Does Sickle Cell Anaemia Have a Relationship With Avascular Pulp Necrosis? A Systematic Review

This systematic review examined the relationship between sickle cell disease (SCD), an inherited genetic hemoglobinopathy, and avascular pulp necrosis (APN) in intact teeth. A comprehensive search of eight electronic databases was performed up to December 2024. Eligible studies included observational or interventional designs reporting APN in intact teeth of individuals with SCD. Risk of bias was assessed with the Joanna Briggs Institute Critical Appraisal Checklists, and certainty of evidence with GRADE. The search retrieved 407 records; four observational studies (two cohort and two case-control) met inclusion criteria, comprising 311 individuals with sickle cell anaemia (SCA). There is a relationship between SCA and APN. However, all included studies presented a risk of bias of 30% or higher, and the certainty of evidence was rated very low. These results provide weak scientific support for the association between APN and SCA, underscoring methodological limitations in the current dental literature.