Iron Deficiency Anemia and Early Childhood Caries

Iron Deficiency Anemia and ahead of time Childhood CariesAssociation amidst entreat inadequateness genus Anemia and archaeozoic childhood tooth decayTommy YeBackgroundEarly childhood dental caries (error correction code) and squeeze deficiency anemia (IDA) ar a global health problem in both the developing and developed countries such as China, India, United States (US) and the United Kingdom. error correction code is a term coined by the Centers of Diseases and Control (CDC) at a 1994 workshop in an attempt to focus attention on the eightfold factors (i.e. socioeconomic, behavi viva voce, and psycho-social) that contribute to caries at such early periods, rather than ascribing mend causation to inappropriate feeding methods (Colak, 2013). As the Ameri after part Academy of Pediatric Dentistry states, ECC skunk be only be defined as the presence of any smooth surface caries for children under the age of 3 and the presence of one or more smooth surface lesions in any pri mary maxillary anterior teeth for those 3 to 5 years of age (or a dmft decay, missing, filled, teeth score of 4 (age 3), 5 (age 4), or 6 (age 5)) (Schroth, 2013). These are the same definitions and criteria that most dental consonant practitioner used to assess children of early childhood caries. ECC commonly starts off as a demineralization of the enamel, which leads to severe decay in mostly the cervical regions of primary maxillary incisors and then later into the other anterior teeth. The decay, in some subject areas, burn down withal affect the labial and/or lingual surfaces of the maxillary anterior teeth. The aetiology of ECC is very complex and is considered multifactorial, but one commonly accepted etiology is the association with frequent consumption of fermentable carbohydrates and improper bottle- or breast-feeding practices ( tone, 2012).Anemia is the reduction of the total circulating red cell mass below the design limits, which in return reduces the oxygen-ca rrying capacity of the blood and ultimately tissue hypoxia and ischemia. Anemia is classified by either its cause (hemolytic anemia, thrombocytopenic anemia, etc.) or its RBC size (macrocytic, microcytic anemia). Nearly fractional of anemia characters are caused by iron deficiency anemia (IDA), where IDA is the consequences of the lack of iron for hemoglobin synthesis (Shaoul, 2011). IDA is prevalent among young children and pregnant women. If left untreated, IDA can lead to the mental and physical development of children and increased death and morbidity of the other anemic patients. Diagnostic exam used to establish the diagnosis of IDA is the off-base blood smear. With the blood smear, we want to analyze ferritin, hemoglobin, and Mean Corpuscular Volume (MCV), as they are key biochemical indicators of iron post (Schroth, 2013).As you can see above, both ECC and IDA are very similar health problems that can both affect children and the patients quality of living tremendously. Some studies reach indicaten that dental caries and its resulting innervation and pain can interfere with proper nutrition including iron intake, causing IDA (Shaoul, 2011). This research has shown that at that place is some connection between ECC and IDA. Despite the fact that ECC and IDA are global health problems declared by the World Health Organization (WHO), in that location is not enough unfluctuating point to highlight the close kind between the two conditions and the mechanism used to explain this deadly relationship. In this report, I aimed to use my clinical case and analysis of multiple studies to prove my point that there is a strong association between iron deficiency anemia and early childhood caries and that more needs to be done to address this concern in terms of dental wariness and intervention.Introduction of F.B. and her presentation of condition or risk of exposure of infectionF.B., a 25-year-old woman with a history of iron deficiency anemia and ea rly childhood caries, presents to New York University College of Dentistry (NYUCD), for a dental check up. She takes no medication for her anemic condition and review of the CBC from her MD were tout ensemble within the normal limits. On exam, she needs several restorations and multiple fixed prosthodontic works.MethodologyClinical Question In ECC patient, ordain patient with iron deficiency anemia increase their chances of having more dental caries and periodontal problems in the future, compared to patient without a significant medical history?PICO PECC patient, Ipatient with iron deficiency anemia, Cpatient without a significant medical history, and Oincrease their chances of having more dental caries and periodontal problemsLiterature Search Literature searches were done in PubMed using the keywords iron deficiency and anemia with the Boolean operator and.Literature ReviewFrom the literature search, I found ternary articles that were applicable to the clinical question and th e aim of this report. The three articles are listed belowAssociation between iron status, iron deficiency anemia, and severe early childhood caries a case-control study by Robert J. Schroth et. alThe Association of childhood iron deficiency anemia with severe dental caries by Ron Shaoul, et. alRelationship between dental caries status and anemia in children with severe early childhood caries by Ru Shing Tang, et. alThe goal of Schroths study was to investigate the relationship of the varied iron and hemoglobin levels btn the ECC and caries-free patients. In order to do such a thing, Schroth and the others decided to perform a case control