Are sickle cell anaemia and sickle cell trait predictive factors for periodontal disease? A cohort study

Accuracy of clinical and radiographic recording protocols for diagnosing periodontitis

OBJECTIVE

To compare the accuracy of periodontal examination at 6-sites full-mouth protocol with clinical and radiographic partial-mouth recording protocols (PRPs) to diagnose periodontitis considering new 2018 case definition.

METHODS

Periodontitis was diagnosed by full-mouth assessment of clinical attachment level (CAL) at 6-sites (n = 8529) according to 2018 case definition (standard reference). Three clinical and radiographic PRPs were considered: (i) 4 interproximal sites of all teeth (4-sites, full-mouth); (ii) 6-sites on Community Periodontal Index of Treatment Needs (CPITN) teeth (6-sites, CPITN teeth); (iii) 4-sites on CPITN teeth (4-sites, CPITN teeth); (iv) radiographic examination on interproximal sites of all teeth (rM-D, full-mouth); and (v) radiographic examination on interproximal sites of CPITN teeth (rM-D, CPITN teeth) using Image J®. Sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV), accuracy, and Κappa (k) were estimated (α = 0.05).

RESULTS

The 4-sites, full-mouth protocol showed 100% sensitivity and NPV, 79.87% PPV, low specificity (38.32%), 69.30% accuracy, and poor agreement (k = 0.468). 6-sites and 4-sites CPITN teeth protocols showed 100% PPV and specificity, sensitivity and NPV of >60%, accuracy of >80%, and good agreement (k > 0.65). All clinical PRPs outperformed radiographic protocols.

CONCLUSION

Clinical PRPs using index teeth are highly accurate in diagnosing periodontitis considering 2018 case definition.

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.

Association between periodontal inflamed surface area and serum acute phase biomarkers in patients with sickle cell anemia

OBJECTIVES

The aim of the present cross-sectional study was to investigate the association between periodontal inflamed surface area (PISA) and serum inflammatory biomarkers in patients with sickle cell anemia.

DESIGN

Patients with sickle cell anemia (n = 80) and systemically healthy individuals (n = 80) were enrolled in the study. Crisis episodes were recorded and blood samples were collected from patients with sickle cell anemia. Clinical periodontal parameters and PISA values were calculated from all patients. Ferritin and high sensitivity C-reactive protein (hs-CRP) levels were analyzed biochemically.

RESULTS

In sickle cell anemia group, presence of periodontitis (p < 0.001) was more frequent than periodontal health (p < 0.001). All clinical periodontal recordings and PISA values were higher in the sickle cell anemia group compared to controls (p < 0.001). Patients with PISA > 776 mm² had 6.06-fold greater chances of having hs-CRP levels above 10 mg/L (OR = 6.06; 95 % CI: 1.9-19.26) and had 31.41-fold greater chances of having ferritin levels above 1000 ng/L (OR = 31.41; 95 % CI: 6.62-149.16). Also, they had 3.27-fold greater risk of having crisis frequency above three times per year (OR = 3.27; 95 % CI: 1.05-10.23) after adjusting for confounders.

CONCLUSION

In patients with sickle cell anemia, positive association was evident between PISA values and serum acute phase biomarkers levels as well as the frequency of acute painful crisis. Patients with increased inflammatory burden may have a higher likelihood of developing periodontitis in the presence of sickle cell anemia. PISA value could be a candidate disease activity indicator in patients with an underlying hematological condition.

Investigation of the relationship between periodontal and systemic inflammation in children with Sickle Cell Disease: A case- control study

Periodontal diseases are chronic inflammatory diseases and tissue destruction increases with oxidative stress in periodontal tissues. Periodontal diseases are associated with systemic diseases such as diabetes, cardio-vascular diseases and rheumatoid arthritis by means of systemic inflammation. Sickle cell disease (SCD) is a chronic inflammatory disease in which vaso-occlusive crisis and endothelial dysfunction are present. It is not known whether the chronic systemic inflammation seen in SCD affect periodontal tissues. The aim of this study was to investigate the relationship between periodontal and systemic inflammation in children with SCD. Forty-three children with SCD and 43 healthy children were included in the study. Physical, dental and periodontal statuses were examined, blood and saliva samples were taken. Levels of pro-inflammatory and oxidative stress mediators in serum and saliva were evaluated. The periodontal findings of the groups were similar. The majority of the subjects in both groups had gingival inflammation. In SCD group, significantly higher serum high sensitive C-reactive protein (Hs-CRP), interleukin (IL)-6, IL-8, tumor necrosis factor (TNF)-α, total oxidant status (TOS), nitric oxide (NO) and salivary IL-6 were observed (p < 0.05). There were positive correlations between salivary IL-6 levels and serum Hs-CRP levels (r = 0.303, p < 0.05). In addition; it was determined that salivary IL-6, TNF-α and NO levels were increased 3-6 times in children with a history of painful crisis or acute chest syndrome compared to children who had never had a painful crisis or acute chest syndrome. Although, observed oral health status was similar in both groups, salivary cytokine levels were increased in children with SCD. The higher salivary cytokine levels may be associated with chronic systemic inflammation and vaso-occlusion observed in children with SCD.

Predictors of dental complications post-dental treatment in patients with sickle cell disease

Objective

Our aim was to explore potential medical or dental indicators associated with dental complications and the utilization of emergency services in sickle cell disease (SCD), especially that clinical reports on adverse outcomes post‐dental treatment are scarce.

