CHOOSING TO LIVE

"If standard of living is your major objective,
quality of life almost never improves; but if quality of life is
your number one objective, your standard of living
almost always improves.”

-- Zig Ziglar, Author and Motivational Speaker


"I used to eat sheet rock,” the patient confessed, "They call it pica.”

He was a small Hispanic man whose boyish, olive-brown face was coarsely scarred and framed with neatly-trimmed jet-black hair. As I filled out his medical history forms, he peered at me with jaundiced eyes, hoping to catch my response.

“I suffered from severe depression and almost died several times,” he said, as if he had often shared this story. “But now I’m trying to get my act together for a kidney transplant. I want to live."

He resided in a nursing home; his kidneys had shut down and he was dependent on dialysis three times a week. Blood chemistry issues also compromised his ability to heal. The downward spiral of mental health had left his general health in shambles.

The patient had been referred by "Donated Dental Service," a volunteer program to treat people who are medically compromised. This man had destroyed most of his dentition with a combination of depression, neglect and the assault of chewing abrasive sheet rock.

The name pica comes from the Latin word for Magpie, a bird that will eat almost anything. The condition is world-wide, but because of patient’s shame and low incidence, pica often goes undetected. Causes may be cultural, physical (malnutrition and mineral deficiencies), and mental (developmental and psychological).

The erosion to this man’s maxillary anterior teeth was remarkable; they were worn down to the alveolar bone exposing unprotected nerves and dentin. His mouth was riddled with worn, fractured, decayed and abscessed teeth. Paired with poor oral hygiene, his dental state was catastrophic. A treatment plan was challenging because pica relapse is not uncommon. His fervent will to live became our motivator in helping him.

Many of his teeth were extracted and replaced with removable upper and lower dental prosthetics. Now he could eat and speak properly, and with his body rid of future dental infection risks, he was a better candidate for a kidney transplant to help satisfy his goal.

He said, "Everybody has been complimenting me on my new smile. I’ve never had straight teeth before. I can’t believe it."

It would be a pleasure to report that this man has received his kidney transplant, but he is not there yet. Despite several setbacks requiring hospitalization, he is slowly improving.

The interconnection of dental, mental and medical problems was clearly apparent in this extreme case of pica. However, these relationships cannot be as neatly separated as we formerly believed.

Medical pathology needs to be evaluated with a differential of possible mental health causes. People tend to ignore their dental health from stress, depression, low self-esteem, physical pain and other conditions. Anti-cholinergic medications, poor diets, poor hygiene and lack of preventive dental services also contribute.

"I want to live."

That was the mantra for our dedicated response.


-- Patrick J Foy, DDS