Sickle Cell Disease and Oral Health

Sickle cell disease (SCD) often causes problems with your immune system. This makes people with SCD more prone to infections. This includes infections in your mouth. Good oral health is important for people with SCD to avoid dental problems and the complications that can result from them.

What is the impact of SCD on oral health?

People with SCD often use medicines that contain sugar, which can contribute to tooth decay. Teeth may also be more susceptible to problems from:^1-3

• Weaker enamel
• Exposed dentin (the layer beneath enamel)
• Calcium buildup on enamel and gums (calcification)

People with SCD may have teeth that look rough or have white, yellow, or brown spots on them. Gums and other tissue may appear pale or yellow in color. Plus, people with SCD are more at risk for gum disease (periodontitis).^1-3

Some people with SCD may have bones in their face, mouth, and teeth that did not properly develop. This can cause teeth to not line up or fit together correctly. The upper jaw/teeth may stick out much further than the lower jaw/teeth (overbite). There may also be tooth crowding or large spaces between teeth.^1-3

These factors put people with SCD at risk for many oral health complications.^1-3

Oral health issues

Sickle cell disease may cause a number of oral health issues like:^1,4,5

• Cavities – Cavities are the most common dental problem worldwide and in people with SCD. Reduced salivary flow observed in people with SCD may explain the high rate of cavities. Cavities are also called dental caries.
• Dental infections – Pulpitis (inflammation of the tissue in the center of the tooth), dental abscess (buildup of pus inside the teeth or gums), and cellulitis (pus buildup in the root of the tooth) are common infections that can put people with SCD at risk of sickle cell crisis.⁴
• Periodontal diseases – This includes gingivitis and gum disease. They are caused by an infection and inflammation of the gums and the bone that surround your teeth.

Tooth pain and pulp necrosis – Bacteria can enter the tooth and cause the innermost part of the tooth (the pulp) to become infected and painful. This is often called a toothache. People with SCD may have a toothache caused by a lack of blood flow to this area of the tooth, which causes the tissue to die (pulp necrosis). Some people with SCD may have severe tooth pain, but others may not experience any pain at all.

How can I care for my oral health when I have SCD?

The best way to avoid these oral health problems is to practice good dental hygiene. This is important for both children and adults with SCD.

When your or your child is visiting the dentist, make sure they have your full medical history. It is also helpful to find a dentist who has an understanding of SCD and potential complications.⁴

Talk to your dentist about keeping visits short and ways for you to stay relaxed and stress-free during cleanings or other procedures. Long and complicated procedures should be avoided when possible. Also, ask your dentist to work with your healthcare team to assess the risk of procedures and plan for medicines that may need to be used during treatment.^3,4

Dental care for children with SCD

Parents of children with SCD should begin brushing their child's teeth when their first tooth appears. They should continue to help their child brush until they are 8 years old. Brush teeth twice a day with a toothpaste that contains fluoride. Floss once a day after brushing.

Children should visit the dentist every 6 months for regular dental care and fluoride treatment. Make sure your child takes their medicine on schedule and is as relaxed as possible before the appointment. Try to use sugar-free medicine and keep an eye on what your child is eating. Cutting back on the amount of sugary food your child eats can improve dental health.^2,6

Dental care for adults with SCD

Adults with SCD should also visit the dentist every 6 months, brush their teeth twice a day, and receive regular fluoride treatments. When brushing, use fluoride toothpaste and a toothbrush with soft bristles. Brush for about 2 minutes using a gentle circular, back-and-forth motion. Flossing daily is also important for dental health. Floss gently and take it 1 tooth at a time.^7,8

Adults also need to make sure their diet does not include too many sugary or acidic foods and drinks. These can have a poor impact on dental health.^7,8

The link between oral health and overall health

Frequent hospitalizations can make it hard for people with SCD to continue good dental hygiene practices. Poor oral health can also lead to recurring hospitalizations from dental infections. In turn, this can trigger and complicate the treatment of sickle cell crises. ⁴

Unfortunately, insurance concerns, financial issues, and lack of access make it hard for some people with SCD to get the preventative dental care they need. In a 2016 study, researchers provided free basic dental care to people with SCD. They found a decrease in hospitalizations for people with SCD who received this dental care. More research to better understand how SCD affects oral health is needed. ⁹

If you are concerned about your oral health or lack access to preventative dental care, talk to your doctor. They can help connect you to a dentist or a low-cost/free dental clinic in your community.