Introduction: Sickle cell disease has pathological effects in dental tissues and the oral cavity. Basic knowledge of sickle cell anemia among dentists and dental students before any dental procedure is mandatory.

Aim: This study aimed to determine the knowledge of dental students related to Sickle Cell Anemia.

Results: Of the 422 dental students, over half of the participants did not ever treat patients with sickle cell anemia 57.7% (n=244) or ask the patient for some investigation 53.7% (n=227) or gives prophylactic antibiotic before extraction 52.4% (n=221). Approximately half 53.6% (n= 226) of students have information about oral manifestations of SCA and reported bleeding 52.8% (n=223) as a serious complication during dental procedures. The majority 75.1% (n=316) think that patient’s physician should be consulted about the patient's myocardial status and most of the participants 57.8% (n=245) think that preventive dental care is important.

Conclusions: The awareness of dental students toward the sickle cell anemia is a satisfactory level, but dental School should provide more courses and training about the policy of treat patient with SCA.

Anemia is a condition defined as lack of red blood cell or hemoglobin which is carries oxygen from the lungs to the tissues.¹ Sickle cell anemia is an inherited blood disorder (IBD) caused by a mutation of the hemoglobin gene that affects hemoglobin structure and morphologic in erythrocytes; resulting in the formation of abnormal, sickle-shaped red blood cells.² In SCA there is reducing the flow of the blood and oxygen into the body organs and impedes blood flow through small capillaries will cause blockage of blood vessels (i.e., vaso-occlusion).³ Epidemiology of Sickle Cell Disease in the United States, about 72 000 people and 2 million are carriers.⁴ In Africa, more than 200 000 infants are born yearly with SCD.⁵ The Eastern Province of Saudi Arabia is known to have one of the highest prevalence rates of SCD worldwide.^6,7

Sickle Cell Disease Diagnosis Via a blood test to checks hemoglobin S National Human Genome Research Institute, 2016; NHBLI, 2018, SCD are now identified via new born screening. If the infant screens positive for SCD, they are retested to confirm the diagnosis. Complication of SCD can be prevent by early diagnosis.^8,9,10

Sickle cell disease affects every major body system and increases the risk of multiple complications (Anemia, Stroke, Pulmonary hypertension, Cardiomyopathy, Renal infarction Osteoporosis, Avascular necrosis Osteomyelitis, Splenic infarction, Retinopathy, Chronic leg ulcers, Anxiety, Depression, Sleep disturbances) and early death.^3,11

The pathological effects of sickle cell disease also occur in dental tissues and the oral cavity. The most common oral manifestations of the sickle cell disease are mucosal pallor, yellow tissue coloration, disorders of enamel and dentin mineralization, delayed tooth eruption, radiographic abnormalities, malocclusion, osteomyelitis of the jaw, hypercementosis, pulp stones, and asymptomatic pulp necrosis, glossitis and gingival enlargement.¹²⁻¹⁵

As a dentists and dental students, basic knowledge of sickle cell anemia before any dental procedure is mandatory because some medication such as non steroidal anti‐inflammatory drugs (example aspirin and ibuprofen) is contraindication, and other example of important to be aware of SCA that the dentist must prescribe antibiotics before dental procedures to avoid the risk of infections.¹⁶⁻¹⁸

Aims of the study: To analyze and evaluate the knowledge, attitudes and Awareness toward Sickle Cell Anemia Among Dental students in Riyadh Elm university , Riyadh City, Kingdom of Saudi Arabia.

Ethical Approval: Study proposal was submitted to the research center of Riyadh Elm University and ethical approval (Institutional Review Board IRB) was obtained. The study was registered under the registration number: FUGRP/2018/188.

Study Method: Quantitative.

Study Design: A cross sectional paper based questionnaire survey and An online survey was developed using surveymonkey.com.

Study Population: Dental students in Riyadh Elm University Riyadh City, Kingdom of Saudi Arabia.

Sample Size: 422 carrying out by using online Raosoft sample size calculator.

Questionnaire: A structured, close-ended, and self-administered questionnaire.

Consist of 24 questions: three questions requesting the respondents’ biographic and practice demographic information. Nine questions related to their general knowledge of sickle cell disease and twelve questions related to their dental knowledge of sickle cell disease.

Statistical Analysis: The information and data from the study entered into an electronic database (SPSS® for windows®V.20).

