Association of sickle cell haemoglobinopathies with dental and jaw bone abnormalities

Impact of oral health conditions on the quality of life of children and adolescents with sickle cell anemia: A cross-sectional study

BACKGROUND

Sickle cell anemia (SCA) is the most common hemoglobinopathy in Brazil and worldwide and is part of a group of chronic genetic diseases resulting from abnormalities in the structure of hemoglobin.

AIM

To evaluate the impact of oral health conditions on the quality of life (QoL) of children and adolescents with SCA.

DESIGN

This is a cross-sectional study with a sample of 76 children and adolescents aged 8-14 years. For inclusion, they were required to have a diagnosis of HbSS SCA in their medical records, without a pain crisis or any dental emergency in the last three months. The children and adolescents with SCA were from Hematology and Hemotherapy Center of Maranhão. Demographic characteristics, socioeconomic status, oral hygiene, caries, malocclusion, and oral health-related quality of life (OHRQoL) were assessed. OHRQoL was assessed using the Child Perceptions Questionnaire. Descriptive statistics, Student's t and Mann-Whitney tests were performed (α = 5%).

RESULTS

Brown race was the most prevalent for both age groups (8-10 years-63.2% and 11-14 years-57.9%). Predominant monthly family income for both age groups was below $106. Visible plaque and gingival bleeding were higher in children aged 8-10 years. Dental caries significantly impacted the QoL of adolescents through the domain "oral symptom" (p = .031). Malocclusion significantly impacted the QoL of adolescents ("total score," p = .026; "social well-being", p = .045).

CONCLUSION

Oral health impairment negatively affected the QoL of adolescents with SCA.

Genetic Patterns of Oral Cavity Microbiome in Patients with Sickle Cell Disease

The Middle Eastern prevalence of sickle cell anemia, a genetic disorder that affects red blood cells, necessitates additional research. On a molecular level, we sought to identify and sort the oral microbiota of healthy individuals and those with sickle cell anemia. Furthermore, it is crucial to comprehend how changes in the genetic makeup of the oral microbiota impact the state of sickle cell anemia. Using next-generation sequencing, the 16S rRNA amplicon was examined using saliva samples from 36 individuals with sickle cell anemia and healthy individuals. These samples were obtained from sickle cell anemia patients (18 samples) and healthy control participants (controls, 18 samples). Various analyses are conducted using bioinformatic techniques to identify distinct species and their relative abundance. Streptococcus, followed by Fusobacterium nucleatum, Prevotella, and Veillonella were the most prevalent genera of bacteria in the saliva of the SCA and non-SCA individuals according to our findings. Rothia mucilaginosa, Prevotella scoposa, and Veillonella dispar species were the dominant species in both sickle cell anemia and non-sickle cell anemia subjects. Streptococcus salivarius, Actinomyces graevenitzii, Actinomyces odontolyticus, and Actinomyces georgiae spp. were the most prevalent bacterial spp. in the studied SCA cases. The sequencing of the 16S rRNA gene yielded relative abundance values that were visualized through a heatmap analysis. Alterations in the oral microflora's constitution can significantly affect the susceptibility of sickle cell anemia patients to develop more severe health complications. Salivary diagnosis is a potential tool for predicting and preventing oral microbiome-related diseases in the future.

Dental Caries in Children with Sickle Cell Disease and Its Association with the Use of Hydroxyurea and Penicillin Prophylaxis in Dar Es Salaam

Purpose

This comparative study sets out to report dental caries status among individuals with Sickle Cell Disease (HbSS) against those with sickle cell trait (HbSA) and those without the disease (HbAA) as controls. The study further assessed the impact of penicillin chemoprophylaxis and hydroxyurea use on dental caries among Sickle Cell Disease participants.

