Iron Deficiency Anemia and Early Childhood Caries

Iron Deficiency Anemia and Early Childhood Caries connector mingled with weight-lift want anaemia and betimes puerility pitTommy YeBackgroundEarly childishness caries (error correction code) and exhort deficiency anaemia (IDA) be a global health problem in twain the developing and developed countries such(prenominal) 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 shop class in an attempt to focus attention on the multiple situationors (i.e. socioeconomic, behavioral, and psycho-social) that moderate to caries at such early come ons, rather than ascribing sole originator to inappropriate feeding methods (Colak, 2013). As the Ameri sack up Academy of Pediatric dentistry states, error correction code can be only be defined as the presence of any smooth coat caries for children under the progress of 3 and the presence of one or more smooth surface lesions in any first maxillary introductory 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 argon the same definitions and criteria that approximately alveolar consonant practician apply to assess children of early childhood caries. error correction code commonly starts pip as a demineralization of the enamel, which leads to severe decay in in ecumenic the cervical regions of primary maxillary incisors and then later into the other(a) anterior teeth. The decay, in some contents, can also affect the labial and/or lingual surfaces of the maxillary anterior teeth. The etiology of ECC is very labyrinthian and is considered multifactorial, only one commonly accepted etiology is the association with frequent expending of fermentable carbohydrates and improper bottle- or breast-feeding practices ( flavor, 2012).Anemia is the reduction of the total circulate red cell mass below the normal limi ts, which in bribe reduces the oxygen-carrying capacity of the personal line of credit and ultimately tissue hypoxia and ischemia. Anemia is classified by either its cause (hemolytic anaemia, thrombocytopenic anemia, etc.) or its RBC size (macrocytic, microcytic anemia). Nearly one-half of anemia cases be caused by adjure deficiency anemia (IDA), where IDA is the consequences of the miss of press out for hemoglobin tax write-off (Shaoul, 2011). IDA is prevalent among young children and pregnant women. If leftover untreated, IDA can lead to the mental and forcible development of children and increased expiry and morbidity of the other anemic uncomplaining ofs. Diagnostic exam used to strand the diagnosis of IDA is the peripheral blood smear. With the blood smear, we want to analyze ferritin, hemoglobin, and flirt with Corpuscular Volume (MCV), as they are key biochemical indicators of iron status (Schroth, 2013).As you can see above, both ECC and IDA are very similar health problems that can both affect children and the patients feel of living tremendously. Some studies convey shown that dental consonant caries and its resulting discomfort and chafe can interfere with proper nutrition including iron intake, causing IDA (Shaoul, 2011). This search has shown that on that point is some connection amid ECC and IDA. Despite the fact that ECC and IDA are global health problems declared by the universe Health Organization (WHO), thither is non enough squiffy render to highlight the close human relationship surrounded by the two disposes and the mechanism used to explain this deadly relationship. In this report, I spirited to use my clinical case and analysis of multiple studies to prove my point that there is a strong crosstie amid iron deficiency anemia and early childhood caries and that more ask to be done to address this solicitude in terms of dental management and discourse.Introduction of F.B. and her presentation of condition or riskF.B., a 25-year-old woman with a history of iron deficiency anemia and early 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 check over of the CBC from her MD were completely within the normal limits. On exam, she needs several restorations and multiple fixed prosthodontic works.MethodologyClinical interrogative sentence In ECC patient, go out patient with iron deficiency anemia increase their chances of having more dental caries and periodontic problems in the future, compared to patient without a meaningful 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 writings search, I found three articles that were applicable to the clinical header and the aim of this report. The three articles are listed belowAssociation between iron status, iron deficiency anemia, and severe early childhood caries a case- instruction information 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 zestfulness, et. alThe goal of Schroths train was to investigate the relationship of the different iron and hemoglobin levels btn the ECC and caries-free patients. In effectuate to do such a thing, Schroth and the others inflexible to practice a case control study. They recruited 266 children, where 144 of them have ECC and the operate 122 of them are caries-free. ECC patients were all recruited from Winnipeg, Canada between October 2009 and August 2011. All of these childre n action the comprehension criteria where they must(prenominal)iness have severe tooth decay involving multiple primary teeth necessitating rehabilitative dental surgery under general anesthetic agent (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 be healthy and are slight than 72 months of age the mediocre age of all the participating children were 40.8 14.1 months.Schroth and the others collected demographic data 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. syndicate income), and family demographics. (Schroth, 2013). Afterward, they collec ted serum samples of all but 4 children in the operational room by the attending anesthesiologist. From the science lab results, Schroth and the others were able to obtain the obligatory data to arrive at the by-line shutdownsChildren w/ ECC had importantly 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 demonstration helped to reinforce and help to support the authors claim that there is an indeed an standoff between iron deficiency anemia and early childhood caries. The authors do non understand the reasons why that is the case, but they hypothesized that it might be receivable to the bodys inflammatory response that accompanies from dental caries. They believed that inflammation associated with ECC may trigger a series of rasets which ultimately leads to the production of cytokines, which may, in turn, inhibit erythropoiesis an d thus reduce the level of hemoglobin in the blood (Schroth, 2013). Dental caries may also cause severe annoyance and discomfort for the ECC patient, which may, in turn, caused the patient to eat less and therefore the low iron level. Ultimately, the decrease in hemoglobin and iron are the main contributor 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 onwards and 4-6 months subsequently 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 examination 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 chronic 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 include chronic or acute illness, known blood dyscrasia, any known form of haemoglobinopathy, children who had undergone type AB 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 modest 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 veridically included in this study (Shaoul, 2011).In order to consider the confounding variables that may reorient the results of their study, Shaoul and the others collected the age, sex, height, weight and the consider 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 the 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 impact the anemic indicators to a non-IDA level, without the need of any supplemental iron. The authors are faint-hearted 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 evaluate the nutritional 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 health check Center. All of these children fulfilled inclusion criteria where they must be diagnosed with ECC fit 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 born prematurely (Tang, 2012). demographic information such as sex, income, body weight and height were obtained from most parents except 50 parents who did non 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 age, 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 one by one associated with all(prenominal) 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 possible by pediatric dentists and pediatricians. The authors do not understand the etiology bum this association but they provided their own hypotheses behind it. They argued that ch ildren with ECC cannot consume iron-rich and vitamin-C rich pabulum because of the pain and discomfort they tangle and as a result, they are forced to rely on softer food that does not impinge on their teeth by drinking often 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 case-by-case 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 abet study. Almost all of the findings were of statist ical 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 NYUCD. Upon entering dental school, F.B. had piteous oral hygiene where she did not floss regularly but brushes in two ways a day. She consumed a heavy carb-rich diet. Her iron deficiency anemia has been bust controlled through a well-balanced diet that includes iron and folate intake. This had been support 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 inclu ding 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 convincing 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 t o make some modifications of my dental management for patient F.B. I would put patient F.B. on more frequent take out and on an aggressive fluoride therapy due to her past ECC history. I will complete all dental restorations or restore any unsound 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 monitoring device her blood count frequently and reinforce oral hygiene instructions. workings Citedolak, H., Dlgergil, . T., Dalli, M., Hamidi, M. M. (2013). Early childhood caries update A check into 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 sever e 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.