Dental and periodontal health status of subjects with sickle cell disease

Prevalence of orofacial alterations in patients with sickle-cell disease: Systematic review and meta-analysis

OBJECTIVE

The aim of this study was to identify the prevalence of orofacial alterations in sickle-cell disease (SCD) and to compare it with the general population.

STUDY DESIGN

This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. The search was conducted on PubMed, Embase, Scientific Electronic Library Online, Web of Science, Cochrane Library, gray literature, and references of the included articles.

RESULTS

A total of 770 records were found, and 28 studies were selected. In SCD, the prevalence of decreased bone density was 57% (95% CI: 35%-80%), with Q: P < .01 and I² = 95%; for stepladder pattern was 30% (IC: 13%-47%), Q: P < .01 and I²: 93%; for delayed eruption was 20% (95% CI: 6%-34%), with Q: P < .01 and I² = 86, Q: P < .01 and I² = 99%; and for malocclusion, 66% (95% CI: 39%-92%), Q: P < .01 and I² = 98%. A high risk of bias was observed in relation to the sample size of the studies. A limited number of articles compared the prevalence of orofacial alterations in patients with SCD and healthy individuals.

CONCLUSIONS

Decreased bone density, malocclusion, orofacial pain, tooth necrosis, eruption delay, periodontal disease, and neuropathies may be present in patients with SCD with variable prevalence.

Orofacial manifestations of sickle cell disease: implications for dental clinicians

Sickle cell disease is a multisystem disease associated with episodes of acute illness and progressive organ damage. It is one of the most common severe monogenic disorders worldwide and is now the fastest growing genetic disorder in the UK. Dental awareness of orofacial manifestation varies geographically due to the inheritance pattern and patient population affected by the disease. This article details the epidemiology, pathophysiology and the orofacial manifestations in light of current literature.

Association between sickle cell disease and dental caries: a systematic review and meta-analysis

Objectives: Although dental caries has been widely reported in individuals with sickle cell disease (SCD), there is still controversial in the literature regarding the association between SCD and dental caries. The aim of this systematic review was to investigate whether individuals with SCD have more dental caries than individuals with non-SCD. Methods: PubMed and Embase databases were searched for eligible studies. The parameters of the permanent decayed, missing and filled teeth (DMFT) index and the permanent decayed, missing and filled surface (DMFS) index were considered as outcome measures. The overall meta-analyses of the DMFT and DMFS index and various subgroup analyses (caries components, age, and genotypes) of DMFT index were performed to calculate the weighted mean differences (WMD) between patients with SCD and non-SCD individuals. Results: A total of 9 studies covering 1478 individuals were included in this meta-analysis. The results of overall meta-analyses indicated that the scores of the DMFT and DMFS index were not significantly different between patients with SCD and non-SCD participants. The results of subgroup analyses by caries components, age, and genotypes showed no significant difference in most items. The result of the missing teeth was significantly lower in patients with SCD than in non-SCD individuals (WMD, -0.14; 95% confidence interval [CI], -0.25 to -0.03; P = 0.01). Discussion and Conclusions: The results revealed that compared with non-SCD individuals, patients with SCD did not suffer from worse dental caries. Considering the limitations, further well-designed studies are necessary to reveal the association between SCD and dental caries.

Detection of toxic elements using laser-induced breakdown spectroscopy in smokers' and nonsmokers' teeth and investigation of periodontal parameters

A laser-induced breakdown spectrometer (LIBS) was built and optimized to detect levels of toxic elements such as lead, cadmium, and arsenic present in the roots of extracted teeth of smokers and nonsmokers. Sixty extracted teeth from patients having a history of chronic periodontitis were divided into two groups of 30 teeth each for smoker and nonsmoker patients and, as controls, a third group of 30 patients who did not have a history of chronic periodontitis. The respective elemental concentration (Pb, Cd, and As) 23-29, 0.26-0. 31, and 0.64-11 ppm are for nonsmokers, 35-55, 0.33-0.51, and 0.91-1.5 ppm are for smokers, and lastly 0.17-0.31, 0.01-0.05, and 0.05-0.09 ppm are for control group. In order to test the validity of the results achieved using our LIBS system, a standard inductively coupled plasma (ICP) technique was also applied for the analysis of the same teeth samples, and ICP results were found to be in excellent agreement with our LIBS results. In addition to this, the gingival index, plaque index, clinical attachment loss (CAL) and probing pocket depth were also recorded. Our LIBS spectroscopic analysis showed high levels of lead, cadmium, and arsenic concentration on root surfaces of teeth, which may be due to CAL.

Caries prevalence and impact on oral health-related quality of life in children with sickle cell disease: cross-sectional study

BACKGROUND

Children with sickle cell disease (SCD) may present oral conditions that can compromise children's health even more. However, there is still no consensus on the association between SCD and dental caries. The aim of this study was to assess caries prevalence in children with sickle cell disease (SCD), and the association of dental caries with socioeconomic factors, disease severity, and oral-health related to quality of life (OHRQoL).

METHODS

The sample was comprised of 106 children with SCD aged 8 to 14 years who were attending the Center for Hematology (Hemominas) in Belo Horizonte, Brazil. They were matched to 385 healthy peers. Data collection included interviews with guardians concerning SCD characteristics, and previous social and oral examinations to determine the caries prevalence. Caries prevalence as measured through the Decayed, Missing and Filled (dmft and DMFT) indices. OHRQoL was evaluated through the Brazilian versions of the Child Perceptions Questionnaires (CPQ8-10, and CPQ11-14 short-form version). Statistical analyses were performed using the chi-square test or Fisher`s exact test and the Mann Whitney test, as well as linear regression.

RESULTS

The DMFT index was 1.3 (SD: 2.1) in younger children with SCD and 1.5 (SD: 1.9) in SCD teens. Younger children with SCD had lower caries experience compared to healthy peers (p = .03). The experience of dental caries among teens with SCD was similar to healthy peers (p > 0.05). In addition, we did not see a significant difference on the mean overall scores of CPQ8-10 between SCD younger children and controls. There was no statistically significant difference in the mean overall scores of teens CPQ11-14 between SCD and the control group. Socioeconomic variables were not associated with dental caries in the participants with SCD. However, SCD severity was associated with higher DMFT indexes (p < 0.05).

CONCLUSIONS

Younger children with SCD had a low experience of dental caries. The dental caries experience in teenagers with SCD was similar to their healthy peers. OHRQoL was similar between SCD participants and controls.

Orofacial manifestations in patients with sickle cell disease

BACKGROUND

The aim of this study was to review the orofacial manifestations in patients with sickle cell disease (SCD).

METHODS

Indexed databases were explored using various combinations of the following keywords: "sickle cell anemia," "sickle cell disease," "oral health status" and "dental inflammation."

RESULTS

Hypoxia has been associated with osteomyelitis of the jaws, particularly the mandible in patients with SCD. Bone marrow hyperplasia in these patients causes depression of nasal bridge, midfacial overgrowth and malocclusion. Mental nerve neuropathy due to osteomyelitis of the mandible causes numbness in the lower lip and chin. A diminished blood supply to teeth causes necrosis of the dental pulp in patients with SCD. Dental caries is a common manifestation in patients with SCD, particularly in those with underprivileged living standards. The association between SCD and periodontal inflammatory conditions remains unclear.

CONCLUSIONS

Oral health problems in patients with SCD are rare and occur mainly as a result of the poor oral hygiene maintenance.