www.sciencejournal.

in
PREVALENCE OF OROFACIAL COMPLICATIONS IN THALASSEMIC PATIENTS FROM SOLAPUR,
MAHARASHTRA STATE, INDIA.
Dama S.B.* and Dama L.B.**
*Department of Zoology, Dr. Babasaheb Ambedkar Marathwada University, Aurangabad, Maharashtra, India.
**Department of Zoology, D. B. F. Dayanand College of Arts and Science, Solapur, Maharashtra, India.
ABSTRACT
The orofacial complications in thalassemia patients, skull and face deformities can be closely related to patient's
age. Early diagnosis and blood transfusion caused less prevalence of rodent face. The aim of the present study is to
surveying the prevalence of orofacial complications in thalassemic patients from Solapur District, Maharashtra
State, India. Present observational survey study, one hundred twenty five thalassemic childrens with age 6 months
to 18 Years, coming for to get blood transfusion from different parts of Solapur district during June 1 st , 2009 to
May 1st, 2013. The questionnaires included general information, medical and dental history. The prevalence of
orofacial complications in thalassemia was: rodent face- male (73.97%), female (75.00%) total (74.4%); saddle
nose- male (79.45%), female (90.38%) total (84.00%); maxillary protrusion- male (79.45%), female (82.69%) total
(80.8%); Upper anterior teeth spacing- male (52.05%), female (53.84%) total (52.8%); Anterior open bite- male
(69.86%), female (78.84%) total (73.6%); deep bite- male (90.41%), female (1.92%) total (53.6%); Mucosal
discoloration- male (0.00%), female (1.92%) total (0.8%); respectively. In this study, Upper anterior teeth spacing
and deep bite was observed, more than the normal population especially in older patients, which is due to rotation
of mandible and protrusion of maxilla leading to over growth of upper anterior teeth of maxilla. Skull and face
deformities can be closely related to the patient's age. Early diagnosis and blood transfusion caused less prevalence
of rodent face.
KEY WORDS: Inherited blood disorder, Mortality, Orofacial Complications, Thalassemia.
INTRODUCTION
Thalassemia is a serious inherited blood disorder. It results in excessive destruction of red blood cells, which leads to
anemia. It is not infectious and cannot be passed from one individual to the other by personal or any other contact, or
through blood transfusion, food or air (Wikipedia, 2008). An estimated 40 million Indians are Thalassemia carriers
and over 10,000 Thalassemia major patients are born every year. Survival of a Thalassemia major depends upon
repeated lifelong blood transfusions and iron chelation. The disease can be prevented by creating awareness, genetic
counseling and screening at pre-nuptial or pre-conceptual stage followed by antenatal diagnosis (National
Thalassemia Welfare Society, 2013). Without treatment, affected children have severe failure to thrive and shortened
life expectancy. Treatment with a regular transfusion program, chelation therapy, bone marrow transplantation and
medication aimed at reducing transfusion iron overload, allows for normal growth and development and extends life
expectancy into the third to fifth decade (GeneReviews 2009).
Recent data indicate that about 7% of the Worlds population is a carrier of a hemoglobin disorder and that 300,000500,000 children are born each year with the severe homozygous states of these diseases (WHO-March of dime,
2006). The carrier rate for beta thalassemia gene varies from 1 to 3% in Southern India to 3% to 15% in Northern
India. Pusaksrikit et al. (1987) finds the occlusion of the teeth in thalassemic patients. Drew and Sach (1997) studied
the management of thalassemia induced skeletal facial deformity. Effects of thalassemia major on components of the
craniofacial complex studied by Bassimitci (1996). Agha (2000), evaluates the maxillofacial anomalies in Beta
thalassemia major. Hypoparathyroidism and intracranial calcification in b-thalassemia major observed by Zafeiriou et
al. Abu Alhaija et al. (2002) observed the cephalometric measurements and facial deformities in subjects with betathalassaemia major. Singh and Venketasubramanian (2004) studied the recurrent cerebral infarction in beta
thalassaemia major. Amini et al. (2007) studied the craniofacial morphology of Iranian children with TM. Salehi et
al. (2007) studied the prevalence of Orofacial complications in Iranian Patients with -Thalassemia Major. In 2008,
Ashraf evaluates the oro-maxillofacial changes in major thalassemia. Verma et al. (2007) studied the intracranial
calcification in beta thalassemia Major. Certain communities in India, such as Punjabis and Sindhis from Northern
India, Kutchis, Bhanushalis, Lohanas from Gujarat, Neobuddhists, Kolis and Agris, Lingayats from Maharashtra
have a higher carrier rate (Verma et al., 2007; Nikam et. al., 2011; 2012a, b, c, d). The present study, to find out the
prevalence of orofacial complications in thalassemic childrens from Solapur District, Maharashtra State, India.
Volume- 1 Issue-1 (2014)

