Treatment of dental complications in sickle cell disease

Review question

We planned to review the evidence regarding the treatment of dental complications in people with sickle cell disease.

Background

Sickle cell disease is a blood disorder which affects at least 5.2% of the world population across a large number of countries. In this condition, a genetic defect means that the haemoglobin in the red blood cells is not normal, instead the blood cells become sickle-shaped and not a normal disc shape. These cells become trapped in blood vessels of various organs, especially during stressful events like a lack of oxygen, dehydration, extreme temperatures, stress, menstruation and infection. Blocked blood vessels lead to sudden episodes of severe pain in the short term and chronic organ damage in the long term.

Sickle cell disease also leads to changes and complications in the mouth, jaw and facial areas. Management of these dental complications is often neglected as people with sickle cell disease focus all their energy on maintaining their general health due to the serious blood disorder. Neglecting minor dental health issues under these circumstances not only worsens the problem but may also cause a painful sickle-cell crisis, leading to emergency hospital admissions. Treatment of oral complications in this group of people needs to be tailored around their blood disorder, in order not to cause any further deterioration to their general health.

There is a lack of information on the appropriate treatment for dental complications in people with sickle cell disease,with no clear guidelines available. This often results in many people being refused treatment by dentists due to a fear of complications. Hence, we planned to investigate this issue and make any evidence in this area available to healthcare providers and people with the disease.

Search date

The evidence is current to: 03 March 2016.

Study characteristics

We were not able to find any randomised controlled studies assessing treatment for any dental complications in people with sickle cell disease.

Key results
No studies were identified, so we can not draw any conclusions or highlight any implications for practice. Studies are needed to establish the best treatment for dental problems in people with sickle cell disease.

Quality of the evidence

There is no evidence from studies (where people are given one treatment or another completely at random) for any treatment for dental complications in people with sickle cell disease.

Authors' conclusions: 

This Cochrane review did not identify any randomised controlled studies assessing interventions for the treatment of dental complications in people with sickle cell disease. There is an important need for randomised controlled studies in this area, so as to identify the most effective and safe method for treating dental complications in people with sickle cell disease.

Read the full abstract...
Background: 

Sickle cell disease is the most common single gene disorder and the commonest haemoglobinopathy found with high prevalence in many populations across the world. Management of dental complications in people with sickle cell disease requires special consideration for three main reasons. Firstly, dental and oral tissues are affected by the blood disorder resulting in several oro-facial abnormalities. Secondly, living with a haemoglobinopathy and coping with its associated serious consequences may result in individuals neglecting their oral health care. Finally, the treatment of these oral complications must be adapted to the systemic condition and special needs of these individuals, in order not to exacerbate or deteriorate their general health.

Guidelines for the treatment of dental complications in this population who require special care are unclear and even unavailable in many aspects. Hence this review was undertaken to provide a basis for clinical care by investigating and analysing the existing evidence in the literature for the treatment of dental complications in people with sickle cell disease.

Objectives: 

To assess methods of treating dental complications in people with sickle cell disease.

Search strategy: 

We searched the Cochrane Haemoglobinopathies Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books.

Date of last search: 11 April 2016.

Additionally, we searched nine online databases (PubMed, Google Scholar, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, Literature in the Health Sciences in Latin America and the Caribbean database, African Index Medicus, Index Medicus for South East Asia Region, Index Medicus for the Eastern Mediterranean Region, Indexing of Indian Medical Journals). We also searched the reference lists of relevant articles and reviews and contacted haematologists, experts in fields of dentistry, organizations, pharmaceutical companies and researchers working in this field.

Date of last search: 03 March 2016.

Selection criteria: 

We searched for published or unpublished randomised controlled studies of treatments for dental complications in people with sickle cell disease.

Data collection and analysis: 

Two review authors intended to independently extract data and assess the risk of bias of the included studies using standard Cochrane methodologies; however, no studies were identified for inclusion in the review.

Main results: 

No randomised controlled studies were identified.

Share/Save