Which radiographic finding is characteristic of sickle cell anemia?

Correct answer: B. A 'step ladder' trabecular pattern between the teeth with generalized osteoporotic bone

• A. Pulpal calcification is a nonspecific finding of aging, trauma, or attrition.
• B. CORRECT. Chronic hemolysis drives marrow hyperplasia, which expands the marrow spaces at the expense of trabecular bone. In the jaws this produces coarse HORIZONTAL trabeculae between the roots — the classic 'STEP LADDER' or 'hair-on-end' pattern — along with generalized osteopenia, loss of trabeculation, and a prominent lamina dura. Similar changes occur in thalassemia.
• C. The cotton-wool pattern is characteristic of Paget disease of bone and chronic diffuse sclerosing osteomyelitis.
• D. Sickle cell produces radioLUCENT (osteopenic) changes, not increased density.

Note: Also watch for delayed healing, risk of sickle crisis under hypoxia/stress, and mandibular osteonecrosis. Avoid long procedures, ensure oxygenation, and avoid excessive epinephrine and dehydration.