ORAL MEDICINE
ORAL MANIFESTATIONS IN IRON DEFICIENCY ANEMIA: A
CASE REPORTS
REPORT OF 40 CASES
Original Articles
Mihaela Florina Loredana Cojanu,1a* Dana Nicoleta Antonescu,1b Iulia Constantinescu,2c Anca Săsăreanu,3d
Sabina Andrada Zurac4e
1
Department of Restorative Odontotherapy, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy Bucharest, Bucharest, Romania
2
Department of Hematology, National Institute of Transfusion Hematology “Prof. Dr. C. T. Nicolau”, Bucharest, Romania
3
Department of Hematology, Institute of Oncology “Prof. Dr. Alexandru Trestioreanu”, Bucharest, Romania
4
Department of Pathology, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy Bucharest, Bucharest, Romania
DMD, Clinical Assistant
a,b
DMD
c,d
e
DMD, Professor Received: June 01, 2017
Received:
Revised: June
June 30,
15, 2017
2017
Accepted: June 29,Revised:
2017
Accepted:
Published: June 30, 2017
Published:
Academic
Academic Editor:
Editor:Constantinus
David Wray, Politis MD, DDS,BDS,
MD (Honours), MM, MHA, PhD,
MB ChB, Professor
FDS, RCPS & Chairperson,
(Glasgow), FDSOral
RCSand Maxillofacial
(Edinburgh), Surgery,
F Med Sci, University Hospitals
Leuven, KUEmeritus,
Professor Leuven, Leuven, Belgium
Professor, Department of Oral Medicine, Dental School, University of Glasgow, Glasgow, UK
Cite this article:
Cojanu MFL,
MFL,Antonescu
AntonescuDN,
DN,Constantinescu
Constantinescu I, Săsăreanu
I, Săsăreanu A, Zurac
A, Zurac SA. Oral
SA. Oral manifestations
manifestations in ironindeficiency
iron deficiency anemia:
anemia: a reportcase reports.
of 40 StomaEdu
cases. Stoma EduJ.J.
2017;4(3):114-125.
2017;4(2):114-125.
AbstrAct DOI: 10.25241/stomaeduj.2017.4(2).art.4
Introduction: The aim of this work is to reveal the clinical, radiological, immunological, cytological,
The aim of this work is to reveal the clinical, radiological, immunological, cytological, microbiological
microbiological and histopathological manifestations of oral manifestations taking the form of
and histopathological manifestations of oral pathology taking the form of sideropenia, correlations and
sideropenia, correlations and interdependence.
interdependence.
Summary: During a four-year period a study was conducted on patients with different clinical forms
Summary: During a four-years period a study was conducted on patients with different clinical forms of
of iron deficiency anemia.
iron deficiency anemia (IDA) and the prevalence of oral diseases in those patients was highlighted. This
The prevalence of oral diseases in patients with sideropenia was also highlighted. This paper
paper discusses 24 case results and presents two clinical cases, patients with iron deficiency anemia (by:
discussed three cases, patients with iron deficiency anemia (by: bleeding, gum bleeding, colon
metrorrhagia, deficiency, gingiva bleeding, colon cancer) and oral symptoms associated. The results are
cancer) and oral manifestations associated. The results are meaningful and applicable to the whole
meaningful and applicable to the whole group studied. Sampling was done according to the directions of
group under study. Sampling was done according to the directions of interest in the study of
interest in the study regarding: sex, age, the type of anemia, dental and periodontal lesions.
sentence sex, age, the type of anemia, dental and periodontal manifestations.
Key learning points: The originality of the study lies in the association of specific examination of the oral
The originality of the study lies in the association of specific examination of the oral cavity with
cavity with the investigations used in other medical specialties, which led to the creation of a more accurate
the investigations used in other medical specialties (clinical gingival periodontal, radiological,
diagnosis and the establishment of a connection (sometimes specific issues) between oral diseases and
cytological, immunohistochemical, microbiological immunoserological), which led to the creation
systemic disease, represented in this study by various forms of sideropenia.
of a more accurate diagnosis and to the establishment of a connection (sometimes specific
Keywords: oral medicine, iron deficiency anemia, sideropenia, dental and periodontal manifestations.
issues) between oral diseases and systemic disease, represented in this study by various forms of
sideropenia.
Keywords: oral medicine, iron deficiency anemia, sideropenia, dental and periodontal manifestations.
1. Introduction The purpose of this paper developed on patients
Anemia represents a world wide health problem with IDA, in collaboration with the “Prof. Dr.
1. Introduction
which affects both developing and developed C.T. erythro-kinetic
Nicolau” and etio-pathogenic.
National Institute of Transfusion
countries. It affects all groups of age. Globally Hematology, is to identify isandassociated
This study developed over a four-year period on The clinical classification describe with
oral
patients with various stages of iron deficiency decreased levels of hemoglobin and/or a
24.8% of the population reveal anemia, in Europe manifestation that occurred and also to establish
anemia (IDA), in collaboration with the National decreased packed red cell volume (hematocrit).3,4
the percentage being 22.9%. Approximately half of immunoserological values, histopathological,
Institute of Transfusion Hematology, and revealed Iron deficiency is also characterized by a reduced
the cases with anemia are due to iron deficiency.1,2 microbiological and cytological aspects
clinical, x-rays, immunological, cytological, value of the mean corpuscular volume (MCV) and
Anemia may be classified clinically, morphologi- associated.
microbiological and pathological characteristics the mean corpuscular hemoglobin concentration
cally, erythro-kinetic
associated to theand etio-pathogenic.
underlying disease. The (MCHC), caused by lack of iron.1
The clinical classification is associated
correlations and interdependence of these clinical with 2. Methodology
Grading:
decreased levels of
conditions were also identified.hemoglobin and/or a Clinical examination
• Mild anemia: Hb 11-9 g/dl,determined
Hct 39-30%; intraoral
decreased packed red cell volume (hematocrit). 3,4
assessment of mucosa,
Anemia represents a world wide health problem • Moderate anemia: Hb 9-7 g/dl, Hct 30-22%; periodontium and caries
which affects both the developing and the • Severe anemia: Hb 7-3 g/dl, Hct 22-10%.14clinical
Iron deficiency is also characterized by a reduced lesions. Detection of caries involved both
value of thecountries
developed mean corpuscular
It affects volume (MCV)
all groups and (visual and tactile) and radiographic examination.
of age.
the mean24,8%
Globally corpuscular hemoglobin
of the population anemia, in Evaluation
concentration
reveal 2. Methodology of the periodontium consisted of
Europe the
(MCHC), percent
caused by being
lack of22,9%, This prevalence
iron.1 while in Romania clinical assessment studyofwas carried on levels,
attachment a numberboneof
39,8% of the population is affected. Approximately topography
Grading: 40 patients with various degrees
(radiographs of iron and
evaluation) deficiency
tooth
•half
Mildofanemia:
the cases with g/dl,
Hb 11-9 anemiaHct 39-30%; anemia – 34
are due to iron mobility; females andstatus
inflammatory 6 males, between
of the tissue,16 and
tissue
•deficiency. 82 years of age contours,
and revealed oral manifestations
1,2
Moderate anemia: Hb 9-7 g/dl, Hct 30-22%; color, texture, edema and sulcular
•Anemia
Severemay be classified
anemia: Hb 7-3clinically,
g/dl, Hctmorphologically,
22-10%.14 among 77.5%
exudates of them
was also (Figures 1,2).
noted.
