Long Term Effects Of Eating Ice

“If you’re chewing on ice one time, it’s not compulsive behavior,” she continues. “But chronic chewing can indicate some emotional concerns.”

Why Chewing Ice Is Bad for Your Teeth

Out of anxiety or nerves, you’ve probably absentmindedly started chewing on something you weren’t supposed to. That category might include ice.

And you might wonder why you’re drawn to chomping on something as cold as ice. According to dentist Karyn Kahn, DDS, it could be because it’s soothing.

“Ice chewing increases the blood flow to the brain and stimulates the parasympathetic nervous system, which gives a calming effect,” she explains. “That perpetuates the habit. People feel better, so they chew ice.”

And while chronic ice chewing isn’t uncommon — it even has a name: pagophagia — it definitely isn’t a habit you want to pick up. Dr. Kahn explains why chewing ice is bad for your teeth and shares some tips on how to stop.

Dangers of chewing ice

In short — there are many downsides. “Chronic ice chewing could be very detrimental to your health and your teeth,” says Dr. Kahn.

For starters, you don’t have to chew ice all the time for it to be an issue. Even just chewing ice a little too forcefully once or twice could lead to issues. “It doesn’t take much biting force to fracture a tooth, especially if the tooth has tiny cracks already,” she says. “Even just eating a piece of bread can fracture a tooth if there are already cracks.”

Here are some other potential negative side effects of ice chewing:

Can chip fillings, crowns and restorations

Fillings and crowns can chip or break easily, Dr. Kahn notes, especially if you’re biting on a tooth that’s already somewhat compromised.

“White crowns are made from a type of porcelain,” she continues. “Some porcelains are stronger than others, but they can still crack or break.”

These breaks can occur if you’re putting stress on your teeth in other ways. For example, it isn’t uncommon to have porcelain fractures if you’re an ice chewer who also grinds and clenches your teeth.

Other tooth restorations in addition to these fillings can also be damaged if you bite down too hard in one area.

Can damage braces

Ice chewing is a particularly bad habit for people wearing orthodontic braces. “This can pull or break the bonded brackets,” Dr. Kahn says.

May cause muscle pain

Chewing ice requires you to use excessive jaw muscle force, which can cause muscle pain.

Damages enamel

Enamel, or the outer layer of your tooth, is the hardest substance in your body. But that doesn’t mean it’s indestructible. “Think of teeth like a china plate,” says Dr. Kahn. “The enamel is very susceptible to fracture. Chewing ice can result in fracture of teeth that may not be able to be restored.”

She reiterates that enamel damage also depends on how much force you’re putting on your teeth. “If you’re grinding and clenching your teeth, and then you put ice chewing on top of that — it’s a lot of force on the teeth.”

Can potentially crack a tooth

Chewing ice can also do more than just damage your chompers. “If you’re biting or chewing ice on a daily basis — or even frequently — you can split or fracture a tooth,” Dr. Kahn warns. “Sometimes, it only takes a soft food to get tooth-to-tooth contact and break the tooth.”

Teeth can develop what are called craze lines. These are microscopic fracture lines within your tooth enamel that often can’t be picked up on an X-ray.

“Sometimes, you can see them by shining a light on a tooth,” she says. “But these craze lines begin very small, just like a crack in a car windshield, and can grow and grow, and get deeper and wider.

“Those craze lines can go so deep that a fractured tooth is non-restorable. You can even lose your tooth if it fractures.”

Is chewing ice a sign of anemia?

Healthcare providers aren’t sure why, but, yes, wanting to chew ice all the time could be a sign of an iron deficiency, otherwise known as anemia.

“Whenever I see someone who is a chronic ice chewer, I refer them back to their primary care physician to have bloodwork done, especially to check iron levels,” says Dr. Kahn. “The ice chewing could indicate iron deficiency.”

How to stop chewing ice

In general, if you’re chewing ice every single day, Dr. Kahn says it’s a sign something is likely going on — whether that points to an iron deficiency, stress or anxiety.

“If you’re chewing on ice one time, it’s not compulsive behavior,” she continues. “But chronic chewing can indicate some emotional concerns.”

For some people who chew ice, the cold sensation is what’s soothing. So, instead of chewing ice, just let it melt in your mouth or blend crushed ice into slushies.

But Dr. Kahn suggests exercising caution when replacing ice chewing with another kind of chewing activity. “If you’re chewing gum, it’s soft, but it uses a lot of muscle force,” she explains. “And if the teeth are susceptible to fracture, you can fracture it, too.”

Your primary care physician might also recommend cognitive behavioral therapy. This is commonly used to address other habits you want to break.

