Oral manifestations and blood profile in patients with thalassemia trait

Differential Diagnosis of Pigmented Lesions in the Oral Mucosa: A Clinical Based Overview and Narrative Review

This paper examines the clinical differentiation of pigmented lesions in the oral mucosa, which poses significant diagnostic challenges across dental and medical disciplines due to their spectrum from benign to potentially malignant conditions. Through a literature review and analysis of clinical cases, this study clarifies current diagnostic methodologies, with an emphasis on differential diagnosis, to provide a practical guide for clinicians. The classification of pigmented lesions, such as endogenous, focal melanocytic, and multifocal pigmentation, based on clinical and histological features, highlights the necessity for a structured and informed approach. A retrospective examination of cases from our oral medicine and pathology clinic, coupled with analysis of photographic and histological records, aids in classifying these lesions. This fosters a better understanding and promotes informed discussions among clinicians, ultimately aiming to enhance early and precise diagnosis, thus improving patient management and outcomes.

Exploring the Impact of Blood Disorders on Dental Caries

Blood comprises various cellular elements and serves as our immune system's second line of defense. Deviations from its normal composition can have adverse effects on health. At the same time, the oral mucosa in the oral cavity functions as the body's first line of defense, and any anomalies or diseases within it can give rise to both systemic and oral complications. If left untreated, caries can lead to severe tooth damage or extraction, potentially affecting an individual's nutrition and overall health. This review article focuses on the importance of understanding the intricate relationship between blood disorders and oral health. It underscores the profound impact of oral manifestations of blood disorders such as β-thalassemia, sickle cell disease, iron deficiency anemia, leukemia, hemophilia, Plummer-Vinson syndrome, erythroblastosis fetalis, Fanconi anemia, cyclic neutropenia, and acute lymphoblastic leukemia on the overall well-being of an individual.

Higher frequencies of anemia, vitamin B12 deficiency, and gastric parietal cell antibody positivity in folic acid-deficient Taiwanese male oral submucous fibrosis patients

Background/purpose

Oral submucous fibrosis (OSF) is a progressive fibrotic oral mucosal disease associated with betel quid chewing. This study evaluated whether Taiwanese male OSF patients with folic acid (FA) deficiency (the serum FA level ≤6 ng/mL, so-called FA-deficient OSF patients) had high frequencies of blood hemoglobin (Hb) and serum iron and vitamin B12 deficiencies, and serum gastric parietal cell antibody (GPCA) positivity.

Materials and methods

The blood Hb and serum iron, vitamin B12, FA, and GPCA concentrations in 59 Taiwanese male FA-deficient OSF patients were measured and compared with the corresponding data in 118 age-matched healthy male control subjects.

Results

We found that 3 (5.1%), 35 (59.3%), and 7 (11.9%) of the 59 FA-deficient OSF patients had blood Hb (<13 g/dL) and serum vitamin B12 (≤450 pg/mL) deficiencies, and serum GPCA positivity, respectively. Furthermore, 59 FA-deficient OSF patients had significantly higher frequencies of serum vitamin B12 deficiency and serum GPCA positivity than 118 healthy control subjects (all P-values <0.05). Of the 3 anemic FA-deficient OSF patients, one had macrocytic anemia and the other two had thalassemia trait-induced anemia.

Conclusion

We conclude that Taiwanese male FA-deficient OSF patients have high frequencies of serum vitamin B12 deficiency and GPCA positivity than healthy control subjects. The vitamin B12 and FA deficiencies in FA-deficient OSF patients are more likely due to OSF symptoms and signs-caused insufficient intake, difficulty in chewing and swallowing, and malabsorption of food fragment-bound vitamin B12 and FA rather than the GPCA positivity in these OSF patients.

Higher frequencies of anemia, hematinic deficiencies, and gastric parietal cell antibody positivity in vitamin B12-deficient Taiwanese male oral submucous fibrosis patients

Abstract Background/purpose

Oral submucous fibrosis (OSF) is a progressive fibrotic oral mucosal disease associated with betel quid chewing. This study evaluated whether Taiwanese male OSF patients with vitamin B12 deficiency (the serum vitamin B12 level ≤ 450 pg/mL, B12-deficient OSF patients) had high frequencies of blood hemoglobin (Hb) and serum iron and folic acid deficiencies, and serum gastric parietal cell antibody (GPCA) positivity.

Materials and methods

The blood Hb and serum iron, vitamin B12, folic acid, and GPCA concentrations in 66 Taiwanese male B12-deficient OSF patients were measured and compared with the corresponding data in 132 age-matched healthy male control subjects.

Results

We found that 6 (9.1%), 19 (28.8%), 35 (53.0%), and 9 (13.6%) of the 66 B12-deficient OSF patients had blood Hb (<13 g/dL) and serum iron (≤70 μg/dL), and folic acid (≤6 ng/mL) deficiencies, and serum GPCA positivity, respectively. Furthermore, 66 OSF patients had significantly higher frequencies of blood Hb and serum iron and folic acid deficiencies, and serum GPCA positivity than 132 healthy control subjects (all P-values < 0.05). Of the 6 anemic B12-deficient OSF patients, one had macrocytic anemia, two normocytic anemia, and three thalassemia trait-induced anemia.

Conclusion

Taiwanese male B12-deficient OSF patients have high frequencies of blood Hb, serum iron and folic acid deficiencies, and serum GPCA positivity. The anemia and hematinic deficiencies in B12-deficient OSF patients are likely due to OSF symptoms and signs-caused insufficient intake, poor chewing, and malabsorption of hematinic elements from ingested food stuffs rather than the GPCA positivity.

