Is sickle cell anemia a risk factor for severe dental malocclusion?

COSTA, Cyrene Piazera Silva; CARVALHO, Halinna Larissa Cruz Correa; SOUZA, Soraia de Fátima Carvalho; THOMAZ, Erika Bárbara Abreu Fonseca

doi:10.1590/1807-3107BOR-2015.vol29.0017

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Original Research • Braz. oral res 29 (1) • 2015 • https://doi.org/10.1590/1807-3107BOR-2015.vol29.0017 copy

Is sickle cell anemia a risk factor for severe dental malocclusion?

Authorship SCIMAGO INSTITUTIONS RANKINGS

The aim of this study was to investigate possible associations between sickle cell anemia (SCA) and the severity of dental malocclusion (MO). This was a retrospective cohort study of 93 individuals with SCA (G1) and 186 individuals without the disease (G2). SCA patients were randomly selected by a simple draw from patients treated in the Centro de Hematologia e Hemoterapia do Maranhão (HEMOMAR) in northeastern Brazil. Patients aged between 16 and 60 were included after being tested for the hemoglobin S gene. G2 consisted of individuals living in the same residence as the patients. The Dental Aesthetic Index (DAI), as well as some morphological deviations not included in DAI, were used for the orthodontic evaluation of MO. Poisson regression with robust variance adjustment was employed to estimate relative risk (RR). In the multivariate analysis, SCA was associated with moderate (RR = 1.36) and very severe MO (RR = 8.0). SCA is correlated with anterior tooth loss (RR = 1.94), anterior spacing (RR = 1.66), overjet (RR = 1.87), anterior crossbite (RR = 1.94), and open bite (RR = 1.94). Thus, SCA is a risk factor for moderate and very severe MO.

Malocclusion; Anemia, Sickle Cell; Epidemiology

Variables	G1 (n = 93)		G2 (n = 186)		p

	n	% (95%CI)	n	% (95%CI)
Ethnicity					0.62^b
White	3	3.2 (0.7–9.1)	8	4.3 (18.7–83.0)
Black	61	65.6 (55.0–75.1)	111	59.7 (52.2–67.8)
Other	29	31.2 (22.0–41.6)	67	36.0 (29.1–43.4)
Gender					0.20^b
Female	47	50.5 (40.0–61.1)	109	58.6 (51.2–65.8)
Male	46	49.5 (38.9–60.0)	77	41.4 (34.2–48.8)
Economic status^a					0.32^b
A–B	23	24.7 (16.4–34.8)	61	32.8 (26.1–40.0)
C	59	63.5 (52.8–73.2)	109	58.6 (51.2–65.8)
D–E	11	11.8 (6.0–20.2)	16	8.6; 5.0–13.6)

		Median (IQD)		Median (IQD)

Age		26.0 (10.0)		26.0 (9.0)	0.59^c
DAI		30.0 (14.0)		29.5 (7.0)	<0.001^c

Severity/OT	G1		G2		Unadjusted	Adjusted^a

	n	% (95%CI)	n	% (95%CI)	RR (95%CI)	RR (95%CI)
Normal occlusion or mild MO/None	22	23.7 (15.4–36.6)	88	47.3 (39.9–54.7)	1.0	1.0
Moderate MO/Optional	36	38.7 (28.8–49.4)	72	38.7 (31.7–46.1)	1.38 (1.06–1.80)	1.36 (1.07–1.73)
Severe MO/Highly desirable	7	7.5 (3.1–14.9)	21	11.3 (7.1–16.7)	1.25 (0.59–2.66)	1.33 (0.76–2.34)
Very severe MO/Essential	28	30.1 (21.0–40.5)	5	2.7 (0.9–6.2)	10.42 (4.27–25.37)	8.0 (3.21–19.33)

	G1		G2		p	Unadjusted	Adjusted^c

	n	%	n	%		RR (95%CI)	RR (95%CI)
Absence of teeth					0.43^a
Yes	39	41.9	69	37.1		1.13 (0.83–1.53)	1.94 (1.33–2.83)
No	54	58.1	117	62.9		1.0	1.0
Crowding					0.37^a
Yes	74	79.6	139	74.7		1.06 (0.93–1.26)	1.06 (0.93–1.21)
No	19	20.4	47	25.3		1.0	1.0
Spacing					< 0.00^1a
Yes	56	60.2	67	36.0		1.67 (1.30–2.15)	1.66 (1.29–2.14)
No	37	39.8	119	64.0		1.0	1.0
Incisor diastema					< 0.00^1a
Yes	14	15.0	0	0.0
No	79	85	186	100.0
Irregularity of the maxilla					< 0.00^1a
Yes	64	68.8	173	93.0		0.74 (0.64–0.85)	0.75 (0.65–0.86)
No	29	31.2	13	7.0		1.0	1.0
Irregularity in mandible					< 0.00^1a
Yes	80	86.0	184	98.9		0.87 (0.80–0.94)	0.88 (0.81–0.95)
No	13	14.0	2	1.1		1.0	1.0
Overjet					< 0.00^1a
Yes	63	67.7	67	36.0		1.88 (1.48–2.38)	1.87 (1.49–2.36)
No	30	32.3	119	64.0		1.0	1.0
Anterior crossbite					0.002^a
Yes	12	12.9	6	3.2		4 (1.55–10.34)	3.9 (1.51–10.10)
No	81	87.1	180	96.8		1.0	1.0
Open bite					< 0.00^1a
Yes	12	12.9	1	0.5		24 (3.16–182.44)	18.46 (2.5–136.45)
No	81	87.1	185	99.5		1.0	1.0
Molar relationship					0.10^b
Normal	4	4.3	12	6.4		1.0	1.0
Half cusped altered	81	87.1	167	89.8		1.02 (0.96–1.09)	1.03 (0.96–1.09)
One cusped altered	8	8.6	7	3.8		1.81 (0.88–3.73)	1.57 (0.78–3.16)

	G1		G2		P ^a	Unadjusted	Adjusted^b

	n	%	n	%		RR (95%CI)	RR (95%CI)
Posterior open bite					0.72
Yes	28	30.1	60	32.3		0.93 (0.64–1.36)	0.99 (0.69–1.42)
No	65	69.9	126	67.7		1.0	1.0
Posterior crossbite					0.21
Yes	10	10.8	12	6.5		1.67 (0.75–3.72)	1.78 (0.82–3.86)
No	83	89.2	174	93.5		1.0	1.0
Overbite					0.06
Yes	24	25.8	30	16.1		1.60 (0.99–2.57)	1.54 (0.97–2.46)
No	69	74.2	156	83.9		1.0	1.0

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[1] Corresponding Author
: Soraia de Fátima Carvalho Souza. E-mail:endosoraia@gmail.com