study. They recruited 266 children, where 144 of them have ECC and the last 122 of them are caries-free. ECC patients were both recruited from Winnipeg, Canada between October 2009 and August 2011. All of these children fulfilled the inclusion criteria where they essential have severe tooth decay involving multiple primary teeth necessitating re habilitative dental surgery under general anesthetic (GA) (Schroth, 2013). The caries-free patients were the control group and were recruited from the same area and time period. They all underwent a dental assessment, without radiographs, by the researchers to ensure they were caries-free (dmft = 0) (Schroth, 2013). Both the ECC and the caries-free patient must(prenominal) be healthy and are less than 72 months of age the average age of all the participating children were 40.8 14.1 months.Schroth and the others collected demographic entropy by making the parents of the children answer an interviewed questionnaire regarding their childs nutritional habits, use of supplements, physical and oral health, oral hygiene and dental habits, socioeconomic status (e.g. household income), and family demographics. (Schroth, 2013). Afterward, they collected serum samples of all but 4 children in the operating room by the attention anesthesiologist. From the laboratory results, Schroth and the others were able to obtain the necessary data to arrive at the following conclusionsChildren w/ ECC had significantly lower ferritin status and hemoglobin levels than caries-free childrenChildren w/ ECC had significantly greater odds for iron deficiency and iron deficiency anemia than caries-free childrenThis conclusion helped to reinforce and help to support the authors claim that there is an indeed an association between iron deficiency anemia and early childhood caries. The authors do not understand the reasons why that is the case, but they hypothesized that it might be referable to the bodys inflammatory response that accompanies from dental caries. They believed that inflammation associated with ECC may trigger a series of events which ultimately leads to the work of cytokines, which may, in turn, inhibit erythropoiesis and thus reduce the level of hemoglobin in the blood (Schroth, 2013). Dental caries may withal cause severe pain and discomfort for the ECC patient, which may, in turn, caused the patient to eat less and hence the low iron level. Ultimately, the decrease in hemoglobin and iron are the main subscriber to anemia or IDA.The purpose of Shaouls study was to investigate the differences in the levels of hemoglobin (Hb), iron, and other anemic indicators before and 4-6 months after an ECC dental restoration. In order to do such a thing, Shaoul and the others decided to perform a case control study. They recruited 155 children, where 33 of them are the control group, who visited the dental clinic for treatment for ECC at Bnai Zion Medical Center in Haifa, Israel between January 2007 and September 2008. All of these children fulfilled the inclusion criteria where they have to all be healthy with no inveterate diseases and all within the age range of 3-18 years old who are presented with ECC and microcytic anemia that are caused by IDA. The exclusion criteria included chronic or acute illness, known blood dyscrasia, any known form of haemoglobi nopathy, children who had undergone abdominal surgery or had been diagnosed with malignancy (Shaoul, 2011). The 30 children that were selected, as the control group, must meet these additional inclusion criteria where they must be presented for an elective minor surgery such as inguinal or umbilical hernia repair, orchiopexy and circumcision and is also caries-free upon examination. For the other 122 children, the surfaces of all their erupted teeth were assessed with the DMFTS index and they must have had six or more teeth that required restoration treatment to be in reality included in this study (Shaoul, 2011).In order to consider the confounding variables that may skew the results of their study, Shaoul and the others collected the age, sex, height, weight and the number of teeth that needs to be treated from both groups. Afterward, they obtained 5 mL serum samples of two groups before and 4-6 months after an ECC restorative procedure. From the laboratory results, Shaoul and th e others were able to obtain the necessary data to arrive at the following conclusionsECC and caries-free children had significantly low BMI, Hb, iron, ferritin, MCV, and RDW (or red cell distribution width) levels before an ECC restorative procedureThere are significant differences between the Hb, iron, ferritin and RDW levels 4-6 months before and after an ECC restorative procedureThis conclusion highlighted that there is an association between iron deficiency anemia and early childhood caries. In addition to that, this study have also demonstrated that a dental treatment of a ECC lesions can effectively heal the anemic indicators to a non-IDA level, without the need of any supplemental iron. The authors are unsure how there is an association between IDA and ECC, but they hypothesize that it might be due to malnutrition (which can explain the low BMI in the results) or due to inflammation from dental caries.The objective of the last study by Tang et. al was to assess the nutriti onal status of an ECC patient and the relationship with IDA. In order to do such a thing, Tang and the others decided to perform a case control study. They recruited 101 children between 2 and 5 years of age who visited the Department of Pediatric Dentistry of Kaohsiung Medical Center. All of these children fulfilled inclusion