*Corresponding author:
Clinical Assistant Mihaela Florina Loredana Cojanu, DMD
Department of Restorative Odontotherapy, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy Bucharest, Bucharest, Romania, 17-23 Plevnei Street, Bucharest, 1 District,
RO-010232 Romania, Tel: +40722766503, Fax: 021.315.85.37, e-mail: loredana.cojanu@gmail.com; lory_cojanu@yahoo.com.
114 Stoma Edu J. 2017;4(2): 114-125 http://www.stomaeduj.com
ORAL
EVALUATION OF MANIFESTATIONS
THE THERAPEUTICIN IRON DEFICIENCY
BENEFITS ANEMIA:
OF GENERAL CASE REPORTS
ANTIBIOTIC THERAPY
IN PERIODONTAL DISEASE
Biological samples
The main factors were taken
involved from gingival
in developing sulcus
caries are:
Original Articles
dental
or structures,pockets.
periodontal the plaque andthe
After dietMGGinfluenced
(May-
by the immune system,
Grünwald-Giemsa) stainingsaliva, timing microscopic
cytologic and topical
fluoride. In addition, there are general
aspects were observed. The samples obtained factors such
as: education, socio-economic
were also cultivated on specific medium and status, behavior,
health attitude,
bacterial growthincome. When one
characteristics wereofobserved.
the risk
factors increases,
Cell staining is a necessary it produces an imbalance,
and useful technique
leading
to to caries
visualize (Fig. 3).5,6 and structure of cells.
morphology
In the oral cavity there are about 700 species
Serology was used to establish Complement
of known bacteria, at least 30 species of fungi
and Immunoglobulin levels. Gingival biopsy was
(especially Candida) and several species of
performed, fixation and sectioning of the tissues.
protozoa (associated with food bacteria) and some
A solution of paraformaldehyde was used to fix
intracellular viruses.7,8,9,10
tissues.
In a healthy oral cavity, what is normallytechnique
IHC is an excellent detection found is
Figure 1. Sex prevalence of IDA. and has the
between 20-50 advantage
bacterialofspecies,
being able the to show
number
exactly
going up where a given protein
to 200-400, in case isoflocated
a disease.within the
These
tissue examined,are
microorganisms in our casesfound
always gingival chorion and
in communities
epithelium.
and vary with Thethemarkers used were: CD1a,
cavity environment. 11,12,13 CD2O,
CD3, CD4, CD5
The most complexcorion,and CD7 accessible
corion, MPO, CD138,
microbial
S100, SMA,ofki67,
ecosystem p63, p53,
the human bodyAE1-AE3,
lies in the CD31 and
oral cavity.
CD34.
The dental surfaces and the mucosa are the arias
of microbial
This prevalencecolonization.
study wasThe constant
carried on a production
number of
of saliva and the intermittent
40 patients with various degrees of iron food feeding with
deficiency
sugars and amino acids generate
anemia – 34 females and 6 males (Fig. 1), between nutrients for
microbial growth. 14
16 and 82 years of age and revealed, 24 patients
The increased
with dental and number of microorganisms,
periodontal lesions, gingiva their
development on a favorable ground
inflammation in 7 patients and lack of symptoms and the
association with the
on 9 of the cases (Fig. 2). inflammatory response of the
host are responsible for caries development on
The main factors involved in developing caries are:
Figure 2. Oral manifestations among patients diagnosed the plaque (Fig. 4).15,16
dental structures, the plaque and diet influenced
with iron deficiency was 77,55%. Immunity is the ensemble of humoral and cellular,
by the immune system, saliva, timing and topical
specific and nonspecific factors, which protect the
Figure 3. Ethological factors influencing the development of caries process and periodontal diseases.
Figure 4. Emergence of salivary biofilm with the development of common microbial flora and exacerbation of the pathogen
flora under the action of systemic predisposing factors.
Stomatology Edu Journal 115
EVALUATION OF THE THERAPEUTIC BENEFITS OF GENERAL ANTIBIOTIC THERAPY
ORAL MANIFESTATIONS IN IRON DEFICIENCY ANEMIA: CASE REPORTS IN PERIODONTAL DISEASE
Original Articles
a b
a. b.
Figure 8. Chronic marginal periodontitis, active approximal and cervical caries lesions: a. facial aspect; b. lingual aspect.
Figure 5. Chronic marginal periodontitis, active approximal and cervical caries lesions: a. facial aspect; b. lingual aspect.
3-4 mm; the gum color changed from light red to
brick red, with aare
microorganisms bordure
always periphery area (lisere)
found in communities
and vary with the cavity environment.touch;
and ulceration areas; bleedings at slight 12,13,14 the
The
dental surfaces and the mucosa are theretreat
periodontal chart revealed slight gum areas of at
the level of the front inferior incisive,
microbial colonization. The constant production periodontal
pockets
of saliva inand11,the12, intermittent
15, 27, 33, 42, food43,feeding
44, 45 with and
slight dental mobility (first degree) at the inferior
sugars and amino acids generate nutrients for
incisive.
microbial growth.15
3.2.2. Hematologic diagnosis – iron deficiency
The increased number of microorganisms, their
anemia due to metrorrhagia (Figures 8,9)
development
HGB 10.47 g/dL; on HCTa favorable
33.75 %; RBC ground3.61and the
106/μL;
association with
MCV 79 fL; Fe 23 μg/dl the inflammatory response of the
host are responsible for caries development
Complementary exams: radiological, cytological, under
Figure 9. Panoramic radiograph. the plaque (Fig. 4).16,17
immunohistochemical, microbiological,
Immunity is the ensemble of humoral and cellular,
immunoserological
environment and aspects
Figure 6. Panoramic image. of cultivation consisting specific and nonspecific factors, which protect the
3.2.3. Serology – slight modification
of minimum three types of colonies both in aerobic
human
CRP 3.0body
g/dL;against
IgA 3.63 infectious diseases,
g/l; IgG 11.84 g/l; parasites
IgM 1.82
and anaerobic
fluoride. In addition,environment.
there are general The isolation
factors such in
aggressions
g/l; C3 1.2 g/l;and C4 0.4malignant
g/l proliferation. The
anaerobic environment was practically impossible,
as: education, socio-economic status, behavior, 3.2.4. Radiological
presence of microorganisms– generalized
and their horizontal
products
although some bacterial species had developed
health attitude, income. When one of the risk minimal bone
initiating loss; radiotransparency
and producing caries causeswith different
an immunity
in this environment too. Anyway, there were found
factors increases, it produces an imbalance, site: cervical
response on 43,on44,specific
based 45; approximately
and nonspecific on 47
Gram negative bacilli, perhaps Enterobacteriaceae
leading to caries (Fig. 3).5,6,7perhaps Streptococcus and 48;
factors. vertical
18,19,20 bone resorption on 13 (Figure 10).
