Their health problems are so bizarre they often take years to diagnose. Many patients are too embarrassed to talk about them, and often end up in the urgent care clinic at The University of Texas Health Science Center at Houston (UTHealth) School of Dentistry.

Their confounding condition? The compulsive eating of non-food substances, such as ice, dirt, ashes, paper, foam rubber, coal, starch, hair—even mucus and feces. The condition is called “pica” (pronounced pie-ka) and derives its name from the Latin word for magpie, a bird known for its indiscriminate tastes.

In the case of pica, dentists are often the first detectives on the scene. Pica often results in disfigured teeth, extreme tooth sensitivity, or worse, which brings patients to the attention of Drs. Cleverick D. Johnson and Sheila H. Koh, professors in the Department of Restorative Dentistry and Biomaterials at the UTHealth School of Dentistry.

One of the doctors’ first pica cases was an African-American female nurse in Houston who was losing weight because she couldn’t eat or drink either cold or hot foods without severe sensitivity and pain. After extensive questioning, the team finally discovered that she along with several members of her family were eating small quantities of clay on a regular basis.

Constant craving

Compulsively eating earth substances like clay, sand or soil is a type of pica called geophasia, Johnson explains. “It’s very common in Africa, the Middle East, China and Vietnam and also occurs in the southeastern part of the US and is often related to iron and zinc deficiencies. What’s uncommon is men who do it; it’s mostly women, and mostly during pregnancy.”

But pica and pregnancy is a subject little known and even less discussed, their research proved. In a paper published in the Journal of General Dentistry, they focused on a 45-year-old woman who sought treatment for multiple dental problems.  Nearly half of her upper and lower front teeth were cracked and broken off. She suffered from general tooth sensitivity. Her other teeth were worn down and had a scooped-out appearance.

It took extensive questioning by both dentists to discover the problem. The woman finally confessed that the tooth damage occurred during four previous pregnancies when she compulsively ate ice and freezer frost four to six hours a day during the second and third trimesters to control excessive weight gain. She was also bulimic and purged (through vomiting) once or twice a day during the third trimester of her pregnancies. Her husband was a popular football player who was often away from home, she told the doctors, and she worried about “all the groupies following him around and looking good.”

“You have to go probing and probing to discover this,” Koh says. “She doesn’t want to gain weight for fear her husband will think she’s become fat and ugly. She is afraid her husband might leave her so she eats ice when she gets hungry.”

“One form of pica is this perceived texture in your mouth,” adds Johnson. “You have to have something to crunch on. And if she admits to eating ice four to six hours a day, it’s probably really twice that much.”

This craving for ice is called pagophagia. Scientific literature—and folklore—suggests a link between compulsive ice chewing and iron deficiency anemia. It’s so common that multiple websites exist (icechewing.com for one) and often include support groups for people with this condition.

Pregnant women also have other abnormal cravings. Johnson recalls a story in the Houston Chronicle several years ago that involved removing a 5-pound hairball from a woman’s stomach. “She just compulsively pulled her hair out and swallowed it during her pregnancy.”

Other pica patients—pregnant or otherwise—have consumed everything from skin and rocks to toilet paper rolls and couch cushions.

Children and pica

For very young children, consuming non-edibles is not unusual... for a while.

Very young children explore their environment with their hands and mouths, often chewing and swallowing non-edible materials. For children, peeling off and consuming lead-based paint is dangerous, but common. Most children learn by the age of 2 years what is appropriate to taste and what is not. Children who compulsively put non-food items in their mouths or try to swallow them for periods longer than a few weeks should be seen by their pediatricians. “If a child is still eating non-food substances after age 3, it’s usually a mental or psychiatric disorder,” Johnson says.

Numerous cases of the more bizarre forms of pica can be found on online, often with graphic photos. One such case involved a 62-year-old man who checked into a French hospital complaining of abdominal pain. To their horror, doctors discovered 12 pounds of coins and an assortment of jewelry pieces in his stomach. The patient, who had a history of psychiatric illness, died. According to his family, the man had been devouring coins for more than a decade, often stealing them when he visited other people’s homes.

Treatment dilemma

When it comes to the dental treatment for pica, there are no easy answers, say Johnson and Koh. By the time they see patients, most of the damage has been done. “The hard thing is that by the time they come to us, the repairs are so costly that it’s almost always a temporary fix,” explains Johnson. He says their patients may need root canals and crowns that can cost thousands of dollars, but they are often women from lower socio-economic backgrounds who can’t afford such treatment.

Diagnosis of pica before such damage occurs is the best scenario and that requires better informational exchange between dentists and other medical personnel. In their paper on pica, Johnson and Koh issued the following plea: “Most dentists have limited interactions with their fellow health care professionals; however, this case demonstrates a greater need for open dialogue and cooperation between health care professionals for the management of complex cases.”

More about Pica

Pica is seen more in young children than adults. Between 10 and 32 percent of children ages 1 – 6 years exhibit these behaviors. Pica can occur during pregnancy. In some cases, conditions due to a lack of certain nutrients, such as iron deficiency anemia and zinc deficiency, may trigger the unusual cravings. Pica may also occur in adults who crave a certain texture in their mouth.

A dentist or physician may diagnose a patient with pica if the eating patterns have lasted more than one month.

Signs and tests

No single test confirms pica. However, pica can occur in people who have lower than normal nutrient levels and poor nutrition (malnutrition).

  • Blood tests can determine many forms of nutritional deficits, such as iron deficiency anemia.
  • Lead levels should always be checked in children who may have eaten paint or objects covered in lead-paint dust to screen for lead poisoning.
  • The health care provider should test for infection if the person has eaten soil or waste.

Treatment

Treatment should first address any missing nutrients or other medical problems, such as lead exposure.

Treatment involves behavioral, environmental and family educational approaches. Other successful treatments include associating the pica behavior with bad consequences or punishment (mild aversion therapy) followed by positive reinforcement for eating the right foods. Medications may help reduce the abnormal eating behavior if pica occurs as part of a developmental disorder such as mental retardation or a psychiatric disorder.

For more information, go PubMed Health, of the US National Library of Medicine.


This article, which has been updated, originally appeared on HealthLEADER, an online wellness magazine produced by The University of Texas Health Science Center at Houston (UTHealth). Visit HealthLEADER for more articles on a broad array of health and wellness topics.