Page 16 - GP Spring 2019

Radiographic Features of a Patient with Sickle Cell Anemia
in Cone Beam CT Scan: A Case Report

By Niloufar Amintavakoli, DDS, MS and Analia Veitz-Keenan, DDS

Introduction ations, stroke, vaso-occlusive crisis, acute tion and large bone marrow spaces (Figure
A number of systemic diseases present chest syndrome, and bony changes. 3,4 1) were noted. Upon further evaluation,
themselves through changes in the oral the presence of periapical radiolucencies
cavity. Some of these oral manifestations Oral manifestations reported with sickle on intact teeth # 23, 24 and 27 was found
are non-specific, but there are other which cell disease include asymptomatic pulpal (Figure 2).
are specific to a particular disorder. It is necrosis, paresthesia of the mandibular
1
paramount for clinicians to be knowledge- nerve, gingival enlargement, midfacial Based on these findings, the primary radio-
able about oral manifestations of systemic overgrowth, and osteomyelitis of the man- graphic diagnosis of a blood disorder with
3,4
diseases for following reasons: 1) the oral dible. In diagnostic images of patients the differential of sickle cell anemia or
manifestation can be the first or a most with sickle cell anemia, increased spacing thalassemia was included. In the patient’s
severe manifestation of the disease which of bony trabeculae with a coarse trabecula- medical history, anemia was reported, but
leads to the proper diagnosis; 2) the pres- tion , impaired visualization of the mandib- the type of anemia was not specified. In an
ence of the oral manifestations may require ular canal, maxillary hyperplasia and pul- interview with the patient and follow-up
a specific change in the dental treatment pal necrosis without an etiological factor with medical records, the diagnosis of sick-
5
plan and dental management. can be seen. The radiographic changes in le cell anemia was confirmed. Considering
2
the skull include thinning of the outer table, the higher chance of osteomyelitis in the
One of these systemic conditions with increase in the granular appearance of the mandible of patients with sickle cell dis-
oral manifestations is sickle cell disease skull, and vertical trabeculations or “hair- ease, prosthodontic treatments were recom-
(SCD). Sickle cell disease is an inherited on-end” appearance, which is related to the mended over dental implants. The patient
hematologic disorder. In this condition, an hyperplasia of the red marrow spaces. 6 was also referred for endodontic manage-
abnormal hemoglobin (S) is formed under ment of the periapical radiolucencies.
low oxygen tension. The red blood cells The exact number of people living with
containing hemoglobin S form in a sick- SCD in the U.S. is unknown, but it is es- Discussion
le shape and have a lower elasticity. Most timated that: SCD affects approximately Increased spacing of the bone trabeculation
of the carriers of sickle cell disease traits 100,000 Americans. 7 is a common finding in patients with sickle
are patients of African, Asian, Arabic and cell disease, but can also be observed in
Mediterranean origin. The clinical mani- Case Report patients with other hematological diseases.
In the evaluation of a cone beam CT scan
festation of sickle cell disease depends on This finding can be related to premature de-
the phenotype of the disease and may in- of a 52-year-old female patient who was struction of erythrocytes, chronic anemia,
referred for pre-implant evaluation of the
clude anemia, impaired function of liver, increased erythropoiesis, and subsequent-
kidneys, and lungs; history of leg ulcer- mandibular body, the presence of osteopo- ly a compensatory marrow hyperplasia as
rotic bone with fewer but coarser trabecula-

Figure 1

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