Significantly lower mean serum vitamin B12 and folic acid levels and a significantly higher frequency of serum iron deficiency in younger than in older atrophic glossitis patients

Background/purpose

: Our previous study found that 19.0%, 16.9%, 5.3%, 2.3%, and 11.9% of 1064 atrophic glossitis (AG) patients have anemia, serum iron, vitamin B12, and folic acid deficiencies, and hyperhomocysteinemia, respectively. This study mainly evaluated the anemia, hematinic deficiencies, and hyperhomocysteinemia in 224 younger (≤50 years old) and 840 older (>50 years old) AG patients.

Materials and methods

The blood hemoglobin (Hb) and serum iron, vitamin B12, folic acid, and homocysteine levels in 224 younger and 840 older AG patients were measured and compared with the corresponding levels in 112 younger (≤50 years old) and 420 older (>50 years old) healthy control subjects (HCSs), respectively.

Results

We found that 224 younger AG patients had significantly lower mean blood Hb and serum iron levels than 112 younger HCSs. Moreover, 840 older AG patients had significantly lower mean blood Hb and serum iron levels and a significantly higher mean serum homocysteine level than 420 older HCSs. In addition, 224 younger AG patients had significantly lower mean serum vitamin B12 and folic acid levels, a lower mean serum homocysteine level (marginal significance, P = 0.056), a significantly higher frequency of serum iron deficiency, and a significantly lower frequency of hyperhomocysteinemia than 840 older AG patients.

Conclusion

The younger AG patients do have significantly lower mean serum vitamin B12 and folic acid levels, a significantly higher frequency of serum iron deficiency, and a significantly lower frequency of hyperhomocysteinemia than the older AG patients.

Significantly higher frequencies of macrocytosis, anemia, serum vitamin B12 and folic acid deficiencies, and hyperhomocysteinemia in male than in female atrophic glossitis patients

Background/purpose

Our previous study found that 19.0%, 16.9%, 5.3%, 2.3%, 11.9%, and 26.7% of 1064 atrophic glossitis (AG) patients have anemia, serum iron, vitamin B12, and folic acid deficiencies, hyperhomocysteinemia, and serum gastric parietal cell antibody (GPCA) positivity, respectively. This study evaluated the anemia, hematinic deficiencies, and hyperhomocysteinemia in 150 male and 914 female AG patients.

Materials and methods

The blood hemoglobin (Hb) and serum iron, vitamin B12, folic acid, homocysteine, GPCA levels in 150 male and 914 female AG patients were measured and compared with the corresponding levels in 75 male and 457 female healthy control subjects (HCSs), respectively.

Results

We found that 150 male AG patients had significantly lower mean blood Hb, serum iron, vitamin B12, and folic acid levels, and significantly higher mean serum homocysteine levels than 75 male HCSs. Moreover, 914 female AG patients had significantly lower mean blood Hb and serum iron levels and significantly higher mean serum homocysteine level than 457 female HCSs. In addition, 150 male AG patients had significantly higher mean blood Hb and serum homocysteine levels, significantly lower mean serum vitamin B12 and folic acid levels, and significantly higher frequencies of Hb, vitamin B12, and folic acid deficiency and hyperhomocysteinemia than 914 female AG patients.

Conclusion

The male AG patients do have significantly higher mean blood Hb and serum homocysteine levels, significantly lower mean serum vitamin B12 and folic acid levels, and significantly higher frequencies of Hb, vitamin B12, and folic acid deficiencies and hyperhomocysteinemia than the female AG patients.

Anemia, hematinic deficiencies, and hyperhomocysteinemia in younger and older burning mouth syndrome patients

Abstract Background/purpose

Our previous study found that 19.8%, 16.2%, 4.8%, 2.3%, and 19.2% of 884 burning mouth syndrome (BMS) patients have anemia, serum iron, vitamin B12, and folic acid deficiencies, and hyperhomocysteinemia, respectively. This study mainly evaluated the anemia, hematinic deficiencies, and hyperhomocysteinemia in 272 younger (≤50 years old) and 612 older (>50 years old) BMS patients.

Materials and methods

The blood hemoglobin (Hb) and serum iron, vitamin B12, folic acid, and homocysteine levels in 272 younger and 612 older BMS patients were measured and compared with the corresponding levels in 136 younger (≤50 years old) and 306 older (>50 years old) healthy control subjects (HCSs), respectively.

Results

We found that 272 younger BMS patients had significantly lower mean blood Hb and serum iron, vitamin B12, and folic acid levels than 136 younger HCSs. Moreover, 612 older BMS patients had significantly lower mean blood Hb, and serum iron and vitamin B12 levels and significantly higher mean serum homocysteine level than 306 older HCSs. In addition, 272 younger BMS patients had higher mean blood Hb level (marginal significance, P = 0.056), significantly lower mean serum vitamin B12 and folic acid levels, and significantly higher frequencies of iron and folic acid deficiencies than 612 older BMS patients.

Conclusion

The younger BMS patients do have higher mean blood Hb level, significantly lower mean serum vitamin B12 and folic acid levels, and significantly higher frequencies of serum iron and folic acid deficiencies than the older BMS patients.

Anemia, hematinic deficiencies, and hyperhomocysteinemia in burning mouth syndrome patients with thyroglobulin antibody/thyroid microsomal antibody positivity but without gastric parietal cell antibody positivity

BACKGROUND/PURPOSE

Our previous study found that 222 of 884 burning mouth syndrome (BMS) patients have thyroglobulin antibody (TGA) positivity and/or thyroid microsomal antibody (TMA) positivity but without gastric parietal cell antibody positivity (GPCA-TGA+/TMA+BMS patients). This study mainly assessed whether the serum TGA/TMA positivity was significantly associated with anemia, hematinic deficiencies, and hyperhomocysteinemia in GPCA-TGA+/TMA+BMS patients.

MATERIALS AND METHODS

The complete blood count, iron, vitamin B12, folic acid, and homocysteine levels were measured and compared between 222 GPCA-TGA+/TMA+BMS patients and 553 GPCA-negative, TGA-negative, and TMA-negative BMS patients (GPCA-TGA-TMA-BMS patients) or 442 healthy control subjects.

