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Oral and Dental Considerations in Management of Sickle Cell Anemia.

Acharya S - Int J Clin Pediatr Dent (2015)

Bottom Line: The sickle-shaped cells are the result of the hemoglobin S being deoxygenated.How to cite this article: Acharya S.Int J Clin Pediatr Dent 2015;8(2):141-144.

View Article: PubMed Central - PubMed

Affiliation: Reader, Department of Pedodontics and Preventive Dentistry, Institute of Dental Sciences, Bhubaneswar, Odisha, India.

ABSTRACT
Sickle cell anemia is a genetic disease that primarily affects the black population. This anemia is due to a homozygous state of the abnormal hemoglobin S. An alteration occurs on the DNA molecule involving the substitution of the amino acid valine for glutamic acid at the sixth position on the beta polypeptide chain. This biochemical variation on the DNA molecule creates a physiological change that causes sickle-shaped red blood cells to be produced. The sickle-shaped cells are the result of the hemoglobin S being deoxygenated. This case report presents a case of 16-year-old female with sickle cell disease and its dental management. How to cite this article: Acharya S. Oral and Dental Considerations in Management of Sickle Cell Anemia. Int J Clin Pediatr Dent 2015;8(2):141-144.

No MeSH data available.


Related in: MedlinePlus

Multiple caries in mandibular teeth orthopantomograph
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Figure 4: Multiple caries in mandibular teeth orthopantomograph

Mentions: Hemoglobin electrophoresis revealed HbS and HbF (Fig. 1). At present visit, the condition was under control because of blood transfusion and chemotherapy. On examination, the patient was conscious, cooperative with normal gait and was well-oriented. Patient also complained of joint pains which is again a sign of sickle cell disease. Extraoral findings were not so suggestive. Evaluation of the oral soft tissues showed signs suggestive of sickle cell anemia, including mucosal pallor and abnormalities of tongue morphology known as ‘smooth tongue’ (Fig. 2). Oral examination (Figs 3 and 4) after dental prophylaxis also revealed multiple active carious lesions in 16 15 25 26 36 31 32 41 42 with abscess in relation to mandibular right second molar (47). The patient had carious broken 11 and 21. Further the child had root stump of 26. The jaw relation was Angle class 1 with increased overjet and incompetent lips. The orthopantomograph radiographic (Fig. 5) findings of distinct radiopaque areas caused by repairs to bone infarction were present in both the maxilla and the mandible. The radiographs also revealed loss of the normal trabecular pattern with increased radiolucency due to decreased number of trabeculae and increased medullary spaces secondary to compensatory hyperplasia; resorption of the lower edge of the mandible on right side. There was a coarse trabecular pattern of ‘staircase’ shape (present mainly in the interproximal bone because of trabeculae that formed horizontal rows), presence of projections similar to ‘hair strands’ due to secondary formation of bone tissue as compensation for resorption that occurred during bone marrow expansion. The lateral skull radiograph (Fig. 6) revealed thickened diploe; the trabeculae are coarse and are running perpendicular to the inner and outer table giving a characteristic appearance of ‘hair-on-end pattern’. After carrying out the physical and complementary examinations it was decided for a complete oral rehabilitation of the child after consultation with a pediatrician as the child had multiple foci of infection which could lead to a sickle crisis. Composite restorations were planned and done for 31 32 41 42 36 15 16 25. Endodontic procedures were performed for 21 22 11 with post and core for 11 and 21 and porcelain fused to metal crowns on them (Fig. 7). Extractions for 47 and 26 were done and rehabilitation planned for missing teeth. All the procedures were carried under antibiotic coverage and strict aseptic conditions. To relieve pain in jaws, advise for over-the-counter pain relievers like NSAIDs was given and if pain is severe more potent analgesics like morphine can be given. It was also advised to the patient that in case of severe painful crises hospitaliza-tion is a better option. Adjuvants like antidepressants, antihistamines can also be given. These are heterogenous compounds which potentiates the analgesic effects of analgesics and also ameliorates their side effects. After this initial therapy, the patient and her family were advised about future oral healthcare. They were also given dietary advice to promote a non-cariogenic meal plan, and received further instruction in tooth-brushing, the use of dental floss and tongue cleaning. Return visits at 3 to 4 weekly intervals for fluoride applications and oral hygiene checks were arranged.