and Gram positive cocci,
The 3.2.5. Cytological – the following were observed:
sp. most complex and accessible microbial A systemic disease can influence the effectiveness
ecosystem of the human body microbial loadedresponse
epithelial cells; connective
3.2. Case no. 2: M.Ş., f, age 25lies in the oral cavity, of the immunity which can lead to an
there inflammatory cells; macrophages, granulocytes,
3.2.1. are
Oralabout 700 species
diagnosis – active of approximal
known bacteria, at
caries: intense microbial activity consequently with dental
least 30 on
species of fungi lymphocytes; cocci, diplococci, Treponema
mesial 12 and 22; (especially Candida)
cervical caries and
lesions or periodontal manifestations.
several species of protozoa (associated denticola, fusobacterium, yeasts.
distal on 43 and 44, facial on 45 with food
; chronic
Cytological exam revealed: epithelial cells loaded
bacteria)
marginal and some intracellular
periodontitis. The exam viruses.
of the8,9,10,11
marginal 3. Cases reports
with germs, polymorphic microbial flora, important
In a healthy oralrevealed:
periodontium cavity, whattartar is normally
indexfound 34.48is 3.1. Case no. 1: M.Ș., f, age 25
granulocyte infiltrate. The immune-histochemical
percent; gum
between 20-50 inflammation index 11.20
bacterial species, the percent;
number 3.1.1. Oralrevealed:
diagnosis – activeof approximal
diagnosis fragments pavement
periodontal
going up to inflammation
200-400, in case index 6.03 percent;
of disease. These caries: mesial on 12 and 22; cervical caries
stratified mucosa, presenting important acanthosis
periodontal pockets with dimensions between
with epithelial cristae irregularly elongated. In
a b c
Figure 10. Laboratory aspects: a. inflammatory infiltrate, macrophages, frequent cocci, bacilli, candida filaments;
b.Figure 7. Laboratory
abundant aspects:
inflammatory a. inflammatory
infiltrate infiltrate, macrophages,
in the corium (IHC-CD3); c. mild vascularfrequent cocci,
hyperplasia bacilli, candida filaments; b.
(IHC-CD34).
abundant inflammatory infiltrate in the corion (IHC-CD3); c. mild vascular hyperplasia (IHC-CD34).
116 Stomatology Edu Journal
Stoma Edu J. 2017;4(2): 114-125 http://www.stomaeduj.com
117
ORAL
EVALUATION OF THE THERAPEUTIC MANIFESTATIONS
BENEFITS IN IRON
OF GENERAL DEFICIENCY
ANTIBIOTIC ANEMIA: CASE REPORTS
THERAPY
EVALUATION OF THE THERAPEUTIC BENEFITS OF GENERAL ANTIBIOTIC THERAPY
IN PERIODONTAL DISEASE
IN PERIODONTAL DISEASE
Original Articles
Articles
Original Articles
a b
a b
Figure
Figure 8.
11.Chronic
Chronicperiodontitis,
periodontitis,active
active cervical lesions:a.a.facial
cervical lesions: facialaspect;
aspect;b.b.lingual
lingual aspect.
aspect.
Figure 11. Chronic periodontitis, active cervical lesions: a. facial aspect; b. lingual aspect.
front incisive;
3.1.2. Hematologic moderate dental –mobility
diagnosis (second
iron deficiency
front incisive; moderate dental mobility (second
degree).
anemia
degree).due to metrorrhagia: HGB 10.47 g/dL;
3.3.2.33.75
HCT Hematologic
%; RBC 3.61 diagnosis
106/μL; ––MCV iron79deficiency
fL; Fe 23
3.3.2. Hematologic diagnosis iron deficiency
Original
anemia
μg/dL. (Figures 11,12)
anemia (Figures 11,12)
HGB 10.8 g/dL; HCT 38 %; RBC 4.79 106/μL; MCV
HGB 10.8 g/dL; HCT
Complementary exams:38 %; RBC 4.79 106/μL;
radiological, MCV
cytological,
73.1 fL; Fe 21 μg/dl.
73.1 fL; Fe 21 μg/dl.
immunohistochemical, microbiological, immuno-
Complementary exams: radiological, cytological,
Complementary exams: radiological, cytological,
serological.
immunohistochemical, microbiological,
immunohistochemical,
3.1.3. Serology – slight modification: microbiological,
CRP 3.0 g/dL;
immunoserological
immunoserological
IgA
3.3.3. Serology – increase of the IgM g/L; C3 1.2
3.63 g/L; IgG 11.84 g/L; IgM 1.82
3.3.3.
g/L; Serology – increase of the IgM
CRP C4 5.50.4 g/L.IgA
g/dL; 1.93 g/l; IgG 12.4 g/l; IgM 2.40
CRP
3.1.4. 5.5 g/dL; IgA 1.93 g/l; IgG horizontal
12.4 g/l; IgM 2.40
g/l ;C33Radiological
1 g/l ;C44 0,2 –generalized
g/l minimal
g/l
bone ;C 1 g/l ;C 0,2 g/l
3.3.4. loss;
3 radiotransparency
Radiological
4
– generalwith differentbone
horizontal site:
3.3.4. Radiological – general horizontal bone
Figure 12. Radiograph aspect –– horizontal
9. Radiograph horizontal bone atrophy with cervical
minimal on 43.44.45;
loss; proximalapproximately
demineralization on 47 onand 48;
34 and
Figure 12. Radiographaspect boneatrophy
aspect – horizontal bone atrophywith minimal loss; proximal demineralization on 34 and
localized
with vertical
localized resorption.
vertical resorption. vertical
recurrent bone resorption
caries lesion on 13 (Fig.
under 6).
restoration on 37
localized vertical resorption. recurrent caries lesion under restoration on 37
3.1.5.