RESULTS

We found that 222 GPCA-TGA+/TMA+BMS patients had significantly lower mean corpuscular volume (MCV) and lower blood Hb and serum iron levels than 442 healthy control subjects and significantly lower MCV and lower serum homocysteine levels than 553 GPCA-TGA-TMA-BMS patients. Moreover, 222 GPCA-TGA+/TMA+BMS patients had significantly greater frequencies of microcytosis, macrocytosis, blood Hb and serum iron deficiencies, and hyperhomocysteinemia than 442 healthy control subjects and significantly higher frequency of microcytosis but significantly lower frequency of hyperhomocysteinemia than 553 GPCA-TGA-TMA-BMS patients. However, no significant differences in the frequencies of macrocytosis, blood Hb, serum iron, vitamin B12, and folic acid deficiencies were discovered between 222 GPCA-TGA+/TMA+BMS patients and 553 GPCA-TGA-TMA-BMS patients.

CONCLUSION

We conclude that the disease of BMS itself does play a significant role in causing macrocytosis, anemia, hematinic deficiencies, and hyperhomocysteinemia in GPCA-TGA+/TMA+BMS patients. However, the serum TGA/TMA-positivity is not significantly associated with anemia and serum iron, vitamin B12, and folic acid deficiencies in GPCA-TGA+/TMA+BMS patients.

Anemia, hematinic deficiencies, and hyperhomocysteinemia in male and female burning mouth syndrome patients

Background/purpose

Our previous study found that 19.8%, 16.2%, 4.8%, 2.3%, 19.2%, and 12.3% of 884 burning mouth syndrome (BMS) patients have anemia, serum iron, vitamin B12, and folic acid deficiencies, hyperhomocysteinemia, and serum gastric parietal cell antibody (GPCA) positivity, respectively. This study mainly evaluated the anemia, hematinic deficiencies, and hyperhomocysteinemia in 212 male and 672 female BMS patients.

Materials and methods

The blood hemoglobin (Hb) and serum iron, vitamin B12, folic acid, homocysteine, GPCA levels in 212 male and 672 female BMS patients were measured and compared with the corresponding levels in 106 male and 336 female healthy control subjects, respectively.

Results

We found that 212 male BMS patients had significantly lower mean blood Hb, serum iron, vitamin B12, and folic acid levels and significantly higher mean serum homocysteine levels than 106 male healthy control subjects. Moreover, 672 female BMS patients had significantly lower mean blood Hb and serum iron levels and significantly higher mean serum homocysteine level than 336 female healthy control subjects. In addition, 212 male BMS patients had significantly higher mean blood Hb and serum homocysteine levels, significantly lower mean serum vitamin B12 and folic acid levels, and significantly higher frequencies of folic acid deficiency and hyperhomocysteinemis than 672 female BMS patients.

Conclusion

The male BMS patients do have significantly higher mean blood Hb and serum homocysteine levels, significantly lower mean serum vitamin B12 and folic acid levels, and significantly higher frequencies of folic acid deficiency and hyperhomocysteinemis than the female BMS patients.

Anemia, hematinic deficiencies, hyperhomocysteinemia, and gastric parietal cell antibody positivity in burning mouth syndrome patients with macrocytosis

Background/purpose

Macrocytosis is defined as having the mean corpuscular volume (MCV) ≥ 100 fL. This study evaluated whether 46 burning mouth syndrome (BMS) patients with macrocytosis had significantly higher frequencies of anemia, hematinic deficiencies, hyperhomocysteinemia, and serum gastric parietal cell antibody (GPCA) positivity than 442 healthy control subjects or 884 BMS patients.

Materials and methods

Complete blood count, serum iron, vitamin B12, folic acid, homocysteine, and GPCA levels in 46 BMS patients with macrocytosis, 884 BMS patients, and 442 healthy control subjects were measured and compared.

Results

We found that 65.2%, 23.9%, 47.8%, 0.0%, 60.9%, and 45.7% of 46 BMS patients with macrocytosis were diagnosed as having blood hemoglobin, iron, vitamin B12, and folic acid deficiencies, hyperhomocysteinemia, and serum GPCA positivity, respectively. Moreover, 46 BMS patients with macrocytosis had significantly higher frequencies of blood hemoglobin and serum vitamin B12 deficiencies, hyperhomocysteinemia, and serum GPCA positivity than 442 healthy control subjects or 884 BMS patients (all P-values < 0.001). In addition, 46 BMS patients with macrocytosis also had a significantly higher frequency of serum iron deficiency than 442 healthy control subjects (P < 0.001). Pernicious anemia was found in 15 BMS patients with macrocytosis.

Conclusion

There are significantly higher frequencies of anemia and serum iron and vitamin B12 deficiencies, hyperhomocysteinemia, and serum GPCA positivity in BMS patients with macrocytosis than in healthy control subjects. BMS patients with macrocytosis also have significantly higher frequencies of anemia, serum vitamin B12 deficiency, hyperhomocysteinemia, and serum GPCA positivity than BMS patients.

Anemia, hematinic deficiencies, and hyperhomocysteinemia in serum gastric parietal cell antibody-positive burning mouth syndrome patients without serum thyroid autoantibodies

Background/purpose

Our previous study found that 70 of 884 burning mouth syndrome (BMS) patients have serum gastric parietal cell antibody (GPCA) positivity but without thyroglobulin antibody (TGA) and thyroid microsomal antibody (TMA) (so-called GPCA⁺TGAˉTMAˉBMS patients). This study assessed whether these 70 GPCA⁺TGAˉTMAˉBMS patients had significantly higher frequencies of macrocytosis, anemia, hematinic deficiencies, and hyperhomocysteinemia than 553 GPCA-negative, TGA-negative, and TMA-negative BMS (GPCAˉTGAˉTMAˉBMS) patients or 442 healthy control subjects.

