Eloise Turner

Abstract

Background: Neurological complications of sickle cell disease (SCD) typically affect the central nervous system, whilst peripheral neuropathies are rare. Involvement of the trigeminal nerve is particularly uncommon and may mimic odontogenic pathology. Awareness of this presentation is important for dental practitioners to ensure appropriate investigation and avoid unnecessary intervention.



Case Series:Case 1: A 45-year-old male with SCD presented with sudden-onset numbness of the left chin and lower face (V2/V3 distribution) coinciding with pain in the LL7. Clinical and radiographic assessment revealed no dental pathology and bloods were consistent with SCD. Symptoms resolved completely within six weeks, consistent with transient trigeminal neuropathy.

Case 2: A 42-year-old male with SCD developed acute paraesthesia of the right lower lip and chin (mental nerve distribution) following a mild sickle cell crisis. Quantitative sensory testing confirmed reduced sharp, thermal and light-touch perception. Gradual recovery was noted over six weeks, with near-complete return of sensation at follow-up.

Case 3: A 36-year-old male with SCD reported a two-week history of left mandibular and maxillary pain, followed by numbness of the left lower lip after a sickle cell crisis. Examination confirmed reduced thermal perception in the left V3 distribution. OPG demonstrated a focal radiopacity with radiolucent margin around LL8 and generalised mandibular osteopenia consistent with SCD. All adjacent teeth were vital. Radiological impression suggested cemento-osseous dysplasia unrelated to the neuropathy. Further imaging (CBCT/MRI) was requested to exclude other pathology.



Discussion: In all three cases, no odontogenic or structural cause for the neuropathy was identified. Findings were consistent with ischaemic or vaso-occlusive microinfarction of the inferior alveolar or mental nerve secondary to sickle cell pathology.



Conclusion: Collectively, these cases highlight the need for heightened clinical vigilance amongst oral medicine and dental practitioners, who may be the first clinicians to evaluate focal facial numbness in individuals with SCD. Early identification of neuropathic symptoms, particularly during or shortly after a vaso-occlusive crisis, can prevent unnecessary dental interventions, prompt appropriate medical liaison and ensure timely monitoring.