(Fig. 13).Cytologic appearance: microbial loaded
(Fig. 13).
lesions distal on 43 and
the under-epithelial 44, facial
connective on 45;
tissue chronic
there was 3.3.5. Cytological
epithelial cells were – microbial
observed loaded macrophages,
interspersed in a
the under-epithelial connective tissue there was 3.3.5. Cytological – microbial loaded macrophages,
an abundant
marginal inflammatory
periodontitis. The lymphoplasmacytic
exam of the marginal mixed cellular
background of componentcells:
inflammatory (epithelial
macrophages, and
an abundant inflammatory lymphoplasmacytic mixed cellular component (epithelial and
infiltrate.
periodontium There revealed:
was a moderatecalculus edema
index of the
34.48 conjunctive), cocci,
granulocytes, bacilli, candida
lymphocytes filaments.
with microbial
infiltrate. There was a moderate edema of the conjunctive), cocci, bacilli, candida filaments.
epithelium and
percent; gingival moderate spongiosis
inflammation with erosive 3.3.6. Histologically – severe inflammatory
epithelium and moderate spongiosisindex 11.20
with erosive elements: cocci, diplococci,
3.3.6. Histologically Treponema
– severe denticola,
inflammatory
and ulcerative
percent; areas. inflammation index 6.03
periodontal infiltrate was
fusobacterium, observed;
yeasts (Fig. the immunohistochemical
and ulcerative areas. infiltrate was observed; the 7-a).
immunohistochemical
3.3 Case
percent; no. 3: S. M., f, age
periodontal pockets41 with dimensions diagnosis
The revealed: fragments
histopathologic examination of pavements
revealed
3.3 Case no. 3: S. M., f, age 41 diagnosis revealed: fragments of pavements
3.3.1.
between Oral diagnosis
3-4 –
mm; gingiva on teeth
color diagram:
changed,activefrom mucosa,
fragments stratified
of squamous presenting acanthosis
mucosa acanthosis
with prominent and
3.3.1. Oral diagnosis – on teeth diagram: active mucosa, stratified presenting and
cervical
light lesions
redlesions
to brickon 13, 31, 41 and 43; arrested parakeratosis with diffuse spongiosis and minimal
cervical onred,
13, with a bordure
31, 41 and 43;periphery
arrested acanthosis
parakeratosis with withdiffuseirregularly
spongiosis and elongated
minimal
brown
area lesionsandon 37 and 48; on periodontal chart: hyperemia and important interstitial edema.
brown(lisere)
lesions on 37 ulceration
and 48; on areas; bleedings
periodontal at
chart: hyperemia cristae
epithelial and importantand abundant interstitial edema.
inflammatory
chronic periodontitis with tartar index of 25.89%; In the under-epithelial connective tissue, there
chronic periodontitis
slight touch; with tartar
the periodontal index
chart of 25.89%;
revealed slight In the under-epithelial
lymphoplasmacytic connective
infiltrate in lamina tissue, there
propria.
gum inflammation index of 10.71%; periodontal was a minimal lymphoplasmocytic inflammatory
gum
gingivainflammation
recession atindex of 10.71%;
the level periodontal
of the front inferior was a minimal
Moderate edema lymphoplasmocytic
within the lamina inflammatory
propria and
inflammation index of 7.14%; generalized infiltrate, with rare and small debris of odontogenic
inflammation index of 7.14%;
incisive, periodontal pockets in 11. 12. 15. 27. generalized infiltrate, with
moderate rare and small debris of odontogenic
gum retraction, with Stillman’s clefts on 16, 26;
gum retraction, tissue in the epithelial
chorion. spongiosis were noted;
33. 42. 45with
43. 44.exudateandStillman’s
atslight
cleftsmobility
dental on 16,(first
26; tissue
focally, in the chorion.
erosive and ulcerative
seropurulent
seropurulent exudate at
pressure
pressure
on the sides
on the sides
of
of 3.3.7. Microbiological – on a areas were present
rich macrophages
degree) at the inferior incisive 3.3.7.7-b;Microbiological – on a rich macrophages
the periodontal pockets at 13,(Fig.
12, 5-a; b). 43, 44;
23, 37, (Fig. c).
inflammatory infiltrate ground, intercellular
the periodontal pockets at 13, 12, 23, 37, 43, 44; inflammatory infiltrate ground, intercellular
bleedings when touching gum level of the inferior cocci and bacilli phagocytosis, the presence of
bleedings when touching gum level of the inferior cocci and bacilli phagocytosis, the presence of
a b c
a b c
Figure 13.
Figure 10.Laboratory
Laboratoryaspects:
aspects:a.a. inflammatory
inflammatory lymphoplasmocytic
lymphoplasmocytic infiltrate
infiltrate with with macrophages
macrophages loaded loaded with germs;
with germs; b.
b. acanthosis
Figure 13. Laboratoryepithelium
acanthotic aspects: a. inflammatory lymphoplasmocytic infiltrate with macrophages loaded withchronic
germs;infiltrate
b. acanthosis
pavements squamous withelongation
epithelium with important important elongation of the
of the papillary interpapillary
cristae cristaechronic
and abundant and abundant
infiltrate in chorion; in of
islands
pavements
corion; epithelium
islands of with important
odontogenic elongation
epithelium in of the
corion; c. papillarymacroscopic
aerobic cristae and abundant
aspect. chronic infiltrate in chorion; islands of
odontogenic epithelium in chorion; c. mild vascular hyperplasia (IHC-CD34).
odontogenic epithelium in chorion; c. mild vascular hyperplasia (IHC-CD34).
118 Stomatology Edu Journal Stoma Edu J. 2017;4(2): 114-125
Stoma Edu J. 2017;4(2): 114-125
http://www.stomaeduj.com
http://www.stomaeduj.com 117
ORAL MANIFESTATIONS IN IRON DEFICIENCY ANEMIA: CASE REPORTS
3.2 Case no. 3: S. M., f, age 41 lesion; secondary caries; plaque and calculus;
Original Articles 3.2.1. Oral diagnosis – on teeth diagram: active general marginal gingivitis; chronic periodontitis;
cervical lesions on 13.31.41 and 43; arrested aggressive periodontitis with localized and general
brown lesions on 37 and 48; on periodontal bone loss. Gathering this information, a graphic
chart: chronic periodontitis with calculus index of image of the oral manifestations distribution in
25.89%; gingival inflammation index of 10.71%; associated systemic disease (IDA in these cases)
periodontal inflammation index of 7.14%; was obtained (Fig. 11).
generalized gingiva retraction, with Stillman’s clefts 4.2. Immunohistochemical analysis
on 16.26; seropurulent exudate when exercising On the patients included in the studied lot gingival
pressure on the sides of the periodontal pockets at biopsy was performed. The harvest was made
13.12.23.37.43.44; bleedings on gingival pressure from the affected periodontal structure. The iron
level of the inferior front incisive; moderate dental deficiency anemia from metrorrhagia (13 cases) is
mobility (second degree) (Fig. 8-a; b). characterized by: 5 cases with lack of T helper cells
3.2.2. Hematologic diagnosis – iron deficiency and PMNs, 3 cases with absence of T helper cells,
anemia: HGB 10.8 g/dL; HCT 38 %; RBC 4.79 106/ 1 case with absence of PMN, frequent Langerhans
μL; MCV 73.1 fL; Fe 21 μg/dL. cells, T and B lymphocytes in 4 cases. The following
Complementary exams: radiological, cytological, was noticed with respect to IDA (11 cases): the
immunohistochemical, microbiological, immuno- absence of T helper cells in 2 cases, the absence
serological. of PMNs in 3 cases and in 4 cases the absence of
3.2.3. Serology – increase of the IgM: CRP 5.5 g/ both T helper cells and PMNs. In 2 cases frequent
dL; IgA 1.93 g/L; IgG 12.4 g/L; IgM 2.40 g/L; C3 1 Langerhans cells, melanocytes and B-lymphocytes
g/L; C4 0.2 g/L. were noticed (Table 1).