Materials and methods

Complete blood count, serum iron, vitamin B12, folic acid, homocysteine, GPCA, TGA, and TMA levels in 70 GPCA⁺TGAˉTMAˉBMS patients, 553 GPCAˉTGAˉTMAˉBMS patients, and 442 healthy control subjects were measured and compared.

Results

We found that 15.7%, 28.6%, 20.0%, 11.4%, 2.9%, and 25.7% of 70 GPCA⁺TGAˉTMAˉBMS patients and 3.8%, 17.7%, 15.9%, 3.8%, 2.7%, and 20.1% of 553 GPCAˉTGAˉTMAˉBMS patients had macrocytosis, blood hemoglobin, iron, vitamin B12, and folic acid deficiencies, and hyperhomocysteinemia, respectively. Moreover, both 70 GPCA⁺TGAˉTMAˉBMS patients and 553 GPCAˉTGAˉTMAˉBMS patients had significantly greater frequencies of macrocytosis, blood hemoglobin, serum iron, vitamin B12, and folic acid deficiencies, and hyperhomocysteinemia than 442 healthy control subjects (all P-values < 0.05). In addition, 70 GPCA⁺TGAˉTMAˉBMS patients also had greater frequencies of macrocytosis, anemia, serum vitamin B12 deficiency, and hyperhomocysteinemia than 553 GPCAˉTGAˉTMAˉBMS patients (all P-values < 0.05).

Conclusion

The GPCA ⁺ TGAˉTMAˉBMS patients have significantly greater frequencies of macrocytosis, anemia, serum iron, vitamin B12, and folic acid deficiencies, and hyperhomocysteinemia than healthy control subjects and significantly greater frequencies of macrocytosis, anemia, serum vitamin B12 deficiency, and hyperhomocysteinemia than GPCAˉTGAˉTMAˉBMS patients.

Oral Candidosis: Pathophysiology and Best Practice for Diagnosis, Classification, and Successful Management

Oral candidosis is the most common fungal infection that frequently occurs in patients debilitated by other diseases or conditions. No candidosis happens without a cause; hence oral candidosis has been branded as a disease of the diseased. Prior research has identified oral candidosis as a mark of systemic diseases, such as hematinic deficiency, diabetes mellitus, leukopenia, HIV/AIDS, malignancies, and carbohydrate-rich diet, drugs, or immunosuppressive conditions. An array of interaction between Candida and the host is dynamic and complex. Candida exhibits multifaceted strategies for growth, proliferation, evasion of host defenses, and survival within the host to induce fungal infection. Oral candidosis presents a variety of clinical forms, including pseudomembranous candidosis, erythematous candidosis, angular cheilitis, median rhomboid glossitis, cheilocandidosis, juxtavermillion candidosis, mucocutaneous candidosis, hyperplastic candidosis, oropharyngeal candidosis, and rare suppurative candidosis. The prognosis is usually favorable, but treatment failure or recurrence is common due to either incorrect diagnosis, missing other pathology, inability to address underlying risk factors, or inaccurate prescription of antifungal agents. In immunocompromised patients, oropharyngeal candidosis can spread to the bloodstream or upper gastrointestinal tract, leading to potentially lethal systemic candidosis. This review therefore describes oral candidosis with regard to its pathophysiology and best practice for diagnosis, practical classification, and successful management.

Vitamin B12 deficiency and anemia in 140 Taiwanese female lacto-vegetarians

BACKGROUND/PURPOSE

Lacto-vegetarians (LVs) tend to have vitamin B12 deficiency (B12D). This study assessed whether 140 female LVs, including 16 B12D/LVs and 124 non-B12D/LVs, had significantly higher frequencies of microcytosis, macrocytosis, and of blood hemoglobin (Hb), red blood cell (RBC), and serum vitamin B12 deficiencies than 140 healthy control subjects (HCSs).

METHODS

The complete blood count and serum vitamin B12 level in 140 female LVs and 140 female HCSs were measured and compared.

RESULTS

We found that 8.6%, 4.3%, 22.9%, 20.0%, and 11.4% of 140 LVs had microcytosis, macrocytosis, and blood Hb, RBC, and serum vitamin B12 deficiencies, respectively. The 140 LVs, 16 B12D/LVs, and 124 non-B12D/LVs had significantly higher frequencies of microcytosis as well as blood Hb and RBC deficiencies than 140 HCSs (all P-values < 0.005). Moreover, both 140 LVs and 124 non-B12D/LVs had significantly higher frequencies of macrocytosis than 140 HCSs. In this study, 32 (22.9%) of 140 LVs including 5 B12D/LVs and 27 non-B12D/LVs had anemia. Of the 5 anemic B12D/LVs, three had normocytic anemia, one had iron deficiency anemia (IDA), and one had thalassemia trait-induced anemia. Moreover, of the 27 anemic non-B12D/LVs, 18 had normocytic anemia, one had IDA, one had thalassemia trait-induced anemia, and 7 had microcytic anemia other than IDA and thalassemia trait-induced anemia.

CONCLUSION

LVs have significantly higher frequencies of microcytosis, macrocytosis, blood Hb, RBC, and serum vitamin B12 deficiencies than HCSs. Normocytic and microcytic anemias are the two most common types of anemia in our LVs.

Anemia, hematinic deficiencies, hyperhomocysteinemia, and gastric parietal cell antibody positivity in burning mouth syndrome patients with or without microcytosis

BACKGROUND/PURPOSE

Microcytosis is defined as having mean corpuscular volume <80 fL. This study evaluated whether 68 burning mouth syndrome (BMS) patients with microcytosis and 816 BMS patients without microcytosis had higher frequencies of anemia, hematinic deficiencies, hyperhomocysteinemia, and serum gastric parietal cell antibody (GPCA) positivity than 442 healthy control subjects.

