Sir, a 25-year-old African was recently admitted to Mayday Hospital with chronic pyrexia of unknown cause. Medically he had hepatitis C and sickle cell anaemia. Two weeks later, he reported symptoms of dental pain and was referred to the Department of Restorative Dentistry. The pain, continuous and throbbing in nature, originated from the upper left quadrant, occurring spontaneously and often keeping the patient awake at night.

Extra-oral examination revealed nothing of note. Intra-orally, the patient had BPE scores of 1, oral hygiene was fair and all of the teeth were present and caries free. Only tooth 36 (UL6) was tender to percussion, there was no associated sinus or swelling but an electric pulp tester failed to get a response. The patient was informed that the tooth may have been losing vitality but, given that it was unrestored and had no obvious crack, the patient was unwilling to have any exploratory treatment carried out. He was advised to take a course of non-steroidal anti-inflammatory drugs for pain relief and was booked in for review two weeks later. The patient cancelled his review appointment as his pyrexia had spontaneously resolved and he had been discharged from hospital. One month later he was contacted and informed us that the tooth had recently developed a swelling and that an emergency dentist had drained the infection through the tooth. He was now symptom free and was seeking a dentist to root treat the tooth.

Given that the patient had sickle cell anaemia, it is possible that sickle cells got trapped in the pulp's vascular supply and impeded the blood flow. This would have lead to hypoxia, cell death and ultimately loss of vitality and symptoms of pulpitis.1 Without treatment, the inflammatory process could have progressed to the apical tissues and stimulated the development of a dental abscess. Indeed there have been reports of patients with sickle cell disease developing spontaneous symptoms of pulpitis2 and requiring treatment. These cases have caused diagnostic puzzles as the teeth themselves were clinically and radiographically sound.

We feel that this is an interesting case report as the patient's symptoms (alongside the absence of any dental disease) would have correlated with a diagnosis of atypical odontalgia. Such patients are typically counselled and prescribed a course of tricyclic antidepressants. This particular case is unusual in that an unrestored tooth clearly required root canal treatment (or even extraction) but the cause of the tooth losing vitality was not dental disease but possibly the patient's underlying haematological disease.