Orofacial Manifestation and Dental Management of Sickle Cell Disease: A Scoping Review

Table 2

Challenges in oral management for individuals with sickle cell disease.

Oral health care	(i) Patients with SCD have chronic overall health problems; their hematological disorder becomes their main priority and oral health becomes secondary, increasing their risk for dental caries.	(i) Preventive dental therapy is the best approach for SCD patients (Rada et al., 1987).
	(ii) Patients with SCD are often seen only for emergency appointments when they have severe mouth pain; thus, most of their dental disease is diagnosed during this visit.	(ii) Excellent oral health can reduce the possibility of oral diseases.
	(iii) Lack of regular dental visits and comprehensive care deteriorates their condition significantly, which further demoralizes and demotivates the patient to see a dentist for regular preventive care.	(iii) Incorporate home fluoride treatment (Rouse and Hays, 1979)
		(iv) Incorporate routine dental check-ups (Rouse and Hays, 1979).
Complaint of pain “without any cause”	(i) Patients with SCD often presented clinically with facial and dental pain without an obvious etiology. This makes it difficult for the provider to properly diagnose the reason for that pain [1, 2].	(i) Dentist should perform thorough medical history.
	(ii) Patients are often perceived by health care practitioners as “drug seekers,” which results in delayed effective pain relief often resulting in under treatment that can prolong suffering and result in repeat emergency visits.	(ii) Pale mucosa, delayed eruption of teeth, hypoplasia of teeth, and radiographic changes are common oral signs in SCD patients (Cox and Soni, 1984).
		(iii) Consult a physician before treating the SCD patient.
		(iv) Use acetaminophen for pain as salicylates causes acidosis.
		(v) Regular use of narcotics to alleviate pain should be avoided to prevent drug addiction.
Severe anxiety for dental procedures	SCD patients have severe anxiety towards the oral care. This is mainly due to the severe pain that is experienced on the facial region including maxillary and mandibular bone. Due to this unresolved pain, patients restrict their visit dentist since they are very nervous and uneasy with the overall dental experience.	(i) Oral sedation helped to decrease preoperative anxiety level (Malamed, 1985).
		(ii) Cullen (1982) proposed chloral hydrate or Valium as a premedication for anxiety.
		(iii) Dental appointment can be scheduled during morning time for a short visit (Primley et al., 1982).
Infections	People with SCD have an increased risk of developing certain infections including pneumonia, blood stream infections, meningitis, and bone infections. Early in life, sickled cells can clog blood vessels in the spleen, leading to damage and increased susceptibility to infection.	(i) Antibiotic therapy is recommended for infections and all efforts should be incorporated to prevent acidosis and dehydration (DeBaun and Galadanci) [3].