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ORAL PIERCING

Tongue piercing causes dental and medical risks
One of every 5 piercing results in infection**

    If you are considering piercing your tongue, lip or check consider these facts first:

 This procedure can present considerable dental and medical risks.  The dental dangers may be directly related to size of the piercing and the length of time worn Procedure-related risks:

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Infection: is a possibility with any opening in skin or oral tissues.  Since the mouth is teeming with bacteria, oral piercing carries a high potential for infection at the site of the piercing.  Handling the jewelry once it has been placed increases the chances of developing an infection.

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Prolonged bleeding: can occur when damage is done to the tongue's blood vessels.

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Swelling and possible nerve damage: Swelling is a common symptom experienced after oral piercing.  Since the tongue is in constant motion it can slow and complicate the healing process.  It has been reported that some swelling due to tongue piercing have been serious enough to block the airway.

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Blood borne disease transmission: of hepatitis B, C, D and G, and syphilis.  Tetanus and tuberculosis are also a risk.  The Institutes of Health has identified piercing as a possible route for the transmission of hepatitis.

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Blood poisoning, toxic shock, septicemia, tetanus, AIDS, staph infections and sexually transmissible disease can be associated with oral piercing.**

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Endocarditis: is a serious inflammation of the heart valves or tissues.  The wound created during oral piercing provides an opportunity for oral bacteria to enter the bloodstream, where it can travel to the heart.  This presents a risk for people who have cardiac abnormalities.

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Jewelry-Related Complications:                   

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Injury to the gums: and also cause the soft tissues to recede. A recent study showed that 50% of people who had worn a long barbell stem piercing (longer than 1.59 cm) for more than two years had their gum tissue pull away from the inside of their lower front teeth.

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Ripped or torn tissue due to metal jewelry constantly contacting the the gum tissue.

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Gum or check infection is the most common problem because the mouth is full of bacteria

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Interference with speaking and swallowing due to swelling or edema which is caused by excess of interstitial fluid in this area.

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Loss of sensation in tongue

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Damage to teeth:  The jewelry can chip, scratch or crack teeth and restorations can be damaged if the jewelry strikes them.  Chipping of the back teeth occurred in nearly half of all people who had worn the piercing for more than four years.  Chipping or cracking occurs when you accidentally bite the jewelry.  Fillings and teeth can be damaged if the jewelry strikes them repetitively in a "wrecking ball" fashion.

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Cracked tooth syndrome can occur with a complete fracture of the back teeth .

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Prolonged or permanent drooling

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Interference with normal oral function:  

Oral jewelry can:

  1. Stimulate excessive saliva production.

  2. Impede the ability to pronounce words clearly.

  3. Cause problems with chewing.

  4. Cause problems with swallowing food.

  5. Some metal alloys can cause allergic contact dermatitis.

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Interference with oral health evaluation: Jewelry in the mouth can block the transmission of X-rays so abnormalities like cysts, abscesses or tumors may not be revealed.

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Aspiration: Unfastened or loose jewelry can be a choking hazard or be ingested causing injury to the digestive tract.

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Jewelry can be ingested, resulting in injury to digestive tract

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Metal hypersensitivity.

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Localized tissue overgrowth

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Prolonged bleeding - from piercing operators inadvertent puncturing of blood vessels in tongue causing serious blood loss, blood clots or strokes.

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The lack of training and education of the person providing the piercing increase the risk of a complication. Make sure to check to see if they are a member of The Association of Professional Pierces.

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National Institutes of Health has identified piercing as possible route for transmission of hepatitis.

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Pain

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Scar tissue formation

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Obstruction to x-rays of mouth

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Chemical burns-result from excessive us of postoperative care products such as Listerine which contain phenol alcohol and hydrogen peroxide which in the early stages of healing may kill the tissues.**

     Proper sterilization techniques and the use of gold jewelry can reduce the risks of infection and metal allergy.  Piercing should be approached with extreme caution and avoided in the tongue, cheek or lips.

