Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosisTreatmentComplications
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Diagnosis
Treatment
Complications
While chewing ice may seem like a harmless habit, it may result in damage to the teeth.
This article describes the symptoms and causes of pagophagia. It also explains how pagophagia is diagnosed and what can be done to manage this condition.
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What Are the Symptoms of Pagophagia?
The primary symptom of pagophagia is the compulsive chewing and eating of ice. While it’s normal to occasionally enjoy crunching on ice cubes, such as after finishing a drink, those with pagophagia may have an intense urge to regularly chew on ice cubes, ice chips, or frost from the freezer. This cause may be psychological but may also be a physiological response to iron-deficiency anemia.
Pagophagia as a Form of Pica
A classic sign of pica-associated pagophagia is relentless chewing of ice even when teeth are damaged or missing.
Pagophagia and Iron-Deficiency Anemia
Pagophagia is an entirely different issue if it occurs as a result of iron deficiency. Iron-deficiency anemia is a form of anemia that occurs when you don’t have enough iron in your body. Iron is essential to the formation of red blood cells andhemoglobin, the iron-containing molecule that carries oxygen throughout the body).
Iron deficiency tends to develop slowly because the body usually has ample reserves in the bone marrow and liver. When iron levels start to plummet, pagophagia can sometimes be an early, albeit commonly missed, sign of deficiency.
When pagophagia occurs with iron deficiency, the consumption of ice will start with a sudden craving and worsen in tandem with the depletion of iron.
Pagophagia is generally not associated with other forms of anemia, such as hemolytic anemia, pernicious anemia, oraplastic anemia.
The symptoms of iron-deficiency anemia in children can differ from those in adults. One of the characteristic signs in kids is the lightening of mucous membranes inside the mouth, on the tongue, and most especially on the inner eyelids andconjunctiva(whites of the eyes).
Tongue Scraping: An Effective Practice?
What Causes Pagophagia?
As with the symptoms of pagophagia, the causes of pagophagia may be either psychological or physiological.
Psychological Causes
Some researchers have noted that people with pagophagia tend to eatat leastone tray of ice per day.Some cases are even more extreme, manifesting with dental injury, tooth loss, and nutritional deficiencies.
According to the American Psychiatric Association (APA), feeding and eating disorders, including pica, are closely aligned withobsessive-compulsive disorder (OCD).Stress almost invariably makes symptoms worse.
It is not uncommon for pagophagia to occur with other forms of pica, including geophagia (the eating of dirt),amylophagia(starch), lithophagia (rocks), andtrichophagia(hair, wool, and other fibers).
Children and adults with autism will often experience pagophagia and other forms of pica as part of a repetitive, and therefore psychologically comforting, behavior.
Iron Deficiency
There is evidence, however, that pagophagia and other forms of picacausethe nutritional deficiencies that lead to anemia. This includes eating disorders that commonly accompany pica, OCD, depression, and other mental health conditions.
It is unclear how common pagophagia is in people with iron-deficiency anemia. Some studies suggest roughly 13% are affected, while others have concluded that as many as one in three may experience these abnormal cravings.
Dry Mouth
Symptoms of dry mouth may include a dry or burning feeling in your mouth, trouble chewing or swallowing, cracked lips, and bad breath.
How Is Pagophagia Diagnosed?
It can be difficult sometimes to determine the cause of pagophagia because people don’t usually see a healthcare provider until the behavior has begun to interfere with their lives. Unless there are other physical symptoms that need addressing, pagophagia as a psychological condition can go undiagnosed and untreated for years.
Diagnosing Pica
There are no lab tests to diagnose pagophagia or any other form of pica. The diagnosis is based on whether certain criteria are met in the APA’s “Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)”.
If, in the process of diagnosis, pagophagia is suspected but blood tests arenotperformed, insist that they are done. This can prevent misdiagnosis and the inappropriate treatment of a physical rather than a psychological condition.
Diagnosing Iron Deficiency
If there are physicalsigns of anemia, an iron deficiency can be confirmed with blood tests. There are several a doctor can perform from a single blood draw to confirm a deficiency. Theseiron testsinclude:
Acomplete blood count (CBC)will also be performed to measure the composition of blood cells in a sample of blood. Results from these tests usually can be returned within one to three business days, depending on the lab.
It is rare that pagophagia is the sole reason for a visit to a doctor unless the symptoms are so severe as to cause genuine distress. Though a person may be referred to a psychiatrist or psychologist, it may be more appropriate to perform blood tests first even if there are no overt symptoms.
Iron deficiency can occur without anemia, often as a result of abnormal blood loss due to abnormal menstrual bleeding,celiac disease, or even anH. pyloriinfection. In the end, if pagophagia is present, blood iron should be tested.
How Is Pagophagia Treated?
Pica
If pagophagia develops with no underlying physical cause, a referral to a psychiatrist or psychologist experienced in feeding and eating disorders should be considered.
Given pagophagia doesn’t incur the health risks that some forms of pica do—likeplumbophagia(the abnormal eating of lead)—there may be less need for medical interventions like leadchelationtherapy. This doesn’t mean that pagophagia therapy is any less concerning.Malnutritionis a common feature of pica and may require aggressive dietary interventions to prevent long-term harm.
Currently, there are no medications approved for the treatment of pica. Some healthcare providers have endorsed the use of Zyprexa (olanzapine), a drug ordinarily used for schizophrenia, to reduce the urge to eat nonfood items.
If pica is an extension of OCD, antidepressants like Anafranil (clomipramine), Luvox (fluvoxamine), Paxil (paroxetine), Prozac (fluoxetine), or Zoloft (sertraline) may be recommended.
If mild iron deficiency anemia is diagnosed, a healthcare provider may first recommend eating more iron-rich foods to replenish the iron reserves in the body.Iron supplementshave proven especially effective for pagophagia and other acute iron deficiency symptoms, including restless leg syndrome.
Additional treatments may be needed based on the underlying cause of iron deficiency.
What Are the Complications of Pagophagia?
Dental Problems
One problem that can occur with pagophagia is tooth damage. This is especially true for children with the condition whose teeth are still developing. Chewing ice habitually can damage toothenameland lead to problems such astooth painand increased cold sensitivity. Many people with pagophagia aren’t even aware of the problem until fillings need replacement or a tooth suddenly chips.
Anemia Complications
Pica Complications
Possible complications of pica include:
Summary
The act of chewing ice shouldn’t cause alarm. In most cases, the habit may be irritating but is otherwise harmless. It is only when it becomes compulsive or excessive that you should consider seeing a healthcare provider. In some cases, it may be a sign of dry mouth or iron deficiency, a condition that can usually be treated with supplements and/or changes in diet.
If the compulsion is interfering with a person’s health or quality of life, it’s important to seek a diagnosis from a qualified mental care professional. Pagophagia and other forms of pica rarely occur on their own and may be a sign of a larger mental health condition in need of treatment.
19 Sources
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