Dental caries and growth impairment among children with thalassemia major in relation to some salivary constituents
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Abstract
Background: A single gene mutation causes beta-thalassemia, an autosomal recessive disorder. It's hemolytic anemia that needs constant blood transfusions for life. In children and adolescents with thalassemia major, no clear concepts are found concerning the association between beta-thalassemia and growth retardation is a common side effect. Saliva contains a variety of biochemists, which may affect the severity of dental caries. Aim: This research aimed to evaluate the link between β -thalassemia major, dental caries and growth impairment in relation to some salivary constituents. Materials and Method: As part of an investigation at the Basra/Iraqi Thalassemia Center, 40 thalassemic children aged 10 to 12 were compared to 40 healthy controls in terms of dental caries (who were the same age and gender as the study group). Anthropometric measurements were used to assess their physical development. A sample of unstimulated whole saliva was taken from each child to determine salivary calcium, phosphorus, and alkaline phosphatase enzyme concentrations. Result: For both the primary and permanent dentition, dental caries experience (dmft/DMFT) was higher among β-thalassemic children, with a statistically significant difference. A higher percentage of thalassemic youngsters were found to be underweight. Although salivary constituents like calcium, phosphorus, and alkaline phosphatase enzyme were higher in the control group than in the study group, there was no statistically significant difference between the two groups. Conclusion: Dental caries and growth impairment were associated with beta-thalassemia major.
Received date: 11-07-2022
Accepted date: 04-09-2022
Published date: 15-03-2026
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References
Schrier SL. Pathophysiology of thalassemia. Curr Opin Hematol 2001;9(2):123-6
Sadiq I.Z, Abubakar FS, Usman HS, Abdullahi AD, Ibrahim B, Kastayal BS, et al. Thalassemia: Pathophysiology, Diagnosis, and Advances in Treatment. Thalass. Rep. 2024;14:81-102.
Mahajan A, Pawar M, Tomer G, Girish PV, Salama MT, Dupare AS. Prevalence of dental caries, oral health status, malocclusion status, and dental treatment needs in thalassemic children: A cross-sectional study. J Family Med Prim Care. 2024 Nov;13(11):5166-5170
Farmakis D, Porter J, Taher A, Domenica Cappellini M, Angastiniotis M, Eleftheriou A. Thalassaemia International Federation Guidelines for the Management of Trans-fusion-dependent Thalassemia. Hemasphere. 2022;29;6(8):e732.
Einy S, Hazan-Molina H, Ben-Barak A, Aizenbud D. Orthodontic Consideration in Patients with Beta-Thalassemia Major: Case Report and Literature Review. J Clin Pediatr Dent. 2016;40(3):241-6.
Fábián TK, Hermann P, Beck A, Fejérdy P, Fábián G. Salivary Defense Proteins: Their Network and Role in Innate and Acquired Oral Immunity. Int. J. Mol. Sci. 2012;13:4295-4320.
Naglerr, Klien I, Zarzhersky N, Drigues N, Reznick A Characterization of the dif-ferentiated antioxidant profile of human saliva. Free Radic Biol Med .2002;32(3):268-77.
Enax J, Fandrich P, Schulze Zur Wiesche E, Epple M. The Remineralization of Enamel from Saliva: A Chemical Perspective. Dent J (Basel). 2024 Oct 23;12(11):339.
Siamopoulou MA, Mavridis A, Galanakis E, Vasako S, Fatourou H, Lapatsanis P Flow rate and chemistry of parotid saliva related to dental caries and gingivitis in patients with thalassemia major. Int J Paediatr Dent. 1992;2:93–97.
Hattab FN, Hazza'a AM, Yassin OM, Rimawi HS. Caries risk in patients with tha-lassemia major. Int Dent J. 2001;51(1):35-8.
Gomber S, Dewan P. Physical growth patterns and dental caries in thalassemia. In-dian Pediatr. 2006 Dec;43(12):1064-9.
DE mattia D, Pettini P, Sabato V, Rubini G, Laforqia A, Schettini F. Oromaxillofacial changes in thalassemia major. Minerva Pediatr. 1996;48(2):1120.
de Almeida Pdel V, Grégio AM, Machado MA, de Lima AA, Azevedo LR. Saliva composition and functions: a comprehensive review. J Contemp Dent Pract. 2008 Mar 1;9(3):72-80.
Milla'n JL. Alkaline Phosphatases- Structure, substrate specificity and functional re-latedness to other members of a large superfamily of enzymes. Purinergic Signal. 2006; 2: 335-341.
Majeska RJ, Wuthier RE. Studies on matrix vesicles isolated from chick epiphyseal cartilage. Association of pyrophosphatase and ATPase activities with alkaline phosphatase. Biochim Biophys Acta. 1975; 391: 51- 60.
Fallon MD, Whyte MP, Teitelbaum SL. Stereospecific inhibition of alkaline phos-phatase by L-tetramisole prevents in vitro cartilage calcification. Lab Invest. 1980; 43: 489-94.
Carlson RV, Boyd KM, Webb DJ. The revision of the Declaration of Helsinki: past, present and future. Br J Clin Pharmacol. 2004; 57: 695–713
Dewi SRP, Septhimoranie S., Muchzal S. Correlation of saliva characteristics and caries in beta-thalassemia major patients. Majalah Kedokteran Gigi Indonesia 2020; 6(2): 100-105
WHO (World Health Organization). Oral health survey, basic methods, 2013 3rd ed., WHO, Geneva.