“Ice chewing is supposed to provide a certain amount of calming effect, and so that’s why it’s perpetuated,” says Dr. Kahn. “Some people feel better after doing it. But sometimes, stress and obsessive-compulsive behavior contribute to ice chewing. In cases like this, some cognitive behavioral therapies might be helpful.”

If you’re afraid you might have done damage to any restorations, fillings, porcelain crowns or even your tooth, call your dentist. Having X-rays and a clinical exam can reveal what’s going on — and offer relief.

Abstract

Pica is an unusual condition in which patients crave and chew substances with no nutritional value. Ice pica (pagophagia) is commonly seen in patient with iron deficiency. People chew ice cubes or add ice to their drinks to cool or refresh themselves, and they may not consider this as an abnormal behavior. Excessive ice chewing/eating can have significant health risks, including electrolyte abnormalities and metabolic disorders. We report a patient admitted to our hospital with severe hyponatremia and seizures due to iron deficiency-associated pagophagia. Ice pica leading to hyponatremia and seizure is not commonly seen in clinical practice. It was a challenging case and the patient was seen and investigated at outpatient clinic for polyuria, though an underlying cause was not identified. Patients may be secretive or reluctant to mention their pica habit. Studies have also shown that most physicians are unaware of pica and most cases can be easily missed.

Introduction

Pica is described as an unusual condition in which patients crave and chew substances (such as ice, clay, soil, dirt, raw rice, or paper) that have no nutritive value [1, 2]. The term pica originates from the Latin word for magpie (Picave), a bird that is famed for its unusual eating behaviors, mainly it is known to eat almost anything. The Greeks and Romans referenced Pica in 13th-century but was not addressed in medical texts until 1563. Pagophagia (craving and chewing ice) is the excessive consumption of ice cubes or iced drinks; it is often associated with iron deficiency with or without anemia [2-4]. Less commonly, other nutritional disorders may cause craving and chewing ice.

The reasons why these patients crave ice is unclear, but some studies have indicated that chewing ice might increase alertness in people with iron deficiency anemia. Pagophagia can have significant health risks, including electrolyte abnormalities and metabolic disorders. We report a case of a patient admitted to medical intensive care unit (MICU) due to severe hyponatremia and seizure, who was found to have iron deficiency-associated pagophagia as the underlying cause. Ice pica leading to hyponatremia and seizures is rare in clinical practice, and to our knowledge from literature review, prevalence is unknown. Studies have indicated most physicians are unaware of pica and most cases are missed [5, 6].

Case presentation

A 54-year-old Caucasian woman was transferred to our MICU from an outside hospital due to altered mental status, seizures, and hyponatremia. On presentation to the outside hospital, she was weak and had a generalized tonic clonic seizure. Her serum sodium was as low as 120 millimoles/litre (mmol/L), serum osmolality 242 milliosmoles/kilogram (mOsm/kg), urine sodium 9 mmol/L and urine osmolality of 70 mOsm/kg. Prior to that hospital admission, the patient was complaining of excessive and frequent urination for several months. She was investigated for possible causes of polyuria by her primary care physician and finally referred to an endocrinologist. Her endocrinologist did not find the exact cause for her symptoms, and empirically the patient was started on desmopressin for polyuria. Her outpatient osmolality was always 260-280 mOsm/kg, she also had mild hyponatremia (133-136 mmol/L), urine sodium 14 mmol/L and urine osmolality of 110 mOsm/kg. Based on her outpatient laboratory results, diabetes insipidus seemed unlikely.

Psychogenic polydipsia was considered and desmopressin was discontinued at outside hospital, but the patient stated she was not drinking too much water and her water intake was 3-4 Liter/day. She was placed on normal saline, her serum osmolality and sodium were gradually corrected, and the patient was transferred to our medical center for high level of care. In our hospital, she was admitted to the MICU with possible psychogenic polydipsia, her laboratory test revealed serum sodium 128 mmol/L, serum osmolality 254 mOsm/kg, urine sodium 11 mmol/L and urine osmolality of 100 mOsm/kg. Upon further evaluation and lab reviews for anemia, the patient was asked if she was eating too much ice. She stated she was craving and chewing multiple bags of ice, which was unusual for her. The patient also mentioned she had abnormal uterine bleeding for which she was treated by a gynecologist. She had no history of similar craving and chewing of ice in the past and denied any current stress or psychiatric illness. On physical examination, the patient was alert and oriented; vital signs were normal. She had mild pale conjunctiva and non-icteric sclera. Chest was clear with normal heart sounds, no murmur or gallop. She had no abdominal tenderness, palpable organomegaly, or any neurologic deficits.