MATERIALS AND METHODS

Complete blood count and serum iron, vitamin B12, folic acid, homocysteine, and GPCA levels in 68 BMS patients with microcytosis, 816 BMS patients without microcytosis, and 442 healthy control subjects were measured and compared.

RESULTS

We found that 73.5%, 44.1%, 4.4%, 2.9%, 13.2%, and 10.3% of 68 BMS patients with microcytosis and 15.3%, 13.8%, 4.8%, 2.2%, 19.7%, and 12.5% of 816 BMS patients without microcytosis had blood hemoglobin, iron, vitamin B12, and folic acid deficiencies, hyperhomocysteinemia, and serum GPCA positivity, respectively. Both 68 BMS patients with microcytosis and 816 BMS patients without microcytosis had significantly higher frequencies of blood hemoglobin, iron, vitamin B12, and folic acid deficiencies, hyperhomocysteinemia, and serum GPCA positivity than 442 healthy control subjects (all P-values < 0.05). Moreover, 68 BMS patients with microcytosis had significantly higher frequencies of blood hemoglobin and iron deficiencies than 816 BMS patients without microcytosis.

CONCLUSION

There are significantly higher frequencies of anemia, serum iron, vitamin B12, and folic acid deficiencies, hyperhomocysteinemia, and serum GPCA positivity in BMS patients with or without microcytosis than in healthy control subjects. BMS patients with microcytosis have significantly higher frequencies of blood hemoglobin and iron deficiencies than BMS patients without microcytosis.

Anemia, hematinic deficiencies, and hyperhomocysteinemia in gastric parietal cell antibody-positive and -negative burning mouth syndrome patients

BACKGROUND/PURPOSE

Our previous study found the serum gastric parietal cell antibody (GPCA) positivity in 12.3% of burning mouth syndrome (BMS) patients. This study assessed whether GPCA-positive BMS (GPCA⁺BMS) patients had significantly higher frequencies of macrocytosis, anemia, hematinic deficiencies, and hyperhomocysteinemia than healthy control subjects or GPCA-negative BMS (GPCA^-BMS) patients.

METHODS

The mean corpuscular volume, blood hemoglobin (Hb), and serum iron, vitamin B12, folic acid, homocysteine, and GPCA levels were measured and compared between any two of three groups of 109 GPCA⁺BMS patients, 775 GPCA^-BMS patients, and 442 healthy control subjects.

RESULTS

We found that 109 GPCA⁺BMS patients had significantly higher frequencies of macrocytosis, blood Hb and serum iron and vitamin B12 deficiencies, and hyperhomocysteinemia than 442 healthy control subjects (all P-values < 0.001) and significantly higher frequencies of macrocytosis, blood Hb and serum vitamin B12 deficiencies, and hyperhomocysteinemia than 775 GPCA^-BMS patients (all P-values < 0.01). Moreover, 775 GPCA^-BMS patients had significantly higher frequencies of macrocytosis, blood Hb and serum iron, vitamin B12, and folic acid deficiencies, and hyperhomocysteinemia than 442 healthy control subjects (all P-values < 0.005). Pernicious anemia (45.5%) and normocytic anemia (24.2%) were the two most common types of anemia in 33 anemic GPCA⁺BMS patients. Moreover, normocytic anemia (61.3%), thalassemia trait-induced anemia (15.5%), and iron deficiency anemia (14.1%) were the three most common types of anemia in 142 anemic GPCA^-BMS patients.

CONCLUSION

GPCA⁺BMS patients have significantly higher frequencies of macrocytosis, blood Hb and serum vitamin B12 deficiencies, and hyperhomocysteinemia than healthy control subjects or GPCA^-BMS patients.

Anemia, hematinic deficiencies, and gastric parietal cell antibody positivity in burning mouth syndrome patients with or without hyperhomocysteinemia

BACKGROUND/PURPOSE

Our previous study found that 170 of 884 burning mouth syndrome (BMS) patients have hyperhomocysteinemia. This study assessed whether these 170 BMS patients with hyperhomocysteinemia had significantly higher frequencies of anemia, hematinic deficiencies, and serum gastric parietal cell antibody (GPCA) positivity than 714 BMS patients without hyperhomocysteinemia or 442 healthy control subjects.

MATERIALS AND METHODS

The blood hemoglobin (Hb) and serum iron, vitamin B12, folic acid, homocysteine, and GPCA levels in 170 BMS patients with hyperhomocysteinemia, 714 BMS patients without hyperhomocysteinemia, and 442 healthy control subjects were measured and compared.

RESULTS

We found that 170 BMS patients with hyperhomocysteinemia had significantly higher frequencies of macrocytosis, blood Hb and serum iron, vitamin B12, and folic acid deficiencies, and serum GPCA positivity than 442 healthy control subjects (all P-values < 0.001) or 714 BMS patients without hyperhomocysteinemia (all P-values < 0.05). Anemia was found in 77 of 170 BMS patients with hyperhomocysteinemia and in 98 of 714 BMS patients without hyperhomocysteinemia. Normocytic anemia (47 cases) and pernicious anemia (15 cases) were the two most common types of anemia in 170 BMS patients with hyperhomocysteinemia. Moreover, normocytic anemia (48 cases), iron deficiency anemia (21 cases), and thalassemia trait-induced anemia (21 cases) were the three most common types of anemia in 714 BMS patients without hyperhomocysteinemia.

CONCLUSION

BMS patients with hyperhomocysteinemia had significantly higher frequencies of macrocytosis, anemia, serum iron, vitamin B12, and folic acid deficiencies, and serum GPCA positivity than healthy control subjects or BMS patients without hyperhomocysteinemia.

