In today’s society, oral piercing is considered by some, particularly the older generation, as a form of rebellion or deviance while others consider it a form of self-expression through body art. While there have been debates that oral piercing, as well as other types of piercing, is associated with psychological health, one thing is for certain – it affects oral health in the long run.

Oral piercings involve areas like the lips, cheeks, tongue and uvula. Usually, these piercings are done without the help of anaesthetics, using a barbell-shaped piece of jewellery to traverse through the chosen area. For tongue piercings, a temporary longer device is initially used to prevent the hole from closing and to convenience eventual swelling. The open end of the stud is then inserted in a ventral-dorsal position, where the lock is screwed on to it between the mandibular and maxillary anterior teeth. Some opt to have the piercing installed laterally, aligning it to the dorsolateral lingual surface. Typically, the piercing wound heals after four to six weeks, should complications not arise.

Another form of oral art is tongue splitting, where the tongue is literally split into two pieces to create an appearance that is “forked”. There have been reports that various techniques are used to do this, including rather primitive ones where a cauterizing pen is used after a scalpel, or a fishing line that is threaded through an existing tongue piercing and pulled forward, which then severs that anterior aspect. The tongue pieces are then kept apart so they can heal as two separate pieces.

When it comes to cheek or lip piercing, usually a piece of jewelry is placed in the labret area and is positioned intra-orally based on the recipient’s aesthetic preferences. Once the desired position is determined, a cork-like device is inserted into the mouth to serve as support on the receiving end of the needle once it is pierced through flesh. Once this is done, a labret stud is used to replace the needle and the cork backing is screwed on to the side which is inside the mouth. This type of piercing may take weeks or months to heal.

There are numerous varied intraoral and perioral complications from oral piercings, although available scientific literature is quite limited. Common symptoms that initially follow the act of piercing are pain, infection, swelling and increased flow of the saliva. These symptoms can be telling of the following complications:

Infections – Infections are mainly due to the aggravation of the piercing wound, existing bacteria in the mouth, as well as the bacteria that is carried by the jewellery. Since the tongue is vascular in nature, the manner in which the jewellery is inserted may fracture or scrape anterior dentition. Bacteria in the mouth form bio films on the jewellery surfaces, creating colonies that make bacteria resistant to some antibiotics and mouthwash. Furthermore, jewellery that has been digitally manipulated may increase the chances of infection due to the chemicals it has been exposed to.

Transmission of diseases – Transmission of blood-borne hepatitis B and C as well as herpes simplex virus are potential risks for oral piercing, as reinforced by The National Institutes of Health. Other disease transmissions such as the passing on of tetanus and localized tuberculosis have also been associated with piercing of the ear.

Endocarditis – Bacteria entering the bloodstream may also eventually lead to Endocarditis, which is the inflammation of the heart or its valves. People who have underlying heart problems, some of which may have no symptoms and have never been diagnosed, are at a bigger risk. Endocarditis has also been previously linked to ear and nose piercings.

Nerve damage or prolonged bleeding – Nerve damage can lead to sensation loss or numbness at the area of the piercing as well as problems with movement (for tongue piercings). Prolonged bleeding may occur if a blood vessel is punctured. There is also the danger of breathing difficulty if tongue swelling becomes too severe that it blocks the recipient’s airway.

Gum disease – The risk factors of gum diseases increase for people with oral piercings, especially those that sport the longer stemmed studs. The barbell-like studs may come into contact and injure gum tissue, as well as cause a recession of it, eventually leading to loose teeth or even tooth loss. Studies have reported that the most common areas for oral site piercing are the lip and the tongue. Tongue piercings may cause damage to the gum tissue at the back of the lower front teeth while lip piercings may damage gum tissue in front.

Tooth damage – Chipping or cracking of the teeth caused by piercing jewellery is quite prevalent. A dental journal previously reported that about 47% of people who employed the use of barbell-shaped jewellery in oral sites for a minimum of four years experienced at least one case of a chipped tooth.

Daily oral function difficulties – Tongue piercing may get in the way of normal daily functions, thus resulting in difficulty in chewing and swallowing food. Motor skills have also been known to be affected; often leading to the inability of the recipient to speak clearly since piercing jewellery stimulates and aggravates the production of saliva. This may also lead to temporary and even permanent drooling. Alteration of taste has also been identified as a consequence.

Metal allergic reaction – Allergic contact dermatitis is a hypersensitivity reaction to the jewellery metal which has been known to occur in piercing cases. Secondary infection due to oral piercing can prove to be quite serious. According to the British Dental Journal, a case of Ludwig’s angina, which is a cellulitis involving the sublingual, sub mandibular and sub mental facial spaces bilaterally that spreads rapidly, manifested a few days after the patient had an oral piercing. She had to undergo intubation in order to clear the airway. The patient failed to respond to antibiotics so in order to remove the jewelry and the control the swelling of the mouth floor, surgical intervention had to be done.

Jewelry aspiration – Piercing jewellery that has loosened in the mouth may become a choking hazard, which may also result in digestive track or lung injury if swallowed. Furthermore, oral ornaments may obstruct dental diagnosis by masking defects and anatomy in x-rays. There is also a theory that galvanic currents occurring from stainless-steel jewellery that comes into contact with intraoral metals may also result in pulpal sensitivity.

When dealing with patients who are thinking of getting them despite the posed health risks, dental professionals must advise patients to make sure that the studs, needles, and other devices used are properly sterilized. Advise patients to ask for their piercing studios’ health certificates, making sure that all employees are knowledgeable and disease-free. For patients that already have oral piercings, advise them to come in regularly for check-ups to ensure optimal oral health.

By arnia