Oral Piercings

Oral jewelry is frequently seen in dental practices, especially with adolescents and young adults. The most common piercings are on the tongue and lip. Piercings can also be found on the uvula, labial frenum and lingual frenum. Another form of piercing is dermal piercings that can be found on the chin, dimples, upper and lower lip, and on the cheeks near the sinuses.

There are several reasons why adolescents and young adults get oral piercings, including control over the body, as a form of identity, something new, following the current trend or fad, influence of friends, inclusion into certain groups, greater acceptance in society, and stimuli provided by the media (Purin, Rosario, Rosario, & Guimaraes, 2014). The shape and size of the oral jewelry is determined by location and personal preference. Most piercing jewelry is made of stainless steel, gold, niobium, titanium, or metal alloy.

The most common type of jewelry used on the tongue is the barbell, it consist of a metallic needle-like, curved, or straight stem with a sphere attached on each end. Another common type of oral jewelry is the labret, which is usually on the lip and is made up of a metal stem with a sphere on one end and a smooth flat disc on the other end. The third type of piercing is a ring with one or two spheres on each end (Vieira, Ribeiro, Pinheiro, & Alves, 2011).

A cheek piercing is usually called dimples because the bilateral placement corresponds with the anatomic locations of the cheek dimples. Web piercing is when the lingual frenum is pierced. The uvula is another piercing, but is an uncommon area to pierce due to the difficulties involved in performing the procedure such as gagging. A different type of oral jewelry used is magnets; it is two components of the stud held together by magnetic force tenfold greater than that of a conventional magnet (Uppal, Kapur, Kaur, Singh, & Kapur, 2012).

Piercings are usually performed by unlicensed, non-medical, and often self-trained individuals who have little knowledge of local anatomy, medical conditions, sterilization, prevention of complications, or emergency procedures. Simple precautions such as using an aseptic technique for puncturing can reduce the occurrence of complications. Pain is often the most common immediate complication (Dermata & Arhakis, 2013). Dental professionals need to be aware of the risks and complications of oral piercings and homecare of the pierced site to properly educate patients.

Dangers associated with oral piercings range from the common inflammation symptoms to serious life-threating conditions and even death. Some of the complications are infection, pain, bleeding, edema, abscess, dental trauma, and oral interferences such as impaired speech (Hennequin-Hoenderdos, Slot, & Van der Weijden, 2011). Objective The purpose of this literature review is to evaluate multiple peer-reviewed articles from professional journals to determine the complications and damage oral jewelry cause to tooth structure, gingival tissue, and other tissues in the oral cavity.

Methods The methods that were used to obtain articles related to this subject include reviewing professional dental and dental hygiene journals and using the internet search engine. The search engines used to find the articles were the Consortium Library UAA/APU, PubMed, and Google Scholar. The criteria used to select articles for the literature review included peer-reviewed scholarly articles from professional journals, full-text availability of the articles, and the accuracy and legitimacy of the articles.

The key words used in the search engines were oral piercings, damage caused by oral piercings, oral jewelry, dermal jewelry, tongue piercings, lip piercings, dermal piercings, intra-oral piercing, facial piercings, risks of oral piercings, risks of oral jewelry, and complications of oral piercings. Many articles were reviewed and analyzed for specific information. Six articles were chosen to convey the majority of the professional information that met the specific criteria listed. Results The analysis of the journal articles showed that there are increased risks, complications, and damage to the oral cavity with oral jewelry.

The most common piercing is on the tongue followed by the lip piercing. Several articles indicated that immediate complications following a piercing are swelling, inflammation, nerve damage, hemorrhage, local infection, increased salivary flow, and changes in taste. According to Balkan Journal of Stomatology, swelling and inflammation can cause problems such as, difficulty speaking and swallowing, interference with mastication, respiratory difficulties or even asphyxia (Dermata & Arhakis, 2013).

Long-term risks include enlargement of the piercing hole, chemical burns associated with excessive after care, granulomas and scar tissue formation, reactive hypertrophic tissues, and keloid scarring. The friction caused by oral piercings can cause gingival recession, clinical attachment loss, tooth mobility, and tooth loss. Oral piercing can cause traumatic injury to teeth such as chipping, fracturing, and pulpal damage (Dermata & Arhakis, 2013). Gingival tissue surrounding the oral piercing can grow over the jewelry, also referred to as embedding.

The embedded jewelry may need surgical removal. There is also a risk of aspiration or inhalation of jewelry parts if not fastened securely or possible damage to the digestive system if swallowed (Badry, Farhart, Karam, & El-Haji, 2014). The Australian Dental Journal revealed that the wear time and habits of lip and tongue piercings significantly affected the prevalence of dental defects and gingival recession. A tongue piercing has been shown to cause more dental defects such as tooth chipping, cracked teeth, and grooves on the teeth, than lip piercings.

