Oral and radiological evaluation of thalassemia major subjects

Objectives: Thalassemia major (β-thalassemia) exhibits the most severe clinical symptoms, which are increasingly causing an obvious problem in Mediterranean-bounding countries. The aim of this study is to examine the clinical, periodontal, radiological and histological features of thalassemia major subjects, and further to compare their findings with non-thalassemic healthy controls. Methods: Subjects (n=14) diagnosed as thalassemia major, and their healthy controls (n=14) were included in this study. Both groups were examined for simplified oral hygiene index (OHI-S) and periodontal index (PI) followed by periapical, panoramic and lateral radiographic evaluations. Gingival biopsies were achieved from maxillary premolar area. Results: Thalassemic subjects revealed with liver and/or spleen problems accompanied by growth retardation, abnormal growth of cranium and maxillary enlargements producing the typical facial appearance with high and bulging cheek bones, retraction of the upper lip, protrusion of the anterior teeth and varying degrees of malocclusion compared to controls. The oral mucosa and gingiva frequently displayed a characteristic pallor in thalassemia major patients. Some of the subjects with thalassemia demonstrated iron pigmentation at their gingivae. OHI-S and PI of thalassemic subjects resulted with 1.70±0.25 and 1.26±0.23, respectively, where they demonstrated a significant increase compared to controls. Radiological analysis revealed thickening of diploe and hair-on-end characteristics at calvarium. There were trabecular thickening; sclerotic changes and necrotic areas characterized by typical bony infarcts noticed at panoramic radiographs. There was an increase in collagen fibers for thalassemic patients, where controls had less collagen at gingival connective tissues. A significant increase for hemosiderin pigmentation was also noticed compared to control group at perivascular sites determined by Prussian blue staining. Conclusion: We state the oral, periodontal and radiological manifestations of thalassemia major and further conclude that hemosiderin accumulation is found at gingival perivascular sites.