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Clinicalpractice Clinical P RACTIC E Overview of Complications Secondary to Tongue and Lip Piercings Contact Author Léo-François Maheu-Robert, DMD; Elisoa Andrian, PhD; Daniel Grenier, PhD Dr. Grenier Email: Daniel.Grenier@ greb.ulaval.ca ABSTRACT In recent years, intraoral and perioral piercings have grown in popularity among teen- agers and young adults. This is of concern to dental and medical professionals because of the risks and complications for oral, dental and general health. The risks and compli- cations associated with tongue and lip piercings range from abnormal tooth wear and cracked tooth syndrome to gingival recession and systemic infections. In this report, we provide an overview of possible problems associated with oral piercings that may be encountered by dentists. For citation purposes, the electronic version is the definitive version of this article: www.cda-adc.ca/jcda/vol-73/issue-4/327.html ody piercing is a cultural practice or In this article, we present a brief review tradition in various civilizations dating of the current literature on potential compli- Bback to antiquity. In recent years, body cations and adverse consequences of tongue piercing has become increasingly fashionable and lip piercings. Our objective is to provide for purely esthetic reasons, and the practice a general overview of possible problems that cuts across all sectors of society. The emer- may be encountered by dentists. In addition, gence of oral piercing, especially among young we highlight the urgent need for dentists and adults, is of concern to dental and medical doctors to inform target patients of the risks professionals because of the risks and com- associated with oral piercings. plications for oral, dental and general health. Intraoral piercings involve the tongue, while Oral Piercing Procedures perioral piercings involve the lips, the cheeks The tongue is usually pierced at the mid- and, to a lesser extent, the uvula and the line, typically in the median lingual sulcus, frenum. Among those with non-traditional although piercings may also be performed on body piercings, the tongue is the most preva- the dorsolateral lingual surface anterior to the lent site followed by the lips.1 Since the first lingual frenum. The principal type of jewellery warnings by Chen and Scully in 19922 of the used in tongue piercings is barbells, which risks and complications associated with oral consist of a bar with a ball screwed onto each piercings, an increasing number of studies on end. Lip piercings are mainly performed on this issue have been published. Risks and com- the middle portion of the lower lip, but may plications (Box 1) are diverse and range from also be near the commissura and on the lower temporary inconveniences related to the pres- lip near the canines. Labrets, with the flat ence of the jewellery in the mouth, to gingival end on the mucosal side of the lip, as well as recession and severe systemic infections. rings and barbells, are commonly used for lip JCDA • www.cda-adc.ca/jcda • May 2007, Vol. 73, No. 4 • 327 ––– Grenier ––– Box 1 Risks and complications associated with oral localized infection.4,6 Potential complications that occur piercings within weeks of the piercing include functional prob- lems, such as dysphonia, dysphagia, interference with Airway compromise mastication and the generation of galvanic currents 3,7 Allergic reaction to metal between the barbell and metallic dental restorations. Bleeding and risk of hemorrhage Hypersensitivity reactions, known as allergic contact dermatitis, to the metal when jewellery is not of the Galvanism best quality or contains nickel have been reported.8 Less Gingival recession common acute symptoms include increased salivary flow Hyperplasic and scar tissue formation rates. Irritation of the skin around the jewellery inserted Increased salivary flow into the lower lip has been shown to be related to contact Inhalation of the jewellery allergy and to saliva flowing through the pierced site.9 In Interference with radiographic images most cases, these complications have not been detrimental Interference with speech, chewing and swallowing and tend to disappear with time. However, more serious and potentially life-threatening complications have been Localized and systemic infections reported, including prolonged bleeding,10–12 infections, Nerve damage and paresthesia disease transmission and airway problems secondary to Pain swelling of the tongue.10,13,14 Finally, the potential risk of Swelling aspiration or inhalation of parts of the jewellery if they Tooth fracture or chipping come loose should not be overlooked.1,3,4 Risk of Hemorrhage Although in 1977 Boardman and Smith1 stated that bleeding is not the most frequent complication of tongue piercings. After the piercing procedure, regular rinsing piercings, prolonged bleeding is of great concern in med- with warm salt water or antiseptic mouthwash is sug- ically compromised patients. During the piercing process, gested, and smoking and alcoholic beverages should be blood vessels may be torn and vascular nerves damaged. avoided. It is