رسائل ماجيستير
English
2003
Clinico-cytological changes of oral soft and hard tissues in children with sickle cell anaemia
Bakhitta At- Alla , Ali Mohamed Idris, Layla Mohamed Ibrahim
كلية الأسنان-جامعة الخرطوم · السودان
Oral health cannot be separated from other body health. Anumber of diseases in children present first with signs and symptoms inthe oral cavity. Sickle cell anaemia (SCA) is an example of systemicdiseases that affect oral soft and hard tissues.The aim of this hospital based case-control study was to detectoral soft and hard tissues lesions, if any, in children with sickle cellanaemia, as well as to quantify the risk for oral cytological atypia, ifany.This study was conducted at a referral clinic for (SCA) at ChildrenEmergency Hospital (CEH) at Khartoum city, during the period Jan.1999 to Dec. 2000 inclusive. The material consisted of children withsickle cell anaemia (n=100), and controls (n=100) with diseases otherthan SCA, but with similar age, sex and place of residence. Casesand controls were examined clinically. Smears of exfoliated cells frombuccal mucosa of some of the cases and controls were takenrandomly. The collected data analyzed. The percentages for the entirevariables were calculated. The relative risk and confidence intervalwere found for the oral lesions and the oral cytological atypia.Results showed an increased risk for gnathopathy, maxillary boneovergrowth, among cases with SCA compared to the controls. Enamelhypoplasia with a relative risk of 27.64 was also detected amongcases. An oral ulceration in the form of oral aphthae and/or oralVIIcandidiasis was found among cases with SCA with a percentage of26% compared to 5% among the controls. Oral cytological atypiadetected included chromatin clumping ,of a relative risk as 5.56,nuclear hyperchromasia showed a relative risk of 2.75, cellularpleomorphism with a relative risk of 2.26, and/or multinucleation of 3.00relative risk.The study couldn't document increased risk for osteomyelitis ofthe jaw and/or avascular necrosis of the TMJ in association with SCAcompared to the controls. The prevalence of dental caries andperiodontal disease were found to be low among SCA patientscompared to the controls.The gnathopathy was believed to be due to bone marrowhypertrophy, resulting from haemolysis. Where as enamel hypoplasiawas due to the adverse effects of the disease on amelogensis due tothe increased sensitivity of the secretary ameloblasts, in terms of itsmetabolic requirements. The Occurrence of oral aphthae and/or oralcandidasis among cases with SCA was believed to be due to defectiveinfection control mechanisms, as a result of defective opsonisation ofpathogenic micro-organisms prior to phagocytosis. Accumulation ofinfarcted tissues and/or splenic hypofunction may also predispose tooral ulcers. The oral cytological atypia detected was partially explainedby the presence of defective cell-mediated immunity caused by zincdeficiency, resulting from haemolysis in these patients. ZincVIIIdeficiency adversely affects the T-helper cells (T-H1) function, andinterleukin (IL-2) production.It was concluded that gnathopathy was the most common oralpathological finding in association with SCA. Enamel hypoplasia, oralaphthae and/or oral candidasis were also detected. Oral cytogicalatypia detected included chromatin clumping, nuclear hyperchromasia,cellular pleomorphism, and/or multinucleation.These changes detected in cases with SCA, though not differentfrom normal dental pathologies, yet they require special care duringtreatment of dental problems owing to the general systemic condition ofthe patient. The oral cytological atypia detected, require furtherinvestigations in order to document an idepth interpretation on therelationship of oral cytological atypia to oral lesions in SCA. Finallyfurther studies are needed to provide more information on the causallink between SCA and the oral health problems.