3.2.4. Radiological – general horizontal bone The 24 patients with dental and periodontal
minimal loss; proximal demineralization on 34 and manifestations showed: the absence of T helper
recurrent caries lesion under restoration on 37 cells and PMNs in 9 cases; PMNs absence in 4
(Fig. 9). cases and in 5 cases the absence of T helper cells
3.2.5. Cytology – microbial loaded macrophages, (which implies the lack of bacterial component in
mixed cellular component (epithelial and 13 cases, as well a decrease of the cellular immune
conjunctive), cocci, bacilli, candida filaments (Fig. line in 14 cases); frequent Langerhans cells, T and
10-a). B lymphocytes in 6 cases (Fig. 12).
3.2.6. Histopathologic appearance: squamous 4.3. Serology
mucosa with hyperkeratosis with parakeratosis, Generally, in the case of anemia there are no
acanthosis, diffuse spongiosis; mild lymphoplas- patent systematic changes of immunoglobulin
mocytic inflammatory infiltrate, mild hyperemia and/or Complement, and, when present, there is
and important interstitial edema within the corion; an associated cause (Table 2).
minute remnants of odontogenic epithelium are This study showed:
identifiable within the corion (Fig. 10-b). • high levels of IgM (associated to dental and
3.2.7. Microbiological – on a rich macrophages periodontal manifestations) in 2 cases;
inflammatory infiltrate ground, intercellular • decreased IgG level in 2 cases (possibly due to
cocci and bacilli phagocytosis, the presence of hypogammaglobulinemia);
some large, creamy, half-transparent colonies • low values of C3 (due to chronic periodontics
belonging to Gram-negative bacteria, considered infections) in 6 cases;
as Klebsiella was noticed (Fig. 10-c). Also, smaller • decreased C4 in 2 cases (SLE, macrophages iron
colonies, also with mucoid aspect, that could storage) (Fig. 13).
be considered by their aspect, as belonging to 4.4. Microbiology
the germs of Pseudomonas sp. Colony culture Samples were taken from gingival sulcus or
anaerobically developed revealed a very abundant periodontal pockets. After the Gram staining,
growth, non differentiated regarding the aspect bacterial cultures were obtained. Bacterial
of the colonies; the colonies were in confluence, investigations were limited, due to the given
creating a creamy aspect and above them some conditions of their metabolical cultivation and
other types of colonies developed with different activity testing. A series of observations started
forms and aspects, difficult to identify. from lesion peculiarities of some of the cases. The
investigation was limited only to morphology and
4. Results characteristics of the cultivation of the growth of
4.1. Oral aspects the respective bacteria, in aerobic and anaerobic
The study noticed the following by clinical environment. A rich bacterial polymorphism was
examination, periodontal chart and radiographs found, which could not be significantly correlated
on patients: active caries lesions; arrested brown with the lesion aspects encountered. Among
lesions; defective restoration; cervical lesions; the isolated major groups, the following can be
fissures; tooth fractures; matte white active cervical mentioned: Gram positive cocci from Micrococcus
118 Stoma Edu J. 2017;4(2): 114-125 http://www.stomaeduj.com
ORAL MANIFESTATIONS IN IRON DEFICIENCY ANEMIA: CASE REPORTS
sp. and Staphylococcus sp. genres (nonhemolytic);
Original Articles
Klebsiella Gram negative bacillus (colonies with
characteristics: big, mucoid); spiral shape bacteria
and morphological aspects specific for yeasts,
labeled as Candida. It should have been surely
necessary to expand the bacterial investigations
with molecular biology tests. There are studies
about the preponderance of some bacteria from
the genres of: Actynomices sp.; Fusobacterium
nucleatum; Bacteroides sp.; Prevotella intermedia,
Aggregatibacter actynomicetemcomitans;
Porphyromonas gingivalis; Tannerella forsythia;
Treponema denticola; Prevotella intermedia;
Fusobacterium nucleatum; Eikenella corrodens;
Eubacterium nodatum; Peptostreptococci;
Selenomonas noxia; Capnocitophaga; Klebsiella,
more frequently met in caries and periodontal
pathology.13 From the group of aerobic and
anaerobic bacteria cultures were developed, whose Figure 11. Distributiom of dental and periodontal
cultivation rate suggested the presence of certain manifestations in types of anemia.
bacterial groups. Seven of the cases indicated the
presence of homogeneous cultures, especially
of positive gram cocci, which can be associated
with the aggressiveness of ecological dominance,
selected under the action of local pressure factors
and even constitutional general factors (anemia
determines growth in monocultures). The frequent
cultures were the associated ones, associations
of at least 2 bacterial groups, which could have
been distinguished through their morphological
characteristics. In one single case, the presence of
Candida was identified, frequently mentioned in
oral conditioned pathology, associated with small,
round scattered colonies, with homogeneous
shape and dimensions, which suggests a bacterial
presence. The presence of a polymorph microbial
flora correlated with the dental and periodontal
affections was also found.
4.5. Cytology
Figure 12. Graphic representation of cases with low
Gathering samples at the level of gingival sulcus cellular defense.
and periodontal pockets from the studied patients
revealed:
• The morphology of exfoliating cells in the
inflammatory process (hyperplasia, parakeratosis,
hyperkeratosis and acanthosis), epithelial cells
microbial filled, with a various flora: cocci, bacilli,
candida filaments, fusobacterium species;
• The presence of inflammatory infiltrate of
several types of cells (neutrophils, monocytes,
lymphocytes, leukocytes, macrophages) histiocytic
proliferation; morphologic and erythrokinetic
characteristics of the cellular factors of the
immunity system were correlated with the type of
anemia (acquired or genetic);
• Microbial polymorph flora characteristic to the
acute or chronic degree of dental and periodontal
manifestations (coccus Gram positive, bacillus
Gram negatives, fusobacterium spp., candida
filaments).
Figure 13. Immunogram graphic representation.