The length of time oral jewelry is worn has a significant effect on attachment loss and probing depth, and it does not differ between the lip or tongue piercing. Gingival recession was significantly associated with the piercing height, closure, and stem length (Plessas & Pepelassi, 2012). The International Journal of Dental Hygiene found that jewelry associated with recession frequently developed as a narrow cleft-like defect on the lingual aspect of the mandibular incisors with recession depths of 2-3mm or greater, often extending to or beyond the level of the mucogingival junction (Hennequin-Hoenderdos et al. 2011).

Local infections are the most frequent consequence of oral piercing and are caused by the accumulation of plaque and calculus at the site of the piercing. A systemic infection, which is caused by microorganisms that enter the systemic blood circulation, can be detrimental to an immunocompromised patient. Some life-threatening situations have been reported such as the development of cerebral brain abscesses and Ludwig’s angina. There is also a possibility of infection by infectious diseases such as Hepatitis B, C, D, and G, HIV infection, tetanus, and tuberculosis (Plastargias & Sakellari, 2014).

According to the International Journal of Contemporary Dentistry, herpes simplex, Epstein-Barr, and infective endocarditis are other infectious diseases that can cause infection due to an oral piercing (Uppal et al. , 2012). A study revealed that a statistically great proportion of the population which has undergone a tongue piercing procedure is not aware of the potential complications of the piercing or how to handle the possible problems that may arise from a piercing (Plastargias & Sakellari, 2014).

This general lack of awareness could be attributed to piercings performed mainly by non-medical practitioners who are not aware of the possible complications of oral piercings or prefer not to tell the patients so as not to scare them off (Oberolzer & George, 2010). It is also important to note that less than one-third of patients clean their piercing regularly (Plessa & Pepelassi, 2012). Homecare, after the piercing has been performed, is essential to keep the risks to a minimum.

Homecare includes, rinsing the mouth with an antimicrobial rinse three to four times a day, eating cold foods the first three to five days to reduce swelling, avoiding hard or spicy food for the first five to seven days, drinking a sufficient amount of water, tightening threaded piercing once or twice a day, washing hands before and after handling mouth jewelry, downsizing jewelry as soon as swelling has subsided, avoiding oral contact such as kissing for four weeks, cleaning jewelry after each meal, avoid opening too wide to prevent tissue trauma, and contact a doctor as soon as possible if an infection is suspected (Uppal et al. 2012).

It is also important to limit the caffeine, alcohol, and cigarettes for the first three days and avoid chewing gum and tobacco until tissue heals (Badry, Farhart, Karam, & El-Haji, 2014). In a dental practice oral jewelry needs to be removed for panoramic radiographs, periapicals and bitewing radiographs because of their location in relation to film placement. Oral jewelry removal during local anesthetic is at the discretion of the dental professional but it may be prudent for the mandibular block as it anesthetizes the tongue.

The tongue ring will need to be removed because it increases the possibility of tooth damage until the anesthesia has completely worn off (Pramod, Suresh, Kadashetti, Shivakumar, Ingaleshwar, & Shetty, 2012). Discussion and Conclusion These articles show that oral piercing are gaining popularity especially with adolescents and young adults, and many of these people are not well informed of the risks and complications with oral piercings.

Adolescents and young adults find a lot of information about oral piercing online or in magazines with a listing of piercing studios, but many of these sources of information neglect to provide information on health risks and other health issues (Hennequin-Hoenderdos et al. , 2011). Since oral piercings are on the rise, dental professionals need to be aware of the risks and the complication. They also need to be able to examine the patient’s oral cavity thoroughly and recognize associated lesions, treat possible complications, educate patients, provide homecare instructions, and provide appropriate guidance on oral piercings.

Dental professional need to play an active role in examining and informing patients with oral piercings on the possible short and long-term complications associated with oral jewelry (Oberholzer & George, 2010). The results of this literature review revealed that patients and the practitioners performing the piercings need to have adequate knowledge of the risks and complications of oral piercings. These articles show that there is a positive correlation between oral jewelry and detrimental effects in the oral cavity.

Oral jewelry is damaging to the hard and soft tissues of the oral cavity and can be prevented or minimized if patients are fully educated of the risks associated with oral piercings. Specific regulations and standards regarding oral piercings need to be placed in piercing studios and other piercing locations by the state. This will ensure that universal precautions and standard of care is incorporated to minimize risks and complications of oral piercings. Creating an education program in high schools and colleges is another way to ensure that these individuals are making an educated decision before getting an oral piercing.