generally recommended that the jewellery Hardee and others11 reported a significant loss of blood not be removed for a long period to prevent the piercing from hemorrhage following a tongue piercing, which site from closing spontaneously. However, once healing resulted in hypotensive collapse. Prolonged bleeding, is complete, the jewellery should be removed daily and hematomas and disturbed wound healing have also been cleaned and brushed thoroughly to maintain good oral reported following lip piercings.3 Because of the signifi- hygiene and avoid plaque and calculus build-up. In a cant complications that may arise when hemorrhage oc- recent survey, De Moor and others3 reported that most curs, intraoral and perioral piercings should be regulated patients never remove their jewellery for cleaning. by licensing piercing establishments. Hardee and others11 Piercing procedures are usually performed without have suggested that all establishments should be given anesthesia by unlicensed, non-medical people, who documentation on potential problems and the manage- are often self-trained and have little knowledge of the ment of bleeding. Furthermore, a systematic review of anatomy of the intraoral and perioral area; serious med- the customer’s medical history before the piercing pro- ical conditions, such as heart valve disease and bleeding cedure should be recommended to rule out a history of a disorders; sterilization procedures; or prevention of com- bleeding disorder.12 plications following piercing.4 Localized Tissue Overgrowth Mucosal Injury Among later complications following oral piercings, Because of its extreme vascularity and its location in traumatic injuries to the mucosal surfaces at the pier- the upper airway, the tongue is particularly vulnerable to cing site have been documented. These include enlarge- complications, which are diverse and range from minor ment of the piercing hole,4 chemical burns associated to potentially life-threatening. Oral and dental complica- with excessive aftercare,15 paresthesia,6 sialadenitis,16 tions associated with tongue piercings are categorized lymphadenitis,17–19 sarcoid-like foreign-body reactions,20 as acute (early) or chronic (late).5 Acute complications granulomas and scar tissue formation at the piercing typically arise within 24 hours following insertion of site after the removal of a labret or barbell.3,9 Moreover, the jewellery into the tongue and are usually confined to barbell shanks that are too short may lead to localized injuries of weak tissues.3 The most common immediate tissue overgrowth, with the mucosal surface of the tongue acute symptoms include pain, swelling, bleeding and healing over the barbell.21 Lingual piercings that become 328 JCDA • www.cda-adc.ca/jcda • May 2007, Vol. 73, No. 4 • ––– Oral Piercings ––– embedded (buried) in the ventral5 or dorsal surface of the remove the oral jewellery permanently or to replace metal tongue have been reported.21,22 In contrast, an excessively balls with non-metallic ones. Recently, soft rubber ends long shank (long-stem barbell) may allow the barbell to and acrylic screw caps have become available and are move in the tissue, which may lead to an inflammatory considered less likely to cause tooth chipping. hyperplastic tissue reaction1 and the accumulation of dental plaque and calculus on the shank.1,3,4,23 Gingival Trauma Intraoral piercings have also been implicated in the Increasing numbers of case reports have pointed to 23,24 formation of hypertrophic keloid tissue. Keloid lesions oral piercings as a significant factor in gingival trauma are formed when unaffected tissue infiltrates the piercing; (Fig. 1). The nature, extent and severity of mucogingival they are characterized by the production of an interstitial defects are usually categorized using Miller’s classifica- mucinous material on the collagen of connective tissue. tion of marginal tissue recession.31 Gingival recession has In the episodic case of keloid or hypertrophic tissue been especially correlated with lip studs or labrets1,3,7,17 without any signs of infection reported by Neiburger,23 and frequently occurs on the labial aspect of the lower an improvement in the patient’s oral hygiene and a re- 3,5,9,17,28,32,33 duction in the size of the barbell shank resulted in a central incisors. Gingival recession, particularly significant improvement, but did not completely resolve on the lingual aspect of the mandibular anterior teeth, 3,5,7,16,32,34 the lesion. In most reported cases of tissue proliferation has also been associated with tongue jewellery. following tongue piercings, surgical interventions were A positive correlation has been demonstrated between not required and complete healing occurred following the prevalence of gingival recession due to tongue and lip 5,33 removal of the jewellery.23,24 piercing and duration of wear. According to Campbell and others,5 lingual recession of gingiva is observed after Dental Trauma 2 years of wear. Long-stem barbells significantly increase Traumatic injuries to the hard dental tissue have been the prevalence of lingual recession.
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