IRON

DEFICIENCY
Elaine Reuben, Minnah Shahzad, Alex Wecker, Fiona
Weeden, Greniqueca Mitchell
What is Iron Deficiency
Anemia?
● Smaller and less pigmented than normal red blood
cells
● Usually presented as asymptomatic in individuals
(CDHO factsheet Anemia, 2019)
● Iron deficiency - type of anemia caused due to
insufficient levels of iron in the body
○ A person’s blood has a lower than normal
amount of red blood cells
○ The red blood cells cannot carry hemoglobin
effectively throughout a person’s body
■ Lack of oxygen throughout the body
(Mayo Clinic, 2019)
 Etiology
● Iron deficiency develops when there’s not enough iron in a person’s body to
produce a sufficient amount of hemoglobin
● In North America and Europe, blood loss is the most common cause of iron
deficiency anemia
○ It is associated with gynecological conditions, menorrhagia, uterine
fibroids, and chronic blood loss(CDHO Advisory Anemia, 2020)
● Loss of blood leads to the loss of iron:
○ Women with heavy menstrual cycles are at risk of developing iron
deficiency
○ Internal bleeding conditions such as peptic ulcers or hiatal hernias lead to
slow chronic blood loss in the body
○ Gastrointestinal bleeding may also be a factor contributing to blood loss
(Mayo Clinic, 2019)
● Other common causes of iron deficiency:
○ Lack of iron in a person’s diet
○ The inability to absorb iron by the small intestine
○ Pregnancy
 Manifestations (Signs and Symptoms)
Tongue Swelling/Soreness
Dizziness/Headache

Fast/Irregular Heart beat

Shortness of Breath

Fatigue/Weakness Cold Feet/Hands

Brittle Nails/Hair
Tingling in Legs

Pale Skin

(Cafasso, 2015)
 Severe Symptoms

Pica Koilonychia (spoon-shaped

nails)
Dental Considerations and Implications
● Most iron deficiency anemia cases are likely to be medically cleared for dental hygiene
procedures
○ Clients with iron deficiency anemia may experience minor blood loss during procedures
and are likely to tolerate this bleeding well (CDHO factsheet Anemia, 2019).
● MILD iron deficiency anemia may present with atrophy of the filiform and fungiform papillae on
the dorsal tongue surface (Darby & Walsh, 2015).
● Iron deficiency can also cause:
○ Burning sensation of the oral mucosa and tongue
○ Atrophic glossitis
○ Swelling of the tongue
○ Lingual varicosity
○ Lichen planus
○ Xerostomia
○ Oral candidiasis may also result from iron deficiency anemia (CDHO factsheet Anemia,
2019).
○ Mucosal pallor is another common oral manifestation (Jarnagin et al., 2020).
● Chronic cases of iron deficiency anemia can be associated with Plummer-Vinson syndrome in rare
circumstances.
○ Plummer-Vinson syndrome - dysphagia, glossitis, angular cheilitis, atrophy of the papillae
on the dorsum of the tongue, atrophy of the upper gastrointestinal tract, and susceptibility
to esophageal and oral cancer (CDHO factsheet Anemia, 2019).
 Case Study
Iris Incisor is a 27 year old female Caucasian born in Whitby, Ontario where she
still currently resides and works as an elementary school teacher. She has
always been a very health conscious person eating a mainly vegetarian diet.
She is a very active person who goes to the gym 4-5 times per week. However,
she is currently in her twelfth week of pregnancy, with twins and has been
experiencing a lot of morning sickness. Iris is a non-smoker and prior to her
pregnancy she enjoyed her daily, evening glass of red wine. Iris has a couple of
existing composite restorations from when she was a teenager, however she
now visits the dentist every 6 months and has adequate oral health habits. Iris
was recently diagnosed with iron-deficiency anemia that has been causing her
to experience xerostomia, a burning sensation on her tongue, as well as a
swollen tongue. Her physician recommended that she begin taking an OTC iron
supplement, however she has been struggling to take them as she finds it
exacerbates her morning sickness.
Scenario
Iris comes in for her regular 6 month recare
appointment. As you walk her into your
operatory and begin to start her medical history
update she informs you that she is 12 weeks
pregnant and has recently been diagnosed with
iron-deficiency anemia. She tells you that she
has been taking an OTC, prenatal iron
supplement, however she has a hard time
keeping the medication down due to her
persistent morning sickness. As Iris continues
to explain her situation to you she suddenly
pauses and places her hand over her eyes. Iris
tells you that she is suddenly, really
light-headed and her heart feels like it’s beating
very fast. You notice that she is looking pale and
she is sweating.
CRITICAL
THINKING
QUESTIONS
 What do you think Iris is likely
experiencing?