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Smoking, drinking and oral sex should be avoided for up to six weeks after an oral piercing

New Information about Oral Piercing:  

The case of the "second tongue"

Body piercing is popular today in the United States and other western societies. One common type of body piercing is tongue piercing, which involves placing a “barbell”-type stud through the tongue. But wearing a tongue stud puts people at risk for chipped teeth, recessed gums, and nerve damage, warns the Academy of General Dentistry . 

However, most people don’t realize that getting an oral piercing also places them at risk for developing a fatal infection or, in some cases, a mini-tongue, according to a report in the January/February 2006 issue of General Dentistry.

In the report, a young woman’s pierced tongue developed a large, round lump adjacent to the piercing. The lump, which she called her “second tongue,” didn’t hurt, nor was it infected, but it was growing. This mass was determined to be a scar tissue formation. Improvement was noted after oral hygiene was increased (frequent use of mouthwash and hydrogen peroxide mouthwash) and the tongue stud was replaced with a shorter shaft. Also Keep the wound clean. Make sure the bar is short so food and bacteria won’t enter the siteReplace the metal barbell heads with plastic ones. The number of adults between ages 21 and 31 who have their tongue pierced continues to increase despite the dangers.

Damage caused by piercing—-tooth fractures, tooth chips.  Pierces weakens the tooth. The damage is almost always in the pre-molars, the middle teeth, almost parallel to the piercing. The best way to prevent damage is to not get your tongue pierced.

Hazards of tongue piercing:
• Infection due to unsterile instruments.
• Pierced blood vessel or artery.
• Development of scar tissue.
• Tooth fractures and chips.   AGD 4/06

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Assessment of the alveolar bone close to tongue stud

One of the latest  trends in ornamental body piercing focuses on the oral cavity, with  the most common piercing site being the tongue. Oral health care  professionals are anecdotally reporting the incidence of
radiographically detectable alveolar bone abnormalities surrounding  the mandibular anterior teeth in patients who wear tongue studs. With the use of convenience sampling, periapical radiographs  were taken of the mandibular anterior teeth of individuals wearing  tongue studs and compared to the radiographs of individuals who had
never worn tongue studs (N = 46). Additionally, a self-report  questionnaire was used to gather demographic data on participants and  specific information related to their piercings.
These findings indicate that individuals wearing a tongue  stud for any length of time are at risk for developing abnormalities  in the alveolar bone surrounding the mandibular anterior teeth.

Asessment of the Alveolar Bone Surrounding the Mandibular Anterior  Teeth of Individuals Wearing a Tongue StudAuthor(s): Susan L
Dougherty RDH, MS ; Kristy Tervort-Bingham RDH, BS Source: Journal of  Dental Hygiene      Volume: 79 Number: 4 Page: 8 Publisher: American
Dental Hygienists' Association Abstract: 1/06
 

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LIP PIERCING: ASSOCIATION WITH GINGIVAL RECESSION

Oral piercing, typically involving the tongue and/or the lip, has been associated with periodontal complications. The purpose of this study was to compare the prevalence of gingival recession on the buccal aspect of mandibular central incisors in subjects with lower lip piercing and in controls.

Methods: Twenty-nine young adults with lip piercing (mean age: 21.8; 15 females) and 29 without (mean age: 22.3; 15 females) were recruited from the community and examined for gingival recession on the buccal aspect of the mandibular central incisors. Results:
There were no demographic (age, gender distribution) differences between the 2 groups of subjects. Prevalence of recession among
subjects with lip piercing (41.4%) was significantly greater than among controls (6.9%) (p=0.0022). The average recession depth was more than double in subjects with piercing compared to controls  Length of time of wear was the only significantlyassociated demographic variable.

Conclusions: These results indicate that lip piercing is strongly associated with increased prevalence and severity of gingival recession on the buccal aspect of mandibular central incisor teeth. Increased time of wear is associated with increased prevalence of recession.

K.I. BLAIR, M.P. CARR, R.G. RASHID, and D.N. TATAKIS, Ohio State University, Columbus, USA Supported by the Sections of Primary Care and Periodontology, 1/06

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Lip Piercings 'Can Shrink Gums'

Researchers have found that having a lip piercing is bad for the gums and can make them shrink back from the teeth.

