The mouthing or chewing of pebbles or grit can cause wear to both the natural dentition and restorations. Chewing of hard objects like metal or ice can cause tooth or restoration fracture. Sharp objects like glass or wood splinters can cause lacerations or other trauma. Atrophy of the tongue is a symptom of anemia, and the patient should be questioned about ice or freezer frost consumption. Ingestion of cigarette butts poses multiple risks, such as gingival recession, periodontal disease and oral cancer.4,6 Pica behavior occasionally manifests as overconsumption of food items. If lemons or candy are consumed in this manner, enamel erosion and tooth decay can result. In addition, caution is necessary if the patient or health care provider substitutes sugar containing foods for the pica substance.
All dental patients should have a thorough medical history taken and reviewed. A complete oral exam should be performed. Any unusual findings should be investigated. Patients with autism, pregnant women, and children with developmental disorders are at higher risk for pica. Any suspicions should be investigated further and patients (or their parents or caregivers, as appropriate) should be directly questioned about pica behavior. If nutritional deficiencies are suspected, a consultation with the patient’s physician is warranted.1,4