Iris is experiencing an episode of tachycardia

(elevated heart rate) along with several other severe
symptoms of anemia, such as feeling light headed,
becoming pale and sweating (CDHO, 2019).
 Would you continue with care?

No, care is contraindicated. Allow Iris to slowly sit up,

taking her time. Offer her some water and a granola
bar or juice box. Assist her with contacting a ride
home and refer her to her family physician for follow
up (CDHO, 2019).
 Do you think that Iris’ iron deficiency
symptoms are impacting her oral cavity?

“Iron deficiency can manifest as burning sensation of

the oral mucosa and tongue, atrophic glossitis,
swelling of the tongue, lingual varicosity, lichen
planus, and xerostomia. 3 Oral candidiasis has also
been linked to iron deficiency anemia, which
exacerbates angular cheilitis and depapillation of the
tongue” (CDHO, 2019).
 Contraindications to Care
For iron deficiency anemia:

● Non-invasive procedures are allowed

○ Medical consult is advised
● Invasive procedures are contraindicated
○ Medical clearance is required for any blood disorders including
iron deficiency anemia.
○ Iris’ anemia would be untreated/unstable (not taking
prescribed meds) so invasive care procedures would not be
advisable

For pregnancy:

● No contraindications to care for invasive and non-invasive

procedures
○ Not high risk pregnancy
 Collaboration
● DH needs to ensure that medical clearance is given by Iris’ physician
before dental hygiene care can proceed.
○ “Anemia related to pregnancy occurs because fluid gain
during pregnancy dilutes the blood, thereby lowering the
relative concentration of red blood cells.” (2019). As such,
continued clearance from her physician would not be required
after her pregnancy comes to term.
 Is a Referral Required?
● Yes
○ Anemia not properly controlled
■ Client experiencing symptoms relating to severe iron deficiency
(light-headed, tachycardia)
■ Client’s inability to keep down iron supplements
Care Plan
● Next appointment
○ Medical clearance
○ Medical alert
○ Any new medications? Side
effects?
○ Any directions given by MD?
● Client Education
○ Diet (foods high in iron)
○ Periodontal disease and
pregnancy
○ Proper oral hygiene care
○ Regular dental visits
○ Self oral examinations
References
Cafasso, J. (2015, October 15). Iron Deficiency Anemia. Healthline; Healthline Media. Retrieved
from https://www.healthline.com/health/iron-deficiency-anemia#treatment
College of Dental Hygienists of Ontario. (2019, March 5). CDHO factsheet anemia. CDHO.
Retrieved from
https://www.cdho.org/Advisories/CDHO_Factsheet_Anemia.pdf
College of Dental Hygienists of Ontario. (2020, July 27). CDHO Advisory Anemia. CDHO.
Retrieved from
https://www.cdho.org/Advisories/CDHO_Advisory_Anemia.pdf
College of Dental Hygienists of Ontario. (n.d.). Prescribed contraindications to scaling teeth and root planing, including curetting
surrounding tissue, on member's own initiative. CDHO.
Retrieved from
https://www.cdho.org/docs/default-source/pdfs/reference/part-iii---contraindications.pdf?sfvrsn=d1dc82a0_6
College of Dental Hygienists of Ontario. (2014, Sept 11). CDHO factsheet pregnancy. CDHO.
Retrieved from
https://www.cdho.org/Advisories/CDHO_Factsheet_Pregnancy.pdf

Darby, M. L., & Walsh, M. M. (2015). Dental Hygiene: Theory and practice (4th ed.). St. Louis, MO: Saunders/Elsevier

Jarnagin, N., RDH, & BSDH. (2020, October 18). Iron-Deficiency Anemia: What Dental
Hygienists Need to Know. Today’s RDH. Retrieved from
https://www.todaysrdh.com/iron-deficiency-anemia-what-dental-hygienists-need-to-know/
Mayo Clinic. (2019, October 18). Iron deficiency anemia - Symptoms and causes. Mayo Clinic.
Retrieved from
https://www.mayoclinic.org/diseases-conditions/iron-deficiency-anemia/symptoms-caus
es/syc-20355034