Seema Devi (name changed), a 53-year-old woman, has changed her doctor three times. She experienced constant mouth burning and recurring oral ulcers. Initially, local practitioners treated her for a mouth infection, but her symptoms persisted. She eventually sought care at a higher healthcare center, where her symptoms were correctly diagnosed as iron deficiency anemia. Her health and oral symptoms improved with iron supplementation within a few weeks.
Anemia is a condition characterized by a low number of red blood cells (RBCs), which are responsible for carrying oxygen to body tissues. RBCs contain a protein called hemoglobin (Hb), which binds to oxygen and facilitates its transport. The number of RBCs and Hb levels vary based on factors such as sex (higher in males), health conditions (e.g., pregnancy, disease), ethnicity, and geographical location (higher at higher altitudes). However, the World Health Organization (WHO) defines anemia when hemoglobin (Hb) levels are less than 12.0 g/dL in women and less than 13.0 g/dL in men.
The Global Nutrition Report 2022, published by WHO, reveals that 53% of women aged 15-49 in India are affected by anemia. The Ministry of Statistics and Programme Implementation (MoSPI) released a report titled "Women and Men in India 2022," which showed a 4% increase in the prevalence of anemia among women from 2019-2021 compared to 2015-2016. Notably, non-pregnant women had a higher prevalence (57.2%) compared to pregnant women (52.2%), possibly due to iron and folic acid supplementation during pregnancy.
Nutritional anemia results from a deficiency of iron, vitamin B12, or B9 (folate) and is most common among Indian women. Women require extra iron intake due to increased iron loss during pregnancy and menstruation. However, inadequate dietary intake of iron, vitamins (B12, B9), and other micronutrients among Indian women can be attributed to factors like poverty, poor diet diversity, lack of awareness of a balanced diet, infections, worm infestation, and gender discrimination in access to nutrient-rich foods in households. The situation is worse for marginalized and rural women, given their limited decision-making power regarding health, education, and food consumption.
Many Indian women suffer from oral and other anemia-related health conditions, which often go misdiagnosed or untreated. Anemia symptoms typically include fatigue, weakness, shortness of breath, rapid heartbeat, chest pain, headache, and pale skin. Early signs of anemia may manifest in the oral cavity, such as swollen and bleeding gums, pale oral mucosa, a smooth and red tongue, mouth burning, ulcers, cracks at the corners of the mouth, fungal growth resembling curd, and black spots. Iron is crucial for muscle function, and anemic patients often experience soreness in chewing muscles, leading to eating difficulties. These conditions are usually treatable with supplementation and subside with the correction of deficiencies, as seen in Seema Devi's case. Recognizing the link between anaemia and its oral manifestations is crucial for the right treatment.
According to the Central Bureau of Health Intelligence, there were 2,91,271 registered dental surgeons in India as of December 31, 2020. Under the Anemia Mukt Bharat initiative, capacity building among dental surgeons, along with an integrated approach involving oral and general physicians at the village, block, and district levels, can reduce the burden of anemia. This approach would also facilitate early detection and proper dental treatment for these patients, improving their quality of life. Oral healthcare professionals can play a significant role in creating awareness among women and promoting long-term healthy eating habits.
(Dr Verma is an assistant professor in the Department of Dentistry at Government Medical College, Kannauj, Uttar Pradesh. Views expressed are her personal.)