Oral piercing: what are the risks?

Body piercing is a body modification practice with an esthetic and ornamental aim which is sometimes considered to be a form of transgression or self-expression.

It consists in the insertion of implants or jewelry in various parts of the body, including the mouth: tongue, cheek or lip piercings represent a widespread fashion not only among teenagers, but also in adults.

The mouth is an area with a potential high infection risk seeing as it is the microbiota harboring the widest variety of micro-organisms after the colon. The presence of bacteria, protozoa, fungi and viruses in the mouth may increase the degree of risk connected to the insertion of an ornament in this body part if compared, for example, to an earring.

Before proceeding with a tongue, mouth or cheek piercing, it is advisable to consult the dentist to be informed on potential risks and for suggestions on how to prevent possible injuries.

These are the possible side effects of an oral piercing:

Complications connected to the perforation:

• Hemorrhage: in a highly vascularized area such as the tongue, the local bleeding due to the piercing and insertion of jewelry or implants could evolve in a larger hemorrhage. It is therefore fundamental to rely on qualified and experienced staff.
• Nerve damage: seeing as the tongue is a richly innervated area of the body, the piercer will have to be very careful not to cause any nerve damage, which could escalate in sensitive, motor or gustatory deficits.
• Infectious diseases: systemic complications due to the perforation may occur, it is therefore absolutely necessary to ascertain the respect of high standards of sterility of the instruments so to avoid the transmission of infectious diseases such as, for example, hepatitis B and C, HIV, Herpes Simplex. Some of these infections, which in healthy subjects may not lead to serious consequences, could instead cause devastating effects in immunosuppressed patients.
• Endocarditis: mostly in cases of tongue piercings, the systemic diffusion of an infection may occur due to the proximity of the tongue to the lymph nodes, with serious consequences such as endocarditis and airway obstructions.

Complications connected to the presence of metallic implants or jewelry (usually on the mucous membranes):

• Pain, edema and local inflammation: these injuries are quite frequent and are connected to the mucous trauma caused by the piercing. These traumas can last for weeks, and, in extreme cases, the tongue swelling may cause an airway occlusion. The inflammation may be further complicated by pieces of food and a bad mouth hygiene, resulting in an increase of bacterial plaque and tartar as well as pain, edema, local infections and gingivitis.
• Hypertrophic scarring: this type of issue may be aggravated by the intake of medicines or by the constant movement of the ring within the tongue.
• Interference with the normal oral functions: the presence of a tongue piercing may interfere with chewing, swallowing and word pronunciation. The ornament may also stimulate an excessive production of saliva.

Last but not least, these are the damages a piercing may cause to teeth and gingiva:

• The habit of playing with the metallic ornament may cause dental trauma: fractures, abrasions or detachment of enamel pieces. Even ceramic restorations are exposed to this risk; it is therefore advisable to choose a non-metallic implant, when the removal is not to be considered.
• Gum recession is very common, mostly in cases of lip or tongue piercing, being caused by the constant trauma on the tissue by the ornament. Gum recession does not only represent an esthetic problem but is also cause of tooth sensibility and tooth decay.

Some patients may underestimate wounds or injuries surrounding the piercing or any symptom, thinking they may be temporary.

The role of the dentist and the dental hygienist, who will have to preventively inform the patient and raise awareness regarding all possible risks, is therefore fundamental, and the respect of the periodic appointments in the dental office will be crucial to intercept in advance any potential complication.