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Year : 2012  |  Volume : 23  |  Issue : 3  |  Page : 426-427

Department of Oral Medicine and Radiology, Rajah Muthiah Dental College and Hospital, Annamalai University, Annamalai Nagar, Chidambaram, India

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Date of Submission09-Nov-2009
Date of Decision10-Sep-2010
Date of Acceptance17-Jan-2011
Date of Web Publication11-Oct-2012


"PICA" means perverted appetite for substances not fit as food or of no nutritional value such as, bricks, clay, soil, ice, laundry starch, etc. The word ''PICA'' is derived from Latin word for Magpie, a species of bird that feeds on whatever it encounters. ''PICA'' has been observed in ethnic groups worldwide in primitive and modern cultures, in both sexes and in all age groups. The case presented here reports a 30 year old female patient who had craving for ingestion of gravel and brick fragments since the age of 13 years. Iron deficiency anemia was found after complete blood count and iron studies. The diagnosis of "PICA" requires that the patient is persistently eating non-food substances for at least 1 month and such behavior is appropriate for the child's stage of development.

Keywords: Anemia, iron deficiency, PICA

How to cite this article:
Aparna PV, Austin RD, Mathew P. PICA. Indian J Dent Res 2012;23:426-7

How to cite this URL:
Aparna PV, Austin RD, Mathew P. PICA. Indian J Dent Res [serial online] 2012 [cited 2019 May 26];23:426-7. Available from:

   Case Report Top

A 30-year old female presented to the Oral Medicine and Maxillofacial Radiology Department with a complaint of wearing away of teeth associated with sensitivity. She gave a previous history of extraction of 37, 46, and 47 before 3 years due to deep caries involvement. Her medical and surgical histories were unremarkable and denied any drug allergies. However, on detailed questioning the patient admitted to the craving and ingestion of small brick fragments and gravel since the age of 13 years. The patient reported that she picked up small pieces of bricks and gravel from the ground, held them between her teeth for varying amounts of time, chewed, and swallowed them. She introduced this practice to herself as she had a significant amount of stress in her personal life since the age of 13 years. Presently, even though the patient is relieved of stress she is psychologically unable to stop the habit. Her history also revealed that she had a road traffic accident at the age of 7 years after which she developed bending of the spine.

The patient was afebrile, had a respiration rate of 18 breaths/min, a pulse of 90 beats/min, and blood pressure of 112/80 mmHg, both without orthostatic changes. General physical examination showed a poorly developed, poorly nourished, anemic women having kyphosis. Her skin was without rashes or lesions. There was no cyanosis, clubbing, or edema. The head and neck examination results were within normal limits, expect for pale conjunctiva and mild tenderness over the massetric region. The intra oral examination revealed a pale oral mucosa, depapillated tongue, and severe attrition of upper and lower teeth [Figure 1]. The oral hygiene level was seen to be reasonable and the periodontal health was good with no evidence of bleeding or significant pocketing. Root stumps were present in relation to 16 and 36. Tooth number 26 presented with deep caries involvement. Radiographic examination revealed only minimal bone loss associated with the teeth with no periapical pathology.
Figure 1: Attrition in both maxillary and mandibular teeth

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Blood was taken in order to look for any possible deficiencies. The following hematological and biochemical investigations were carried out: Hemoglobin was found to be 8.6 g/dl, hemocrit - 29.5%, WBC - 11.4 cells/μl, platelets - 81,000/μl, MCV - 74.7 fl, RBC 3.95 × 10 6 /μl. Examination of her blood smear revealed anisocytosis and hypochromia. The reticulocyte count was 0.7%. The electrolytes, liver enzymes, and urinalysis were all within normal limits. The electrocardiogram showed normal sinus rhythm with a rate of 80 beats/min. The chest and abdomen radiograph showed normal study. Iron studies revealed an iron level of 24.5 μg/dl, SIBC - 501.0 μg/dl, SFL - 6.74 μg/ml. Thyroid studies and hepatitis serology were normal. The above investigations were suggestive of iron deficiency anemia.

The patient was given diet counseling and was advised to withdraw the habit. She was then referred to General Medicine department for further evaluation and management of iron deficiency. And later, she was referred to department of Conservative Dentistry and Endodontics for the management of dentinal hypersensitivity.

   Discussion Top

This case report emphasis the importance of skilled way of history recording. The patient described showed reluctance to reveal her craving for gravel and brick fragments, and only after a thorough detailed questioning, she admitted her craving history. Her iron deficiency anemia was confirmed by complete blood count and iron studies, which was corrected by parenteral iron supplementation and diet modifications.

For centuries, it has been recognized that the people with craving unusual foodstuffs may be associated with disorders of blood and green complexion, which was first described by Lange and named as chlorotic syndrome by Verandal in 1600s. [1]

PICA has been thought to be a symptom of anemia since the time of Hippocrates. The relationship to iron deficiency anemia has been noted but never fully understood. The answer to the question of whether iron deficiency anemia is a cause or an effect of PICA is still unknown. [1],[2]

In some patients with malnutrition who eat clay, iron deficiencies have been diagnosed. It is not clear whether deficiency prompted the ingestion of the clay or whether eating the clay resulted in the inhibition of iron-absorption as clay is thought to impair iron absorption by binding iron in the gut. [3]

Coltman (1969) described a form of PICA , compulsive ice eating [Pagophagia]. [4] In double-blind studies, he found iron deficient ice eaters lost their craving for ice approximately 2 weeks after iron supplementation. The PICA ceased before the anemia was corrected. Therefore, he believed PICA was a sequel to and not a cause of iron deficiency. [1]

The association of iron deficiency and craving for ice also has been reported by Osman et al. They also reported that after iron therapy, Pagophagia has resolved spontaneously within 2 weeks. [5] The association between pica and the iron deficiency has been reported. [6],[7]

   References Top

1.Loggi DG Jr, Regenye GR, Miles M. Pica and iron deficiency anaemia: A case report. J Oral Maxillofac Surg 1992;50:633-5.  Back to cited text no. 1
2.Barker D. Tooth wear as a result of pica. Br Dent J 2005;199:271-3.  Back to cited text no. 2
3.Wintrobe MH. Iron deficiency and iron deficiency anemia. In: Wintrobe MM, Greer JP, et al. Clinical Hematology. 11 th ed. Philadelphia: Lippincott Williams and Wilkins; 2003.  Back to cited text no. 3
4.Coltman CA Jr. Pagophagia and iron lack. JAMA. 1969 Jan 20;207:513-6.  Back to cited text no. 4
5.Osman YM, Wali YA, Osman OM. Craving for ice and iron deficiency anemia: A case series from Oman. Pediatr Hematol Oncol 2005;22:127-31.  Back to cited text no. 5
6.Giudicelli J, Combes JC. Pica and iron deficiency in adolescence. Arch Fr Pediatr 1992;49:779-83.  Back to cited text no. 6
7.Muñoz JA, Marcos J, Risueño CE, de Cos C, López R, Capote FJ, et al. Iron deficiency and pica. Sangre (BARC) 1998;43:31-4.  Back to cited text no. 7

Correspondence Address:
Potluri Venkatalakshmi Aparna
Department of Oral Medicine and Radiology, Rajah Muthiah Dental College and Hospital, Annamalai University, Annamalai Nagar, Chidambaram
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0970-9290.102246

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