Page 17 - GP Spring 2019

well as changes of bony trabeculae. These Conclusions and Recommendations 9. Costa et al, Association between Sickle Cell
5
changes maybe more prominent in younger In this article we have reported radiograph- Anemia and Pulp, J Endod (2013);39:177–181.
patients, due to lower adaption to the dis- ic features of a patient with sickle cell ane- 10. Demirbas Kaya, A., B. O. Aktener, and
ease, higher incidence of crises and high- mia. A complete medical history as well as C. Unsal. 2004. “Pulpal Necrosis With Sick-
er amounts of red bone marrow. Another complete evaluation of the radiographic le Cell Anaemia”. International Endodontic
5
Journal 37 (9): 602-606. doi:10.1111/j.1365-
radiographic finding of the trabeculation features is a very crucial step in manage- 2591.2004.00853.x.
of patients with sickle cell anemia is the ment of patients with systemic disease. The
horizontal trabecular pattern which creates result of these findings may change and af- Dr. Niloufar Amintava-
a “stepladder” effect between the roots of fect the treatment plan as reported in this koli received her den-
mandibular molars. case. Understanding radiologic manifesta- tal degree from Shahid
5
tions and its pathophysiology can enhance Beheshti University of
In addition, these patients have a higher the dental management of these patients Medical Sciences in
chance (200 times more frequent) of devel- and prevent further complications. 2009 and an MSc in
oping osteomyelitis, especially in the man- Oral & Maxillofacial
dible. There have been different hypothe- References Radiology from the
4
ses for this finding including obstruction of 1. Parks, E. and Lancaster, H. (2003). Oral man- University of Toronto in 2013. She is a
blood flow and resulting tissue ischemia. ifestations of systemic disease. Dermatologic Clinical Assistant Professor in Oral and
Another hypothesis is the colonization of Clinics, 21(1), pp.171-182. Maxillofacial Pathology, Radiology and
bacteria in the bony infarctions caused by 2. Porter, S., Mercadante, V. and Fedele, S. Medicine at the New York University
(2017). Oral manifestations of systemic dis-
vaso-occlusive crisis. These bacteria can ease. BDJ, 223(9), pp.683-691. College of Dentistry.
originate from a local (periodontal) or hae- 3. Javed et al. (2013), Orofacial manifestations
matogenous source. In the jaws, staphylo- in patients with sickle cell disease American Dr. Analia Veitz-Keenan is
cocci and Escherichia coli are commonly Journal of the Medical Sciences 345 (3) , pp. a practicing general den-
cultured from these lesions. 5, 8 The higher 234-237. tist and an AGD member.
probability of osteomyelitis in these pa- 4. Neves F et al. (2011), Radiographic chang- She holds the position of
tients may complicate the prognosis any es of the jaws in HbSS and HbSC genotypes of Clinical Associate Profes-
surgical intervention including implant sickle cell disease, Spec Care Dentist (2011) sor in the Department of
31(4): 129-133.
placement in the jaws. 5. Neves F et al. (2012), Correlation between Oral Maxillofacial Pathology, Radiology
One of the radiographic findings in the jaws maxillofacial radiographic features and system- and Medicine and is currently the Direc-
ic severity as sickle cell disease severity predic-
of patients with sickle cell anemia is pul- tor, Clin Oral Invest (2012) 16:827–833. tor of Evidence Based Dentistry in the
pal necrosis without an etiological factor. 6. Sebes, JI, and LW Diggs. 1979. “Radiograph- Department of Epidemiology and Health
This can be related to changes in the pulpal ic Changes Of The Skull In Sickle Cell Ane- Promotion at NYU College of Dentistry,
microcirculation during vasoocclusive epi- mia”. American Journal Of Roentgenology 132 where she teaches to undergraduate and
sodes, which leads to ischemic necrosis. It (3): 373-377. doi:10.2214/ajr.132.3.373. post-graduate students, as well as coor-
was reported that the presence of this find- 7. https://www.cdc.gov/ncbddd/sicklecell/data. dinates and teaches activities for faculty.
ing is more frequent in adolescents than in html. Last access 12/18/18. Dr. Veitz-Keenan has lectured in several
adults, which can be related to the variation 8. Al-Ismaili, Hilal, Omar Nasim, and Ab- national and international dental meet-
dulaziz Bakathir. 2017. “Jaw Osteomyelitis
in the severity and type of vasoocclusive As A Complication Of Sickle Cell Anaemia ings and has authored many articles
episode according to age. This suggests In Three Omani Patients: Case Reports And in national and international journals.
vitality testing of all teeth in these patients Literature Review”. Sultan Qaboos University She maintains a private practice in
should be routine in the dental visits. 9,10 Medical Journal 17 (1): e93-97. doi:10.18295/ Brooklyn, NY.
squmj.2016.17.01.016.

Figure 2

www.nysagd.org l Winter 2019 l GP 17