Stomatology Edu Journal 119
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EVALUATION IN IRON DEFICIENCY
OF THE THERAPEUTIC BENEFITSANEMIA: CASEANTIBIOTIC
OF GENERAL REPORTS THERAPY
IN PERIODONTAL DISEASE
Original Articles table 1. Specific markers values on patients with IDA and oral manifestations
Hematologic
No. Name sex Age diagnosis Etiology of anemia Oral diagnosis
1 L.A. F 25 IDA Chronic gastrointestinal Chronic gingivitis
blood loss Numerous stained class 5 caries lesions
2 E.R. F 35 IDA Chronic gastrointestinal Chronic gingivitis
Colon cancer blood loss Cervical lesions consistent with brown
arrested lesions
3 G.I. F 32 IDA Metrorrhagia Chronic gingivitis
Cavitated active cervical lesions
4 P.D. F 35 IDA Metrorrhagia Chronic gingivitis
Matte, white, active cervical lesions
5 I.F. F 29 IDA Metrorrhagia Generalized marginal gingivitis
Multiple adjacent defects that fit the
description of abfraction lesions
6 M.Ş. F 39 IDA Metrorrhagia Chronic marginal periodontitis
Active approximal and cervical caries
lesions
7 N.V. F 35 IDA Metrorrhagia Chronic marginal periodontitis
Multiple active caries lesions
8 Ş.G. F 30 IDA Metrorrhagia Chronic marginal periodontitis
Thrombocytopenia Extensive active caries
9 Ş.A. F 25 IDA Metrorrhagia Chronic marginal periodontitis
Active recurrent caries lesions
10 C.A. F 30 IDA Metrorrhagia Chronic marginal periodontitis
Smooth surface caries lesions presenting
microfractures in the surface
11 C.V. F 27 IDA Metrorrhagia Chronic gingivitis
active root-surface caries lesions
12 T.A. F 34 IDA Metrorrhagia Chronic periodontitis
Systemic lupus erythematosus Chronic inflammation Inactive or arrested caries lesions
13 T.C. F 28 IDA Metrorrhagia Chronic periodontitis
Cavitated active cervical lesions
14 B.L. F 21 IDA Deficiency Aggressive periodontitis
Extensive active cervical caries
15 B.R. M 22 IDA Deficiency Chronic gingivitis
Matte, white, active cervical lesions
16 V.M. F 26 IDA Deficiency Chronic gingivitis, Arrested lesions and
active localized caries
17 G.C. F 25 IDA Deficiency Chronic periodontitis
Arrested caries lesions
18 M.R. F 23 IDA Deficiency Chronic periodontitis
Arrested non-cavitated lesions
19 I.B. F 20 IDA Deficiency Aggressive periodontitis, Extensive active
root-surface caries lesions
20 R.A. M 29 IDA Deficiency Chronic periodontitis
Non-cavitated lesions and fissures
21 S.A. F 43 IDA Deficiency Chronic periodontitis, Active caries
lesions with small and large cavities
22 R.M. F 31 IDA Deficiency Chronic periodontitis generalized
Cavitated lesions
23 I.M. F 24 IDA Deficiency Chronic periodontitis
Active discolored lesions
24 S.M. F 41 IDA Deficiency Chronic periodontitis
Active cervical lesions
120 Stoma Edu J. 2017;4(2): 114-125 http://www.stomaeduj.com
ORAL
EVALUATION OF MANIFESTATIONS
THE THERAPEUTICIN IRON DEFICIENCY
BENEFITS ANEMIA:
OF GENERAL CASE REPORTS
ANTIBIOTIC THERAPY
IN PERIODONTAL DISEASE
Original Articles
Plasmatic MPO MPO cD3 cD3 cD5 cD5 cD7 cD7
sMA s100 s100 cD20 cells cD4 chorion epith chorion epith chorion epith chorion epith
gran tissue 2 2 1 1 1 1 1 2 1 2 1 1 1
- 1 1 1 1 1 1 1 2 1 2 1 1 1
- 1 1 - - 0 0 0 0 1 1 1 1 1
- 1 1 2 1 0 1 0 2 1 1 1 1 1
gran tissue 1 1 - - 0 0 0 0 0 0 1 - -
gran tissue 1 1 1 2 0 2 1 1 1 2 1 1 1
gran tissue 1 1 1 1 1 0 0 2 1 2 1 1 1
- 1 1 1 2 0 1 1 2 1 2 1 1 1
- 2 2 1 1 0 1 1 1 1 1 1 1 1
- 2 2 - - 0 1 0 1 1 2 1 1 1
gran tissue 1 1 - - 1 1 0 2 1 1 1 1 1
- 1 1 1 1 1 1 2 2 2 2 1 1 1
gran tissue 1 1 - - 1 2 2 2 1 2 1 1 1
gran tissue 2 2 1 2 0 2 1 1 1 1 1 1 1
- 2 2 - - 0 0 0 2 1 2 1 1 1
- 1 1 2 1 1 - - - - - - - -
gran tissue 1 1 1 1 0 2 1 1 1 1 1 1 1
- 1 1 2 1 1 1 0 1 1 1 1 1 1
- 2 2 2 1 1 1 0 2 1 1 1 1 1
- 2 2 1 1 0 1 0 2 1 2 1 1 1
- 2 2 - - 1 0 0 2 1 1 1 1 1
- 1 1 - - 1 1 0 2 1 1 1 1 1
gran tissue 1 1 1 1 1 1 2 1 1 1 1 1 1
- 1 1 1 1 0 1 0 2 1 2 - - -
Stomatology Edu Journal 121
ORAL MANIFESTATIONS
EVALUATION IN IRON DEFICIENCY
OF THE THERAPEUTIC BENEFITSANEMIA: CASEANTIBIOTIC
OF GENERAL REPORTS THERAPY
IN PERIODONTAL DISEASE
Original Articles table 2. Serological values on patients with IDA and oral manifestations.