Methods

This was a comparative cross-sectional study in which 93 children aged 30 to 60 months were recruited. There were 60 participating children who had SCD (HbSS), 17 with SCD trait (HbAS) and 16 were without SCD or SC trait (HbAA). A questionnaire was used to record sociodemographic details including mean age in months and sex and on haemoglobin genotype for all the participants. Specifically, for the participants with HbSS, information on their whether they are taking hydroxyurea (HU), and penicillin chemoprophylaxis was recorded. To assess the prevalence of dental caries, clinical examination of all primary maxillary and mandibular teeth to determine the presence or absence of dental caries lesions was also recorded.

Results

A total of 1197 teeth from 93 children were examined, whereby, 45 (2.4%) of them had dental caries. The participating children with HbAA genotype (6.6%, N=21) had more dental caries than their HbSS counterparts (2.0%, N=24), while none of the participants with HbAS exhibited dental caries. Among the participants with HbSS, males and those who use HU were 3.79 and 3.07 times more likely to have dental caries than their counterparts, female and non-users of HU, respectively.

Conclusion

Dental caries was observed to be low among participants with HbSS when compared to those with HbAA. More research utilizing more robust methodologies is recommended.

Evaluation of Mandibular Bone Microstructure in CT Scans of People with Sickle Cell Disease

OBJECTIVE

 Sickle cell disease (SCD) is a common inherited disease, and is characterized by a genetic modification that determines the production of a hemoglobin with altered morphology. This anatomical change of hemoglobin leads to vaso-occlusive disorders and premature hemolysis of the cell, causing chronic anemia and bone marrow hyperplasia due to increased hematopoietic demand. As a consequence, several skeletal changes are reported in the skull, spine, ribs, pelvis, femur, and metatarsals. In the craniofacial region, dentofacial deformities are described, especially maxillary protrusion. However, studies evaluating bone microarchitecture are scarce. The aim of this study is to evaluate the mandibular bone microstructure of people with SCD on computed tomography (CT) scans.

MATERIALS AND METHODS

 Morphometric parameters were analyzed on CT scans of the mandible of people with SCD and people without this disease or any other disease affecting bone metabolism, matched for sex and age.

STATISTICAL ANALYSIS

 The results were compared by Student's t-test for paired samples and for an error probability of 5%.

RESULTS

 This study demonstrated that the mandibular bone of people with SCD presents significantly less number, connectivity and thickness of bone trabeculae, as well as having a lower fractal dimension and greater porosity.

CONCLUSION

 Mandibular bone of people with SCD has lower bone density and more widely spaced trabeculae.

The influence of iron on bone metabolism disorders

Iron is a necessary trace element in the human body, and it participates in many physiological processes. Disorders of iron metabolism can cause lesions in many tissues and organs, including bone. Recently, iron has gained attention as an independent factor influencing bone metabolism disorders, especially the involvement of iron overload in osteoporosis. The aim of this review was to summarize the findings from clinical and animal model research regarding the involvement of iron in bone metabolism disorders and to elucidate the mechanisms behind iron overload and osteoporosis. Lastly, we aimed to describe the association between bone loss and iron overload. We believe that a reduction in iron accumulation can be used as an alternative treatment to assist in the treatment of osteoporosis, to improve bone mass, and to improve the quality of life of patients.

Mechanisms underlying the adaptive pulp and jaw bone trabecular changes in sickle cell anemia

OBJECTIVE

Mechanisms underlying the oral outcomes in sickle cell anemia (HbSS) have been less explored. This study aimed to investigate the association of morbimortality indicators and hydroxyurea use with adaptive pulp and jaw bone trabecular changes in HbSS.

METHODS

This cross-sectional study included 123 individuals with HbSS. The exposures were the morbimortality indicators of HbSS (number of vaso-occlusive crises, organ damage, hemoglobin level, and leukocyte count) and the use of hydroxyurea for HbSS treatment. The outcomes were adaptive pulp and jaw bone trabecular changes confirmed by radiographic examination. Associations were estimated by Poisson regression in crude and adjusted analyses for sex, skin color, socioeconomic class, and age.