ISSN: 2348 604X (Print); 2348 6058 (Online)

2014 DAMA International. All rights reserved

100

www.sciencejournal.in
MATERIALS AND METHODS
Thalassemia patients
The geographical regions of Solapur District, Thalassemia analyzed (Figure -1) in the framework research work:
i) Akkalkot ii) Barshi iii) Karmala iv) Madha v) Malshirus vi) Mangalveda vii) Mohol viii) North Solapur ix)
Pandharpur x) South Solapur xi) Sangola xii) Solapur City. All individuals were non-related and their selection
depended on their well-defined phenotypes, transfusion-dependency, and geographical origins. Present observational
survey study, one hundred twenty five (Male =73, Female =52) clinically proved by their medical reports, cases of
thalassemic childrens with age 6 months to 18 Years, coming for to get blood transfusion from different parts of
Solapur district, Maharashtra State during June 1 st 2009 to May 1st, 2013. The entire survey study was carried out
under the observations of Medical officer from Thalassemia transfusion centre, Indian Red Cross Society, Gopabai
Damani Blood Bank, Solapur Maharashtra, India. The study population consisted of one hundred twenty five, cases
of Thalassemia children attending for regular blood transfusions in the 5 blood banks and hospitals collaborating in
this multicentre study were carried out, with prior written consent from the parents/ guardians. Provided
questionnaires included all information (General, medical and dental). Clinical orofacial examination of the patients
was performed by means of disposable mirror, probe and flash light and sterilized gauze. Data were analyzed through
the standard statistical methods.
RESULTS AND DISCUSSION
The prevalence of orofacial complications (Table 1) in Thalassemia patients was: rodent face (Figure 2) male
(73.97%), female (75.00%) total (74.4%); saddle nose (Figure 3) male (79.45%), female (90.38%) total (84.00%);
maxillary protrusion (Figure 4) male (79.45%), female (82.69%) total (80.8%); Upper anterior teeth spacing (Figure
5) male (52.05%), female (53.84%) total (52.8%); Anterior open bite (Figure 6) male (69.86%), female (78.84%)
total (73.6%); deep bite (Figure 7) male (90.41%), female (1.92%) total (53.6%); Mucosal discoloration (Figure 8)
male (0.00%), female (1.92%) total (0.8%); respectively. Present study, orofacial complications are seen, mainly
dental and facial abnormalities include spacing of teeth, open bite, protrusion of maxilla, saddle nose and rodent face
maxillary protrusion, anterior teeth spacing, anterior open bite, and deep bite and mucosal discoloration.

Figure- 1. Map of India; Red Color indicates Maharashtra State. B- Map of Solapur Solapur District, the
geographical area of thalassemia in the framework of this research work.
Volume- 1 Issue-1 (2014)

ISSN: 2348 604X (Print); 2348 6058 (Online)

2014 DAMA International. All rights reserved

101

www.sciencejournal.in
Table-1. Showing the sex wise prevalence of orofacial complications in thalassemic patients.
Parameter

Sex

Yes
SCT

No
SCT

Yes
BTI

No
BTI

Yes
BTMi

No
BTMi

Yes
TM

No
TM

Yes
(%)

No
(%)

Rodent face

40

14

54 (73.97)

19 (26.02)

F
T

0
0

0
1

3
12

1
4

4
9

0
1

32
72

12
26

39 (75)
93 (74.4)

