 Welcome back to another session of Dentistry and More. Today we have anemia, so we are focusing on classification and oral manifestations. So we are now touching the treatment parts or the general symptoms, but we are mainly focusing on the clinical variants of anemia and that's oral manifestations. So anemia is a condition where the RBC, the number of RBC is less than normal, okay. So that is known as anemic condition. So we have classification based on its morphology and etiology and clinical variants. The morphological classifications are the normalcytic, normalchromic, normalcytic hypochromic, normalcytic hypochromic and microcytic hypochromic. It is based on the size of RBC and the color of RBC. So the size is nothing but the MCV that is mean copiscular volume. So MCV is mean copiscular volume and the color is represented in MCHC that is mean copiscular hemoglobin concentration, MCHC. So in the first classification that is normalcytic, normalchromic, the size is normal and the color is normal, whereas a normalcytic hypochromic, so here the hypochromic that is size is normal but the color is less or defective. Next one is a macrocytic hypochromic and macrocytic the size is large and the color is less. Microcytic hypochromic, the size is small and the color is less. So that is based on the morphology, okay. Next we have etiological classification. So it is based on the etiology or the based on the study of course or origin. So we have hemorrhagic anemia that is due to the loss of plate, it could be acute loss in accident or also could be due to a chronic loss and hemolytic anemia, hemolytic anemia there can be extrinsic hemolytic anemia and intrinsic hemolytic anemia. The intrinsic one are thalassemia and sickle cell anemia, these two are intrinsic type whereas extrinsic type we have many reasons like liver failure, renal problems, liver failure, renal issues, then burns, hypersplenism, hepatitis malaria, a pencil in sulphur drugs problem, poisoning by late call, presence of rich factors or autoimmune diseases like rheumatoid arthritis and ulcerative colitis and all these cases there are extrinsic reasons of hemolytic anemia, there will be hemolysis. So the blood loss for the RBC will be less. Next is a nutritional deficiency anemia where the anemia is caused due to the nutrition problem. So mostly it could be due to iron or protein or B12 or folic acid, all these are required for normal production of hemoglobin. So when this iron or protein or B12 or folic acid is not there, the hemoglobin production will be impaired. Okay, so that is nutritional deficiency anemia, after that we have aplastic anemia. Aplastic anemia is bone marrow disorder and lastly we have anemia of chronic disease, the disease due to rheumatoid arthritis, tuberculosis, chronic renal failure or Portuguese disease. So that is etiological classification. Now we have the most important one that is a clinically significant variant. So anyway it comes under the etiological classification but we are focusing mainly on the iron deficiency anemia, it comes under nutritional deficiency and pernicious anemia or adesence not disease, adesence anemia. It is also a nutritional deficiency anemia, regular plastic also nutritional deficiency anemia, sickle cell anemia is hemolytic anemia, talacemia is also hemolytic anemia. They are due to the intrinsic factors and aplastic anemia is due to the bone marrow disorder. So the first one is iron deficiency anemia is the most common type of anemia. So it develops due to inadequate availability of iron for the hemoglobin synthesis because for hemoglobin synthesis it requires iron. So when iron is not there the hemoglobin synthesis will be impaired and it results in iron deficiency anemia. And here the RBC will be microcytic size will be less and hypochromic the color will be impaired. So it will be impaired or less MCV and less MCHC. So the causes of iron deficiency anemia it is due to the loss of blood or the decreased intake of iron or the poor absorption of iron or over consumption or our requirement of iron. The normal iron is present but body needs more iron for conditions like pregnancy and growth. In these cases body needs more iron. So in those case the hemoglobin synthesis will be impaired when there is poor absorption it will be impaired when there is less intake or loss of blood. It will results in iron deficiency anemia. So what are the features of iron deficiency anemia one is brittle nails and brittle hair then the spoon shaped nails which is known as scolonegias then there will be atrophy of papilla in the tongue. Sorry papilla in the tongue will be atrophied and there will be dysphagia that is difficulty in swallowing. This is dysphagia. Next is a pernicious anemia or Addison's anemia. This anemia due to deficiency of vitamin B12 it is due to the atrophy of the gastric mucosa because of autoimmune destruction of parietal cells. Parietal cells destruction is happening. So the gastric atrophy so destruction of parietal cells results in decreased production of intrinsic factor. Okay so there will be decreased production of intrinsic factor intrinsic factor production will be decreased thereby there will be poor absorption of vitamin B12. There will be poor absorption of vitamin B12 which is actually the maturation factor for RBC. Okay this B12 is a maturation factor for RBC. So this is connected parietal cells are destroyed intrinsic factor is less produced so there will be poor absorption of B12 which is a maturation factor for RBC so there will be less RBC production. So these RBCs are larger but immature with almost normal or slightly low hemoglobin level. Okay so this pernicious anemia is common in old age and it is more common in females. Okay female predilection is there and it is associated with other autoimmune diseases like disorders of thyroid gland and Addison's disease. Characteristic feature of this type of anemia are lemon yellow skin. Okay there will be lemon yellow skin and red sore tongue and neurological disorders such as paracetia that is abnormal sensations like numbness, tingling, burning will be there and