RESULTS

The vaso-occlusive crises (mean ratio (MR) = 3.5, p = 0.045), lower hemoglobin (MR = 2.4, p = 0.037), and higher leukocyte count (MR = 2.17, p = 0.036) were risk factors, while the use of hydroxyurea was inversely associated with adaptive pulp changes (MR = 0.23, p = 0.024). The vaso-occlusive crises were associated with jaw bone trabecular changes (MR = 1.33, p = 0.02).

CONCLUSION

Adaptive pulp changes may be a potential clinical marker of chronic vasculopathy in HbSS. The use of hydroxyurea may reduce the frequency of adaptive pulp changes.

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.

Oral microbiota analyses of Saudi sickle cell anemics with dental caries

OBJECTIVES

The objectives of this study were to identify the composition of oral microbiota in a cohort of patients with sickle cell anemia (SCA) and a high mean number of decayed, missing, and filled permanent teeth (DMFT) and compare it to a cohort of patients with SCA and a low number of DMFT and elucidate the effect of fetal haemoglobin levels on the oral microbiota composition.

METHODS

Patients who had been diagnosed with SCA, who were homozygous for sickling β-globin mutation (β^S/β^S), who had Arab-Indian haplotype, and who ranged in age from 5 to 12 years were included in this study. Oral saliva from each participant (n = 100) was collected in GeneFiX™ Saliva DNA Microbiome Collection tube and DNA was extracted using GeneFiX™ DNA Isolation Kits. The composition of oral 16S rRNA from patients with SCA and high dental caries (n = 27, DMFT ≥5) and low dental caries (n = 73, DMFT ≤4) was analysed. Sequencing was performed on an Ion Personal Genome Machine using, Ion PGM Hi-Q view Sequencing 400-bp kit.

RESULTS

We observed an overall increase in abundance of Proteobacteria, Chloroflexi, and Bacteroidetes in the high DMFT index group compared to those with a low DMFT index. In addition, there was an overall increased abundance of microbiota from Proteobacteria, Fusobacteria, Firmicutes, and Bacteroidetes in the patients with SCA with low fetal haemoglobin compared to those with high fetal haemoglobin (P < .05). Enterobacteriaceae species were the most significant abundant species of bacteria found in both the high DMFT index group and low fetal haemoglobin cohort (P < .05).

CONCLUSIONS

Our data indicate that SCA in Saudi patients with high DMFT have a higher predominance of pathogenic bacteria compared to those with low DMFT. Furthermore, SCA in Saudi patients with low fetal haemoglobin have a higher predominance of pathogenic bacteria compared to those with higher fetal haemoglobin.

Vaso-occlusive Pain Crisis Mimicking Mandibular Abscess in an Adolescent with Sickle Cell Disease

In people with sickle cell disease (SCD), oral abscesses are concerning clinical conditions and carry a high risk of postoperative sickle cell complications. We present an unusual case of a 14-year-old girl with SCD whose initial presentation of facial swelling, headaches, jaw pain, and paresthesia mimicked an odontogenic abscess. She was diagnosed with vaso-occlusive crisis in the mandibular bone and successfully managed noninvasively. This is among the youngest cases of paresthesia in the lower lip in SCD, which provided a clue that postponing invasive aspiration or biopsy was possible under empiric antibiotics and close observation.

Manifestation and Mechanisms of Abnormal Mineralization in Teeth

Tooth biomineralization is a dynamic and complicated process influenced by local and systemic factors. Abnormal mineralization in teeth occurs when factors related to physiologic mineralization are altered during tooth formation and after tooth maturation, resulting in microscopic and macroscopic manifestations. The present Review provides timely information on the mechanisms and structural alterations of different forms of pathological tooth mineralization. A comprehensive study of these alterations benefits diagnosis and biomimetic treatment of abnormal mineralization in patients.

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.

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.