A new study has determined that periodontal-inflamed surface area (PISA) and inflammatory biomarkers in serum are common in patients with sickle cell anemia (SCA), one of several forms of sickle cell disease (SCD).

The study, published in the Archives of Oral Biology, found that patients with SCA also experienced frequent acute pain crises.

“According to a recent systematic review, a guideline is still lacking on the management of oral diseases of patients with sickle cell anemia,” the authors wrote. “Therefore, the aim of the present study was to evaluate the association between periodontal status, periodontal inflamed surface area and serum acute phase biomarkers levels in patients with sickle cell anemia.”

The research team conducted a cross-sectional study of 80 patients with SCA and 80 healthy controls at a single dental center in Turkey. Data on dental checkup frequency, number of teeth, demographics, and smoking status were recorded. All participants underwent clinical periodontal measurements such as pocket depth, clinical attachment loss, plaque index, PISA values, and bleeding on probing.

Read more about SCD comorbidities

The results showed that having SCA was a significant risk factor for periodontal disease and its associated biomarkers of inflammation. In particular, a PISA value greater than 776 mm2 was associated with a much higher risk of having elevated levels of C-reactive protein and ferritin and a 3-fold greater risk of having pain crises more than 3 times per year.

Periodontal disease is also closely linked to oral hygiene habits, and although the frequency of dental checkups was similar between the 2 groups, the healthy patients brushed their teeth more frequently than the patients with SCA. The severity of periodontitis was also greater among the patients with SCA than among the healthy controls.

The authors recommend increasing awareness of the elevated presence of PISA among patients with SCA, encouraging excellent oral hygiene habits, and close monitoring by dental health professionals.


Sari A, Ilhan G, Akcali A. Association between periodontal inflamed surface area and serum acute phase biomarkers in patients with sickle cell anemia. Arch Oral Biol. 2022(143):105543. doi:10.1016/j.archoralbio.2022.105543