STORY BY

Liz Bennett

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 Dental Branch at Houston.

Their problems? Compulsive eating of non-food substances including ice, dirt, ashes, 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 indiscriminant tastes.

In the case of Pica, dentists are often the "first detectives on the scene." Pica often results in disfigured teeth, painful tooth sensitivity, or worse, which brings them to the attention of Drs. Cleverick D. Johnson and Sheila H. Koh, associate professors of Restorative Dentistry and Biomaterials at the UT Dental Branch.

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. What the team finally discovered, after extensive questioning, was that she, along with several members of her family, was 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 U.S 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, as they report in a recent paper in the Journal of General Dentistry. Their paper focuses on a 45-year-old woman seeking treatment for tooth sensitivity who had multiple dental problems. Almost half of her top and bottom front teeth were cracked and broken off. Her other teeth were worn down and had a scooped-out look.

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 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 by pregnant women is called pagophagia and it’s so common that a website, www.icechewing.com has been established and includes a support group for people with this condition. And 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 out of a woman’s stomach. “She just compulsively pulled her hair out and swallowed it during her pregnancy.”

Children and pica

Other pica patients have consumed everything from skin and rocks to lead, he adds, “but mostly the lead is lead paint eaten by little kids,” Johnson says. Very young children explore their environments with their hands and mouths, often consuming non-edible materials. Most children learn by the age of 24 months 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 about three years old, it’s usually a mental or psychiatric disorder.”

Numerous cases of the more bizarre forms of pica can by found on the Internet, often with graphic photos. One such case, entitled “Incredible Inedibles,” involved a 62-year-old man who checked into a French hospital complaining of abdominal pain. Doctors, to their horror, 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 treatment for pica, there are no easy answers, say Johnson and Koh. By the time they see patients – dental patients in their case – most of the damage has been done. “The hard thing is that by the time they come to us, the repairs are so costly 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 recent paper on pica, Drs. 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.”

UPDATED: 9-27-2006

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