Serious Gum Disease With Sickle Cell May Lead to Repeat Pain Crises
Periodontal disease seen as common, severity tied to 3 or more annual VOCs
People with sickle cell anemia are at a significantly higher risk of developing periodontitis, a serious gum disease, a study reported.
In turn, periodontitis was associated with elevated levels of inflammation markers in patients and a three times greater chance of more than three painful vaso-occlusive crises (VOCs) each year.
These findings highlight the importance of “setting of a strict periodontal screening program for this special patient population and the control/reduction of periodontal inflammation,” its researchers wrote.
The study, “Association between periodontal inflamed surface area and serum acute phase biomarkers in patients with sickle cell anemia,” was published in the journal Archives of Oral Biology.
Periodontal disease seen as prevalent with sickle cell anemia
Sickle cell anemia, the most common form of sickle cell disease, and often its most severe form, has been associated with an increased release of inflammatory molecules called cytokines. This cytokine production perpetuates a chronic inflammatory state that can lead to the development of other diseases, including those affecting the gums.
“Patients with sickle cell anemia are vulnerable to infections, therefore, it is claimed that patients are more susceptible to periodontal diseases that are associated with the existing systemic inflammatory status,” the researchers wrote.
The prevalence of periodontal disease with sickle cell anemia is largely unknown, however, limiting guidelines for its clinical management.
A team of researchers in Turkey evaluated the gum disease’s prevalence in people with sickle cell anemia and compared findings with those of healthy individuals, who served as controls.
They also explored the possible link between periodontal inflamed surface area (PISA) and levels of inflammatory biomarkers in the blood. PISA, a marker of gum disease severity, measures the amount of inflamed gum tissue.
The study involved 80 adults with sickle cell anemia, all recruited at a hospital where they were being treated for a VOC, and 80 healthy adults, matched for gender, age (mean age between 28 and 30), body mass index (BMI, a measure of body fat), smoking status, and frequency of dental check-ups. Participants were followed from January 2019 to November 2020.
Analyses showed that periodontitis was more prevalent among patients than controls, both in this inflammatory gum disease’s early and more advanced stages (stages 1 and 3–4).
Although the extent of periodontitis and gingivitis, a milder form of gum disease, was similar between those with and without sickle cell, PISA values were greater in patients than in controls. Similarly, other gum clinical parameters — plaque index, gingival index, bleeding on probing percentages, probing of pocket depths, clinical attachment loss, and periodontal epithelium surface area — also were more elevated in the SCA group.
Probing pocket depth represents the space between the teeth and the surrounding gums and bone, and is a measure of gum disease. Typically, a depth greater than 3 mm can be indicative of gum inflammation and possibly erosion of the bone surrounding a tooth.
The percentage of sites with probing pocket depths below 3 mm, between 4–6 mm, and above 6 mm was significantly higher in patients with periodontitis compared with controls. Likewise, the prevalence of clinical attachment loss — a more accurate indicator of gum support around a tooth — below 3 mm and between 3–4 mm was markedly higher in sickle cell patients with periodontitis than controls.
Next, researchers assessed the correlation between gum disease and blood work parameters. This analysis found a negative correlation between gum disease measures and the levels of hemoglobin — the protein responsible for transporting oxygen in red blood cells — in people with sickle cell anemia. Being negatively correlated here means that greater evidence of gum disease associated with lower hemoglobin levels.
A weak negative correlation also was seen between PISA values and hemoglobin levels, suggesting that, overall, patients with poorer oral health had more severe anemia.
In contrast, the number of missing teeth in a patient correlated positively with inflammatory protein levels, namely high sensitivity C-reactive protein (hs-CRP) and ferritin.
Statistical analyses also showed that patients with PISA values above 776 mm2 were at a slightly more than six times higher risk of elevated hs-CRP levels (above 10 mg/L), and they had a more than 30 times higher chance of elevated ferritin levels (above 1,000 nanograms per liter, ng/L).
These people also were more likely — over three times more likely — to experience more than three pain crises per year.
Overall, these findings indicate that “sickle cell anemia can increase the likelihood of developing periodontitis clinically reflected by elevated periodontal inflamed surface area levels,” the researchers wrote.
“It is therefore important to have an awareness on the marked presence of periodontitis in patients with sickle cell disease and it can be vital to encourage excellent oral care in this cohort,” they wrote.