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Piercing is becoming
a more prevalent form of body art and
self-expression in today's society. However, oral piercings, which
involve the tongue (the most common site), lips, cheeks, uvula or a
combination of sites, have been implicated in a number of adverse
oral and systemic conditions.
Patients typically undergo piercing procedures without anesthetic.
In tongue piercing, for example, a barbell-shaped piece of jewelry
typically is placed to transverse the thickness of the tongue at the
midline in its anterior one-third using a needle. Initially, a
temporary device longer than the jewelry of choice is placed to
accommodate postpiercing swelling. The free end of the barbell stem
then is inserted into the hole in a ventral-dorsal direction. The
recipient grasps the free end of the shank between the maxillary and
mandibular anterior teeth and screws the ball onto the stem. The
barbell also can be placed laterally, with the studs on the
dorsolateral lingual surface. In the absence of complications,
healing takes four to six weeks.
In lip or cheek piercing, jewelry position (usually a labrette) is
determined primarily by aesthetics with consideration to where the
jewelry will rest intraorally. Once position is determined, a cork
is usually placed inside the mouth to support the tissue as it is
pierced with a needle. The needle is inserted through the tissue and
into the cork backing. The needle then is replaced with the labrette
stud, and the disc backing is screwed into place. Healing time can
range from weeks to months.
Common symptoms following piercing include pain, swelling, infection
and increased salivary flow. Potential complications of intraoral
and perioral piercings are numerous, although available scientific
literature is rather limited and consists mainly of case reports.
Possible adverse outcomes secondary to oral piercing include
increased salivary flow; gingival injury or recession; damage to
teeth, restorations and fixed porcelain prostheses; interference
with speech, mastication or deglutition; scar-tissue formation; and
development of metal hypersensitivities. Because of the tongue's
vascular nature, prolonged bleeding can result if vessels are
punctured during the piercing procedure. In addition, the technique
for inserting tongue jewelry may abrade or fracture anterior
dentition, and digital manipulation of the jewelry can significantly
increase the potential for infection. Airway obstruction due to
pronounced edema or aspiration of jewelry poses another risk, and
aspirated or ingested jewelry could present a hazard to respiratory
or digestive organs. In addition, oral ornaments can compromise
dental diagnosis by obscuring anatomy and defects in x-rays. It also
has been speculated that galvanic currents from stainless-steel oral
jewelry in contact with other intraoral metals could result in
pulpal sensitivity.
The National Institutes of Health has identified piercing as a
possible vector for bloodborne hepatitis (hepatitis B, C, D and G)
transmission. Disease transmission (e.g., hepatitis B, tetanus,
localized tuberculosis) has been associated with ear piercing, and
cases of endocarditis have been linked to both nose and ear
piercing.
Secondary infection from oral piercing can be serious. A recent
article in the British Dental Journal reported a case of Ludwig's
angina, a rapidly spreading cellulitis involving the submandibular,
sublingual and submental fascial spaces bilaterally, that manifested
four days after the 25-year-old patient had her tongue pierced.
Intubation was necessary to secure the airway. When antibiotic
therapy failed to resolve the condition, surgical intervention was
required to remove the barbell-shaped jewelry and decompress the
swelling in the floor of the mouth.
Because of its potential for numerous negative sequelae, the ADA
opposes the practice of intraoral/perioral piercing.
Copyright ©
1999 American Dental Association.
Reproduction or republication strictly prohibited without prior written
permission.
See Terms & Conditions of Use for further legal information.
May 14, 1999
Document address:
http://www.ada.org/prac/position/piercing.html
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