13 (25)
32 (25.6)

11

41

13

58 (79.45)

15 (20.54)

41

47 (90.38)

5 (9.61)

T
M

0
0

1
1

14
11

2
1

9
6

1
0

82
41

16
13

105 (84)
58 (79.45)

20 (16)
15 (20.54)

F
T

0
0

0
1

4
15

0
1

3
9

1
1

36
77

8
21

43 (82.69)
101 (80.8)

9 (17.30)
24 (19.2)

Maxillary
anterior teeth
spacing

30

24

38 (52.05)

35 (47.94)

F
T

0
0

0
1

4
9

0
7

2
5

2
5

22
52

22
46

28 (53.84)
66 (52.8)

24 (32.87)
59 (47.2)

Anterior open
bite

10

35

19

51 (69.86)

22 (30.13)

35

41 (78.84)

11 (21.15)

T
M
F
T
M
F
T

0
0
0
0
0
0
0

1
1
0
1
1
0
1

14
1
0
1
0
0
0

2
11
4
15
12
4
16

8
0
0
0
0
0
0

2
6
4
10
6
4
10

70
6
1
7
0
1
1

28
48
43
91
54
43
97

92 (73.6)
66 (90.41)
1 (1.92)
67 (53.6)
0 (0)
1 1.92)
1 (0.8)

33 (26.4)
7 (9.58)
51 (98.07)
58 (46.6)
73 (100)
51 (8.07)
124 (99.2)

Saddle nose

Maxillary
protrusion

Deep bite

Mucosal
discoloration

80
70
60
50
40
30
20
10
0

Male
Female
Total
YES
SCT

No
SCT

Yes
BTI

No
BTI

Yes
No
BTMi BTMi

Yes
TM

No
TM

Yes
No
Total Total
%
%

Figure 2. Prevalence of orofacial complications in thalassemia patients: Rodent face.

Volume- 1 Issue-1 (2014)

ISSN: 2348 604X (Print); 2348 6058 (Online)

2014 DAMA International. All rights reserved

102

www.sciencejournal.in
100
80
60
40
20
0

Male
Female
YES
SCT

No
SCT

Yes
BTI

No
BTI

Yes
No
BTMi BTMi

Yes
TM

No
TM

Yes
No
Total Total
%
%

Total

Figure 3. Prevalence of orofacial complications in thalassemia patients: Saddle nose.

100
80
60
40
20
0

Male
Female
YES
SCT

No
SCT

Yes
BTI

No
BTI

Yes
No
BTMi BTMi

Yes
TM

No
TM

Yes
No
Total Total
%
%

Total

Figure 4. Prevalence of orofacial complications in thalassemia patients: Maxillary protrubution.

60
50
40
30
20
10
0

Male
Female
Total
YES
SCT

No
SCT

Yes
BTI

No
BTI

Yes
No
BTMi BTMi

Yes
TM

No
TM

Yes
Total
%

No
Total
%

Figure 5. Prevalence of orofacial complications in thalassemia patients: Maxillary anterior teeth spacing.

Volume- 1 Issue-1 (2014)

ISSN: 2348 604X (Print); 2348 6058 (Online)

2014 DAMA International. All rights reserved

103

www.sciencejournal.in
100
80
60
40
20
0

Male
Female
Total
YES
SCT

No
SCT

Yes
BTI

No
BTI

Yes
No
BTMi BTMi

Yes
TM

No
TM

Yes
No
Total Total
%
%

Figure -6. Prevalence of orofacial complications in thalassemia patients: Anterior open bite
120
100
80
60
40
20
0

Male
Female
Total

YES
SCT

No
SCT

Yes
BTI

No
BTI

Yes
No
BTMi BTMi

Yes
TM

No
TM

Yes
No
Total Total
%
%

Figure 7. Prevalence of orofacial complications in thalassemia patients: Deep bite.

120
100
80
60
40
20
0

Male
Female
Total
YES
SCT

No
SCT

Yes
BTI

No
BTI

Yes
No
BTMi BTMi

Yes
TM

No
TM

Yes
No
Total Total
%
%

Figure 8. Prevalence of orofacial complications in thalassemia patients: Mucosal discoloration.

