Malocclusion and Craniofacial Characteristics in Saudi Adolescents with Sickle Cell Disease

BACKGROUND: Sickle cell disease can result in dentofacial abnormalities. However, in Saudi Arabia, there are limited data with respect to orthodontic manifestations in patients with sickle cell disease. OBJECTIVE: To determine the malocclusion and craniofacial characteristics in sickle cell disease adolescents and compare them with that of controls from the Eastern Province of Saudi Arabia. METHODS: This comparative cross-sectional study included 112 Saudi patients with sickle cell disease, aged 12–18 years, and 124 age-matched Saudi controls from three major hospitals in Al Khobar and Dammam, Saudi Arabia. The Dental Aesthetic Index was used to assess malocclusion and orthodontic treatment needs. Digital lateral cephalometric radiographs were recorded for each patient and control, and its analysis included linear and angular measurements. RESULTS: The prevalence of malocclusion was 87.5% in sickle cell disease patients and 54% in controls (P = 0.0001). The percentage of sickle cell disease patients with severe malocclusion that required orthodontic treatment was higher than that of controls (37.5% vs. 26.6%). In the sickle cell disease cohort, incisal segment crowding (72.4%), overjet (67.3%) and maxillary misalignment in the anterior segment (56%) were the most prevalent types of malocclusions and were significantly higher than that of controls (P < 0.05). About 38% and 67% of the sickle cell disease patients had openbite and posterior crossbite, respectively, compared with 19.3% (P = 0.001) and 37.1% (P = 0.0001) of controls, respectively. Cephalometric analysis showed that SNA (86.7°) and ANB (9.9°) angles were significantly higher in sickle cell disease patients than in controls (81.5° and 2°, respectively). In addition, lower central incisor-to-Frankfort horizontal plane (55°) and interincisal angles (121.5°) were significantly lower in sickle cell disease patients than in controls. CONCLUSION: Adolescents with sickle cell disease had a higher prevalence of malocclusion and greater orthodontic treatment needs than controls. Similarly, they had greater incisal crowding, overjet, openbite and posterior crossbite and demonstrated higher SNA, ANB and lower interincisal angles than controls. The findings of this study suggest that adolescents with sickle cell disease should be provided frequent dental examinations and early orthodontic treatment to improve their oral health, and thus quality of life.