Tooth wear patterns can reveal a lot about a person. Despite our best efforts to educate patients on preventing dental damage, electricians strip wires with their teeth, seamstresses hold pins and CEOs brux like their career depends on it. Very rarely, clinicians see extreme wear from highly atypical activities, such as eating non-food items. At some point everyone has chewed the end of a pen, but when this goes beyond normal habits, it can be dangerous for both oral and general health.
The extreme presentation of abnormal chewing and eating of non-food items is called pica. Cases have included everything from clay to pieces of brick or metal. Pica can arise from a number of different conditions. Medical causes that might compel someone to eat non-food items include mineral deficiency, (particularly zinc), anemia (especially from parasite infection) and atypical pregnancy cravings. However, autism, schizophrenia, and developmental disorders can often contain pica as a co-morbid condition.
Some people, however, develop pica as a stress response or OCD-mediated behavior. This is the "classical" presentation of pica, occurring in the relative absence of other behavioral or psychological conditions. One notable case report details the condition of a seven-year-old girl who could not stop consuming pieces of brick. The compulsion began at age 5, and although her parents tried explaining the danger of her behavior, scolding, and punishing her, she continued eating brick pieces. This led to chronic abdominal pain and severe dental attrition with numerous caries.
When the patient presented for treatment, the clinician noted the unusual degree of wear and learned of the patient's brick consumption. A panel of tests (including serum iron, serum zinc, hemoglobin and stool/urine) was ordered to examine whether a deficiency or parasite infection was responsible for the pica. The patient's levels of serum iron, zinc, and calcium were all well below normal, being the most likely cause for the patient's pica. Bricks contain iron as well as calcium and are the rich red color associated with high-iron foods.
In addition to dental treatment, the patient was prescribed iron, zinc and calcium supplements, and the parents were coached on behavioral modification techniques beginning with a reduction, rather than elimination, of the child's brick consumption. Monthly follow-ups were scheduled, and by month two the patient had a marked decrease in her consumption of brick pieces. By month six, the patient's habit had stopped entirely, and her oral health is excellent.
In this case, the pica was a result of mineral deficiency, but not all cases are so straightforward. Many people are unable to control their compulsion and continue to eat non-food items despite the risk of harm. In these cases all a clinician can do is advise the patient of ways to mitigate the damage, and recommend that the patient come in for more regular checkups.
Source:
Advani, S., Kochhar, G., Chachra, S., & Dhawan, P. (2014). Eating everything except food (PICA): A rare case report and review. Journal of International Society of Preventive & Community Dentistry, 4(1), 1–4. http://doi.org/10.4103/2231-0762.127851
The information contained in this, or any case study post in Incisor should never be considered a proper replacement for necessary training and/or education regarding adult oral conscious sedation. Regulations regarding sedation vary by state. This is an educational and informational piece. DOCS Education accepts no liability whatsoever for any damages resulting from any direct or indirect recipient's use of or failure to use any of the information contained herein. DOCS Education would be happy to answer any questions or concerns mailed to us at 106 Lenora Street, Seattle, WA 98121. Please print a copy of this posting and include it with your question or request.
