Oral Candida flora in a group of Jordanian patients with β-thalassemia major

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.

Periodontal condition of patients with Thalassemia Major: A systematic review and meta-analysis

OBJECTIVES

The aim of this systematic review was to evaluate the existing evidence on the association between Thalassemia major (TM) and periodontal condition.

MATERIALS & METHODS

MEDLINE via OVID, EMBASE, and The Cochrane Database (including the Central Register of Controlled Trials (CENTER)), were searched up to September 2018 to identify observational studies eligible for systematic review and meta-analyses. Newcastle-Ottawa Scale (NOS) was used for quality assessment.

RESULTS

The initial search resulted in 172 articles, and of these, 16 articles were included and a qualitative synthesis was carried out. Based on the quantitative data from 14 studies, significant differences were found in gingival index (GI) (p < 0.001), bleeding on probing (p = 0.02) as well as plaque index (PI) (p < 0.01) measures between TM and systemically healthy controls. Additional analyses (young vs. adult) for GI and PI revealed that such significant differences were only observed in adults, even though overall analysis showed no subgroup effect. The majority of the studies qualified as "intermediate quality".

CONCLUSION

Patients with TM had significantly higher gingival inflammation scores compared to controls. Therefore, routine comprehensive periodontal screening in TM is recommended in order to prevent occurrence of periodontal diseases and eventually reduce the complexity of the oral health care. Also, conduction of further well-designed observational studies is recommended to contribute to this topic.

Oral Changes in Patients with Sickle Cell Anemia of Dentistry Interest

AbstractSickle cell anemia is determined by the presence of S hemoglobin in homozygous, autosomal recessive and characterized by the presence of red cells with abnormal shape (sickle shape). The clinical manifestations may vary from one individual to another, and it may appear in the first year of the patient’s life, which emphasizes the importance of early diagnosis as the main measure of positive effect in the care of people with the disease. The aim of this study was to conduct a review of the literature on oral alterations of dental surgeon’s interest in patients with sickle cell anemia. The search for the key words “sickle cell anemia” and “oral manifestations” was carried out in the Scientific Electronic Library Online database (SciELO), linked to the Virtual Health Library (VHL). The oral manifestations described in the literature were: paleness of the oral mucosa, smooth, bleached and despapilated tongue or jaundice, delays in dental eruption, periodontal disease, hypo mineralization of the enamel, pulp calcifications, hypercementose, aseptic pulp necrosis, mandibular nerve neuropathy, osteomyelitis and orofacial pain. People with the disease may also exhibit mouth ulcers, particularly in the gums. Anemia causes a high degree of suffering for patients, who deserve special attention from all the multiprofessional team that attends them. Therefore, it is important that the dental surgeon understands and knows the symptoms of the disease, as well as its implications for oral health, as well as the best treatment. The adoption of constant care, with prevention measures in oral care and health, is important to inhibit the occurrence of dental infections.Keywords: Anemia, Sickle Cell. Dental Care. Oral Manifestations.ResumoA anemia falciforme é determinada pela presença da hemoglobina S em homozigose, de caráter autossômico recessivo e caracterizada pela presença de células vermelhas com formato anormal (forma de foice). As manifestações clínicas variam de acordo com o indivíduo e ao longo do percurso da doença, pois pode surgir no primeiro ano de vida do paciente, o que enfatiza a importância do diagnóstico precoce como principal medida de efeito positivo na assistência às pessoas com a doença. O objetivo deste trabalho foi realizar uma revisão de literatura sobre as alterações bucais de interesse do cirurgião-dentista em pacientes com anemia falciforme. A busca pelas palavras chaves “anemia falciforme” e “manifestações bucais” foi realizada na base de dados Scientific Electronic Library Online - SciELO, vinculada à Biblioteca Virtual em Saúde - BVS. As manifestações bucais descritas na literatura foram: palidez da mucosa oral, língua lisa, descorada e despapilada ou icterícia, atrasos na erupção dentária, doença periodontal, hipomineralização do esmalte, calcificações pulpares, hipercementose, necrose pulpar asséptica, neuropatia do nervo mandibular, osteomielite e dor orofacial. Os portadores também podem exibir úlceras bucais, particularmente na gengiva. A anemia provoca alto grau de sofrimento aos pacientes que merecem atenção especial de toda a equipe multiprofissional que os assiste. Desta forma, é importante que o cirurgião-dentista conheça a doença, assim como suas implicações para a saúde bucal e a condução do melhor tratamento. A adoção de cuidados, com medidas de promoção e prevenção em saúde bucal, é importante para evitar a ocorrência de infecções dentárias.Palavras-chave: Anemia Falciforme. Assistência Odontológica. Manifestações Bucais.

Comparative effectiveness of different types of splenectomy for children with congenital hemolytic anemias

OBJECTIVE

To compare the effectiveness of different types of splenectomy in children with congenital hemolytic anemias.

STUDY DESIGN

We constructed key questions that addressed outcomes relevant to clinicians and families on effects of partial or total splenectomy, including hematologic effect, splenic function, and the risk of adverse events. We identified from Pubmed and Embase 703 studies that evaluated different types of splenectomy and accepted 93 studies that satisfied entry criteria. We graded the quality of each report and summarized the overall strength of research evidence for each key question.

RESULTS

We did not identify any randomized clinical trials. All types of splenectomy have favorable clinical outcomes in most diseases. We did not identify any hematologic advantage of laparoscopy compared with laparotomy. Adverse events are uncommon in most studies and are minimized with use of laparoscopy.

CONCLUSIONS

There is a need for randomized clinical trials and improved data collection of different types of splenectomy in congenital hemolytic anemias. Outcomes studied should address the concerns of families and clinicians to assess the risks and benefits of various treatments.

Craniofacial parameters of Syrian children with β-thalassemia major

AIM

To investigate cephalometric craniofacial parameters (skeletal and dental) of β-thalassemic-major patients and to compare findings with a group of healthy patients in the same age group.

METHODS

Fifty-one Syrian thalassemic-major patients aged 8-12 years were recruited. Lateral cephalometric radiographs were taken. Linear and angular cephalometric measurements were recorded and compared with Syrian controls (n=50) in the same age group.

RESULTS

Thalassemic patients, when compared with controls, showed significant retrognathia in the mandible (reduced sella [mid-point of sella turcica]-nasion [most anterior point on the frontonasal suture] B-point [deepest point on the concavity of the mandibular profile between the alveolar crest and the point of the chin] angle, and decreased sella-nasion-pogonion [most anterior point on the bony chin] angle, P<0.0001), a significant decrease in ramus height (articulare-gonian=36.51 ± 3.87 mm, P<0.0001). They also exhibited a significant class II skeletal pattern (P<0.0001) and a convex facial profile as the nasion A-point (deepest point on maxillary profile between the anterior nasal spine and the alveolar crest) pogonion angle and maxillomandibular A-point-nasion P-point angle increased. They also showed a highly-significant decrease in the total posterior facial height (sella gonion [most posterior, inferior point on the angle of the mandible]=64.24 ± 5.73 mm, P<0.0001) and significant increase in the total anterior facial height (N-Me = 110.78 ± 6.66 mm, P=0.009) when compared to controls.

CONCLUSION

Thalassemic patients exhibited a skeletal class II malocclusion, retrognathia of the mandible, a short height of the ramus, an increase in anterior facial height, and a decrease in posterior facial height.