Vol. 95 No. 2 February 2003
ORAL SURGERY ORAL MEDICINE ORAL PATHOLOGY MEDICAL MANAGEMENT UPDATE
Editor: Donald Falace
Scott S. DeRossi, DMD,a and Sree Raghavendra, DMD,b Philadelphia, Pa
UNIVERSITY OF PENNSYLVANIA SCHOOL OF DENTAL MEDICINE
(Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003;95:131-41)
Anemia is a disease resulting from a decrease in the normalamount of circulating hemoglobin. A variety of factors cause this decrease, including iron deﬁciency, hemolysis, a decrease in the production of red blood cells (RBCs), folic acid deﬁciency, or a combination of these entities. Many types of anemia have oral manifestations, and the disease itself or its medical management can affect the provision of dental care. This article will discuss some ofthe more common anemias, their systemic and oral manifestations, and suggested modiﬁcations for dental care. CLASSIFICATION/ETIOLOGY Anemia can be classiﬁed by pathogenesis into bloodloss anemias, hemolytic anemias, hemoglobinopathies, and hypoproliferative anemias. This classiﬁcation of anemia is summarized in Table I. Anemia also can be classiﬁed by the appearance of the RBC on the peripheralblood smear by virtue of its size (microcytic, normocytic, or macrocytic) or by the concentration of hemoglobin (hypochromic, normochromic).1 This article will discuss some of more common anemias, including iron deﬁciency anemia, hemolytic anemias, glucose-6 phosphate dehydrogenase (G-6-P-D) deﬁciency, sickle cell anemia, thalassemia, anemias caused by vitamin Bl2 deﬁciency and folic acid deﬁciency,and aplastic anemia (Table II).
Table I. Classiﬁcation of anemia by pathogenesis
Blood loss anemia Hemolytic anemias Iron deﬁciency anemia; PlummerVinson syndrome Glucose-6-phosphate dehydrogenase deﬁciency; druginduced; immune mediated Sickle cell anemia; thalassemia; Cooley’s anemia Vitamin B12 deﬁciency; pernicious anemia; folic acid deﬁciency; aplastic anemia
Hemoglobinopathies ordisorders of hemoglobin Hypoproliferative anemias
Assistant Professor, Department of Oral Medicine, University of Pennsylvania School of Dental Medicine. b Oral Medicine Resident, Department of Oral Medicine, University of Pennsylvania School of Dental Medicine. Received for publication Apr 8, 2002; returned for revision ????; accepted for publication Sept 5, 2002. © 2003, Mosby, Inc.1079-2104/2003/$30.00 0 doi:10.1067/moe.2003.13
Blood loss anemias Iron deﬁciency anemia. Iron deﬁciency anemia is the most common of all anemias, affecting approximately 30% of the world population and accounting for up to 500 million cases worldwide.2 In the United States, 5% to 11% of women and 1% to 4% of men are iron deﬁcient, and 5% of women and 2% of men have iron deﬁciency anemia.3 Inindividuals of Southeast Asian background, there is an increased prevalence, suggesting a cultural component to this anemia. Speciﬁcally, a diet of milk, rice and soup, with a lack of meat, and prolonged bottle-feeding are suggested causes of iron deﬁciency anemia in this population.4 Other causes of iron deﬁciency anemia include chronic blood loss such as menstrual or menopausal bleeding, parturition,bleeding hemorrhoids, or a bleeding malignant ulcer in the gastrointestinal tract. Malabsorption of iron can also cause this anemia, such as is seen in subtotal or complete gastrectomy, a habit of eating clay (pica), or as part of a malabsorption syndrome. Pica, which is the craving of unusual foodstuffs, is associated with iron deﬁciency anemia, especially pagophagia or the craving for ice, whichis the most common kind of pica. Up to 58% of patients with iron 131
132 DeRossi and Raghavendra Table II. Manifestations and treatment of anemia
Kind of anemia Blood loss anemia Iron deﬁciency anemia
ORAL SURGERY ORAL MEDICINE ORAL PATHOLOGY February 2003
Manifestations Pica, especially pagophagia Impaired motor and mental development in children Pallor: Koilonychia Atrophic tongue...