Anemia, hematinic deficiencies, hyperhomocysteinemia, and gastric parietal cell antibody positivity in burning mouth syndrome patients with vitamin B12 deficiency

Background/purpose

Our previous study found that 42 of 884 burning mouth syndrome (BMS) patients have vitamin B12 deficiency. This study assessed whether the vitamin B12-deficient BMS (B12D/BMS) patients had significantly higher frequencies of anemia, hematinic deficiencies, hyperhomocysteinemia, and serum gastric parietal cell antibody (GPCA) positivity than healthy control subjects and evaluated whether all B12D/BMS patients had pernicious anemia (PA).

Materials and methods

The blood hemoglobin (Hb) and serum iron, vitamin B12, folic acid, homocysteine, and GPCA levels in 42 B12D/BMS patients and 442 healthy control subjects were measured and compared.

Results

We found that 42 B12D/BMS patients had significantly lower mean blood Hb and serum iron and vitamin B12 levels as well as significantly higher mean corpuscular volume (MCV) and mean serum homocysteine level than healthy control subjects (all P-values < 0.05). Moreover, 42 B12D/BMS patients had significantly higher frequencies of macrocytosis (52.4%), blood Hb (61.9%) and serum iron (26.2%) and vitamin B12 (100.0%) deficiencies, hyperhomocysteinemia (83.3%), and serum GPCA positivity (42.9%) than 442 healthy control subjects (all P-values < 0.001). Moreover, of 26 anemic B12D/BMS patients, 15 (57.7%) had PA, 5 (19.2%) had macrocytic anemia other than PA, 4 (15.4%) had normocytic anemia, and 2 (7.7%) had thalassemia trait-induced anemia.

Conclusion

B12D/BMS patients have significantly higher frequencies of macrocytosis, blood Hb and serum iron and vitamin B12 deficiencies, hyperhomocysteinemia, and serum GPCA positivity than healthy control subjects. Although PA is the most common type of anemia in our B12D/BMS patients, only 15 (35.7%) of 42 B12D/BMS patients have PA.

Anemia, hematinic deficiencies, hyperhomocysteinemia, and gastric parietal cell antibody positivity in burning mouth syndrome patients with iron deficiency

Background/purpose

Our previous study found that 143 of 884 burning mouth syndrome (BMS) patients have iron deficiency (ID). This study assessed whether all BMS patients with ID (so-called ID/BMS patients) had iron deficiency anemia (IDA) and evaluated whether the ID/BMS patients had significantly higher frequencies of anemia, hematinic deficiencies, hyperhomocysteinemia, and serum gastric parietal cell antibody (GPCA) positivity than healthy control subjects.

Materials and methods

The blood hemoglobin (Hb) and serum iron, vitamin B12, folic acid, homocysteine, and GPCA levels in 143 ID/BMS patients and 442 healthy control subjects were measured and compared.

Results

We found that 143 ID/BMS patients had significantly lower mean blood Hb and serum iron, vitamin B12, folic acid levels as well as significantly higher mean serum homocysteine level than healthy control subjects (all P-values < 0.01). Moreover, 143 ID/BMS patients had significantly higher frequencies of blood Hb (55.9%) and serum iron (100.0%), vitamin B12 (7.7%), and folic acid (2.1%) deficiencies, hyperhomocysteinemia (27.3%), and serum GPCA positivity (12.6%) than 442 healthy control subjects (all P-values < 0.001). Furthermore, of 80 anemic ID/BMS patients, 5 (6.3%) had pernicious anemia, 5 (6.3%) had macrocytic anemia other than pernicious anemia, 42 (52.5%) had normocytic anemia, 21 (26.3%) had IDA, and 7 (8.8%) had thalassemia trait-induced anemia.

Conclusion

ID/BMS patients had significantly higher frequencies of blood Hb and serum iron, vitamin B12, and folic acid deficiencies, hyperhomocysteinemia, and serum GPCA positivity than healthy control subjects. Normocytic anemia is the most common type of anemia in ID/BMS patients.

Anemia, hematinic deficiencies, hyperhomocysteinemia, and gastric parietal cell antibody positivity in atrophic glossitis patients with vitamin B12 deficiency

BACKGROUND/PURPOSE

Our previous study found that 56 of 1064 atrophic glossitis (AG) patients have vitamin B12 deficiency. This study assessed whether the AG patients with vitamin B12 deficiency (B12D/AG patients) had significantly higher frequencies of anemia, hematinic deficiencies, hyperhomocysteinemia, and serum gastric parietal cell antibody (GPCA) positivity than healthy control subjects.

METHODS

The blood hemoglobin (Hb) and serum iron, vitamin B12, folic acid, homocysteine, and GPCA levels in 56 B12D/AG patients and 532 healthy control subjects were measured and compared.

RESULTS

We found that 56 B12D/AG patients had significantly lower mean blood Hb and serum iron levels as well as significantly higher mean corpuscular volume (MCV) and mean serum homocysteine level than healthy control subjects (all P-values < 0.05). Moreover, 56 B12D/AG patients had significantly higher frequencies of macrocytosis (53.6%), blood Hb (64.3%), iron (26.8%), and folic acid (3.6%) deficiencies, hyperhomocysteinemia (89.3%), and serum GPCA positivity (55.4%) than 532 healthy control subjects (all P-values < 0.005). In addition, of 36 anemic B12D/AG patients, 22 (61.1%) had pernicious anemia (PA), 6 (16.7%) had macrocytic anemia other than PA, 4 (11.1%) had normocytic anemia, 3 (8.3%) had iron deficiency anemia (IDA), and one (2.8%) had microcytic anemia other than IDA and thalassemia trait-induced anemia.

CONCLUSION

We conclude that B12D/AG patients have significantly higher frequencies of macrocytosis, blood Hb, iron, and folic acid deficiencies, hyperhomocysteinemia, and serum GPCA positivity than healthy control subjects. PA is the most common type of anemia in our B12D/AG patients.

