IRON AND ORAL HEALTH

• Introduction
• History
• Source
• Requirement
• Distribution & Forms of iron in the body
• Functions
• Metabolism
• Deficiency
• Applications
• Dental considerations
• Conclusion
• References
INTRODUCTION
• Transition element.

• Iron is an essential micronutrient.

• Integral component of several proteins and enzymes involved in

formation of HAEMOGLOBIN & MYOGLOBIN, Cytochrome,
cytochrome oxidase, peroxidase and catalase.
HISTORY
• “Lauha bhasma” (calcined iron)  ancient Indian medicine.

• GREEK  MARS  IRON

Iron was used to treat weakness,
which is common in anaemia.

• 1713  iron present in blood.

• Early 19th century  Blaud developed his famous ‘BLAUD’S PILL’

for anemia.

COMPOSITION
Ferrous sulfate
+
Potassium carbonate for anaemia.
 SOURCES OF IRON
NON-HAEM
HAEM-IRON:
IRON:
• Liver
• Cereals • Oil seeds
• Meat
• Green leafy • Jaggery
• Poultry
vegetables • Dried fruits
• Fish
• Legumes
• Nuts
FOODS increasing the Absorption FOODS reducing the Absorption
of Iron
of Iron
• Calcium containing food like
• Foods containing Vitamin C
milk , curd and cheese.
• Citrus fruits
• Fiber containing food
• Amla , tomatoes
• Phytates containing foods like
• Sprouts
pulses, legumes,grains

• Tea

• Coffee
DIETARY SUPPLEMENTS OF IRON:-

• Multivitamin/ multimineral supplements with iron

for women- 18mg iron

• Iron-only supplements usually deliver more than the DV,

IRON SUPPLEMENTS:-
with many providing 65 mg iron (360% of the DV).
1.Iron salts:-
Ferrous sulfate, Ferrous gluconate,
Ferric citrate, Ferric sulfate.
2.Other forms:-
Heme Iron Polypeptides, Carbonyl Iron, Iron
Amino-acid Chelates, And Polysaccharide-iron
Complexes
Recommended daily iron supplementation as a public health
intervention

 Infants and children (6 – 23 ) months  10-12.5 mg elemental

iron  daily for 3 consecutive months in a year.
 Pre-school age children (2-5 years)  30 mg elemental iron
 daily for 3 consecutive months in a year.
 School age children (> 5 years)  30–60 mg elemental iron
 daily for 3 consecutive months in a year.
 Daily Requirement

• Food and Nutrition Board (FNB) developed Dietrary Reference

Intakes (DRI) which provide the intake recommendations for iron
and other nutrients.

• DRI is a general term for a set of reference values

DRI used for planning and assessing nutrient intakes of
healthy people.

• Average daily level of intake sufficient to

meet the nutrient requirements of
RDA nearly all (97%–98%) healthy
individuals. Used to plan nutritionally
adequate diets for individuals.
Recommended Dietary Allowances (RDAs) for Iron

Age Male Female Pregnancy Lactation

Birth to 6 months 0.27 mg* 0.27 mg*

7–12 months 11 mg 11 mg

1–3 years 7 mg 7 mg

4–8 years 10 mg 10 mg

9–13 years 8 mg 8 mg

14–18 years 11 mg 15 mg 27 mg 10 mg

19–50 years 8 mg 18 mg 27 mg 9 mg

51+ years 8 mg 8 mg

The RDAs for vegetarians are 1.8 times higher than for people who eat meat.
This is because heme iron from meat is more bioavailable than non-heme
iron from plant-based foods, and meat, poultry, and seafood increase the
absorption of non-heme iron
AVG.DAILY IRON INTAKE FROM AVG. DAILY IRON INTAKE FROM
FOODS. FOODS & SUPPLEMENTS

Children(2-11 11.5-13.7 Children(2-11 13.7-15.1

years) mg/day years) mg/day

Teens(12-19 15.1 mg/day Teens(12-19 16.3 mg/day

years) years)

Adult men 16.3-18.2 Adult men 19.3-20.5

mg/day mg/day

Adult women 12.6-13.5 Adult women 17-18.9

mg/day mg/day

Median dietary intake in pregnant women is 14.7 mg/day

DISTRIBUTION OF IRON IN THE BODY

Total quantity of iron in the body is 4 g.

Approximate distribution of iron in the body is as
follows:

Haemoglobin : 65%
to 68% STORAGE FORM:
Muscle as myoglobin FUNCTIONAL FORM Reticulo-endothelial
: 4% Plasma as transferrin system : 25% to 30%
Intracellular oxidative : 0.1% ( Ferritin &
haeme compound : Hemosiderin )
1%
Daily loss of IRON
• 1mg – lost through faeces daily.
IRON IS NOT LOST THROUGH URINE

• 1g Hb-3.34 mg of Iron

• Normally, 100 ml of blood-15 gm Hb

50 mg iron

• About 50 ml of blood is lost during menstruation. Thus 25 mg of

iron is lost.

