Sickle Cell Disease and Pulpal Necrosis: A Review of the Literature for the Primary Care Dentist

A case of difficult diagnosis of a patient with sickle cell disease and tooth pain fuelled a literature review by a primary care general dental practitioner. A literature search was conducted to review the relationship between sickle cell disease and pulpal necrosis. The results indicated statistically significant associations of sickle cell disease and tooth pain without any carious or traumatic pathology. It is important for the primary care dentist to be aware of the relationship between sickle cell disease and pulpal necrosis to prevent misdiagnosis and consequently mistreatment. Background A female patient, 49, of African-Carribean descent with sickle cell disease presented to the dental clinic with chronic pain. The tooth involved was an upper right first premolar free of caries and trauma. On a periapical radiograph the surrounding alveolar bone had large areas of ‘black banding’. The patient reported that large ‘black bands’ had also been seen on radiographs of her hip and shoulder and eventually the orthopaedic physician had come to the diagnosis of bone necrosis secondary to the patient's sickle cell disease. With this information, a provisional diagnosis of pulpal necrosis secondary to avascular necrosis was made, once all other possible diagnoses had been excluded. The premolar was extirpated and at a review appointment there was complete resolution of symptoms. The author performed a literature review because as a primary care dentist he had never come across this diagnosis before and noted that other primary care practitioners might be interested to learn about it.