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A Guide to Oral Piercings

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A Guide to Oral Piercings ARTICLE CPD: ONE HOUR CPD questions This article has four CPD questions attached to it which will earn you one hour A guide to oral piercings of verifiable CPD. To access the free BDA CPD hub, go to https://cpd.bda.org/ login/index.php E. M. King,*1 E. Brewer2 and P. Brown1 Introduction The prevalence of oral piercings in the UK is need for further professional information. Results Fifty-three increasing. Consequently, the dental profession is encountering dentists responded. Only 24.5% were very confident discussing an increasing number of complications associated with piercings. piercing complications. The advice provided varied markedly, Providing patient preventative advice regarding piercing with the majority (73.6%) reporting they had acquired knowledge complications is important, however the level of advice offered through experience alone. Only one dentist reported providing by UK dentists is currently unknown. Aims The aim of this written information and 83% responded that they would like to have survey was to establish the current knowledge, attitudes and access to printed information directed at patients. Conclusions behaviours of dentists regarding advice provided to patients The results of this survey suggest that dental professionals are with oral piercings. Methods A questionnaire was sent to not fully confident discussing risks and preventative advice with 200 dentists across Wales with questions regarding perceived patients. To address this, patient information leaflets have been confidence in providing advice, type of advice provided, the developed to encourage dentists to discuss complications associated sources dentists use to acquire knowledge and the perceived with oral piercings with patients. Introduction such as the cheeks (Figs 3 and 4) and frenulae Legislation Body modification, the purposeful (Fig. 5), is becoming more prevalent.2,3 Oral Following the death of a Sheffield teenager from alteration of normal human anatomy piercings have been a recent topic of debate septicaemia caused by a lip piercing in 2002, to achieve a desired appearance, is a in the Welsh Government, and in May 2017 a the risks of body piercing were discussed in the popular practice that has led to a rise new Public Health (Wales) Bill was accepted House of Commons.4,5 As a result, a voluntary in the prevalence of oral piercings. by the National Assembly for Wales to ban code of practice was implemented for piercers In 1992, the first report relating to all intimate piercing, which includes tongue which included guidance regarding the practice oral piercing appeared in the dental piercing, before the age of 18. To establish of body piercing, specific recommendations literature titled ‘Tongue piercing: the current attitudes of the dental profession for hygienic procedures, checking medical a new fad in body art’.1 However, towards oral piercings, a national survey was history before piercing and the prevention of rather than a fad, oral piercings conducted among General Dental Practitioners piercing individuals below 16 years of age unless have become increasingly popular. (GDPs) across Wales. Furthermore, a literature parental consent is given. This code of practice Common sites for oral piercings review was conducted to establish the current is summarised in the document ‘Advice and include the tongue (Fig. 1) and global trends in oral piercings and discuss the Safe Practice for Body Piercing – Guidance lips (Fig. 2) however piercing potential complications resulting from such for Operators’ produced by the British Body 6 of alternative anatomical sites body modifications. Piercing Association. It is unknown how many ©MishaBeliy/iStock/Getty Plus Images 1 Morriston Hospital, Restorative Dentistry, Heol Maes Eglwys, Morriston, Swansea, SA6 6NL, United Kingdom 2Oral Surgery, Prince Charles Hospital, Merthyr Tydfil, CF47 9DT, United Kingdom 17 BDJ Team www.nature.com/BDJTeam ©2018 British Dental Associati on. All ri ghts reserved. ARTICLE piercers have adopted this code of practice and therefore compliance can vary between Fig. 1 Midline tongue piercing with stainless steel tongue bar (barbell) establishments. Currently the legislation for licensing and registration of piercing establishments varies between local authorities. In England and Wales, local authorities have the power to apply the Health and Safety at Work Act 1974 to impose infection control and safety requirements.7 Furthermore, there are specifications stated in the Local Government (Miscellaneous Provisions) Act 1982 and the Local Government Act 2003 for local authorities in England and Wales to require the registration of individuals providing body piercings.8 The Local Government Act 2003 also