• Iron loss is increased during haemorrhage and

blood donation.
FUNCTIONS OF IRON

• Haemoglobin formation

• Brain development &

Function

• Regulation of body temperature

• Muscle activity

• Catecholamine metabolism

• Immune system

• OXYGEN TRANSPORT & CELL RESPIRATION

1. Haemoglobin formation

The role of iron in haemoglobin synthesis at both

• cellular level and

• total erythropoiesis of the intact organism.

 at cellular level- presentation of iron to the cell

invitro- soluble salts of iron are easily assimilated by

immature RBCs.
invivo- transport vehicle is an iron-binding plasma
protein.
 Pronormoblast and normoblast stages have great capacity to
assimilate iron.
National Academy of Sciences (US) and
National Research Council (US) Division of
2. Brain development & Function
• Iron is a necessary nutrient for rapidly

proliferating or differentiating tissues

• As fetal and early postnatal life shows

rapid brain growth and development ,

it exhibits high requirements of iron.

• Deficiencies of nutrients that affect brain development and function shift

the world’s IQ potential negatively by at least 10 points .

• According to WHO, Iron deficiency is the most common of these nutrient

deficiencies, affecting an estimated 2 billion people worldwide including
20–30% of pregnant women and their offspring.

Adv Nutr. 2011 Mar; 2(2): 112–121

IRON METABOLISM
Daily loss
• In males, about 1 mg of iron is excreted everyday through
• feces. In females, the amount of iron loss is very much
• high. This is because of the menstruation.
• One gram of hemoglobin contains 3.34 mg of iron.
• Normally, 100 mL of blood contains 15 gm of hemoglobin
• and about 50 mg of iron (3.34 × 15). So, if 100 mL of
• blood is lost from the body, there is a loss of about 50 mg
• of iron. In females, during every menstrual cycle, about
• 50 mL of blood is lost by which 25 mg of iron is lost. This
• is why the iron content is always less in females than in
• males.
• Iron is lost during hemorrhage and blood donation
• also. If 450 mL of blood is donated, about 225 mg of iron
• is lost.
pathology
• Anaemia is defined as reduced haemoglobin
concentration in
• blood below the lower limit of the normal range for the
age and
• sex of the individual. In adults, the lower extreme of the
normal
• haemoglobin is taken as 13.0 g/dl for males and 11.5 g/dl
for
• females. Newborn infants have higher haemoglobin level
and,
• therefore, 15 g/dl is taken as the lower limit at birth,
whereas
• at 3 months the normal lower level is 9.5 g/dl
Iron deficiency anemia
• Iron deficiency anaemia develops when the supply of iron is
• inadequate for the requirement of haemoglobin synthesis.
• Initially, negative iron balance is covered by mobilisation from
• the tissue stores so as to maintain haemoglobin synthesis. It is
• only after the tissue stores of iron are exhausted that the supply
• of iron to the marrow becomes insufficient for haemoglobin
• formation and thus a state of iron deficiency anaemia develops.
• The development of iron deficiency depends upon one or more
• of the following factors:
• 1. Increased blood loss
• 2. Increased requirements
• 3. Inadequate dietary intake
• 4. Decreased intestinal absorption
• CLINICAL FEATURES
• Common in women between the 20-45 years.
• At periods of active growthin infancy, childhood and
adolescence
• More frequent in premature adults.
• Manifestations are
1. Anaemia FIRST STAGE:
2. 2. Epithelial changes Storage of iron depletion

• LABORATORY FINDINGS:-
DEVELOPMENT OF ANAEMIA SECOND STAGE:
Iron deficient erythropoiesis

THIRD STAGE:
Frank iron deficiency anemia
• Features of iron deficiency anemia:
• 1. Brittle nails,
• 2. Spoon shaped nails (koilonychias),
• 3. Brittle hair,
• 4. Atrophy of papilla in tongue
• 5. Dysphagia (difficulty in swallowing
• Side effects
• • 10 to 20 percent of patients complain of nausea,
• epigastric distress and/or vomiting after taking oral
iron
• preparations
• • Constipation
• • Black stools (can confuse with melaena)
• • Try smaller dose of elemental iron
• • switch from a tablet to a liquid preparation
• Public health Scenario
• • A moderate degree of iron-deficiency anemia
affected
• approximately 610 million people worldwide or 8.8%
of
• the population.
• • It is slightly more common in female (9.9%) than
males
• (7.8%).
• • Mild iron deficiency anemia affects another 375
million
• NACP (National Anemia Control Programme):
• • Pregnant women are regularly screened for anemia
• during pregnancy.
• • Pregnant women are given 100 tablets of 60 mg
• Elemental Iron and 500 μg Folic Acid as prophylaxis
• to prevent anemia
• • Pregnant Women with Moderate Anemia are given
• 200 IFA tablets to be taken twice a day.
• • Pregnant Women with severe anemia (Hb% < 7gm/dl)
• are treated with Parenteral Iron
• • Lactating Mothers are provided 60 mg of elemental
• Iron and 500 mcg of Folic Acid tablets for 3 months.
• 0n 18-04-2011, a meeting was held in Prime
Minister’s Office
• on the promotion of consumption of Iron Fortified
Iodized Salt
• as a measure to deal with malnutrition in the
country.