding on probing, and probing pocket depth).

RESULTS

The association of convex facial profile and class II skeletal pattern with Thalassemic status was statistically significant when compared to healthy individuals. Decayed, missing, and filled teeth in the permanent and deciduous dentition, plaque index, and probing pocket depths of the control group were significantly higher compared with the thalassemic group. Surprisingly, 67.8% of thalassemic patients did not show bleeding on probing.

CONCLUSION

Families of the thalassemic patients attending the National Thalassaemia Centre are from a low socioeconomic background. Their DMFT and periodontal health are significantly better than those of healthy individuals.

Patterns of physical growth and dental development in Jordanian children and adolescents with thalassemia major

Dental development and physical growth are of particular interest in pediatric dentistry and orthodontics. This study evaluated these variables in patients with thalassemia major (TM). Physical growth was assessed in 54 patients (31 males and 23 females) aged 5.5 to 18.3 years and dental development was analyzed using panoramic radiographs from 39 of the 54 patients. The Demirjian system was used to characterize dental development of the seven left mandibular permanent teeth. Chronologic age (CA) and dental age (DA) were compared using the paired t-test, and the correlation between CA and extent of delay in dental development (DA minus CA) was assessed using Pearson's correlation coefficients. Growth retardation (< 10th percentile for height and weight) was present in 75.9% of TM patients. Height less than the third percentile was noted in 41.9% (13/31) of males and 34.8% (8/23) of females. Mean (SD) body mass index was 16.5 ± 2.2 kg/m(2). The extent of growth retardation increased with advancing age. Patient radiographs revealed a delay in dental development in 31 of 39 (79.5%) of participants (mean delay, 1.12 years in males and 0.81 years in females; range, 0.1 to 2.7 years). The mean difference between CA and DA was 0.97 years (P < 0.001). CA was significant correlated with extent of dental developmental delay (r = 0.64, P < 0.01). The results show that, among children and adolescents with TM, the proportions of those who had short stature, were underweight, and had a low growth rate increased with age. In addition, participants had significant delays in dental development.

Mesiodistal crown diameters and tooth size discrepancy of permanent dentition in thalassemic patients

Objectives: To provide a description of mesiodistal crown diameters (MD) and tooth-size discrepancy (TSD) of the permanent dentition in patients with thalassemia major (TM) and to compare the results with those of unaffected control group. Study design: The sample consisted of 46 thalassemic patients, 25 males and 21 females aged 7.3 to 23.7 years (mean ± SD = 11.2 ± 3.9 years) and control group matched by age and sex. Dental casts of the participants were measured for MD, using a digital sliding caliper. Descriptive statistics were computed for each individual tooth. Student t-test was used for comparison of mean values between males and females as well as between thalassemic and control groups. The differences between sets of data were evaluated by analysis of variance (ANOVA). Results: All means for MD of thalassemic males and females were smaller than their controls, with 20 of the 24 comparisons being statistically significant (ranged from P<0.05 to P<0.001). In both thalassemic and control groups, males exhibited significantly larger MD than females in most instances. Canines displayed the most sexual dimorphic teeth in the dentition. Lateral incisors showed the greatest variability indicated by the coefficient of variation, while the first molars were the least variable teeth (7.6% vs. 5.3%). There were no statistically significant differences in the anterior and overall tooth-size discrepancy ratios between sexes or between thalassemic and control groups. The mean anterior ratio (79.5%) and overall ratio (92.4%) of the control group were significantly larger than of Bolton ratios; P< 0.001 and P<0.05, respectively. Conclusions: The present study demonstrated that thalassemic males and females exhibited significantly smaller MD than the control group. The TSD ratios in both thalassemic and control groups were significantly larger than those of Bolton sample. These findings should be taken into account when planning orthodontic treatment for thalassemic patients.

Key words:Permanent dentition, tooth size, thalassemia major.

Dental arch dimensions in subjects with beta-thalassemia major

AIM

Thalassemia is a group of inherited hemoglobinopathies with thalassemia major representing the severe form of the disease characterized by craniofacial deformities. The aim of this study is to provide a detailed description of dental arch dimensions in subjects with thalassemia major.

SUBJECTS AND METHODS

The sample consisted of 43 thalassemic subjects, 24 males and 19 females, aged 7.3 to 15.4 years (mean ± SD = 10.6 ± 3.5 years) and control group matched by age and sex. Dental casts of the participants were measured for arch lengths, arch widths, using a digital sliding caliper. Student t-test was used for comparison of mean values between males and females as well as between thalassemic and control groups.

RESULTS

The results show that all means of maxillary and mandibular arch dimensions in thalassemic males and females were smaller than their controls, with 14 of the 16 comparisons being statistically significant (ranged from p < 0.05 to p < 0.001).The segmental arch lengths in the maxilla and mandible of thalassemic group were reduced by an average of 2.59 and 2.55 mm respectively, compared with the control group. The mean maxillary and mandibular arch depths (lengths) in the thalassemic group were shorter by 3.21 and 2.63 mm respectively, relative to the controls (p < 0.001). All arch widths thalassemic patients were significantly reduced by an average ranged from 1.33 to 1.90 mm in the maxilla and 1.37 to 1.77 mm in the mandible.

CONCLUSION

The present study showed that the maxillary and mandibular dental arches dimensions are significantly reduced in patients with thalassemia major compared with healthy control subjects.

CLINICAL SIGNIFICANCE

Changes in the size of dental arches and tooth dimensions in thalassemic patients have an impact on the occlusal relationships.These changes should be taken into account when planning orthodontic treatment and orthognathic surgery.

Does the periodontal health of thalassemia major patients have an impact on the blood lipid profiles? A preliminary report

Cardiac symptoms and premature death from cardiac causes are still suggested to be a major problem in thalassemic patients. One of the main reasons for the cardiovascular events in thalassemia major (TM) patients has suggested having iron overload, in addition to other reasons such as hypoxia, abnormal lipoproteins levels, atherosclerotic conditions, etc. This study aims to investigate whether the periodontal health has an impact on the blood lipid levels. Twenty-four TM patients and sex-matched controls (C) enrolled to this study. The measurements of the periodontal parameters (gingival index, plaque index, bleeding on probing, probing depth, and clinical attachment level) were recorded. Besides, in venous blood samples the lipid profile was investigated. All of the periodontal parameters were significantly higher in TM group than in C group (P<0.05). Triglyceride and cholesterol/high density lipoprotein ratio had significant positive correlations with the periodontal parameters (P<0.05). Multiple regression analyses present significant associations between gingival index, plaque index scores, and the cholesterol/high density lipoprotein ratio (P<0.001). Our study results showed that the lipid profile of TM patients might be affected by their periodontal health. Further studies are needed to determine the lipid profile involvement magnitude and the cardiovascular disease risk caused by the periodontal health of TM patients.