Of the 422 dental students, the majority were aged between 24-27 years (n=193, 46.5%). almost the half 212 (50.2%) were males and 210 (49.8%) were females. One hundred six (25.0%) were in Level 12 followed by 79 (18.6%) in level 11 and 74 (17.5%) Is dental intern (Table 1).

Table 2 shows participants general knowledge of the sickle cell disease. Over the half of the participants 55.9% (n=237) reported that results in anemia make SCD serious disease, 55.0 % (n=233) reported that newborn screening programs is the appropriate time to test for SCD, the majority of student think that the role of hemoglobin is to transport oxygen 63.6% (n=269) and the early morning is the protocol to treat patients with SCA 55.0% (n=231).

Although 53.6% (n=226) knew the effective method to reduces the risk of SCD, but only 44.6% (n=186) reported antibiotics is the method to reduce it. Approximately one quarter 24.2% (n=102) didn’t not know how sickle cell anemia is cured.

The majority of students (71.4%) were aware about sickle cell disease is inherited blood disorder (Figure 1). Approximately two third (64.1%) reported that Sickle Cell Disease diagnosis Via a blood test (Figure 2).

Table 3 shows participants dental knowledge of the sickle cell disease. Over half the participants did not ever treat patients with sickle cell anemia 57.7% (n=244) or ask the patient for some investigation 53.7% (n=227) or gives prophylactic antibiotic before extraction 52.4% (n=221).

Approximately half 53.6% ( n= 226) of students have information about oral manifestations of SCA and reported bleeding 52.8% ( n=223) as a serious complication during dental procedures. The majority 75.1% (n=316) think that patient’s physician should be consulted about the patient's myocardial status and most of the participants 57.8% (n=245) think that preventive dental care is important.

With regard to students’ self-reported use of pain killer, they reported Paracetamol as best medication for SCA (28.1% n=118). About (43.8%, n=183) reported the main contraindication for dental treatment with the sickle cell anemia patients is any surgical procedure.

Around one third of the participants reported that hair-on-end appearance is the most radiographic feature appearance for sickle cell anemia patients (Figure 3). The distribution of the most common oral manifestation reported by the participants (Figure 4).

Chi square test showed a statistically significant association between knowledge questions and demographics (p<0.05).Females, 24-27 years, and level 12 participants were more likely to have a better knowledge (Table 4).

Figure 1 Response of the participants to how sickle cell disease is cause.

Figure 2 Response of the participants to diagnosis of sickle cell disease.

Figure 3 Response on the most common radiographic feature for sickle cell anemia.

Figure 4 Response on the most common oral manifestation.

Sickle cell disease has pathological effects in dental tissues and the oral cavity. Basic knowledge of sickle cell anemia among dentists and dental students before any dental procedure is mandatory so this study aimed to determine the knowledge of dental students related to Sickle Cell Anemia.

Descriptive analysis showed satisfactory knowledge about the complication related to SCA. Gomes et al.,¹⁹ describes that the level of knowledge of primary health care workers in Brazil about sickle cell disease is low (45.8% ) , while Isah et al.,²⁰ study the majority of respondents have high knowledge about sickle cell disease (97.6%). Approximately 55% of African American Students’ Awareness of Sickle Cell Disease.²¹ Malay et al.,¹⁸ reported that level of knowledge of first year dental students was found to be nearly 100%. Silva et al,.²² reported the knowledge of sickle cell anemia, 44.0% of the students solved the questions and regards to odontological complications caused by sickle cell anemia only 30.4% marked the correct answer, the result of this study show less knowledge comparing to our study.

More than 50% were aware of the fact that bleeding was the most common related complication, which is reported by multiple studies.^23,24 One of those investigations was carried out by,²⁵ which showed a distinct relationship between SCA and problems linked with coagulation of blood leading to prolonged bleeding.

Regarding the diagnosis only 44% of students knew about the diagnosis of anemia and 22% of students answered correctly regarding treatment of anemia 18. This could be a reason of these students being linked to theoretical courses instead of clinical exposure. Comparing these findings with our results suggest that the level of clinical students’ knowledge in clinical criteria including the diagnosis and treatment part of anemia is superior.

Training programs should be conducted to make the dental students aware of anemia and the importance of precautionary measures to avoid any complications during dental procedure. In addition, raise the level of awareness by all possible ways among dental students as they could educate their patients in the future.

The awareness of dental students toward the sickle cell anemia is a satisfactory level, but dental School should provide more courses and training about the policy of treat patient with SCA.

None.

The author declares that there is no conflict of interest.

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