A recent review article in Anemia revealed that oral and dental issues are significant problems in patients with sickle cell disease (SCD), but noted that the issues are often overlooked because of the urgency of other disease effects.
“Patients with SCD have chronic overall health problems. The hematological disorder becomes their main concern, and impaired oral health becomes secondary,” wrote the authors, led by Mayank Kakkar of the Eastman Institute for Oral Health at the University of Rochester in New York.
They conducted a systematic review of articles that were published from January 2010 to March 2020, but they were not able to locate any clinical trials regarding dental treatment in SCD. Therefore, they presented the results of their literature review to outline the oral aspects of the disease and offer management strategies.
The researchers highlighted additional oral and dental issues that they hope healthcare providers, particularly dentists, will consider when treating this patient population.
First, the researchers noted that these patients often experience developmental enamel defects, leading to hypoplasia and increased risk of dental caries. They also emphasized that vaso-occlusive crisis (VOC) can affect microcirculation in the dental pulp, leading to symptomatic or asymptomatic pulpal necrosis. Therefore, patients might have underlying issues in apparently healthy teeth. VOC also can affect the major nerves supplying the maxilla and the mandible, leading to loss of sensation and neuropathy.
Patients with SCD often present to dental professionals with pain and sensitivity, the authors wrote, which may be due to inflammation of the pulp (pulpitis) caused by nearby caries. The literature search also revealed that blood clots within blood vessels can lead to calcified pulp stones.
Based on their findings, the authors made several recommendations for SCD care providers and dental professionals:
- schedule dental visit at the time of SCD diagnosis
- improve patient and community education about good oral hygiene
- manage anxiety that can accompany dental care and pain so that patients do not avoid dental visits, including pharmacological options if necessary
- provide nutrition counseling to reduce sugar intake that can exacerbate dental issues
- perform periodic oral health screening at least every six months
- encourage regular use of fluoride
Patients with SCD “frequently present to dental clinics for emergency appointments rather than preventive care. Thus, by the time they come to a dental office, their oral health is quite deteriorated,” the authors concluded. “Early detection, intervention, and prevention are crucial for improving oral health care, and involving a multidisciplinary approach plays an important role in managing people with SCD.”