Necrose pulpar assintomática em dentes hígidos de indivíduos com anemia falciforme: investigando causas e necessidade de tratamento

Abstract

Introduction: Individuals with sickle cell anemia (SCA) may present with healthy teeth with asymptomatic pulp necrosis (APN), probably due to the vasoconstriction of the pulpal organ circulation due to the accumulation of sickle cells, which die early and adhere more easily to the vascular endothelium. In this way, the objectives of the present study were informed about the processes involved in the association between SCA and APN (first study); and to investigate the need for endodontic treatment of these teeth (second study), through clinical, imaging and microbiological parameters. Methods: Both studies were of the transverse type nested to a retrospective cohort. In the first study, the sample consisted of 140 individuals over the age of 16, assisted by the Hematology and Haemotherapy Supervision of Maranhão (HEMOMAR), in São Luís, MA, Brazil. Patients are subjects with at least one tooth with a healthy crown, absence of history of paresthesia of the inferior alveolar nerve in the last six months, without previous history of dental trauma and without periodontal disease. The diagnosis of APN in teeth with healthy crowns was obtained through pulsatile oxygen saturation percentage (%SaO2) using a pulse oximeter adapted to Odontology (PO). The body %SaO2 and the number of sickle cell crises in the last year (No. SCCs/year) were obtained from each individual. No. SCCs/year was considered a continuous variable. Co-morbidities (CoM) were considered as latent variables formed by the following indicators: presence of heart diseases, hepatic, type 2 diabetes mellitus and osteoarticular lesions. The dichotomous outcome for APN in teeth with healthy crowns. No. SCCs/year and of body %SaO2 were tested as mediator variables of the CoM-APN association. The model was analyzed through Modeling with Structural Equations complemented by Aciclic Directed Charts (α=0.05). In the second study, 10 HEMOMAR-assisted sickle individuals with at least one tooth with a healthy crown without pulp calcification, clinical APN diagnosis using PO and the cold pulp sensitivity test (n=27 teeth) were selected. Pulp calcifications, periodontal ligament and periodontal ligament were identified in tomographic analyzes. A bacterial detection was performed by means of bacterial culture, fluorescence and Polymerase Chain Reaction (PCR) in real time. The difference in prevalence of APN according to how co-variables color, sex, age and maxillaries were identified by Fisher's exact test (α=0.05). Results: In the first study, we observed 125 without APN and 15 with APN. As CoM were associated with the presence of APN (SFC=1.061, p=0.028). It was not explained by the No. SCCs/year (SFC = 0.1228, p = 0.579), nor by the body %SaO2 (SFC=0.1288, p=0.579). In the second study, the clinical diagnosis of APN was confirmed in most teeth (81.5%). NPA was more prevalent in the upper jaws (p=0.016). An amount of bacterial DNA detected was less than 100 copies/μL in only 18.5% of the sample. The imaging findings identified in 18.5% of the teeth were: thickening of the periodontal ligament 0.5 mm (n=3), hypercementose (n=1) and pulp node (n=1). Conclusion: It was concluded that the presence of CoM in SCA individuals, mainly as osteoarticular lesions, increases the prevalence of APN in healthy teeth (first study). There is no need for immediate endodontic treatment in these teeth, but it is recommended periodic clinical and photographic proservation as a protocol to prevent infection in these individuals (second study).