Oral and Dental Considerations in Management of Sickle Cell Anemia.

Acharya S - Int J Clin Pediatr Dent (2015)

Multiple caries in mandibular teeth orthopantomograph
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4562049&req=5

Figure 4: Multiple caries in mandibular teeth orthopantomograph
Mentions: Hemoglobin electrophoresis revealed HbS and HbF (Fig. 1). At present visit, the condition was under control because of blood transfusion and chemotherapy. On examination, the patient was conscious, cooperative with normal gait and was well-oriented. Patient also complained of joint pains which is again a sign of sickle cell disease. Extraoral findings were not so suggestive. Evaluation of the oral soft tissues showed signs suggestive of sickle cell anemia, including mucosal pallor and abnormalities of tongue morphology known as ‘smooth tongue’ (Fig. 2). Oral examination (Figs 3 and 4) after dental prophylaxis also revealed multiple active carious lesions in 16 15 25 26 36 31 32 41 42 with abscess in relation to mandibular right second molar (47). The patient had carious broken 11 and 21. Further the child had root stump of 26. The jaw relation was Angle class 1 with increased overjet and incompetent lips. The orthopantomograph radiographic (Fig. 5) findings of distinct radiopaque areas caused by repairs to bone infarction were present in both the maxilla and the mandible. The radiographs also revealed loss of the normal trabecular pattern with increased radiolucency due to decreased number of trabeculae and increased medullary spaces secondary to compensatory hyperplasia; resorption of the lower edge of the mandible on right side. There was a coarse trabecular pattern of ‘staircase’ shape (present mainly in the interproximal bone because of trabeculae that formed horizontal rows), presence of projections similar to ‘hair strands’ due to secondary formation of bone tissue as compensation for resorption that occurred during bone marrow expansion. The lateral skull radiograph (Fig. 6) revealed thickened diploe; the trabeculae are coarse and are running perpendicular to the inner and outer table giving a characteristic appearance of ‘hair-on-end pattern’. After carrying out the physical and complementary examinations it was decided for a complete oral rehabilitation of the child after consultation with a pediatrician as the child had multiple foci of infection which could lead to a sickle crisis. Composite restorations were planned and done for 31 32 41 42 36 15 16 25. Endodontic procedures were performed for 21 22 11 with post and core for 11 and 21 and porcelain fused to metal crowns on them (Fig. 7). Extractions for 47 and 26 were done and rehabilitation planned for missing teeth. All the procedures were carried under antibiotic coverage and strict aseptic conditions. To relieve pain in jaws, advise for over-the-counter pain relievers like NSAIDs was given and if pain is severe more potent analgesics like morphine can be given. It was also advised to the patient that in case of severe painful crises hospitaliza-tion is a better option. Adjuvants like antidepressants, antihistamines can also be given. These are heterogenous compounds which potentiates the analgesic effects of analgesics and also ameliorates their side effects. After this initial therapy, the patient and her family were advised about future oral healthcare. They were also given dietary advice to promote a non-cariogenic meal plan, and received further instruction in tooth-brushing, the use of dental floss and tongue cleaning. Return visits at 3 to 4 weekly intervals for fluoride applications and oral hygiene checks were arranged.

Bottom Line: The sickle-shaped cells are the result of the hemoglobin S being deoxygenated.How to cite this article: Acharya S.Int J Clin Pediatr Dent 2015;8(2):141-144.

View Article: PubMed Central - PubMed

Affiliation: Reader, Department of Pedodontics and Preventive Dentistry, Institute of Dental Sciences, Bhubaneswar, Odisha, India.

ABSTRACT
Sickle cell anemia is a genetic disease that primarily affects the black population. This anemia is due to a homozygous state of the abnormal hemoglobin S. An alteration occurs on the DNA molecule involving the substitution of the amino acid valine for glutamic acid at the sixth position on the beta polypeptide chain. This biochemical variation on the DNA molecule creates a physiological change that causes sickle-shaped red blood cells to be produced. The sickle-shaped cells are the result of the hemoglobin S being deoxygenated. This case report presents a case of 16-year-old female with sickle cell disease and its dental management. How to cite this article: Acharya S. Oral and Dental Considerations in Management of Sickle Cell Anemia. Int J Clin Pediatr Dent 2015;8(2):141-144.

No MeSH data available.


Related in: MedlinePlus