Pica practices, anemia, and oral health outcomes: a systemic review

Abstract Objectives Pica is a non-nutritive eating behavior. The potential impact of pica on oral health and the association between pica and anemia are understudied. We examined the current evidence on the relationship between pica practices, anemia, and oral health outcomes. Methods We used Popula...

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Main Authors: Brenda A. Z. Abu, Abigail Morrissey, Yan Wu, Daniel A. Castillo, Rachel Becker, TongTong Wu, Kevin Fiscella, Steven Gill, Jin Xiao
Format: Article
Language:English
Published: BMC 2025-01-01
Series:BMC Oral Health
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Online Access:https://doi.org/10.1186/s12903-024-05371-7
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author Brenda A. Z. Abu
Abigail Morrissey
Yan Wu
Daniel A. Castillo
Rachel Becker
TongTong Wu
Kevin Fiscella
Steven Gill
Jin Xiao
author_facet Brenda A. Z. Abu
Abigail Morrissey
Yan Wu
Daniel A. Castillo
Rachel Becker
TongTong Wu
Kevin Fiscella
Steven Gill
Jin Xiao
author_sort Brenda A. Z. Abu
collection DOAJ
description Abstract Objectives Pica is a non-nutritive eating behavior. The potential impact of pica on oral health and the association between pica and anemia are understudied. We examined the current evidence on the relationship between pica practices, anemia, and oral health outcomes. Methods We used Population, Intervention, Control, and Outcomes (PICO) terms to create MeSH terms to assess 1) the relationship between pica and iron deficiency anemia (IDA), 2) the relationship between IDA and oral health, and 3) the relationship between pica, anemia, and oral health outcomes. The review was registered on Prospero [CRD42022349022]. We searched databases including PubMed, Embase, Web of Science, Cochrane Library, and, clinicaltrials.gov in June 2022. Results From 4,159 searched articles, 89 met the inclusion criteria. Studies were published between 1959 and 2022 from 33 countries. Nearly half of these studies (55.1%, n = 49) were case reports. The most common picas included geophagia (soil/dirt) (44.9%, n = 40 papers), pagophagia (ice) (22.5%, n = 20), amylophagia (starch) (15.7%, n = 14), paint/metal (5.6%, n = 5), paper (5.6%, n = 5) and others such as pica for foam and hair. Fifteen case reports and one intervention study showed the effects of pica practice on oral health, such as tooth abrasion, dental caries, and de-papillated tongue. Furthermore, 81% of the papers reported the co-occurrence of pica with anemia and 15 papers reported a significant association (p < 0.05) between pica and low hemoglobin levels ranging from < 12.0 to 2.7g/dL among all age groups, including among pregnant and postpartum women. Pica practices were strongly associated with IDA (serum ferritin < 15.0 − 4.3 mcg/ml) but showed a non-statistically significant trend of association with oral health outcomes. Conclusion Pica was strongly associated with anemia and IDA. Tooth abrasion and dental caries were observed among pica users. Future studies could define the strength of the pica-oral health association, and the potential mediators, such as anemia.
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spelling doaj-art-ef327e35325c49c1a616651d0630c82c2025-01-05T12:48:25ZengBMCBMC Oral Health1472-68312025-01-0125112410.1186/s12903-024-05371-7Pica practices, anemia, and oral health outcomes: a systemic reviewBrenda A. Z. Abu0Abigail Morrissey1Yan Wu2Daniel A. Castillo3Rachel Becker4TongTong Wu5Kevin Fiscella6Steven Gill7Jin Xiao8Wegmans School of Health and Nutrition, College of Health Sciences and Technology, Rochester Institute of TechnologyWegmans School of Health and Nutrition, College of Health Sciences and Technology, Rochester Institute of TechnologyEastman Institute for Oral Health, University of Rochester Medical CenterEastman Institute for Oral Health, University of Rochester Medical CenterEastman Institute for Oral Health, University of Rochester Medical CenterEastman Institute for Oral Health, University of Rochester Medical CenterDepartment of Family Medicine, University of Rochester Medical CenterEastman Institute for Oral Health, University of Rochester Medical CenterEastman Institute for Oral Health, University of Rochester Medical CenterAbstract Objectives Pica is a non-nutritive eating behavior. The potential impact of pica on oral health and the association between pica and anemia are understudied. We examined the current evidence on the relationship between pica practices, anemia, and oral health outcomes. Methods We used Population, Intervention, Control, and Outcomes (PICO) terms to create MeSH terms to assess 1) the relationship between pica and iron deficiency anemia (IDA), 2) the relationship between IDA and oral health, and 3) the relationship between pica, anemia, and oral health outcomes. The review was registered on Prospero [CRD42022349022]. We searched databases including PubMed, Embase, Web of Science, Cochrane Library, and, clinicaltrials.gov in June 2022. Results From 4,159 searched articles, 89 met the inclusion criteria. Studies were published between 1959 and 2022 from 33 countries. Nearly half of these studies (55.1%, n = 49) were case reports. The most common picas included geophagia (soil/dirt) (44.9%, n = 40 papers), pagophagia (ice) (22.5%, n = 20), amylophagia (starch) (15.7%, n = 14), paint/metal (5.6%, n = 5), paper (5.6%, n = 5) and others such as pica for foam and hair. Fifteen case reports and one intervention study showed the effects of pica practice on oral health, such as tooth abrasion, dental caries, and de-papillated tongue. Furthermore, 81% of the papers reported the co-occurrence of pica with anemia and 15 papers reported a significant association (p < 0.05) between pica and low hemoglobin levels ranging from < 12.0 to 2.7g/dL among all age groups, including among pregnant and postpartum women. Pica practices were strongly associated with IDA (serum ferritin < 15.0 − 4.3 mcg/ml) but showed a non-statistically significant trend of association with oral health outcomes. Conclusion Pica was strongly associated with anemia and IDA. Tooth abrasion and dental caries were observed among pica users. Future studies could define the strength of the pica-oral health association, and the potential mediators, such as anemia.https://doi.org/10.1186/s12903-024-05371-7PicaOral healthAnemiaIron deficiency anemiaInterventions
spellingShingle Brenda A. Z. Abu
Abigail Morrissey
Yan Wu
Daniel A. Castillo
Rachel Becker
TongTong Wu
Kevin Fiscella
Steven Gill
Jin Xiao
Pica practices, anemia, and oral health outcomes: a systemic review
BMC Oral Health
Pica
Oral health
Anemia
Iron deficiency anemia
Interventions
title Pica practices, anemia, and oral health outcomes: a systemic review
title_full Pica practices, anemia, and oral health outcomes: a systemic review
title_fullStr Pica practices, anemia, and oral health outcomes: a systemic review
title_full_unstemmed Pica practices, anemia, and oral health outcomes: a systemic review
title_short Pica practices, anemia, and oral health outcomes: a systemic review
title_sort pica practices anemia and oral health outcomes a systemic review
topic Pica
Oral health
Anemia
Iron deficiency anemia
Interventions
url https://doi.org/10.1186/s12903-024-05371-7
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