In this study, Upper anterior teeth spacing and deep bite was observed, more than the normal population especially in
older patients, which is due to rotation of mandible and protrusion of maxilla leading to over growth of upper anterior
teeth of maxilla. The anterior open bite was slightly more than normal population. Regular and repeated bloodinfusion keeping the hemoglobin in an appropriate level (at least 10g/dl), along with iron removal can prevent face
and skull deformities. There was not any relationship between the complications and sex. Skull and face deformities
can be closely related to the patient's age. Most of the patients were in the first and second decade of life. Early
diagnosis and blood transfusion caused less prevalence of rodent face. The goal for future research in thalassemia is
not only to introduce new strategies of diagnosis and treatment of thalassemia but also to discover ways to prevent
transfusion-induced malaria, HCV, HIV, HBsAg, VDRL and other complications in thalassemic patients. Current
work deals with specific complications in thalassemia patients such as orofacial complications, consigunity, ethnicity,
hyperthyroidism, Alloimmunization, Hb level at pre and post blood transfusions, anthropologic measurements,
Volume- 1 Issue-1 (2014)

ISSN: 2348 604X (Print); 2348 6058 (Online)

2014 DAMA International. All rights reserved

104

www.sciencejournal.in
hematological study and transfusion-induced or transmitted pathogens, complications in liver, spleen,
alloimmunization etc. Efforts should be towards promoting awareness of thalassemia amongst the public and health
professionals, and promoting the establishment and improvement of policies aimed at the prevention and medical
treatment of thalassemia. The orofacial complications in patients with thalassemia major were similar to findings of
other studies (Drew and Sach, 1997; Bassimitci et. al., 1996; Agha Hoseini and Shabandy, 2000). The results of
orofacial complications in thalassemic patients showed that the rate of rodent face, maxillary protrusion, Anterior
open bite, and saddle nose increased with age. This was quite predictable because the maxilla is one of the most
common bones affected by thalassemia (Kliegman and Behromon, 2002; Faiez, 2013). The evaluation of oromaxillofacial changes in major thalassemia observations were similar to results reported by Salehi (2007) and Ashraf
et al., (2008). Overall, it indicated a reduction in complications during last decades, which was due to early diagnosis,
treatment, and regular follows up. The orofacial complications, the data were corroborated with the reports of Kremer
(1986). Bimaxillary protrusion and other abnormalities are also frequently seen in thalassemia major cases (Salehi et.
al., 2007). Pratima Raju et al. (2009) are evaluating the oral manifestations as correlates in TM cases in current dental
practice in central part of India. This study will be helpful in further defining the orofacial complications in
thalassemic patients.
ACKNOWLEDGEMENTS
The authors thank Dr. P.K. Joshi, Secretary and Dr. Rajiv Pradhan, Joint Secretary for their excellent technical
assistance as well as the doctors and technicians of Smt. Gopabai Damani Blood Bank (Indian Red Cross Society)
Solapur for their help in blood collection during this study. The authors also thanks to Head, Department of Zoology,
Dr. Babasaheb Ambedkar Marathwada University, Aurangabad- 431001, Maharashtra, India.
REFERENCES
Abu Alhaija E.S., Hattab F.N. and Al-Omari M.A. (2002). Cephalometric measurements and facial deformities in
subjects with beta-thalassemia major. Eur. J. Orthod. 24: 9-19.
Agha Hoseini F. and Shabandy M. (2000). Evaluation of maxillofacial anomalies in B-tha-lassemia major [PhD
Thesis]. Dental school, Tehran University of Medical Sciences, Iran.
Amini F., Jafari A., Eslamian L. and Sharifzadeh S. (2007). A cephalometric study on craniofacial morphology of
Iranian children with beta-thalassemia major. Orthod. Craniofac. Res. 10: 36-44.
Bassimitci S., Yucel-Eroglu E. and Akalar M. (1996). Effects of thalassemia major on components of the
craniofacial complex. Brit. J. Orthodo. 23: 157162.
Drew S.J. and Sach S.A. (1997). Management of thalassemia induced skeletal facial deformity. J. Oral Maxfac.
Surg. 55(1): 1331-1339.
Faiez N. Hattab (2013). Patterns of physical growth and dental development in Jordanian children and adolescents
with thalassemia major. J. Oral Sci. 55(1): 71-77.
Kliegman R.M. and Behromon R.E. (2002). Nelson Essential of Pediatrics. 4th ed. Saunders Co. 662-663.
Kremer B.H. and Gotzfried H.F. (1986). Orofacial changes in beta-thalassemia major. Dtsch Z Mund Kiefer
Gesichtschir.10(5): 382-390.
National Thalassemia Welfare Society (2013). URL: http://www.thalassemiaindia.org/
GeneReviews (2009). http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgibook=gene&part= a- thal.
Nikam et al., (2011). Prevalence of red cell alloimmunization in repeatedly transfused patients with - Thalassemia
in Solapur District, Maharashtra State, India. UGC-Sponsored Proc. Nat. Workshop Seminar Bio-Resources BioIndustries Economic Zool. 1-3.
Nikam S.V., Dama S.B., Jawale C.S., Deshmukh P.S., Patil S.S., Tembhurkar V.R. and Dama L.B. (2012a).
Height and weight correlation in thalassemic patients from Solapur District, Maharashtra, India. DAV. Int. J. Sci.
1(1): 54-57.
Nikam S.V., Dama S.B., Dama L.B. and Saraf S.A. (2012b). Geographical distribution and prevalence percentage
of thalassemia from Solapur district, Maharashtra, India. DAV Int J Sci, 1(2): 91-95.
Nikam S.V., Dama S.B., Chondekar R.P., Dama L.B. and Jawale C.S. (2012c). Mortality In Thalassemic Patients
From Solapur District, Maharashtra State, India. Bangladesh J. Med. Sci. 11(3): 03.
Nikam S.V., Dama S.B (Kinagi), Patil S.S (Kadadi). and Dama L.B. (2012d). Literacy Status in Thalassemic
Patients from Solapur District, Maharashtra, India: A Statistical Study. Trends Life Sci. 1(1). 22-24.

