The objectives of this study were to identify the composition of oral microbiota in a cohort of patients with sickle cell anemia (SCA) and a high mean number of decayed, missing, and filled permanent teeth (DMFT) and compare it to a cohort of patients with SCA and a low number of DMFT and elucidate the effect of fetal haemoglobin levels on the oral microbiota composition. Patients who had been diagnosed with SCA, who were homozygous for sickling β-globin mutation (β^S/β^S), who had Arab-Indian haplotype, and who ranged in age from 5 to 12 years were included in this study. Oral saliva from each participant (n = 100) was collected in GeneFiX™ Saliva DNA Microbiome Collection tube and DNA was extracted using GeneFiX™ DNA Isolation Kits. The composition of oral 16S rRNA from patients with SCA and high dental caries (n = 27, DMFT ≥5) and low dental caries (n = 73, DMFT ≤4) was analysed. Sequencing was performed on an Ion Personal Genome Machine using, Ion PGM Hi-Q view Sequencing 400-bp kit. We observed an overall increase in abundance of Proteobacteria, Chloroflexi, and Bacteroidetes in the high DMFT index group compared to those with a low DMFT index. In addition, there was an overall increased abundance of microbiota from Proteobacteria, Fusobacteria, Firmicutes, and Bacteroidetes in the patients with SCA with low fetal haemoglobin compared to those with high fetal haemoglobin (P < .05). Enterobacteriaceae species were the most significant abundant species of bacteria found in both the high DMFT index group and low fetal haemoglobin cohort (P < .05). Our data indicate that SCA in Saudi patients with high DMFT have a higher predominance of pathogenic bacteria compared to those with low DMFT. Furthermore, SCA in Saudi patients with low fetal haemoglobin have a higher predominance of pathogenic bacteria compared to those with higher fetal haemoglobin.

The purpose of this study is to comprehensively review the relationship between malocclusion and anxiety and depression. While the physical implications of malocclusion are well documented, recent scholarship has shifted focus to examining the direct relationship between malocclusion and both anxiety and depression. It has been hypothesized that individuals with skeletal or dental malocclusion experience a range of psychological sequelae, including diminished quality of life (QoL), reduced oral-health-related quality of life (OHRQoL), increased vulnerability and appearance-related bullying, and impaired body image. Furthermore, these factors are postulated to collectively contribute to overall mental health, with malocclusion potentially serving as a contributing etiological factor in the development of elevated levels of anxiety and depression. Contemporary scholarship has established a complex relationship between dentofacial deviations and the psychological well-being of affected individuals. Evidence shows that malocclusion may contribute to increased depression and anxiety levels in some individuals, influencing their social functioning and treatment-seeking behavior. Dentofacial disharmony has also been associated with altered self-perception, potentially impacting an individual’s OHQOL and overall quality of life. While the findings exhibit some inconsistency, a modest body of evidence indicates a possible correlation between pronounced skeletal or dental malocclusion and anxiety and depression. These adverse psychosocial impacts, in turn, contribute to an elevated risk of anxiety and depression, underscoring the far-reaching consequences of malocclusion beyond oral health. Therefore, clinicians need to consider these issues in their treatment plans, incorporating interdisciplinary approaches that address both orthodontic and psychological aspects of patient care.