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Original Article
Year :  |  Volume : 7   |  Issue :1   |  Page :15-17  

Anitha Jayakumar, Deepa Gurunathan

Correspondence Address:Department of Pedodontic and Preventive Dentistry, Saveetha Dental College, Chennai, Tamil Nadu, India

Source of Support: None , Conflict of Interest: None

DOI: 10.4103/2231-4040.197331

How to cite this article:

Jayakumar A, Gurunathan D. Estimation of ferritin levels in children with and without early childhood caries - A case–control study. J Adv Pharm Edu Res 2017;7(1):15-17.

  Introduction   Top

Ferritin is a major iron storage protein. In case of iron deficiency, serum ferritin levels play a critical role in diagnosis and treatment.[1] Serum ferritin is an acute phase protein. Serum ferritin level is an indicator of body iron stores and may be normal or elevated in infective, inflammatory, or malignant disease.[2] Iron ions will be precipitated on the enamel surface as thin acid-resistant coatings containing gels and crystals of hydrous iron oxides. By absorbing salivary calcium and phosphate ions, the iron ions can nucleate the formation of apatites and the replacement of minerals takes place during the acid phases of carious process.[3]

The disease of early childhood caries (ECC) is “the presence of one or more decayed (non-cavitated or cavitated lesions), missing (due to caries), or filled tooth surfaces in any primary tooth in a child 71 months of age or younger.” In children younger than 3 years of age, any sign of smooth surface caries is indicative of severe ECC (S-ECC). From age 3 through 5, one or more cavitated, missing (due to caries), or filled smooth surface in primary maxillary anterior teeth or a decayed, missing, or filled score of ≥4 (age 3), ≥5 (age 4), or ≥6 (age 5) surfaces constitutes S-ECC.[4] ECC and Severe-ECC (S-ECC) can be virulent form of caries, beginning soon after tooth eruption, developing on smooth surfaces, progressing rapidly, and having a detrimental impact on the dentition.[5] Children with S-ECC are believed to be malnourished, anemic, underweight, and have altered somatic growth pattern.[6] Tang et al., 2013, investigated the relationship between the caries status of the children and anemia and also showed that S-ECC was strongly associated with anemia.[7] S-ECC is a risk marker for anemia due to iron deficiency.[8]

Micronutrient deficiency, inadequate intake of iron, has direct influence on the nutritional status of young children and is the most common cause of anemia. Anemia is a nutrition problem worldwide, and its prevalence is higher in developing countries than the developed countries.[9] In a study conducted in South Karnataka, among 300 preschool children, 62% of children showed clinical sign of anemia.[10]

In a study by Clarke et al., 2007, S-ECC children reported with a high prevalence of anemia. Shaoul et al., demonstrated the resolution of dental caries leads to a parallel resolution of iron deficiency anemia without iron treatment.

The following statements provide evidence that the relationship between the iron status and severe caries is salient.[11,12]

• Low hemoglobin (Hb) levels in S-ECC children may be attributed to the body’s inflammatory response to chronic pulpitis. This inflammation triggers a series of events that ultimately leads to the production of cytokines which in turn inhibits erythropoiesis and reduces Hb level.[12,13]

• Pain experienced by S-ECC children may lead to anemic conditions due to poor diet intake.[11]

• Chronic infections are also known to lower Hb levels, which may contribute to anemia.[14]

Hence, the aim and objective of this study are to estimate the ferritin levels in children with and without ECC and to compare it with the severity of ECC. 

  Materials and methods   Top

The ethical approval for the study was obtained from the institutional review board. A convenient sample of 114 children aged <72 months of age were recruited for the study. Among 114 children, 79 children were with ECC (case group), and 35 were without ECC (control group). Children with and without ECC, ASA 1 patient (healthy), and ASA 2 patient (mild systemic disease and no functional limitation) were included in this study. ASA 3 or greater children (complex metabolic or medical disorder) and children under vitamin supplementation were excluded from the study. Oral examination was done to record the severity of ECC based on Wayne’s classification (Table 1).

After getting concern from the parents, 2 ml of blood samples were collected from the participants by venipuncture. Blood samples were collected either from antecubital fossa or metacarpal veins in children by the experienced nurses or laboratory technicians. The collected samples were kept in the test tubes and were transported to the diagnostic centers on the same day. In the diagnostic center, ferritin levels were estimated in the blood using electrochemiluminescence immunoassay method. Statistical data analysis was performed using SPSS 23 versus software. Unpaired t-test was performed to determine the significance in ferritin levels between case and control groups, and one-way ANOVA test was performed for multivariate analysis.

  Results   Top

Discussion   Top

Conclusion   Top

References   Top




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