A patient from sub-Saharan Africa presents with joint pain. Which radiographic finding of the jaws is characteristic of sickle cell anemia?

Correct answer: D. A 'stepladder' trabecular pattern between the roots of posterior teeth

• A. ❌ Punched-out radiolucencies without a corticated border suggest multiple myeloma or Langerhans cell histiocytosis.
• B. ❌ Ground glass is characteristic of fibrous dysplasia (and hyperparathyroidism).
• C. ❌ Cotton-wool opacity is the late radiographic phase of Paget disease of bone.
• D. ✅ CORRECT — Marrow hyperplasia in sickle cell anemia widens the marrow spaces and coarsens the horizontal trabeculae, producing the classic STEPLADDER pattern between posterior tooth roots. Other features include generalized osteoporosis, a 'hair-on-end' skull appearance, and a prominent lamina dura.

Note: Dental management in sickle cell disease: avoid hypoxia, dehydration, acidosis, and cold — all trigger sickling crises. Prefer local anesthesia with adequate oxygenation.