Citation Information :
Davidopoulou S, Pikilidou M, Yavropoulou MP, Kalogirou TE, Zebekakis P, Kalfas S. Aggravated Dental and Periodontal Status in Patients with Sickle Cell Disease and Its Association with Serum Ferritin. J Contemp Dent Pract 2021; 22 (9):991-997.
Aim: The present study aimed to evaluate the possible consequences of sickle cell disease (SCD) on dental and periodontal health in middle-aged patients and to examine the association of certain cardiovascular parameters and serum ferritin with the dental and periodontal status.
Materials and methods: Thirty-seven patients (mean age 43.2 years old) with SCD and 30 non-SCD and otherwise healthy individuals (mean age 38.9 years old) were examined for caries experience and periodontal status in addition to cardiovascular characteristics and ferritin level in serum.
Results: Compared to controls, SCD patients exhibited higher plaque and gingival bleeding scores, higher prevalence of periodontal diseases, and higher caries experience. Multiple stepwise linear regression analysis showed that caries experience was predominantly determined by the presence of SCD and the age, while major determinants of periodontitis were the ferritin levels and the male gender. The results reveal an aggravation of oral health in SCD patients regarding both caries and periodontal diseases.
Conclusion: A potential role of the increased central inflammatory response, reflected by the elevated ferritin level in serum, is suggested for the impaired periodontal health of SCD patients.
Clinical significance: Compliance with precautionary dental checks and early management of dental complications is of great importance in order to improve oral health status and prevent general health complications in SCD patients.
Modell B, Darlison M. Global epidemiology of haemoglobin disorders and derived service indicators. Bull World Health Organ 2008;86(6):480–487. DOI: 10.2471/blt.06.036673.
Frenette PS, Atweh GF. Sickle cell disease: old discoveries, new concepts, and future promise. J Clin Invest 2007;117(4):850–858. DOI: 10.1172/JCI30920.
Pinto VM, Balocco M, Quintino S, et al. Sickle cell disease: a review for the internist. Intern Emerg Med 2019;14(7):1051–1064. DOI: 10.1007/s11739-019-02160-x.
Ter Maaten JC, Serné EH, Bakker SJ, et al. Effects of insulin on glucose uptake and leg blood flow in patients with sickle cell disease and normal subjects. Metabolism 2001;50(4):387–392. DOI: 10.1053/meta.2001.21681.
Pikilidou M, Yavropoulou M, Antoniou M, et al. Arterial stiffness and peripheral and central blood pressure in patients with sickle cell disease. J Clin Hypertens (Greenwich) 2015;17(9):726–731. DOI: 10.1111/jch.12572.
Gladwin MT. Cardiovascular complications and risk of death in sickle-cell disease. Lancet 2006;387(10037):2565–2574. DOI: 10.1016/S0140-6736(16)00647-4.
Liem RI, Chan C, Vu TT, et al. Association among sickle cell trait, fitness, and cardiovascular risk factors in CARDIA. Blood 2017;129(6):723–728. DOI: 10.1182/blood-2016-07-727719.
Kalbassi S, Younesi MR, Asgary V. Comparative evaluation of oral and dento-maxillofacial manifestation of patients with sickle cell diseases and beta thalassemia major. Hematology 2018;23(6):373–378. DOI: 10.1080/10245332.2017.1404219.
Passos CP, Santos PR, Aguiar MC, et al. Sickle cell disease does not predispose to caries or periodontal disease. Spec Care Dentist 2012;32(2):55–60. DOI: 10.1111/j.1754-4505.2012.00235.x.
Arowojolu MO, Savage KO, Aken'ova YA. Periodontal disease in homozygous HBSS adolescent Nigerians. Afr J Med Med Sci 1996;25(3):261–264. PMID: 10457802.
Arowojolu MO. Periodontal probing depths of adolescent sickle cell anaemic (SCA) Nigerians. J Periodontal Res 1999;34(1):62–64. DOI: 10.1111/j.1600-0765.1999.tb02223.x.
Arowojolu MO, Savage KO. Alveolar bone patterns in sickle cell anemia and non-sickle cell anemia adolescent Nigerians: a comparative study. J Periodontol 1997;68(3):225–228. DOI: 10.1902/jop.1918.104.22.168.
Crawford JM. Periodontal disease in sickle cell disease subjects. J Periodontol 1988;59(3):164–169. DOI: 10.1902/jop.1922.214.171.124.
Guzeldemir E, Toygar HU, Boga C, et al. Dental and periodontal health status of subjects with sickle cell disease. J Dent Sci 2011;6(4):227–234. DOI: 10.1016/j.jds.2011.09.008.
Mahmoud MO, Ghandour IA, Attalla B. Association between sickle cell anaemia and periodontal diseases among 12- to 16-year-old Sudanese children. Oral Health Prev Dent 2013;11(4):375–381. DOI: 10.3290/j.ohpd.a30603.
De Carvalho HL, Thomaz EB, Alves CM, et al. Are sickle cell anaemia and sickle cell trait predictive factors for periodontal disease? A cohort study. J Periodontal Res 2016;51(5):622–629. DOI: 10.1111/jre.12342.
Yue H, Xu X, Liu Q, et al. Association between sickle cell disease and dental caries: a systematic review and meta-analysis. Hematology 2020;25(1):309–319. DOI: 10.1080/16078454.2020.1748927.
Costa SA, Moreira ARO, Costa CPS, et al. Iron overload and periodontal status in patients with sickle cell anaemia: a case series. J Clin Periodontol 2020;47(6):668–675. DOI: 10.1111/jcpe.13284.
Wang W, Knovich MA, Coffman LG, et al. Serum ferritin: past, present and future. Biochim Biophys Acta 2010;1800(8):760–769. DOI: 10.1016/j.bbagen.2010.03.011.
