Clinico-cytological changes of oral soft and hard tissues in children with sickle cell anaemia

Abstract

Oral health cannot be separated from other body health. A number of diseases in children present first with signs and symptoms in the oral cavity. Sickle cell anaemia (SCA) is an example of systemic diseases that affect oral soft and hard tissues. The aim of this hospital based case-control study was to detect oral soft and hard tissues lesions, if any, in children with sickle cell anaemia, as well as to quantify the risk for oral cytological atypia, if any. This study was conducted at a referral clinic for (SCA) at Children Emergency Hospital (CEH) at Khartoum city, during the period Jan. 1999 to Dec. 2000 inclusive. The material consisted of children with sickle cell anaemia (n=100), and controls (n=100) with diseases other than SCA, but with similar age, sex and place of residence. Cases and controls were examined clinically. Smears of exfoliated cells from buccal mucosa of some of the cases and controls were taken randomly. The collected data analyzed. The percentages for the entire variables were calculated. The relative risk and confidence interval were found for the oral lesions and the oral cytological atypia. Results showed an increased risk for gnathopathy, maxillary bone overgrowth, among cases with SCA compared to the controls. Enamel hypoplasia with a relative risk of 27.64 was also detected among cases. An oral ulceration in the form of oral aphthae and/or oral VII candidiasis was found among cases with SCA with a percentage of 26% compared to 5% among the controls. Oral cytological atypia detected included chromatin clumping ,of a relative risk as 5.56, nuclear hyperchromasia showed a relative risk of 2.75, cellular pleomorphism with a relative risk of 2.26, and/or multinucleation of 3.00 relative risk. The study couldn't document increased risk for osteomyelitis of the jaw and/or avascular necrosis of the TMJ in association with SCA compared to the controls. The prevalence of dental caries and periodontal disease were found to be low among SCA patients compared to the controls. The gnathopathy was believed to be due to bone marrow hypertrophy, resulting from haemolysis. Where as enamel hypoplasia was due to the adverse effects of the disease on amelogensis due to the increased sensitivity of the secretary ameloblasts, in terms of its metabolic requirements. The Occurrence of oral aphthae and/or oral candidasis among cases with SCA was believed to be due to defective infection control mechanisms, as a result of defective opsonisation of pathogenic micro-organisms prior to phagocytosis. Accumulation of infarcted tissues and/or splenic hypofunction may also predispose to oral ulcers. The oral cytological atypia detected was partially explained by the presence of defective cell-mediated immunity caused by zinc deficiency, resulting from haemolysis in these patients. Zinc VIII deficiency adversely affects the T-helper cells (T-H1) function, and interleukin (IL-2) production. It was concluded that gnathopathy was the most common oral pathological finding in association with SCA. Enamel hypoplasia, oral aphthae and/or oral candidasis were also detected. Oral cytogical atypia detected included chromatin clumping, nuclear hyperchromasia, cellular pleomorphism, and/or multinucleation. These changes detected in cases with SCA, though not different from normal dental pathologies, yet they require special care during treatment of dental problems owing to the general systemic condition of the patient. The oral cytological atypia detected, require further investigations in order to document an idepth interpretation on the relationship of oral cytological atypia to oral lesions in SCA. Finally further studies are needed to provide more information on the causal link between SCA and the oral health problems.