progressive weakness and ataxia. Ataxia is nothing but muscular incoordination. So that was about pernicious anemia. Now let's move to the megaloblastic anemia. Megaloblastic anemia is due to the deficiency of another maturation factor known as folic acid. Here the RBCs are not matured. Okay so the DNA synthesis is also defective so the nucleus remains immature. The RBC will be megaloblastic and hypochromic. So features of pernicious anemia also appear in this case but there will not be any neurological symptoms because neurological symptoms are present only with the pernicious anemia. Okay that was about megaloblastic anemia. Now let's move to the sickle cell anemia. Sickle cell anemia is an inherited blood disorder characterized by sickle shaped RBC. So it is also called hemoglobin SS disease or sickle cell disease. It is commonly seen in people in African region and it is sickle cell anemia is due to abnormal hemoglobin called hemoglobin S. So in this alpha chains are normal but the beta chains are abnormal. Okay so hemoglobin has alpha and beta chains but the beta chains are abnormal. So RBCs are like more fragile and which leads to hemolysis because it is attaining a sickle or crescent shaped. So in children this hemolyzed sickle cell aggregate and block the blood vessels leading to infarction that is a stoppage of blood supply and this infarction is common in small bones. Okay so this infacted small bones in hand and four crystals in varying length in the digits. This condition is known as hand and foot syndrome and jaundice is also common in this children because the infarction is seen in small bones mainly the hand and foot. There is a digits only seen the digits so it is known as hand and foot syndrome. Next we have thalassemia. Thalassemia is also known as churlis anemia or mediterranean anemia is an inherited disorder characterized by abnormal hemoglobin. It is more common in Thailand and to some extent in mediterranean countries Thailand and mediterranean countries. So this thalassemia is of two types one is alpha thalassemia and next one is a beta thalassemia. So in normal hemoglobin the number of alpha and beta chains are equal. In thalassemia the production of these chains become imbalanced because of the defective synthesis of the globin genes. Okay so defective synthesis of globin genes. Okay globin genes. So this causes the precipitation of these polyprotein chains in the immature RBCs leading to disturbance in the erythropoiesis. So we have alpha thalassemia which is commonly seen in fetal life or infancy. In this alpha chains are less absent or abnormal or defective. This leads to defective erythropoiesis and hemolysis. The infants may be stillborn or may die immediately after birth whereas a beta thalassemia is more common type which is seen in the adult people where the beta chains are less defective or absent. That also leads to defective hemolysis and erythropoiesis. The next one is aplastic anemia. Aplastic anemia is due to the disorder of bone marrow that is red bone marrow. This bone marrow is reduced and replaced by fatty tissue. This bone marrow disorder occur due to the repeated exposure of x-ray exposure or the toxins like benzene radium or due to the tuberculosis or due to the viral infections such as HIV infection or hepatitis. So that was all about the classification of anemia. We have the first classification was about our morphology then the etiological classification. Then we changed the etiological classification into clinical significant variant. The iron deficiency, phonetious anemia or reticence anemia. Third one is migroglastic sickle cell anemia and thalassemia. Lastly the aplastic anemia. Now what are we going to study is about the oral manifestations. In oral manifestations there are some common symptoms. It includes paler, common oral symptoms. It is common for most of the anemic condition that is paler of oral mucosa. Then glossitis or glossodynia where we taste disturbance. These are common symptoms. Then regarding the aplastic anemia it may increase susceptibility to oral infections. There will be oral infections which may require antibiotic prophylaxis or mouthwash because there are chances of spontaneous or uncontrolled gin-chival bleeding. Gin-chival bleeding. That also we have to deal with anti-fibrinolytic medications or avoidance of intramuscular injections and block anesthesia. So we need to be very careful with the aplastic anemic patients because there are chances of infection and bleeding. Whereas a pernicious anemia patient. Pernicious anemia. There will be ankylalkylitis, then mucocytus and thresh oral ulcer. All these will be for pernicious anemia. Ankylalkylitis mucositis, thresh and oral ulcer. Then regarding the sickle cell anemia. The main contraindication for dental treatment with sickle cell anemia patient is routine care during a crisis. We need to schedule dental appointments during the morning with minimum treatment for a patient with a brief visit. We need to prescribe the brief visit in morning. Then we need to we need to prescribe CNS depressants very cautiously. Use of acetaminophen for treatment of pain because salicylates may induce acidosis and avoid elective surgery such as removal of asymptomatic impact at tooth. And then district monitor prevented dental care at routine follow of visit. A three month recall may be necessary in some cases. So that was about we use oral manifestations. It was basically common oral symptoms. Then we have symptoms of pernicious anemia and the precautions we should take while dealing with a plastic anemia and sickle cell anemia. So that's all for today. We covered the classification and oral manifestations of anemia. So it was a lengthy session but the questions are mostly asked sometimes the clinical variants that is end efficiency anemia pernicious mycoblastics sickle cell palacine or plastic anemia along with the oral manifestations. Sometimes description will be asked in general medicine. So anyway understanding anemia is very much essential not just for that's all for today. I'll come up with a new topic in the industry and more. Thank you.