Hematologic
No. Name sex Age diagnosis Etiology of anemia Oral diagnosis
1 L.A. F 25 IDA Chronic gastrointestinal Chronic gingivitis
blood loss Numerous stained class 5 caries lesions
2 E.R. F 35 IDA Chronic gastrointestinal Chronic gingivitis
Colon cancer blood loss Cervical lesions consistent with brown arrested lesions
3 G.I. F 32 IDA Metrorrhagia Chronic gingivitis
Cavitated active cervical lesions
4 P.D. F 35 IDA Metrorrhagia Chronic gingivitis
Matte, white, active cervical lesions
5 I.F. F 29 IDA Metrorrhagia Generalized marginal gingivitis
Multiple adjacent defects that fit the description of
abfraction lesions
6 M.Ş. F 39 IDA Metrorrhagia Chronic marginal periodontitis
Active approximal and cervical caries lesions
7 N.V. F 35 IDA Metrorrhagia Chronic marginal periodontitis
Multiple active caries lesions
8 Ş.G. F 30 IDA Metrorrhagia Chronic marginal periodontitis
Thrombocytopenia Extensive active caries
9 Ş.A. F 25 IDA Metrorrhagia Chronic marginal periodontitis
Active recurrent caries lesions
10 C.A. F 30 IDA Metrorrhagia Chronic marginal periodontitis
Smooth surface caries lesions presenting microfractures
in the surface
11 C.V. F 27 IDA Metrorrhagia Chronic gingivitis
active root-surface caries lesions
12 T.A. F 34 IDA, Systemic lupus Metrorrhagia Chronic periodontitis
erythematosus Chronic inflammation Inactive or arrested caries lesions
13 T.C. F 28 IDA Metrorrhagia Chronic periodontitis
Cavitated active cervical lesions
14 B.L. F 21 IDA Deficiency Aggressive periodontitis
Extensive active cervical caries
15 B.R. M 22 IDA Deficiency Chronic gingivitis
Matte, white, active cervical lesions
16 V.M. F 26 IDA Deficiency Chronic gingivitis
Arrested lesions and active localized caries
17 G.C. F 25 IDA Deficiency Chronic periodontitis
Arrested caries lesions
18 M.R. F 23 IDA Deficiency Chronic periodontitis
Arrested non-cavitated lesions
19 I.B. F 20 IDA Deficiency Aggressive periodontitis
Extensive active root-surface caries lesions
20 R.A. M 29 IDA Deficiency Chronic periodontitis
Non-cavitated lesions and fissures
21 S.A. F 43 IDA Deficiency Chronic periodontitis
Active caries lesions with small and large cavities
22 R.M. F 31 IDA Deficiency Chronic periodontitis generalized
Cavitated lesions
23 I.M. F 24 IDA Deficiency Chronic periodontitis
Active discolored lesions
24 S.M. F 41 IDA Deficiency Chronic periodontitis
Active cervical lesions
122 Stoma Edu J. 2017;4(2): 114-125 http://www.stomaeduj.com
ORAL
EVALUATION OF MANIFESTATIONS
THE THERAPEUTICIN IRON DEFICIENCY
BENEFITS ANEMIA:
OF GENERAL CASE REPORTS
ANTIBIOTIC THERAPY
IN PERIODONTAL DISEASE
5. Conclusions
4.4. Microbiological
Original Articles
Microbiological macroscopic aspects the patients
• The microbial macroscopic determinations
showed which were dealt with:
showed
Biological species
samples were of: taken
Streptococcus
from gingival mutans,
sulcus
or periodontal
Lactobacillus, pockets. After
Porphyromonas the Gram coloration,
gingivalis,
serum immunoglobulins complement through the described technique, bacterial
Tannerella
cultures were forsythia etc. correlated
obtained. Bacterialwith the degree
investigations
IgA IgG IgM c3 c4 crP
were
of limited, due
impairment to oral
of the the given conditions of their
structures;
325 1401 102 100 14,3 ++
metabolical cultivation and activity testing. A series
•of The evolutionstarted
observations of thefrom caries andpeculiarities
lesion other oral
133 876 70 60 20 ++
of some of the
manifestations can cases,
be slow theor investigation
rapid depending was
limited only to morphology and characteristics
158 1450 234 110 30 ++ on
of thethecultivation
patient’sof background,
the growth of the microbial
the respective
bacteria, in aerobic
component and the and anaerobic
systemic factors environment.
(anemia in
228 1010 65 123 23,2 ++ Due to the investigations studied, a rich bacterial
this case), which can change the general state;
polymorphism was found, which could not be
192 1500 142 140 20 - •significantly
A reduced or abundant
correlated with the lesion inflammatory
aspects
encountered. Among the major groups isolated,
polymorphous infiltrate was also revealed,
mention can be made of: Gram positive cocci
363 484 182 120 40 ++ depending
from Micrococcus on the sp. degreeand of the inflammation
Staphylococcus sp.
genres (nonhemolytic); Klebsiella
and tissue destruction (neutrophils, macrophages,Gram negative
166 1100 124 100 60 ++ bacillus (colonies with characteristics: big,
histiocytes,
mucoid); spiral lymphocytes,
shape bacteria plasma and cells) and also
morphological
205 1100 150 130 30 ++ aspects specific for yeasts, labeled
related to the epithelial alterations (hyperplasia, as Candida. It
should have been surely necessary to expand the
acanthosis, parakeratosis);with molecular biology
bacterial investigations
255 1030 496 110 20 ++
•tests.
TheThere are studies about the
immunohistochemical preponderance
exam showed a
of some bacteria from the genres of: Actynomices
372 1060 124 80 30 ++ chronic inflammatory nucleatum;
sp.; Fusobacterium process consisting Bacteroides of
sp.; Prevotella
numerous intermedia,
T cells (pan T markersAggregatibacter
CD3 and CD5
actynomicetemcomitans; Porphyromonas
332 1250 120 70 30 ++ positive) retaining CD7 expression and belonging
gingivalis; Tannerella forsythia; Treponema
mostly to T helper
denticola; phenotype
Prevotella (CD4+).
intermedia; inflammatory
Fusobacterium
77 1540 108 126 14,3 - nucleatum; Eikenella corrodens; Eubacterium
infiltrate includes also B-lymphocytes (expressing
nodatum; Peptostreptococci; Selenomonas noxia;
274 1160 123 110 30 - CD20), neutrophils,
Capnocitophaga; Langerhans
Klebsiella, more cells (expressing
frequently met
in caries and periodontal pathology.
CD1a and S100); it also revealed a moderate From the
184 1002 100 110 50 ++ group of aerobic and anaerobic bacteria cultures
vascular hyperplasia
were developed, whosewithcultivation
significantrate angiogenesis
suggested
185 1210 90 110 20 - the presence
(revealed withofCD34
certain bacterial groups. Seven of
marker);
the cases indicated the presence of homogeneous
•cultures,
The immunoserological
especially of positive examgramdemonstrated
cocci, which
78 1220 129 100 20 ++
can be associated with the
modifications of the Immunogram values and ofaggressiveness of
144 983 182 110 40 ++ ecological dominance, selected under the action
the Complement
of local system;and
pressure factors these findings
even are not
constitutional
156 1410 176 100 30 ++
general factors
characteristic for (anemia
the systemic determines
affection, growth in
but for
monocultures). The frequent cultures were the
infections;
associated ones, associations of at least 2 bacterial
136 68 154 160 40 ++
•groups,
The results
whichlead couldto ahavebetter understanding
been distinguished of
through their morphological characteristics.
271 1210 122 90 30 ++ the determining factors of oral pathology (in
In one single case, the presence of Candida
clinical types of anemia);
was identified, frequently further studies involving
mentioned in oral
158 1340 168 70 30 - conditioned pathology, associated with small,
larger groups of subjects are necessary in order to
round scattered colonies, with homogeneous
164 1200 122 90 30 - definitely
shape andestablish a causal
dimensions, relation
which between
suggests these
a bacterial
presence.
entities. What was also found was the presence
216 1230 139 110 20 ++ of a polymorph microbial flora correlated with the
dental periodontal affections.
193 1240 240 100 20 ++ 4.5. Cytological
Acknowledgments
Gathering samples at the level of gingival sulcus
The
and authors declare
periodontal no conflict
pockets fromofthe interest related
40 patients
studied revealed:
to this study. There are no conflicts of interest and
• The morphology of exfoliating cells in the
no financial interests to be disclosed.
Stomatology Edu Journal 123
ORAL MANIFESTATIONS IN IRON DEFICIENCY ANEMIA: CASE REPORTS
References
Original Articles
1. Greer JP, Arber DA, Glader B, et al. Editors. 11. Roberson TM, Heymann HO, Swift Jr EJ. Editors.
Wintrobe's clinical hematology, 13th Edition. Sturdevant’s Art and Science of Operative Dentistry,
Philadelphia, PA: Lippincott, Williams & Wilkins; 2009. Fifth edition. St. Louis, MI: Mosby Elsevier Inc.; 2006.