Kuczmarski RJ, Ogden CL, Grummer-Strawn LM, Flegal KM, Guo SS, Wei R, Mei Z, Curtin LR, Roche AF, Johnson CL. CDC growth charts: United States. Adv Data. 2000 Jun 8;(314):1-27.
Navazesh M, Kumar S. Measuring salivary flow challenges and opportunities. J Am Dent Assoc. 2008;139(5):35-40.
Jaddoa M, Qasim AA. Assessment of the Correlation between the Salivary Flow Rate and Dental Caries Experience among Children with β-Thalassemia Major. Indian Journal of Forensic Medicine & Toxicology, 2020;14.1:1123.
Babu NSV, Shah S. Comparative assessment of salivary flow rate, buffering capacity, resting pH and dental caries in children with beta thalassemia. Middle East N. Afr. Sci, 2018;4(3):18-22.
Mahajan A, Pawar M, Tomer G, Girish PV, Salama MT, Dupare AS. Prevalence of dental caries, oral health status, malocclusion status, and dental treatment needs in thalassemic children: A cross-sectional study. J Family Med Prim Care. 2024 Nov;13(11):5166-5170.
Scutellori PN. Orzincolo C., Andraghetti D., Gamberini MR. Anomalies of the mas-ticatory apparatus in beta-thalassemia. The present status after transfusion and iron-chelating therapy. Radio Med. 1994; 87: 389-396.
Al-Jobouri HS, Al-Casey M. Selected salivary constituents among 16-18 years pa-tients with β thalassemia major in relation to oral diseases. J Bagh Coll Dent. 2011;23(2):124-7.
Nabi AT, Muttu J, Chhaparwal A, Mukhopadhyay A, Pattnaik SJ, Choudhary P. Implications of β-thalassemia on oral health status in patients: A cross-sectional study. J Family Med Prim Care. 2022 Mar;11(3):1174-1178.
Akbarnejad AA, Mahjoub S, Tamaddoni A, Masrour-Roudsari J, Seyedmajidi SA, Ghasempour M. Salivary Oxidative Stress, Total Protein, Iron and pH in Children with β-Thalassemia Major and their Correlation with Dental Caries. J Dent (Shiraz). 2022 Sep;23(3):266-271..
Wong HM, Peng SM, Wen YF, King NM, McGrath CP. Risk factors of developmental defects of enamel--a prospective cohort study. PLoS One. 2014 Oct 2;9(10):e109351.
Hattab FN. Mesiodistal crown diameters and tooth size discrepancy of permanent dentition in thalassemic patients. J Clin Exp Dent. 2013; 5(5): e239-44.
Lugliè PF, Campus G, Deiola C, Mela MG, Gallisai D. Oral condition, chemistry of saliva, and salivary levels of Streptococcus mutans in thalassemic patients. Clin Oral Investig. 2002; 6(4):223-6.
Wu KH, Tsai FJ, Peng CT. Growth hormone (GH) deficiency in patients with be-ta-thalassemia major and the efficacy of recombinant GH treatment. Ann Hematol. 2003; 82(10):637-40.
Dama LB, Dama SB. Growth of children with thalassemia. Bangladesh Journal of Medical Science. 2015; 14(1): 22–25. DOI: 10.3329/bjms.v14i1.16149.
Arab-Zozani M, Kheyrandish S, Rastgar A, Miri-Moghaddam E. A Systematic Re-view and Meta-Analysis of Stature Growth Complications in β-thalassemia Major Patients. Ann Glob Health. 2021; 87(1):48.
Badfar G, Nasirkandy MP, Shohani M, Mansouri A, Shabani E, Rahmati S, et al. Prevalence of short stature, underweight and delayed puberty in Iranian patients with thalassemia major: a systematic review and meta-analysis. Iran J Ped Hematol Oncol.2017; 7(4): 245–259.
De Sanctis V. Growth and puberty and its management in thalassaemia. Horm Res. 2002;58 Suppl 1:72-9.
Tiosano D, Hochberg Z. Endocrine complications of thalassemia. J Endocrinol Invest. 2001 Oct;24(9):716-23..
Farooq I, Bugshan A. The role of salivary contents and modern technologies in the remineralization of dental enamel: a narrative review. F1000Res. 2020 Mar 9;9:171.
Rani ST, Reddy ER, Kiranmai M, Mudusu SP, Srikanth S, Jain S. Comparative Eval-uation of BMI, Dental Age, Salivary Alkaline Phosphatase Levels, and Oral Health Status in Children with β Thalassemia Major. Int J Clin Pediatr Dent. 2019;12(4):303-306.
Lugliè PF, Campus G, Deiola C, Mela MG, Gallisai D. Oral condition, chemistry of saliva, and salivary levels of Streptococcus mutans in thalassemic patients. Clin Oral Investig. 2002 Dec;6(4):223-6.
DhoteV, THosar N, et al. Evaluation of oral hygiene status and salivary biochemistry of patients with Thalassemia major: a clinical study. IOSR-JDMS J Med Dent Sci. 2015; 14(12):98–102.
AL-Zaidi, R.R., (2013). Dental caries among a group of boys with βthalassemia major (10-12 years old) in relation to selected salivary ions and mutans streptococci. M.Sc. Thesis, College of Dentistry, University of Baghdad.
Jensen CE, Tuck SM, Agnew JE, Koneru S, Morris RW, Yardumian A, Prescott E, Hoffbrand AV, Wonke B. High prevalence of low bone mass in thalassaemia major. Br J Haematol. 1998 Dec;103(4):911-5.