Her laboratory tests revealed a hemoglobin of 9.2 grams/deciliter and mean corpuscular volume (MCV) of 75 femtolitres. Iron deficiency with pica was considered, and an iron panel revealed: iron level 9 micrograms/deciliter (normal value 60-160 micrograms/deciliter), transferrin saturation 2% (normal value 20-50%), iron binding capacity 377 micrograms/deciliter (normal value 250-460 micrograms/deciliter), and ferritin level 4.8 nanograms/milliliter (normal value 15-200 nanograms/milliliter). Vitamin B12, folate, cortisol, and thyroid-stimulating hormone (TSH) were all normal. She had normal renal function and no anion gap. Computed tomography of head and electroencephalogram were normal. The patient was given parenteral iron infusion for five days with oral iron supplementation. Craving for ice improved significantly while the patient was in hospital following iron infusion. The patient was stable, had no more seizures, and was discharged with oral iron supplementation. She was seen on three-month follow-up and she stated craving for ice had resolved. Lab work revealed hemoglobin of 12.8 grams/deciliter, serum sodium 142 mmol/L and serum osmolality of 285 mOsm/kg.

Discussion

Pica remains a mysterious and fascinating occurrence, and many physicians miss this diagnosis. Pagophagia, which is craving and chewing ice, is often associated with iron deficiency with or without anemia [1, 5, 6]. Interestingly, pica sufferers with low iron levels did not crave or eat items that were naturally high in iron [6]. It is commonly seen in pregnant women and in the pre-adolescent age group [4]. Iron absorption can also be reduced in the presence of non-nutritive substances. Pica is strongly associated with iron deficiency and is believed to be a symptom of deficiency rather than its cause [4, 7, 8]. In a few cases, pagophagia has been in association with compulsive behavior or depressive disorders. These patients use pagophagia as a coping mechanism to deal with their psychological stressors [9]. The prevalence of pica is not studied well, but published data from iron deficient pregnant women revealed that it ranges between 8-65%. According to the study in Latin America by Lopez et al., prevalence of pica was 23-44% in iron deficient pregnant women [2]. The diagnosis can be missed unless it is specifically asked. This under estimation is probably related to health professionals’ unawareness and/or lack of knowledge about pica [2, 5, 6].

A study with 81 patients with iron deficiency anemia showed that revealed iron therapy can cure the pagophagia before the hemoglobin level recovers [10]. A case-control study in France from April 19, 1999 to April 18, 2000 involved 158 anemic patients admitted to a hospital. Non-food substances, mainly clay and ice, were ingested regularly by 35 patients (44%) with iron-deficiency anemia and by seven (9%) in the control group (P < 0.0001), but the prevalence of food craving did not differ significantly between the groups. A case series of three patients revealed resolution of pagophagia following iron therapy in patients who had severe iron deficiency anemia with a low serum ferritin level. These patients were eating many bags and trays of ice per day [7].

Studies have shown that many physicians are unaware of the pica symptoms [5, 6]. In addition, patients may be secretive or reluctant to mention their pica habit. This can make diagnosis difficult, and it can be missed unless the physician specifically addresses this possibility. Thus, pica can have significant health risks, including electrolyte abnormalities and metabolic disorders, secondary to a delayed diagnosis. A case series reported by Khan and Tisman showed all three of their patients with iron deficiency-related pica were missed by their primary care physician and academic supervisors [6]. It is recommended to evaluate patient with pica for iron deficiency and its causes. Iron therapy can cure the pagophagia earlier than hemoglobin recovery [10, 11]. If the cause of pica is an emotional or developmental disorder, cognitive behavioral therapy may be helpful [9].

Conclusions

Continuous craving for ice may be a sign of an underlying condition that requires medical attention, but most patients are unaware of that and may not tell their physician. Our patient presented with seizure from hyponatremia due to iron deficiency-associated pagophagia. Her hyponatremia was also likely exacerbated by desmopressin use. This kind of presentation is rarely seen in clinical practice, and can be challenging for physicians to consider pica. Cases can be easily missed and misdiagnosed unless specifically addressed. We recommend physicians consider pica and ask specific questions if patient is chewing too much ice or not.

The content published in Cureus is the result of clinical experience and/or research by independent individuals or organizations. Cureus is not responsible for the scientific accuracy or reliability of data or conclusions published herein. All content published within Cureus is intended only for educational, research and reference purposes. Additionally, articles published within Cureus should not be deemed a suitable substitute for the advice of a qualified health care professional. Do not disregard or avoid professional medical advice due to content published within Cureus.

The authors have declared that no competing interests exist.

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