Anemia, a condition characterized by a reduced number of red blood cells or hemoglobin concentration, affects millions of individuals globally.
It presents with systemic symptoms such as fatigue, pallor, and in severe cases, cardiovascular and neurological complications.
But can anemia affect oral health—and more specifically, the color of the teeth?
Although anemia itself does not typically cause intrinsic dental discoloration, there are indirect pathways through which it can be associated with pigmentation or staining of teeth.
These connections are important for both medical and dental professionals to understand, especially when managing pediatric patients or those undergoing iron therapy.
Possible Links Between Anemia and Tooth Discoloration
1. Iron Supplementation and Extrinsic Staining
The most common dental pigmentation associated with anemia comes not from the disease itself, but from the oral iron supplements prescribed to treat it—especially liquid formulations given to children.
Iron ions in supplements can oxidize when exposed to the oral environment, binding to the enamel surface and leading to black or dark brown extrinsic stains.
These stains are typically superficial but can be difficult to remove with regular brushing. Professional dental cleaning can effectively eliminate them.
► DENTAL BOOK: Little and Falace's Dental Management of the Medically Compromised Patient – 10th Edition (2023)
2. Enamel Defects in Iron Deficiency Anemia
Chronic iron deficiency, particularly during tooth development in early childhood, may contribute to hypomineralization of enamel.
This can make the teeth more porous and susceptible to staining from external sources like food, beverages, and iron-based medications.
In some cases, teeth may appear dull, chalky, or even slightly discolored due to poor enamel integrity, which is an indirect consequence of the underlying nutritional deficiency.
3. Pigmentation in Hemolytic Anemias
Patients with hemolytic anemias (e.g., sickle cell anemia or thalassemia) may experience hyperbilirubinemia, which can result in yellow-green pigmentation of developing teeth (a rare but documented phenomenon).
These discolorations are intrinsic and may be observed as a result of bilirubin deposition during odontogenesis.
Additionally, some hemolytic conditions may alter the facial and dental structures, but these effects are mostly morphological rather than pigmentary.
Key Takeaways
✔ Iron supplements, especially in liquid form, are the primary cause of tooth staining in anemic patients.
✔ Anemia-related enamel defects can increase susceptibility to extrinsic pigmentation.
✔ Rare forms of intrinsic tooth discoloration may occur in severe hemolytic anemias due to bilirubin deposition.
✔ Preventive oral hygiene, diluted iron administration through straws, and regular dental check-ups are essential in managing these effects.
► Read also: Pharmacological Management of Pediatric Odontogenic Infections: A Comprehensive Guide for Dental Professionals
Discussion and Conclusion
While anemia itself is not inherently responsible for tooth discoloration, it creates physiological and therapeutic contexts that make dental pigmentation more likely.
The most clinically significant factor is iron supplementation, especially in pediatric patients, which often leads to superficial but cosmetically concerning stains.
This underscores the importance of interdisciplinary care—medical professionals prescribing iron should advise patients to consult their dentist for preventive oral hygiene measures.
In cases of developmental enamel defects, often linked to chronic nutritional deficiencies such as iron-deficiency anemia, the susceptibility of teeth to extrinsic stains is markedly increased.
These structural alterations not only impact esthetics but may also compromise long-term dental health, increasing the risk of caries and hypersensitivity.
On the rarer end of the spectrum, intrinsic staining due to bilirubin deposition in hemolytic anemias highlights how systemic conditions can directly affect odontogenesis.
Though infrequent, these cases emphasize the need for early diagnosis and comprehensive treatment plans in patients with chronic blood disorders.
Ultimately, understanding the link between anemia and dental pigmentation offers an opportunity for better preventive strategies, patient education, and collaborative care between healthcare providers.
Pediatricians, hematologists, and dentists should work together to mitigate the oral side effects of anemia and its treatment—ensuring both systemic and dental health are preserved.
📚 Scientific References
This study aimed to assess the effects of iron salts on the demineralization and discoloration of primary incisor enamel subjected to artificial cariogenic challenge (ACC) versus saline immersion.
Extrinsic tooth staining potential of iron replacement therapy causes a belief among the parents that these drugs cause tooth decay. In order to clarify this suspicion, the relationship between iron replacement therapy, dental iron concentrations and tooth decay was examined.
3. Effect of Enamel Surface Coating on Staining Capability Due to Iron-containing Supplements (2024)
In vitro experimental study demonstrating that applying an enamel protective coating can significantly reduce iron supplement staining in primary teeth.