stipulates standards of cross infection control. With the aim of preventing transmission of infectious diseases, the Health and Safety Executive have produced the SR12 publication to help piercers comply with the Control of Substances Hazardous to Health Regulations (COSHH) 2002.9 Local Fig. 2 Lip piercing (also termed labret) with a titanium lip bar authorities can choose whether to adopt and enforce these guidelines in addition to their own byelaws; therefore piercing standards vary across the UK. While many piercing establishments enforce their own age restrictions, there are currently no laws restricting piercings for minors in England. Many local authorities have developed licensing frameworks that make it possible to state a minimum age; however there are inconsistencies across the UK. Some local councils prohibit cosmetic piercing under 16 years of age whereas some state 18 years of age.10–12 In Scotland, individuals under 16 are required to have parental consent before undergoing any piercing. In Northern Ireland, the piercing of nipples and genitalia of children under the age of 16 is regarded as indecent assault under sexual offences legislation, and can lead to prosecution. The Welsh Government has raised serious concerns about the medical implications Fig. 3 Cheek piercing viewed intra-orally with titanium bar in situ associated with intimate piercings, and the potential vulnerability of young people receiving such piercings. In 2015, the Welsh Government introduced a Public Health (Wales) Bill which included a clause to ban all intimate piercing before the age of 18. The Welsh Dental Committee (WDC) responded to the consultation and strongly suggested that intimate piercing should include tongue piercing, and as a result tongue piercing was added to the list of intimate piercings. The Public Health (Wales) Bill was accepted by the National Assembly for Wales in May 2017 and the age for intimate piercing, including tongue piercing, has been raised to 18 years old. This is now in keeping with similar legislation such as tattooing of minors and www.nature.com/BDJTeam BDJ Team 18 ©2018 British Dental Associati on. All ri ghts reserved. ARTICLE It is currently unknown how many patients Fig. 4 Cheek piercing viewed extra-orally with oral piercings attend for emergency treatment in the UK. In 2006, a UK-based survey of 126 piercees reported that 99% had problems with their tongue piercing, 7% of which required healthcare following the piercing.16 A US study of 100 emergency departments has reported an estimated annual presentation rate of 3,494 injuries associated with oral piercings.14 In this study, patients aged 14 to 22 years old accounted for 73% of the emergency visits. Several investigations have aimed to identify the prevalence of the different complications associated with oral piercings (Table 1). Commonly reported acute complications include pain, swelling, haemorrhage, infection and masticatory and speech impairment. Less frequently reported immediate complications include haematoma, delayed healing, puncture Fig. 5 Piercing of the lingual frenulum with stainless steel bar in place. Note the ac- wound, laceration, dental trauma, allergy, cumulation of plaque on the ball ends of the piercing dysphagia and hypersalivation.14,15,17–21 Commonly reported chronic complications include pain, infection, swelling, bleeding, tissue hyperplasia, soft tissue trauma, gingival recession, dental trauma, dental pain, speech impairment, taste disturbances and ingestion of piercing. Less frequently reported chronic complications include masticatory/eating impairment, gingivitis, plaque accumulation (Fig. 5), hypersalivation, galvanic reaction, tooth migration and dysphagia.14,16–21 Complications have been shown to be more common in patients who habitually play with their piercing.15 Several rare and sometimes serious oral piercing complications have been reported (Table 2).22 Prior to the enforcement of COSHH regulations, it was hypothesised that oral piercings could increase the risk of transmission of blood borne viruses such as HIV and ‘TONGUE PIERCING WAS THE SECOND hepatitis B and C.23 It is essential that all professions who MOST COMMON BODY PIERCING encounter oral piercings are properly informed and able to provide advice regarding oral piercing complications. The level of advice RESULTING IN COMPLICATIONS offered by UK dental professionals regarding oral piercings is currently unknown. There is no (FOLLOWING THE NAVEL). ’ current consensus among dental professionals regarding the type of complications that should be discussed with patients. There female genital mutilation. The age increase with oral piercings is reported by Bone et al. many easily available advice leaflets developed will help to avoid circumstances where young (2008).2 In 16–24-year-olds, 50.1%
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