criteria where they must be diagnosed with ECC according to criteria established by the American Academy of Pediatric Dentistry. The exclusion criteria included children with medical problems, mental or physical disabilities, and those who had been innate(p) prematurely (Tang, 2012). Demographic information such as sex, income, body weight and height were obtained from most parents except 50 parents who did not provide their income via a questionnaire. The surfaces of all the childrens erupted teeth were assessed with the DMFT and DEFS indices.In order to adjust for the confounding variables that can skew the result of the study, Tang and others obtained the a ge, gender, BMI, and mothers education. Besides obtaining the demographic information, Tang and the other also collected blood serum from all but two participants. With this sample, Tang and the others were able to arrive at the following conclusionChildren with ECC had significantly greater odds for anemia and IDA and are independently associated with each other.This conclusion demonstrated that children with ECC are at an even higher risk than caries-free patients for anemia and IDA and that this association between ECC and IDA is a very deadly combination that needs to be addressed as early as executable by pediatric dentists and pediatricians. The authors do not understand the etiology behind this association but they provided their own hypotheses behind it. They argued that children with ECC cannot consume iron-rich and vitamin-C rich aliment because of the pain and discomfort they felt and as a result, they are forced to rely on softer food that does not impinge on their tee th by drinking lots of cows milk. Furthermore, because the children with ECC have lots of dental caries, they are suffering from inflammation from these caries that may induce the production of cytokines that suppresses the synthesis of Hgb (Tang, 2012).In relationship to the Literature analysis form (LAF) adapted from Dr. Ralph V. Katz of NYUCD, (presented below) the above three articles all lack a null hypothesis and can contribute to a moderate statement of causation for being a case control study. All authors have clearly separated the independent variables by using a control group, eligibility criteria, and adjusted statistical analyses such as the Chi-square and T-test in the first and third study and T-test in the second study. Almost all of the findings were of statistical significance (PDescription of F.B.F.B. emigrated to the U.S. at age 15 from Albania with her parents, in pursuit of the American Dream. She drinks socially and do not smoke. She is a dental student at NYU CD. Upon entering dental school, F.B. had poor oral hygiene where she did not floss regularly but brushes twice a day. She consumed a heavy carb-rich diet. Her iron deficiency anemia has been better controlled through a well-balanced diet that includes iron and folate intake. This had been confirmed via a CBC, where all anemic indicators were within the normal limit. She had no other significant medical history. Her vital signs were within the normal limits as well.DiscussionsThe general consensus of the three articles clearly indicates that there is clearly a relationship between ECC and IDA and that more studies needs to be done to determine the actual etiology behind this association. Despite all the evidence that show that there is an association, the studies including the above three articles that are available are just not substantial to show a strong causation. In addition, the limitations in each of studies that I described above are also making these articles less convincin g to incorporate into our dental practices.ConclusionDespite the fact that the studies do not show a strong causation for the association between ECC and IDA, the evidence is convincing enough that warrants further research and questions among the dental and medical communities throughout the world. The evidence also helped to answer my clinical question if ECC patient with IDA (in this case, patient F.B) will increase their chances of having more dental caries and periodontal problems in the future. As you can see from the results provided by the three articles, there might be some connection between ECC and IDA and can cause more dental decay or worsen the patients IDA condition if left untreated, which was noted in Shaoul et. als studies. These results prompted me to make some modifications of my dental management for patient F.B. I would put patient F.B. on more frequent recall and on an aggressive fluoride therapy due to her past ECC history. I will complete all dental restorat ions or restore any defective restorations prior to performing any prosthodontic work. To make sure that she understands the association between ECC and IDA, I would also make sure to monitor her blood count frequently and reinforce oral hygiene instructions.Works Citedolak, H., Dlgergil, . T., Dalli, M., Hamidi, M. M. (2013). Early childhood caries update A review of causes, diagnoses, and treatments.Journal of Natural Science, Biology, and Medicine,4(1), 2938. Doi10.4103/0976-9668.107257Tang et al. (2012), Relationship between dental caries status and anemia in children with severe early childhood caries. Kaohsiung Journal of Medical Sciences, 29, 330-336.Schroth et al. (2013), Association between iron status, iron deficiency anaemia, and severe early childhood caries a casecontrol study. BMC Pediatrics 13(22), 1-7.Shaoul et al (2011), The Association of childhood iron deficiency anemia with severe dental caries. Acta Pediatrica 101, e76-9.AppendixLAFPhotographs of F.B.