The longer people wear the piercing, the worse the recession is,researchers from Ohio State University in found - in a study of 58 young adults. In 2003 The British Dental Association reported the same risk with tongue piercings in the BDJ. Oral piercing - a trend growing in popularity - can cause life-threatening infections and reactions.

The Ohio team said that people with lip piercings were far more likely to have receding gums than those without piercings, reports the BBC. When the dental researchers examined the young people's mouths they found average recession depth was more than double in those with piercings, compared with those without piercings.

Dr Dimitris Tatakis and his team presented their findings at a conference of the International & American Association for Dental Research. Professor Jimmy Steele, from Newcastle University's Dental School in
the UK, told the BBC that people who had, or were considering getting a lip piercing should take heed of the findings.


`The metal of the lip stud is physically rubbing over the gum at the neck of the tooth causing the gum to recede. Once this has happened, you don't get the gum back and it often becomes more difficult to clean and therefore even more prone to gum disease in the future. The effect is quite localised so it will only be one or two teeth
affected - but they are front teeth, so not ones you want to lose.
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He said it was only really a problem for long-term wearers and that taking the stud or ring out at night time and making sure the teeth were really clean would help reduce the risk of complications.

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ASSESSMENT OF THE ALVEOLAR BONE SURROUNDING THE MANDIBULAR ANTERIOR
TEETH OF INDIVIDUALS WEARING A TONGUE STUD


.It is imperative to be aware of the increasing occurrence of oral piercing and its health implications such as infection, fractured teeth, damaged gingival tissue, increased salivary flow, and negative affects on speech, mastication, swallowing, and alveolar bone abnormalities surrounding the mandibular anterior teeth associated with the wearing of a tongue stud.
The findings from this study indicated that individuals wearing a tongue stud for any length of time are at risk for development of alveolar bone abnormalities surrounding the mandibular anterior teeth.

*Susan L. Dougherty, RDH, MS
Weber State University presented ADHA Annual Session 2004 1.06.05

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A Fatal Fad?

Tongue studs cause more problems than chipped teeth.

These oral piercing place you at risk for developing a fatal infection, such as Ludwig's angina or endocarditis, according to a report in the May/June 2004 issue of General Dentistry.  This bacterial infection of the floor of the mouth occurs after a tooth infection, mouth injury, oral surgery and oral piercings.  After getting an oral piercing, the mouth has an open wound which allow bacteria to travel through the bloodstream.  Bacteria then cause the floor of the mouth to rapidly swell, which can block the airway or prevent the swallowing of saliva. 

Endocarditis occurs when bacteria travels into the bloodstream through the piercing hole and infects the heart.  Most body piercers are unlicensed and not members of the medical profession.  Because of this health histories are not recorded or reviewed, emergency medical kits are not available, antibiotics are not prescribed and postoperative care is not available.  Post operative care can also help identify these serious infections before they become fatal.

Ludwigs's angina is a life threatening acute severe infection of the jaws that causes swelling that can close off the airway.  This can be treated with an incision and drainage

Endocarditis is a disease caused by a microorganism infecting the heart valves or endocardium.  The microorganism can center the blood stream through the piercing wound.  This can be treated with antibiotics.

Dentalnotes Summer pg 2 2004

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Pierced teens warned about drooling 

 Teens who get their lips or tongues pierced may end up "drooling like a St Bernard" or speaking like a drunk. The Dental Hygienists Association of Australia said piercings could cause:
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prolonged drooling

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slurred speech

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difficulty chewing 

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swallowing problems

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damaged teeth

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reduced taste sensation

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permanent nerve damage. 

Many people were also unaware that smoking, drinking and oral sex should be avoided for up to six weeks after an oral piercing because of an increased risk of tissue damage and bacterial infections. "Biting fingernails, putting your pencil in your mouth, kissing anyone, sticking your tongue in anyone's mouth, or anywhere else for that matter - oral sex is definitely out," according to AAP.  March 2003

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Tongue piercing plus heart defect spell trouble for patient 

    People with heart-related abnormalities such as this one are advised to take antibiotics whenever they are having invasive procedures, such as surgery or dental work. Dental work — and possibly body piercing — poses a risk of infection to such individuals because bacteria in the mouth can gain access to the bloodstream. Once inside the body, the bacteria can take hold in the heart, causing a potentially life-threatening infection.  2 months after his tongue was pierced, the man was hospitalized with fever, chills and shortness of breath. Blood tests revealed that the man's heart was infected with a type of mouth bacteria known as H. aphrophilus. The stud of the piercing also tested positive for the presence of the same bacteria. The man received a 6-week course of antibiotics via a catheter and recovered. Although he usually took antibiotics before a trip to the dentist, the man did not take antibiotics prior to the piercing. 
SOURCE: Emerging Infectious Diseases 2002;8:850-851.

