Manifestações orofaciais em pacientes com anemia falciforme

Abstract

Sickle cell anemia is a hematological disease caused by a genetic mutation in the beta gene of the hemoglobin molecule, resulting in an abnormal hemoglobin that can polymerize promoting sickling of red blood cells. This process results in vaso-occlusion and hemolytic anemia which are responsible for different clinical and orofacial manifestations in individuals with this hematological disease. The objectives of this study were (1) compare the prevalence of orofacial manifestations in patients with and without sickle cell anemia and (2) verify the distribution of these changes in patients with sickle cell anemia by gender and age. It was conducted a cross-sectional study in which 330 subjects were divided into two groups, underwent a clinical examination dental: group of 165 individuals with sickle cell anemia (group SCA) and a control group of 165 clinically normal and no history sickle cell anemia in the family. The sample size calculation was estimated considering the total of patients with sickle cell anemia registered at Hemominas Foundation – Hemocentro Regional de Montes Claros, which included 415 subjects in 2008, a prevalence of 50% for the occurrence of orofacial manifestations in this population; precision of 5% and confidence level of 90%. For the control group, was adopted the valid sample proportion of 1:1. After collecting data, was made the database and performed statistical analysis using SPSS® 17.0 for Windows. Initially, univariate analysis was performed by describing the absolute and relative frequency of orofacial manifestations in SCA and control groups. Subsequently, bivariate logistic regression and Poisson test were conducted to verify the association between the prevalence of orofacial manifestations between the SCA and control groups, and the distribution of these changes by gender and age among patients with sickle cell anemia. This analysis became possible to estimate prevalence ratios by calculating the odds ratios (OR) and their respective confidence intervals (95%). The level of significance was 5%. The results revealed that the most prevalent orofacial manifestations found in patients with sickle cell anemia were pallor of oral mucosa, previous mental nerve neuropathy, delayed tooth eruption, maxillary protrusion and previous mandibular pain. There were not cases of mandibular osteomyelitis, current mental nerve neuropathy and toothache in the absence of specific dental abnormalities. Patients with sickle cell anemia had a prevalence of previous mental nerve neuropathy and delayed tooth eruption significantly higher than patients without the disease. Regarding the prevalence of orofacial manifestations in patients with sickle cell anemia by gender and age, associations were statistically significant in relation to the previous mental nerve neuropathy and gender and previous mandibular pain and age. It was concluded that sickle cell anemia is associated with the prevalence of previous mental nerve neuropathy and delayed tooth eruption. Furthermore, was observed that previous mental nerve neuropathy is more frequent among women with sickle cell anemia and previous mandibular pain among individuals with sickle cell anemia aged over 21 years of age.