Pathology · patient case question
Which radiographic pattern is characteristic of sickle cell anaemia in the jaws?
Patient case: The Hypothyroid Patient with an Aching Jaw
Patient: 54-year-old female
Chief Complaint: Generalized aching in the jaws and fatigue.
Background: Hashimoto thyroiditis diagnosed two years ago. Recently also investigated for bone pain; laboratory work shows a raised alkaline phosphatase with low vitamin D.
Medications: Levothyroxine
Vital Signs: BP 118/74 mmHg · HR 58 bpm · RR 14 · T 97.4°F
Findings: Dry cool skin, coarse hair, periorbital puffiness, slow relaxation of deep tendon reflexes. Intraorally the tongue is enlarged with scalloped margins. Panoramic film shows generalized reduced bone density.
Show answer and explanation
Correct answer: B. A stepladder trabecular pattern between the roots of posterior teeth
- A. GROUND-GLASS describes FIBROUS DYSPLASIA, and also appears in hyperparathyroidism.
- B. CORRECT. The STEPLADDER pattern — horizontal, coarse trabeculae running between the roots of the posterior teeth — is the classic jaw finding in sickle cell anaemia. It results from marrow hyperplasia: chronic haemolysis drives compensatory expansion of the marrow spaces, which resorbs the fine trabeculae and leaves a coarser, more horizontal pattern. Generalized osteoporosis, a widened diploë with a 'hair-on-end' skull appearance, and delayed eruption accompany it.
- C. COTTON-WOOL describes PAGET DISEASE of bone in its later mixed and sclerotic phases, and is also used for chronic diffuse sclerosing osteomyelitis.
- D. PUNCHED-OUT radiolucencies with no corticated rim are characteristic of MULTIPLE MYELOMA, classically in the skull and jaws.
Note: Dental management in sickle cell disease: avoid anything that precipitates a crisis — hypoxia, dehydration, acidosis, infection and stress. Use profound local anaesthesia, keep appointments short, use nitrous oxide with at least 50% oxygen, treat infections aggressively, and avoid general anaesthesia where possible.