From the Guidelines
Dentists should be aware of the signs and symptoms of anemia in their patients, as oral manifestations can be the first clinical indicators of this condition, and refer them for medical evaluation if necessary, as anemia can compromise tissue healing and increase susceptibility to infections, potentially complicating dental treatment outcomes. Anemia presents in the oral cavity primarily as pallor of the mucous membranes, particularly noticeable in the gingiva, palate, and conjunctiva 1. Patients may exhibit angular cheilitis (cracking at the corners of the mouth), glossitis (inflammation of the tongue), and atrophic glossitis where the tongue appears smooth, shiny, and red due to papillary atrophy. The oral mucosa may appear pale or yellowish, and patients might report oral burning sensations, dysgeusia (altered taste), or dysphagia (difficulty swallowing) 1.
Classification of Anemia
According to the European consensus on the diagnosis and management of iron deficiency and anaemia in inflammatory bowel diseases, anemia can be classified based on the mean corpuscular volume (MCV) and reticulocytes, into microcytic, normocytic, and macrocytic anemia 1. Microcytic anemia can be caused by iron deficiency, anemia of chronic disease, lead poisoning, or hereditary microcytic anemia. Normocytic anemia can be caused by acute hemorrhage, renal anemia, anemia of chronic disease, or severe aplastic anemia. Macrocytic anemia can be caused by vitamin B12 deficiency, folate deficiency, or myelodysplastic syndrome.
Dental Treatment Modifications
For patients with confirmed anemia, dental treatment modifications may include:
- Shorter appointments to reduce stress and fatigue
- Stress reduction protocols to minimize anxiety and discomfort
- Avoiding vasoconstrictors in local anesthetics for severe anemia cases to prevent further reduction in oxygen delivery to tissues
- Postponing elective procedures until the condition is managed to prevent complications and ensure optimal healing
Importance of Iron Replacement
Iron replacement is essential to improve quality of life and decrease the risk of complications related to anemia, as stated in the AGA clinical practice update on management of iron deficiency anemia 1. Oral iron supplementation is usually initiated first, but IV iron may be necessary in some cases, especially in patients with severe iron deficiency or conditions where oral iron may not be well absorbed.
Multidisciplinary Management
Multidisciplinary management, including gastroenterologists, hematologists, and nutritionists, is often necessary in complex cases of anemia, as stated in the AGA clinical practice update on management of iron deficiency anemia 1. Nutritional consultation can help increase dietary iron intake, and a hematology consultation can help with complex anemia situations or if there is difficulty accessing IV iron.
From the Research
Signs and Symptoms of Anemia in Relation to Dentistry
Anemia is a condition characterized by a lack of enough healthy red blood cells to carry adequate oxygen to the body's tissues, making it a concern for various healthcare professionals, including dentists. The symptoms of anemia can be subtle and may not always be immediately apparent, but they can impact dental health and treatment outcomes.
Common Signs and Symptoms of Anemia
- Weakness and fatigue, which can affect a patient's ability to tolerate dental procedures 2
- Lethargy, which may influence a patient's adherence to dental treatment plans and oral hygiene practices
- Palpitations, which could be relevant during dental procedures that may cause stress or anxiety
- Headache and shortness of breath, which might be exacerbated by lying down in a dental chair or by the stress of dental procedures
- Pale skin, which can be observed during a dental examination
Anemia Diagnosis and Its Relevance to Dentistry
Diagnosing anemia typically involves a full blood count, and the results may suggest that the anemia is caused by a nutritional deficiency of iron, vitamin B12, or folate 2. Understanding the cause of anemia is crucial for managing the condition and for dentists to provide appropriate care, as anemia can affect healing, increase the risk of infection, and impact the choice of dental materials and procedures.
Treatment of Anemia and Dental Considerations
Treatment of iron deficiency anemia with pharmacological iron can lead to significant increases in serum folate and vitamin B12 levels, even in patients with baseline low levels of serum vitamin B12 3. Dentists should be aware of these changes when managing patients with anemia, as they may need to adjust dental treatment plans accordingly. For example, patients with anemia may require more frequent dental visits for monitoring, special considerations for dental anesthesia, or adjustments in dental materials to accommodate potential healing issues.
Anemia in Specific Populations and Dental Implications
Anemia affects a significant portion of the global population, including infants and children, with iron deficiency being the most common cause 4. Dentists treating pediatric patients should be aware of the recommendations for screening and managing anemia in this population. Similarly, understanding the evaluation and diagnostic tests for anemia, such as complete blood cell counts, reticulocyte counts, and tests for vitamin B12 and folate levels, can help dentists identify and manage anemia in their patients effectively 5, 6.