Anemia, hematinic deficiencies, and gastric parietal cell antibody positivity in atrophic glossitis patients with or without hyperhomocysteinemia

BACKGROUND/PURPOSE

Our previous study found that 127 of 1064 atrophic glossitis (AG) patients have hyperhomocysteinemia. This study assessed whether the AG patients with hyperhomocysteinemia had significantly higher frequencies of anemia, hematinic deficiencies, and serum gastric parietal cell antibody (GPCA) positivity than AG patients without hyperhomocysteinemia or healthy control subjects.

METHODS

The blood hemoglobin (Hb) and serum iron, vitamin B12, folic acid, homocysteine, and GPCA levels in 127 AG patients with hyperhomocysteinemia, 937 AG patients without hyperhomocysteinemia, and 532 healthy control subjects were measured and compared.

RESULTS

We found that 127 AG patients with hyperhomocysteinemia had significantly higher frequencies of blood Hb and serum iron, vitamin B12, and folic acid deficiencies and serum GPCA positivity than 532 healthy control subjects (all P-values < 0.001) and significantly higher frequencies of blood Hb and serum vitamin B12 and folic acid deficiencies and serum GPCA positivity than 937 AG patients without hyperhomocysteinemia (all P-values < 0.001). Moreover, 127 AG patients with hyperhomocysteinemia had significantly higher frequencies of macrocytic anemia and significantly lower frequencies of normocytic anemia than 937 AG patients without hyperhomocysteinemia (both P-values < 0.001). Pernicious anemia (22 cases) was found only in AG patients with hyperhomocysteinemia but not in AG patients without hyperhomocysteinemia.

CONCLUSION

AG patients with hyperhomocysteinemia had significantly higher frequencies of anemia, serum iron, vitamin B12, and folic acid deficiencies, and serum GPCA positivity than healthy control subjects and significantly higher frequencies of anemia, serum vitamin B12 and folic acid deficiencies, and serum GPCA positivity than AG patients without hyperhomocysteinemia.

Does serum gastric parietal cell antibody titer have influence on anemia and vitamin B12 deficiency in atrophic glossitis patients?

BACKGROUND/PURPOSE

Our previous study found 284 gastric parietal cell antibody (GPCA)-positive atrophic glossitis (AG) patients (so-called GPCA⁺AG patients in this study) in a group of 1064 AG patients. This study evaluated whether high-titer (GPCA titer ≥ 160) GPCA⁺AG patients had greater frequencies of anemia, vitamin B12 deficiency, macrocytosis, and hyperhomocysteinemia than low-titer (GPCA titer < 160) GPCA⁺AG patients.

METHODS

Complete blood count, serum iron, vitamin B12, folic acid, homocysteine, and GPCA levels in 117 high-titer GPCA⁺AG patients, 167 low-titer GPCA⁺AG patients, and 532 healthy control subjects were measured and compared.

RESULTS

We found that 12.0%, 29.1%, 23.1%, 16.2%, 1.7%, and 23.1% of 117 high-titer GPCA⁺AG patients and 5.4%, 17.4%, 17.4%, 7.2%, 1.2%, and 14.4% of 167 low-titer GPCA⁺AG patients were diagnosed as having macrocytosis, blood hemoglobin, iron, vitamin B12, and folic acid deficiencies, and hyperhomocysteinemia, respectively. Moreover, both 117 high-titer and 167 low-titer GPCA⁺AG patients had significantly greater frequencies of macrocytosis, blood hemoglobin, serum iron and vitamin B12 deficiencies, and hyperhomocysteinemia than 532 healthy control subjects (all P-values < 0.05). In addition, 117 high-titer GPCA⁺AG patients also had greater frequencies of anemia (P = 0.029, statistically significant), serum vitamin B12 deficiency (P = 0.027, statistically significant), macrocytosis (P = 0.075, marginal significance), and hyperhomocysteinemia (P = 0.085, marginal significance) than 167 low-titer GPCA⁺AG patients.

CONCLUSION

For GPCA⁺AG patients, high-titer GPCA⁺AG patients have greater frequencies of anemia, serum vitamin B12 deficiency, macrocytosis, and hyperhomocysteinemia than low-titer GPCA⁺AG patients.

Gastric parietal cell and thyroid autoantibodies in oral precancer patients

BACKGROUND/PURPOSE

Gastric parietal cell antibody (GPCA), thyroglobulin antibody (TGA), and thyroid microsomal antibody (TMA) may be present in oral mucosal disease patients. This study mainly assessed the frequencies of serum GPCA, TGA, and TMA positivities in 131 oral precancer patients.

METHODS

Serum GPCA, TGA, and TMA levels were measured in 131 oral precancer patients including 96 oral leukoplakia, 26 oral erythroleukoplakia, and 9 oral verrucous hyperplasia patients and in 131 age- and sex-matched healthy control subjects.

RESULTS

We found that 131 oral precancer patients had higher frequencies of serum GPCA (10.7% vs. 2.3%, P = 0.012, statistically significant), TGA (4.6% vs. 2.3%, P = 0.498), and TMA (8.4% vs. 2.3%, P = 0.054, marginal significance) positivities than 131 healthy control subjects. We also found that 1 (0.8%), 6 (4.6%), and 16 (12.2%) oral precancer patients had the presence of three (GPCA + TGA + TMA), two (GPCA + TGA, GPCA + TMA, or TGA + TMA), or one (GPCA only, TGA only, or TMA only) autoantibody in their sera, respectively. Of 10 TGA/TMA-positive oral precancer patients whose serum thyroid-stimulating hormone (TSH) levels were measured, 80%, 10%, and 10% of these 10 TGA/TMA-positive oral precancer patients had normal, lower, and higher serum TSH levels, respectively. We also found a significantly higher GPCA positive rate in 26 smokers consuming >20 cigarettes per day than in 61 smokers consuming ≤20 cigarettes per day (P = 0.008).

CONCLUSION

Approximately 17.6% of 131 oral precancer patients have serum GPCA/TGA/TMA positivity. Only approximately 20% of TGA/TMA-positive oral precancer patients have either hypothyroidism or hyperthyroidism.

