A brief introduction to intraoral piercings

Throughout the millennia, people around the world have modified their bodies with piercings and tattoos. In recent years, the dental profession has seen a rise in modifications in the oral cavity, especially among young people. Though on the surface these piercings may seem decorative, they come with myriad side effects. The dental professional should be aware of some of the complications that can arise from intraoral and perioral piercings and tattoos so that they can better serve their patient population. 

In the dental office

• Piercings are easy to get stuck in impression material, especially PVS. Piercings through the lingual or labial frenum are especially tricky as the dental practitioner may not be aware of their presence, especially if the patient has removed them for radiographs. You don’t want to spend an hour cutting an imbedded piercing out of an impression!
• The inside of the lip is a somewhat popular place for tattoos. These should be noted on an intraoral exam and monitored for changes. These tattoos tend to fade over time as well, so an old tattoo may appear similar to many types of oral pathology such as a melanotic macule, blue nevus or even melanoma. If something looks suspicious, discuss with the patient if they have had a tattoo in the area for your differential diagnosis. 
• Don’t forget to ask patients to remove any metal piercings before taking X-rays Metals may obstruct anatomical variations on a radiograph. 

Short-term effects

• Fresh piercing sites are liable to become infected, especially those in the mouth. Keeping intraoral piercings clean while they heal is a difficult task due to the millions of bacteria in the oral cavity, but alcohol-free mouthwashes or saltwater rinses can help with the healing process. Magic Mouthwash may also offer relief. 
• Other immediate complications arising after piercings or tattoos include swelling, tenderness, bleeding or hematoma formation. 
• Some metals such as nickel may cause hypersensitivity or allergic reactions. Stainless steel is a better alternative for piercing sites. 
• Jewelry can become loose without the patient being aware. They could swallow or even aspirate the jewelry, so remind patients to make sure they tighten their piercing at frequent intervals. 

Long-term effects

• Piercings such as lip rings, tongue studs or labial frenum piercings can rub against the gingiva and cause irritation. Long-term, this can lead to gingival recession and bone resorption, and eventually tooth mobility or tooth loss. People with lip rings were found to be more than four times and those with tongue rings almost three times more likely to develop recession than those without piercings.
• Many people with oral piercings, especially tongue studs, develop habits of playing with the piercing between their teeth. Damage has been seen in 26% of people with lip piercings and 44% of people with tongue piercings. This can contribute to sensitivity as well as being unesthetic. 
• Piercings within the oral cavity can be a vector for the spread of bacteria into the bloodstream. This can lead to further complications such as infective endocarditis or even Ludwig’s angina. The piercing site may also make patients more prone to other blood-borne illnesses such as hepatitis. Synthetic materials may harbor less pathogenic bacteria than metals, something to keep in mind when counseling patients.

Be sure to discuss the side effects of these types of piercings with your patients so they can be better informed. And keep track of any changes at the piercing site and the related dentition and periodontium.

~Emily Williams, Georgia ’20, ASDA Contributing Editor