What is Sickle Cell Disease?
Sickle Cell Disease (SCD) is a group of disorders that affects hemoglobin. It is an atypical hemoglobin molecule (hemoglobin S) which can distort red blood cells into a sickle or crescent shape.
How does SCD affect the oral health of children?
Children with SCD may present anemia, repeated infections, and shortness of breath. Also, they might episodes of pain. These manifestations of the condition need to be taken into consideration when treating children with SCD.
Dental characteristics of Sickle Cell Disease:
- Delayed teeth eruption.
- Enamel Hypoplasia (Softening of the outer-most layer of the teeth).
- Malocclusion (abnormal alignment of the teeth.)
- Periodontitis (condition that affects the gingiva and bone around the teeth).
Dental Management and Prevention
Prevention is essential in managing the dental health of the child with SCD. Scheduling your child for early professional
dental examinations as well as following a more frequent dental schedule is recommended.
Tips for Proper Dental Hygiene
- Use sugar free medication.
- Apply topical fluoride and visit the dentist every 6 months.
- Parents should begin brushing when the first baby tooth erupts and should assist their child in brushing until the child reaches 8 years of age.
- Use fluoridated toothpaste; for children under 3 years old use a smear amount of fluoridated toothpaste and for children above 4 years old use a pea size amount.
- Parents should monitor dietary practices (i.e. avoid prolonged use of bottle, reduce amounts of sugar consumed, reduce frequency of sugar consumed).
Preparing an SCD Child for a Dentist Appointment
Discuss the medications currently being taken with the child's dentist. Antibiotics might be recommended if the child has a compromised splenic function. A medical clearance from the child’s hematologist or primary care physician might be needed prior to treatment.
Dental treatment done in office might be divided in multiple appointments to avoid prolonged dental procedures. In some cases, inhalation sedation might be useful, ask the dentist about this option. If the child requires general anesthesia it is recommended that this be done in a hospital setting.
Celia Roman, DDS - Nicklaus Children's Pediatric Dentistry Residency Program
References
Managing the dental patient with sickle cell anemia: a review of the literature. Deirdre R. Sams, DDS John B. Thornton, DMD, MA Paul A. Amamoo, MD. University of Alabama at Birmingham. The American Academy of Pediatric Dentistry. Volume 12, Number 5. Accessed December 1st, 2017. Website: http://www.aapd.org/assets/1/25/Sams-12-05.pdf
NHI U.S. National Library of Medicine. Reviewed: August 2012. Published: November 28, 2017. Accessed 2017. Website: https://ghr.nlm.nih.gov/condition/sickle-cell-disease#
Schnog, et al. Sickle cell disease; a general overview. The Netherlands Journal of Medicine. NOVEMBER 2 0 0 4 , V O L . 6 2 , N O . 1 0. Accessed December 1st, 2017. Pubmed Website: https://www.ncbi.nlm.nih.gov/pubmed/15683091
CDC Centers for Disease Control and Prevention. Page last reviewed August 9, 2017. Page last updated August 31, 2016. Accessed December 1, 2017. Website: https://www.cdc.gov/ncbddd/sicklecell/data.html
Sickle cell disease and dental treatment. Article · Literature Review · April 2008. Piccin, et al. Journal of the Irish Dental Association. Department of Hematology, Our Lady’s Children’s Hospital, and Irish Blood Transfusion Service. Accessed December 1st, 2017. ResearchGate Website: https://www.researchgate.net/publication/5276629_Sickle_cell_disease_and_dental_treatment
Acharya, Sonu. "Oral and Dental Considerations in Management of Sickle Cell Anemia." International Journal of Clinical Pediatric Dentistry 8.2 (2015): 141–144. PMC. Accessed December 1st, 2017. NCBI Website: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4562049/
NHI National Heart, Lung and Blood Institute. U.S. Department of Health and Human services. Updated: August 10, 2017. Accessed December 1st, 2017. Website: https://www.nhlbi.nih.gov/health/health-topics/topics/sca#overview