Google Scholar(4115) 12. Gao B, Gupta RS. Phylogenetic framework and
2. Nørskov-Lauritsen N, Kilian M. Reclassification of molecular signatures for the main clades of
Actinobacillus actinomycetemcomitans, Haemophilus the phylum Actinobacteria. Microbiol Mol Biol
aphrophilus, Haemophilus paraphrophilus Rev. 2012;76(1):66-112. Review. doi: 10.1128/
and Haemophilus segnis as Aggregatibacter MMBR.05011-11.
actinomycetemcomitans gen. nov., comb. nov., [Full text links] [Free PMC Article] [PubMed] Google
Aggregatibacter aphrophilus comb. nov. and Scholar(148) Scopus(100)
Aggregatibacter segnis comb. nov., and emended 13. Lamont RJ, Jenkinson HF. Oral Microbiology at a
description of Aggregatibacter aphrophilus to include Glance. Oxford, UK: Wiley-Blackwell Publishing; 2010.
V factor-dependent and V factor-independent isolates. Google Scholar(49)
Int J Syst Evol Microbiol. 2006;56(Pt 9):2135-2146. 14. Summitt JB, Robbins JW, Hilton TJ, et al.
doi: 10.1099/ijs.0.64207-0 Editors. Fundamentals of Operative Dentistry: A
[Full text links] [PubMed] Google Scholar(245) Contemporary Approach, Third Revised edition.
Scopus(127) Chicago, IL, United States: Quintessence Publishing
3. Bach J-F, Lesavre P. [Immunology] French. Paris, Co Inc.; 2006.
France: Ed. Flammarion Médicine-Sciences; 1989. Google Scholar(656)
4. Popescu Mut D. [Clinical Hematology] Romanian. 15. Jobin MC, Mohsen A, Richard PE. The Molecular
Bucureşti, România: Ed. Medicală; 2001. Biology of the Survival and Virulence of Treponema
5. Allison DG, Gilbert P, Lappin-Scott HM, Wilson M. denticola, Molecular Oral Microbiology, Caister
Editors. Community structure and co-operation in Academic Press, Norfolk, UK; 2008.
biofilms. Cambridge, UK: Cambridge University Press; Google Scholar(3)
2000. 16. Marsh PD, Nyvad B. The oral microflora and biofilm
6. Flint SR, Moos KF, Porter SR, Scully C. Oral and on teeth. In: Fejerskov O, Kidd EAM. Dental caries:
Maxillofacial Diseases, Third Edition. New York, NY: The disease and its clinical management, 2nd edition.
Taylor & Francis eBooks; 2004. Oxford, Ames, Iowa: Blackwell Munksgaard;2008,
7. Dumitriu HT, Dumitriu S. [Periodontology] Romanian. 163-187.
VI Edition. Bucureşti, România: Ed. Viaţa Medicală 17. Socransky SS, Haffajee AD, Goodson JM, et al. New
Românească; 2015. concepts of destructive periodontal disease. J Clin
8. Bernhard AE, Field KG. A PCR Assay to discriminate Periodontol. 1984;11(1):21-32.
human and ruminant feces on the basis of host [Full text links] [PubMed] Google Scholar(853)
differences in Bacteroides-Prevotella genes encoding Scopus(416)
16S rRNA. Appl Environ Microbiol. 2000;66(10):4571- 18. Cojanu MFL. [Gingival-periodontal manifestations
4574. in anemias] Romanian. Bucureşti, România: Editura
[Full text links] [Free PMC Article] [PubMed] Google Universitară “Carol Davila”; 2014.
Scholar(630) Scopus(408) 19. Newman HN, Wilson M, editor. Dental plaque
9. Jenkinson HF, Lamont RJ. Oral microbial communities revisited, oral biofilms in health and disease. Cardiff,
in sickness and in health. Trends Microbiol. UK: BioLine; 1999.
2005;13(12):589-595. Review. doi: 10.1016/j. 20. Cionca N, Giannopoulou C, Ugolotti G, et al.
tim.2005.09.006 Microbiologic testing and outcomes of full-mouth
[Full text links] [PubMed] Google Scholar(469) scaling and root planing with or without amoxicillin/
Scopus(265) metronidazole in chronic periodontitis. J. Periodontol.
10. Lamont RJ, Burne RA, Lantz MS, LeBlanc DJ. Editors. 2010;81(1):15-23. doi: 10.1902/jop.2009.090390.
Oral Microbiology and Immunology. Washington, DC: [Full text links] [PubMed] Google Scholar(95)
ASM Press; 2006. Scopus(51)
EVALUATION OF THE THERAPEUTIC BENEFITS OF GENERAL ANTIBIOTIC THERAPY
Google Scholar(85)
IN PERIODONTAL DISEASE
Mihaela Florina Loredana COJANU
DMD, DMSc, Teaching Assistant
Restorative Odontotherapy Department
Faculty of Dental Medicine
“Carol Davila” University of Medicine and Pharmacy Bucharest
Bucharest, Romania
Clinical Dentist in Bucharest, Romania
CV
Loredana Cojanu is a clinical dentist with experience and passion for aesthetic dentistry who graduated
from the Dental Medicine “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania; PhD
in Periodontology; Competence in Implantology. She is currently a Teaching Assistant in Restorative
Odontotherapy Department of Dental Medicine “Carol Davila”. She is a member of ESCD, SSER. An author of
scientific articles, she also has collaboratively authored book chapters in academic textbook.
Questions
What means the acronym IDA?
124 qa. Immune disorder activity;
qb. Iron deficiency anemia;
Stoma Edu J. 2017;4(2): 114-125 http://www.stomaeduj.com
ORAL MANIFESTATIONS IN IRON DEFICIENCY ANEMIA: CASE REPORTS
What means the acronym IDA?
Original Articles
qa. Immune disorder activity;
qb. Iron deficiency anemia;
qc. Increased data analyses;
qd. Iron disease autoimmune.
Anemia is associated with:
qa. Decreased levels of hemoglobin (Hb);
qb. Increased values of hematocrit (Hct);
qc. High levels of hemoglobin (Hb);
qd. Developing countries only.
Oral manifestations can appear due to:
qa. A healthy diet;
qb. An imbalance immune system;
qc. Lack of risk factors;
qd. Normal dental structures.
Increased number of microorganisms in the oral cavity, the inflammatory reaction of the host
and immunity response based on specific and nonspecific factors in the previous clinical cases
are revealed by:
qa. Normal microbial macroscopic aspects;
qb. Epithelial cells with no trace of cocci, bacilli, candida filaments and fusobacterium species;
qc. Lack of inflammatory infiltrated;
qd. Immunohistochemical exam that showed a chronic inflammatory process.
14 - 16 September 2017, Las Vegas, NV, USA
https://www.dentsplysironaworld.com
Stomatology Edu Journal 125