Atrophic glossitis: Etiology, serum autoantibodies, anemia, hematinic deficiencies, hyperhomocysteinemia, and management

Atrophic glossitis (AG) is characterized by the partial or complete absence of filiform papillae on the dorsal surface of the tongue. AG may reflect the significant deficiencies of some major nutrients including riboflavin, niacin, pyridoxine, vitamin B12, folic acid, iron, zinc, and vitamin E. Moreover, protein-calorie malnutrition, candidiasis, Helicobacter pylori colonization, xerostomia, and diabetes mellitus are also the etiologies of AG. Our previous study found the serum gastric parietal cell antibody (GPCA), thyroglobulin antibody (TGA), and thyroid microsomal antibody (TMA) positivities in 26.7%, 28.4%, and 29.8% of 1064 AG patients, respectively. We also found anemia, serum iron, vitamin B12, and folic acid deficiencies, and hyperhomocysteinemia in 19.0%, 16.9%, 5.3%, 2.3%, and 11.9% of 1064 AG patients, respectively. Moreover, GPCA-positive AG patients tended to have relatively higher frequencies of hemoglobin, iron, and vitamin B12 deficiencies and hyperhomocysteinemia than GPCA-negative AG patients. Supplementations with vitamin BC capsules plus corresponding deficient hematinics for those AG patients with hematinic deficiencies can achieve complete remission of oral symptoms and AG in some AG patients. Therefore, it is very important to examine the complete blood count, serum hematinic, homocysteine, and autoantibody levels in AG patients before we start to offer treatments for AG patients.

Hematinic deficiencies and anemia in gastric parietal cell antibody-positive and -negative oral submucous fibrosis patients

BACKGROUND/PURPOSE

Previous studies showed that approximately 13-15% of male oral submucous fibrosis (OSF) patients are serum gastric parietal cell antibody (GPCA)-positive. This study assessed whether serum GPCA or OSF itself was a significant factor that caused hematinic deficiencies and anemia statuses in GPCA-positive or GPCA-negative OSF patients (GPCA+/OSF and GPCA-/OSF patients).

MATERIALS AND METHODS

The frequencies of macrocytosis (mean corpuscular volume or MCV ≧ 100 fL) and blood hemoglobin (Hb), iron, vitamin B12 and folic acid deficiencies were determined and compared between any two of the four groups of 149 male OSF, 23 male GPCA+/OSF, and 126 male GPCA-/OSF patients and 149 age-matched male healthy control subjects.

RESULTS

All three groups of OSF patients (including 149 OSF, 23 GPCA+/OSF, and 126 GPCA-/OSF patients) had a significantly higher frequency of Hb, vitamin B12, or folic acid deficiency and of macrocytosis than 149 healthy control subjects (all P-values < 0.05). The 23 GPCA+/OSF patients did have a significantly lower mean serum vitamin B12 level and a significantly higher MCV or frequency of vitamin B12 deficiency than the 126 GPCA-/OSF patients. Two of the 23 GPCA+/OSF patients had pernicious anemia. Of the 126 GPCA-/OSF patients, 6 had macrocytic anemia, 2 had iron deficiency anemia, and 4 had thalassemia trait-induced anemia.

CONCLUSION

We conclude that OSF itself does play a significant role in causing hematinic deficiencies and anemia in OSF, GPCA+/OSF, and GPCA-/OSF patients. The serum GPCA is the major factor that causes vitamin B12 deficiency, macrocytosis, and pernicious anemia in GPCA+/OSF patients.

Oral lichen planus - Differential diagnoses, serum autoantibodies, hematinic deficiencies, and management

Oral lichen planus (OLP) is a chronic inflammatory oral mucosal disease that occurs more frequently in middle-aged and elderly female patients. Previous studies indicate that OLP is a T-cell dysfunction-induced localized autoimmune disease. Clinically, six types of OLP, namely reticular, papular, plaque-like, atrophic/erosive, ulcerative, and bullous types, can be identified. OLP more commonly affects buccal mucosa, tongue, and gingiva. It always has a bilateral and symmetric distribution of the oral lesions. Plaque-like and atrophic/erosive OLP may be misdiagnosed as oral leukoplakia and oral erythroleukoplakia, respectively. Our previous study found serum autoantibodies in 195 (60.9%) of the 320 OLP patients. Specific serum anti-nuclear, anti-smooth muscle, anti-mitochondrial, gastric parietal cell, thyroglobulin, and thyroid microsomal autoantibodies are present in 28.1%, 8.4%, 1.6%, 26.3%, 21.3%, and 24.4% of 320 OLP patients, respectively. Furthermore, we also discovered that 21.9%, 13.6%, 7.1%, 0.3%, and 14.8% of 352 OLP patients have hemoglobin, iron, vitamin B12, and folic acid deficiencies, and abnormally high serum homocysteine level, respectively. Therefore, it is very important to examine the serum autoantibody, hematinic and homocysteine levels in OLP patients before starting the treatments for OLP patients. Because OLP is an immunologically-mediated disease, corticosteroids are the drugs of choice for treatment of OLP.

Clinical management of the homozygous α-thalassemia with unusual mandibular manifestation of hematopoiesis

Alpha (α)-thalassemias are the most common genetic disorder of hemoglobin (Hb) synthesis, affecting up to 5% of the world's population. These congenital hemolytic anemias induce extramedullary hematopoiesis, including the liver, spleen, sinuses, and the diploic spaces of the skull. Oral health problems in patients with thalassemias are mostly related to a varied degree of facial deformities, malocclusions, and/or dental arch dimensions. We present a case with a 49-year-old man, diagnosed with homozygous α thalassemia that came to the Faculty of Dentistry at the University of Murcia for a dental treatment. It was observed that the patient had an unusual mandibular manifestation of hematopoiesis.