Dr. Rupak Sethuraman
SPECIFIC LEARNING OBJECTIVES
 Various hematological disorders affecting the oral
maxillofacial region.
 Oral manifestations, diagnosis and management of
these disorders.
IRON DEFICIENCY ANEMIA
 Iron deficiency is defined as a reduction in total body
iron to an extent that iron stores are fully exhausted
and some degree of tissue iron deficiency is present.
 The most common cause is physiologic and relates to
nutritional deficiency.
 More common in females during their young age due
to menstrual iron losses and during pregnancy due to
increased demands.
 Other less common causes of iron deficiency anemia
are increased gastrointestinal blood loss from gastritis
due to chronic use of aspirin or other nonsteroidal
anti-inflammatory drugs and regular blood donations
in premenopausal women.
 Pathologic iron deficiency anemia is invariably due to
excessive blood loss.
CLINICAL MANIFESTATIONS
 Chronic fatigue
 Pallor of the lips, conjunctivae and oral mucosa
 Brittle and spoon shaped nails
 Palpitations and shortness of breath
 Numbness and tingling in fingers
 Bone pain
ORAL MANIFESTATIONS
 Glossitis with atrophy of filiform and fungiform
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papillae
Pale oral mucosa
Oral candidiasis
Recurrent aphthous stomatitis
Erythematous mucositis
Burning mouth syndrome
DIAGNOSIS
 Anemia as shown by reduced hemoglobin on a
Complete Blood Count is typically the first clue to iron
deficiency.
 A peripheral blood smear and examination of the
erythrocytes show microcytic and hypochromic red
blood cells in chronic iron deficiency anemia.
 Definitive diagnosis requires that there should be
reduction in serum ferritin (which is the storage form
of iron).
TREATMENT
 The treatment of iron deficiency should always be
initiated with oral iron supplementation.
 Ferrous sulfate is the preferred form of oral iron
because of low cost and high bioavailability, typically
administered at 325 mg (60 mg iron) orally three times
daily.
 The patient’s health should improve in 4 to 8 weeks.
 When this therapy fails parenteral iron can be given.
 Common preparations include iron dextran, iron
gluconate and iron sucrose.
ORAL HEALTH CONSIDERATIONS
 For dental patients with extremely low hemoglobin
levels, physician consultation
treatment is recommended.
prior to surgical
 When the hemoglobin is less than 8 g/dl, general
anesthesia should be avoided and the potential for
clinical bleeding and faulty wound healing should be
recognized.
 Use of narcotic analgesics should be limited for those
patients diagnosed with severe anemia, and dentists
should be aware that anemia places a patient at
increased risk for ischemic heart disease.
LEUKEMIA
 Leukemia results from the proliferation of a clone of
abnormal hematopoietic (blood forming) cells with
improper differentiation, regulation, and programmed
cell death (apoptosis).
 Leukemia is classified based on clinical behavior
(acute or chronic) and the primary hematopoietic cell
line affected (myeloid or lymphoid).
 The four principal diagnostic categories are the
following:
 Acute Myelogenous leukemia (AML),
 Acute Lymphocytic leukemia (ALL),
 Chronic Myelogenous leukemia (CML), and
 Chronic Lymphocytic leukemia (CLL)
CLINICAL PRESENTATION
 Symptoms include
 Fever
 Weight loss
 Muscle or joint pain
 Fatigue/Malaise
 Anemia/ pallor
 Mucosal bleeding
 Petechiae and
 Local infections
 The most common manifestations or clinical signs of
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acute leukemia at initial presentation are
Lymphadenopathy
laryngeal pain
gingival bleeding
oral ulceration and
Gingival enlargement
ORAL HEALTH CONSIDERATIONS
 Prechemotherapy dental assessment
 Maintenance of oral hygiene and
 Management of periodontal infection have been
shown to be effective in preventing oral and systemic
complications during treatment.
 Decrease in platelet and White blood cell count is
common in acute leukemia and
management before dental treatment.
may require
 Any Questions??
 Thank you