The association of childhood iron deficiency anaemia with severe dental caries

Iron is an essential nutritional element. Iron deficiency anaemia (IDA), the consequence of the lack of iron for haemoglobin (Hb) synthesis, represents a major public health problem in both developing and industrialized countries (1,2). Despite a plethora of publications on the importance of iron, iron deficiency (ID) continues to be the most common nutritional deficiency in the world (1,2). Its deficiency might cause irreversible shortand long-term dysfunction to the developing central nervous system (1,3). Health authorities around the globe regularly issue guidelines regarding iron supplementation to avoid ID in children (4,5). Nevertheless, the fact that ID is still frequently encountered may be related to other factors. Severe childhood dental caries (SC) and other dental pathologies are common in children and adolescents. The strongest predictors of the incidence of caries appear to be baseline levels of caries activity, oral hygiene level, counts of cariogenic microorganisms in plaque and saliva, history of fluoride use, sucrose intake and parental socioeconomic status (6). Dental caries and its resulting discomfort and pain can interfere with proper nutrition including iron intake causing IDA (7–9). In this study, we aimed to investigate the Hb, iron and other anaemia indexes status of our patients before and 4–6 months after the dental SC restoration. We compared the values with an ageand sex-matched control groups. This study was approved by the hospital’s ethics committee. Children were sequentially enrolled as they presented for dental treatment at the dental clinic at the Bnai Zion medical center for SC between January 2007 and September 2008. One hundred and fifty children were screened for the study. Participants were required to meet the following inclusion criteria: healthy children with no chronic illness, ages 3–18 years who presented with SC pathology and a microcytic anaemia caused by ID. The exclusion criteria included chronic or acute illness, known blood dyscrasia, any known form of haemoglobinopathy, children who had undergone abdominal surgery or had been diagnosed with malignancy. The control group included thirty children who presented for elective minor surgery (inguinal or umbilical hernia repair, orchiopexy and circumcision) and had no caries on dental examination. Demographic data including age, sex, height, weight and number of teeth needed to be treated were collected for both groups. None of our participants had received red cell transfusions. Under sedation, a 5 mL of blood sample was obtained for complete blood count, iron, ferritin, transferrin, B12, folic acid and albumin. The blood sample was repeated in the study group 4–6 months later. Children in both groups were examined by a paediatric dentist. The dental assessment included the clinical examination for dental decay and the gingival tissues as an indication of oral hygiene. The surfaces of all erupted teeth were assessed using the DMFTS index (decay, missing, filled teeth and surfaces). Children were included in the study when they had six or more teeth that required restoration treatment. ID was defined as iron levels below 50 lg ⁄ dL and ⁄ or ferritin levels below 24 ng ⁄ mL. RDW (red cell distribution width) >14.5% and Mean Corpuscular Volume (MCV) < 80 fL indicated ID. ID anaemia was defined when in addition to ID, Hb levels were below 12 gr ⁄ dL. The study patients did not receive iron supplementation throughout the study. Acta Pædiatrica ISSN 0803–5253