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Medically Compromised Patient Care

Course Number: 628


Anemia is a condition characterized by a deficiency of hemoglobin. Basically, there are too few red blood cells (RBC) present, which is caused by blood loss, decreased production of RBC’s or increased destruction of RBC’s. Patients with this condition have an increased susceptibility to infections and poor wound healing. Clinically, they may present with the following oral manifestations: pallor in oral mucosa, loss of papilla from tongue (sore and red), or angular cheilitis.

There are several types of anemia, such as iron deficiency anemia, pernicious anemia, and sickle-cell anemia. Patients with iron deficiency anemia experience low iron levels. Those with pernicious anemia have insufficient B12 levels due to lack of an intrinsic factor. A distinguishing factor of sickle cell anemia is that the RBC is sickle shaped and it occurs in approximately 1 in 500 African Americans15. Patients who carry 1 gene for the disorder have sickle cell trait and may have routine dental treatment. If patients carry a gene from each parent, they have sickle cell disease.

There are several modifications to dental treatment when a patient presents with sickle cell anemia. First, confirm with the medical doctor to determine the patient’s level of disease control. A medical consult is necessary when disease is poorly controlled or when oral infection is present. During dental treatment, it is helpful to limit local anesthetic with vasoconstrictor. Nitrous oxide sedation is ok to use during a short appointment with at least 50% oxygen.1,16 Finally, these patients require premedication for major surgical procedures. The most critical emergency that can occur is sickle cell crisis, so it is important to treat during a non-crisis period.

Table 10. Follow-Up Questions for Patients with Anemia (1)
  • What type of anemia do you have?
  • Are you being treated and does the treatment control the condition?
  • Has the physician given you any warnings regarding medical or dental treatment or drugs to avoid?
  • Do you have any problems healing too slowly?