IRON OVERLOAD, COMPROMISED SALIVARY FUNCTION, AND DENTAL CARIES RISK IN BETA-THALASSEMIA MAJOR: A CROSS-SECTIONAL

Amilia Ramadhani(1*), Hafizh Zufar Pramuditya(2), Putri Silvia Nurcahyani(3), Ali Taqwim(4), Muhammad Basalamah(5), A. Haris Budi Widodo(6), Lantip Rujito(7)


(1) Jenderal Soedirman University
(2) Jenderal Soedirman University
(3) Jenderal Soedirman University
(4) Jenderal Soedirman University
(5) Banyumas District General Hospital
(6) Jenderal Soedirman University
(7) Jenderal Soedirman University
(*) Corresponding Author

Abstract


Background: β-thalassemia major patients exhibit higher dental caries prevalence due to systemic complications including iron overload from regular blood transfusions. This study aimed to assess dental caries status, salivary pH, and buffer capacity in β-thalassemia major patients and investigate correlations with ferritin blood concentration.

Method: A cross-sectional analytical study was conducted on 24 β-thalassemia major patients aged 12-17 years. Salivary function was assessed by salivary pH and buffer capacity. Dental caries status was evaluated using the DMF-T index. Ferritin blood concentrations were correlated with salivary function and dental caries using Pearson analysis.

Outcome: Mean salivary pH was 5.74±0.63 (acidic), buffer capacity was 3.98±0.21, DMF-T score was 6.17±1.97, and ferritin level was 5830.54±2823.91 ng/mL. Ferritin levels showed moderate negative correlations with salivary pH (r=-0.718, p<0.001) and buffer capacity (r=-0.737, p<0.001), and positive correlation with DMF-T scores (r=0.696, p<0.001). Strong negative correlations were found between DMF-T scores and salivary pH (r=-0.915, p<0.001) and buffer capacity (r=-0.913, p<0.001).

Conclusion: Iron overload significantly compromises salivary parameters, creating an acidogenic oral environment that promotes dental caries development in β-thalassemia major patients, emphasizing the need for integrated oral health monitoring in thalassemia management protocols.

Keywords


Beta-thalassemia; Dental caries; Ferritins; Iron overload; Oral health

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References


Cappelini M., Farmakis D, Porter J, Taher A, editors. 2021 Guidelines for The Management of Transfusion-Dependent Thalassemia. 4th ed. Thalassemia International Federation. 2021. 1–351 p.

World Health Organization. Thalassaemias and Other Haemoglobinopathies - Report by the Secretariat. Genet Disord Indian Subcont. 2004;(May):245–64.

Wahidiyat PA, Sari TT, Rahmartani LD, Iskandar SD. Thalassemia in Indonesia. Hemoglobin. 2022;46(1):3630269.

Shamsah MSA, Zaidan TF. Oro - Facial Manifestations, Oxidative Stress Marker and Antioxidant in Serum and Saliva of Patients with Beta Thalassemia Major. J Baghdad Coll Dent. 2015;27(2):93–7.

Al-Raeesi S, Kowash M, Hassan A, Al-Halabi M. Oral manifestations and dentofacial anomalies in β-thalassemia major children in Dubai (UAE). Spec Care Dent. 2018;38(1):25–30.

Akbarnejad AA, Mahjoub S, Tamaddoni A, Masrour-Roudsari J, Seyedmajidi SA, Ghasempour M. Salivary Oxidative Stress, Total Protein, Iron and pH in Children with β-Thalassemia Major and their Correlation with Dental Caries. J Dent. 2022;23(3):266–71.

Al-Zaidi RR, Samarrai SKE. Dental caries among a group of boys with β-thalassemia major (10-12 years old) in relation to salivary Mutans streptococci. J Baghdad Coll Dent. 2014;26(June):157–9.

Arora R, Malik S, Arora V, Malik R. Comparison of Dental Caries Prevalence in β-Thalassemia Major Patients with their Normal Counterparts in Udaipur. Am Int J Research Formal, Appl Nat Sci. 2014;5(1):6–9.

Dewi SRP, Septhimoranie S, Muchzal S. Correlation of saliva characteristics and caries in beta-thalassemia major patients. Maj Kedokt Gigi Indones. 2020;6(2):100–5.

Joshi A, Gupta A, Lihala R, Vaid P. Association of salivary pH in patients with dental caries and periodontal disease. Int J Res Med Sci. 2021;10(1):240.

Ali SR, Al Haidar AH. Evaluation of Some Salivary Characteristics in Relation to Dental Caries among Children with Beta-Thalassemia Major. J Res Med Dent Sci. 2022;10(8):115–20.

Bellagambi FG, Lomonaco T, Salvo P, Vivaldi F, Hangouët M, Ghimenti S, et al. Saliva sampling: Methods and devices. An overview. TrAC - Trends Anal Chem. 2020;124.

Alkhateeb AA, Manci LA, Presland RB, Rothen ML, Chi DL. Unstimulated Saliva-Related Caries Risk Factors in Individuals with Cystic Fibrosis: A Cross-Sectional Analysis of Unstimulated Salivary Flow, pH, and Buffering Capacity Alaa. Physiol Behav. 2017;51(1):1–6.

World Health Organization. WHO guideline on use of ferritin concentrations to assess iron status in individuals and populations [Internet]. Vol. 11, Sustainability (Switzerland). Switzerland; 2020. 1–82 p.

Walter PB, Fung, Ellen B, Killilea DW, Jiang Q, Hudes M, Madden J, et al. Oxidative stress and inflammation in iron-overloaded patients with β-thalassaemia or sickle cell disease. Br J Haematol. 2006;135(2):254–63.

Rao GV, Preethi V, Daneswari V, Reddy V, Sivakalyan V, Garge R. A comparative study of salivary flow rate, pH, buffer capacity, total antioxidant capacity, and ferritin levels in children with beta thalassemia major and healthy children. Int J Clin Pediatr Dent. 2021;14(3):342–8.

Zabokova-Bilbilova E, Bajraktarova B, Sotirovska-Ivkovska A, Fildisevski A. Analysis of Buffer Value of Bicarbonate In Saliva. Balk J Stomatol. 2007;11:167–70.

Babu NSV, Shah S. Comparative Assessment of Salivary Flow Rate, Buffering Capacity, Resting PH and Dental Caries in Children with Beta Thalassemia. J Middle East North Africa Sci. 2018;4(3):18–22.

Zhou J, Jiang N, Wang Z, Li L, Zhang J, Ma R, et al. Influences of pH and iron concentration on the salivary microbiome in individual humans with and without caries. Appl Environ Microbiol. 2017;83(4):1–12.

Karayilmaz H, Yalçin-Erman H, Erken-Güngör Ö, Öztürk Z, Felek R, Küpesiz A. Evaluation the oral hygiene conditions, oral candida colonization and salivary streptococcus mutans and lactobacilli density in a group of β-thalassemic children and adolescents. Med Oral Patol Oral y Cir Bucal. 2019;24(6):e712–8.

Akbari MS, Doran KS, Burcham LR. Metal Homeostasis in Pathogenic Streptococci. Microorganism. 2022;10(1501):1–17.

Kumar N, Hattab FN. Oral and Dental Care. In: Taher AT, Farmakis D, Porter J., Cappelini M., Musallam K., editors. Guidelines for the Management of Transfusion-Dependent β-Thalassaemia (TDT). 5th ed. Nicosia, Cyprus: Thasassaemia International Federation; 2025.


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DOI: https://doi.org/10.26714/ijd.v5i2.17807

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