Guo LN, Yang YZ, Feng YZ. Serum and salivary ferritin and Hepcidin levels in patients with chronic periodontitis and type 2 diabetes mellitus. BMC Oral Health 2018;18(1):63. DOI: 10.1186/s12903-018-0524-4.
Chakraborty S, Tewari S, Sharma RK, et al. Effect of non-surgical periodontal therapy on serum ferritin levels: an Interventional Study. J Periodontol 2014;85(5):688–696. DOI: 10.1902/jop.2013.130107.
Yassin M, Soliman A, De Sanctis V, et al. Liver iron content (LIC) in adults with sickle cell disease (SCD): correlation with serum ferritin and liver enzymes concentrations in transfusion dependent (TD-SCD) and non-transfusion dependent (NT-SCD) patients. Mediterr J Hematol Infect Dis 2017;9(1):e2017037. DOI: 10.4084/MJHID.2017.037.
Schmitt A, Carra MC, Boutouyrie P, et al. Periodontitis and arterial stiffness: a systematic review and meta-analysis. J Clin Periodontol 2015;42(11):977–987. DOI: 10.1111/jcpe.12467.
O'Leary TJ, Drake RB, Naylor JE. The plaque control record. J Periodontol 1972;43(1):38. DOI: 10.1902/jop.19126.96.36.199.
Petersen PE, Baez RJ. Oral health survey: basic methods. 5th ed. WHO; Geneva, Switzerland; 2013. Available from: https://apps.who.int/iris/handle/10665/97035.
Tonetti MS, Greenwell H, Kornman KS. Staging and grading of periodontitis: framework and proposal of a new classification and case definition. J Periodontol 2018;89(Suppl. 1):S159–S172. DOI: 10.1002/JPER.18-0006.
Mehta CR, Patel NR, Senchaudhuri P. Efficient Monte Carlo methods for conditional logistic regression. J Am Stat Assoc 2000;95(449): 99–108. DOI: 10.2307/2669530.
Brandão CF, Oliveira VMB, Santos ARRM, et al. Association between sickle cell disease and the oral health condition of children and adolescents. BMC Oral Health 2018;18:169. DOI: 10.1186/s12903-018-0629-9.
Laurence B, George D, Woods D, et al. The association between sickle cell disease and dental caries in African Americans. Spec Care Dentist 2006;26(3):95–100. DOI: 10.1111/j.1754-4505.2006.tb01430.x.
Laurence B, Woods D, George D, et al. Self-perceived loss of control and untreated dental decay in African American adults with and without sickle cell disease. J Health Care Poor Underserved 2006;17(3):641–651. DOI: 10.1353/hpu.2006.0107.
Costa SM, Martins CC, Bonfim Mde L, et al. A systematic review of socioeconomic indicators and dental caries in adults. Int J Environ Res Public Health 2012;9(10):3540–3574. DOI: 10.3390/ijerph9103540.
Franek E, Napora M, Blach A, et al. Blood pressure and left ventricular mass in subjects with type 2 diabetes and gingivitis or chronic periodontitis. J Clin Periodontol 2010;37(10):875–880. DOI: 10.1111/j.1600-051X.2010.01613.x.
Tsakos G, Sabbah W, Hingorani AD, et al. Is periodontal inflammation associated with raised blood pressure? Evidence from a National US survey. J Hypertens 2010;28(12):2386–2393. DOI: 10.1097/HJH.0b013e32833e0fe1.
Vidal F, Cordovil I, Figueredo CM, et al. Non-surgical periodontal treatment reduces cardiovascular risk in refractory hypertensive patients: a pilot study. J Clin Periodontol 2013;40(7):681–687. DOI: 10.1111/jcpe.12110.
Łysek R, Jankowski P, Polak M, et al. Association between central and peripheral blood pressure and periodontal disease in patients with a history of myocardial infarction. Pol Arch Med Wewn 2016;126 (1–2):41–47. DOI: 10.20452/pamw.3265.
Ben-Shlomo Y, Spears M, Boustred C, et al. Aortic pulse wave velocity improves cardiovascular event prediction: an individual participant meta-analysis of prospective observational data from 17,635 subjects. J Am Coll Cardiol 2014;63(7):636–646. DOI: 10.1016/j.jacc.2013.09.063.
Laurent S, Cockcroft J, Van Bortel L, et al. Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J 2006;27(21):2588–2605. DOI: 10.1093/eurheartj/ehl254.
Darnaud C, Courtet A, Schmitt A, et al. Association between periodontitis and pulse wave velocity: a systematic review and meta-analysis. Clin Oral Investig 2021;25(2):393–405. DOI: 10.1007/s00784-020-03718-2.
Lockhart PB, Bolger AF, Papapanou PN, et al. Periodontal disease and atherosclerotic vascular disease: does the evidence support an independent association?: a scientific statement from the American Heart Association. Circulation 2012;125(20):2520–2544. DOI: 10.1161/CIR.0b013e31825719f3.
Huang W, Zhan Y, Zheng Y, et al. Up-regulated ferritin in periodontitis promotes inflammatory cytokine expression in human periodontal ligament cells through transferrin receptor via ERK/P38MAPK pathways. Clin Sci (Lond) 2019;133(1):135–148. DOI: 10.1042/CS20180679.
Laurence B, Haywood C Jr, Lanzkron S. Dental infections increase the likelihood of hospital admissions among adult patients with sickle cell disease. Community Dent Health 2013;30(3):168–172. PMID: 24151791.
Mulimani P, Ballas SK, Abas AB, et al. Treatment of dental complications in sickle cell disease. Cochrane Database Syst Rev 2016;4:CD011633. DOI: 10.1002/14651858.CD011633.pub2.