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Researchers Find Tongue Piercing Could Lead To Gum and Tooth
Problems...

 A new study  found that extended wear of tongue jewelry (barbell-type) could increase your chance of gum recession and tooth chipping.

This study found gum recession in 35% of subjects with pierced tongues for four or more years, and in 50% wearing long-stemmed barbells for two or more years.

During tongue movement, long-stem barbells are more likely to reach and damage the gums than short barbells which can lead to more serious dental/oral complications.

Additionally, almost half of those wearing either type of barbell for four or more years had chipped teeth. The prevalence of tooth chipping was greater in those wearing short- stemmed barbells (1/4 inch - 5/8 inch) for four or more years because tooth chipping was a result of habitual biting of the barbell. 

Mouth piercing and smoking combined could cause a mouthful of trouble because smokers have:
bulletmore calculus on their teeth
bulletdeep pockets between their teeth and gums 
bulletloss of the bone and tissue that support your teeth. 

Combine these problems with gum recession from tongue piercing and you are on your way to having a serious infection called gum disease.

Anyone with a pierced mouth should receive a thorough oral examination of their gums and teeth to identify problem areas. Taking precautions now will increase your chance of keeping your teeth for a lifetime.
Journal of Periodontology, March 2002

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Oral Piercing in Athletes

Intraoral piercing and tongue jewelry place athletes at greater risk for serious medical and dental consequences that are confounded when the athlete attempts to compete while wearing a mouthguard with the tongue jewelry in place.

All body jewelry should be removed during sporting events
Oral piercing in athletes: Implications for general dentists Suzann P. McGeary, RDH, DDS, Deborah Studen-Pavlovich, DMD, Dennis N.Ranalli, DDS, MDS General Dentistry 2002, March

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Consequences: From Pierced Tongue to Infected Brain

Doctors at Yale believe that a brain abscess in a woman in her 20's was caused by an infection she suffered after having her tongue pierced.

Dr. Richard Martinello stated that the woman first reported that her tongue became swollen and produced a sour taste a few days after it was pierced and a stud put in place. 

About a month later she began suffering from headaches, fever and vomiting and had trouble with her balance. A CAT scan performed in a local hospital revealed a brain abnormality in the cerebellum, which is associated with coordination.  Tests showed the presence of four types of bacteria commonly found in the mouth.  After six weeks of antibiotics, the woman made a full recovery.  She was reported to be against oral piercing at the time this article was written.
December 25, 2001 - JOHN O'NEIL, Wed, 26 Dec 2001 23:49:42 -0000

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Forked Tongue    This is a dangerous procedure.

Latest Fashion Craze....It seems today's youth don't find it rebellious enough to have piercings in the ears, nose, eyebrows and tongue. The latest growing trend is to have the tongue split in two, creating a serpent-like forked tongue or tongue splitting, reports the Boston Globe. In the US, some states are considering outlawing the practice, saying it is nothing short of mutilation. Often this operations feels like" it is being done with a scalpel heated by a blowtorch." Often no anesthetic is used. It can cost 500 dollars. A dentist in Illinois, David Miller, has written a bill requiring that tongue-splitting be done by a doctor or dentist, and then only for medical reasons. The bill was passed in the Illinois House and is awaiting a vote in the Senate.  8/03

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Source: American Dental Association, Academy of General Dentistry, Health Center.

[Leichter JW, Lovegrove J, Murray C Elective lip piercing and gingival recession: case report Oral Health 2003;93(10):51-56.]

**The Adverse Effects of Oral Piercing.  Dietz. Contemporary Dental Assisting, Sept 2005 pg 11-13

February 06, 2008

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