Volume- 1 Issue-1 (2014)

ISSN: 2348 604X (Print); 2348 6058 (Online)

2014 DAMA International. All rights reserved

105

www.sciencejournal.in
Pratima Raju., Minal Chaudhary and Vijay Wadhwan (2009). Evaluation of Oral manifestations as correlates in
Thalassemia major cases in current dental practice in Central part of India. Internet J. Hematol. 6(2).
Pusaksrikit S., Isarangkura P. and Hathirat P. (1987). Occlusion of the teeth in thalassemic patients. Birth
Defects.Orig. Artic. Ser. 23: 429-433.
Salehi M.R., Farhud D.D., Tohidast T.Z. and Sahebjamee M. (2007). Prevalence of orofacial complications in
iranian patients with -thalassemia major. Ir. J. Publ. Health. 36 (2): 43-46.
Ashraf Sayyedi, Fereydoun Pourdanesh, Bahador Sarkari, Sayyed Hesamedin Nabavizadeh (2008). Evaluation of
oro-maxillofacial Changes in major thalassemia. Inside Dentistry. 4(2).
Singh R. and Venketasubramanian N. (2004). Recurrent cerebral infarction in beta thalassaemia major.
Cerebrovasc. Dis. 17(4): 344-345.
Verma S., Saxena A.K. and Marwaha R.K. (2007). Intracranial calcification in beta thalassemia Major. Ind.
Pediatr. 44: 856-858.
WHO-March of dime (2006).
Wikipedia (2008). URL: http://en.wikipedia.org/w/index.php?title=Thalassemia& action=edit.
Zafeiriou D., Athanasiou M., Katzos G., Economou M. and Kontopoulos E. (2001). Hypoparathyroidism and
intracranial calcification in b-thalassemia major. J. Pediatr. 138: 411.

Volume- 1 Issue-1 (2014)

ISSN: 2348 604X (Print); 2348 6058 (Online)

2014 DAMA International. All rights reserved

106