Materials and methods

A retrospective analysis of dental treatments of 47 eligible adults with confirmed SCD between May 2016 and October 2019. Logistic regression analysis was used whether clinical outcomes, course of dental treatment, and regularity of dental care are associated with dental complications after dental procedures and/or resulted in emergency care or hospital admissions.

Results

We identified a new, statistically significant association (p‐value = .01) between the number of prescription medications taken and complications (10%) after dental procedures. The most frequent dental procedures were tooth extractions (36%) and pain management (28%) during a non‐scheduled dental encounter (68%). The majority of cases did not participate in regular recall exams and periodical oral hygiene maintenance.

Conclusions

A higher number of prescription medications was associated with an increased risk of post‐dental complications in SCD patients. A thorough medical history, including a list of prescribed medications, and collaboration with the patient medical team are important to assess the risk of complications post‐dental procedures and the need for antibiotic prophylaxis according to the case complexity.

Evidence-based dental management in the new era of sickle cell disease: A scoping review

BACKGROUND

Sickle cell disease (SCD) is an emerging global health issue with rapid progress in therapy especially since 2017. However, systematic reviews found no clinical trials on dental treatment of SCD.

TYPES OF STUDIES REVIEWED

Using a scoping review approach, the authors examined citations from 13 national SCD guidelines and 10 books spanning 4 decades. The authors also searched the following databases: PubMed, Cumulative Index to Nursing and Allied Health Literature, ScienceDirect, Scientific Electronic Library Online, and GoogleScholar. Eligibility criteria included SCD, oral health care and dental treatment, related to oral and systemic health, original data, or observations.

RESULTS

Systemic treatment of SCD might have opposing effects on caries, perhaps explaining the conflicting results published. Malocclusion correlates with marrow expansion. Other unusual orofacial findings reflect ischemia. Of 86 full-text articles examined, only 1, a Brazilian esthetic dentistry study, was a randomized clinical trial. No disease-specific data were found on risk of developing bacterial endocarditis, safety of inhaled nitrous oxide, safety of epinephrine with local anesthetic, or the benefit of comprehensive oral health care.

PRACTICAL IMPLICATIONS

In SCD, oral health and systemic health could be strongly linked. Penicillin, vaccines, and hydroxyurea might impact caries and bone. The interaction of SCD treatments and oral health merit study.

Iron overload and periodontal status in patients with sickle cell anaemia: A case series

AIM

To investigate the association among iron overload, periodontal status, and periodontitis progression rate in sickle cell anaemia (SCA).

MATERIALS AND METHODS

This case series evaluated 123 patients. Clinical attachment level (CAL) and probing depth (PD) were evaluated at six sites per tooth. Alveolar bone loss was estimated using periapical radiography. Study outcomes were periodontal status (measured as number of sites with CAL of ≥3 mm, CAL of ≥5 mm, PD of ≥4 mm, and PD of ≥6 mm) and periodontitis progression rate (determined as ratio of alveolar bone loss to age). Serum transferrin saturation and ferritin levels were obtained from medical records. Poisson regression was performed to estimate associations. Covariables included in the adjusted models (comorbidities, skin colour, socioeconomic class, and vaso-occlusive crisis) were defined by DAGs.

RESULTS

Serum transferrin saturation level revealed a significant positive association with the number of sites with CAL of ≥3 mm, CAL of ≥5 mm, PD of ≥4 mm, and PD of ≥6 mm. Patients with serum transferrin saturation level of >45% were 1.93 times more likely to have rapid periodontitis progression.

CONCLUSION

High serum transferrin saturation level is associated with a greater extent of periodontitis and rapid periodontitis progression in SCA.

Association between sickle cell disease and the oral health condition of children and adolescents

BACKGROUND

Sickle cell disease (SCD) is the most prevalent monogenic hereditary pathology associated with the presence of hemoglobin SS in the world. It can affect individuals, leading to changes in the face and body, causing a deficiency in dental and bone tissue formation that can ultimately result in a higher level of predisposition to developing dental caries. This study aimed to evaluate the oral condition of children and adolescents with SCD in comparison with the condition of healthy controls.

METHODS

This was a cross-sectional study of children and adolescents aged 5 to 18 of both sexes from a hematology center in Bahia, Brazil, and subjects without hemoglobinopathies from a public school of the same state (comparison group). There were 124 individuals, 63 in the comparison group and 61 in the disease group. Interviews, dental and periodontal exams using the DMFT and Periodontal Community Index, respectively, were performed, and the salivary buffer capacity and salivary flow rates of the entire sample population were evaluated. The categorical variables were compared using a chi-square test or Fisher's exact test. For comparison of means, the Student's-t test was used for independent samples that presented symmetrical distribution.

RESULTS

The study showed that the DMFT was 2.08 (2.71) for the SCD group and 1.05 (1.67) for the comparison group (p = 0.013). For dmft, the values were 2.3 (2.6) and 0.88 (1.2), respectively, (p = 0.018). Exams of the periodontium showed the presence of gingival bleeding and dental calculus, with no statistical significance between groups (p = 0.984). When evaluating salivary flow and buffer capacity, no significant differences were observed for the flow rates (p = 0.485), but the SCD group presented a lower buffer capacity compared with the comparison group (p = 0.006). Individuals who used hydroxyurea had a dmft (2.50) higher than that of the comparison group (2.00), and salivary flow was lower than the normal rate in 70% of the children who did not use this medication.

CONCLUSION

Children and teenagers with SCD had deficient oral health when compared with the comparison group, presenting a higher level of dental caries and lower buffer capacity.