BY Tori Abner, BS, Zaida Franco, BS, and Bader Alqahtani, BS
Body piercings have been around for a long time as a way for individuals and cultures to express themselves through ornamentation. The ancient Egyptians pierced their navels to signify royalty. Roman centurions wore nipple rings as a sign of virility and courage. The Mayans pierced their tongues for spiritual purposes. The Eskimos and Aleuts pierced the lips of female infants as part of a purification ritual, and the lower lips of boys as part of passage into puberty. In the late 1990s, body piercing became popular in Western society.1 It has continued to be popular even at the present time.
Due to this increase in popularity, it is important that dental hygienists recognize the different types of piercings, the warning signs of infection, and understand possible complications and the professional obligations associated with oral piercings.
There are many types of oral piercings that can cause complications to oral health. One example is lip piercing. There are currently at least 13 different ways to get a lip piercing. Vertical labret piercings, snakebite piercings, and Monroe piercings are some of the most common lip piercings. People have the option of a lip stud or lip ring. If a lip stud is chosen, a labret stud is a better option due to the flat disk on the back of the stud. The flat disk on the back is less likely to irritate the gums or other parts of the mouth than the inner curve of a ring. A bio plastic labret stud could also be used instead of a labret stud for a softer backing.
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One oral health problem with lip piercings is that they can cause gingival trauma and recession in relation to lip studs.2
Lip piercings are prevalent, but the most common type of oral piercing is the tongue piercing. Many people opt to have a single tongue piercing, which is usually in the middle of the tongue in a vertical position. Others choose to pierce their tongue in a horizontal manner, displaying the two barbells on the lateral surfaces of the tongue, or have multiple rings placed throughout the tongue. When people first pierce their tongue, they're given a surgical steel ring that will help decrease swelling of the tongue.
The surgical steel ring is usually one inch in length and made from steel that is approved for body implants. This type of jewelry is one of the heaviest metals, but many people choose surgical steel due to its durability, strength, and lower likelihood of allergic reactions.3
Although surgical steel is a common metal used for tongue rings, there are other materials that can be used as well, such as titanium, 14 karat gold, and acrylic. Titanium is very popular because of its durability and less stress on piercings, while 14 karat gold is better to use after the six-week healing process. The ideal ring is acrylic, which is more flexible and provides the user with more versatility. The reason most people switch to acrylic after the six-week healing process is to avoid chipping teeth. Acrylic also works well with people who are allergic to the metals mentioned above.3
Two types of oral health complications can arise from tongue piercings. Acute complications can occur immediately after a piercing. Some examples are swelling of the tongue, pain, changes in speech, difficulty in swallowing and mastication, and allergic reaction to the metals. Chronic complications include fracturing of the teeth and restorations, pulpal damage, trauma to the gingiva, localized tissue overgrowth, bifid tongue, persistent difficulties in oral functions, and swallowing of the piercing or parts.4
Bloodborne infections are also cause for concern. If the needle is contaminated, the person getting the piercing can contract HIV and hepatitis. New and sterile needles should always be used when getting a piercing. Piercing guns cannot be sterilized completely, which is why it is important that a needle be used instead of a piercing gun.5 More serious complications can also occur. While it is rare, there is the risk of obtaining Ludwig's angina, a bacterial infection on the floor of the mouth, or endocarditis, which occurs when bacteria passes through the piercing hole into the bloodstream and infects the heart.6
According to the National Electronic Injury Surveillance System of the U.S. Consumer Product Safety Commission, about 24,459 oral piercing injuries were presented to United States emergency departments from 2002 through 2008. Some of the injury percentages were lips (46%), tongue (42%), teeth (10%), infections (42%), and soft-tissue puncture wounds (29%).7
Keeping piercings clean
Cleansing methods vary with each piercing. Saline solutions are available over the counter, preferably wound-washing vs. contact solution. Instructions recommend warming the saline solution and using a pad to dab the solution onto every side of the piercing site. Sea salt soaks are another method of cleansing. The technique for this is to boil 250 mL and put one quarter teaspoon non-iodized sea salt or rock salt into the boiling water and mix. Once the mix is warm, swish for 15 to 30 seconds, two or three times a day.
Non-alcohol-based mouthwash is the best option for smokers. They can carry a small bottle around and swish after each cigarette.10
Cleaning the piercing is a basic step in the healing process. Yet over-cleaning is a possibility when caring for a new oral piercing. If a patient presents with a white/yellow-coated tongue, the hygienist can make recommendations based on which method of cleansing they are using. Too much salt, the wrong type of salt, and too frequent use of mouthwash can cause white/yellow-coated tongue.
Patients should be encouraged to refrain from touching the piercing unless they absolutely have to, and in that case, to wash their hands first and only touch the piercing while cleaning the site.10 After the piercing is healed, it is imperative that it be scrubbed daily with a soft-bristle brush to prevent biofilm buildup, especially on the ventral side of the tongue.9
Piercings and dental hygiene appointment
Dental hygienists need to be aware and have a thorough understanding of oral piercings and their care in order to properly educate patients.8 It can be assumed that an increase in patients with oral piercings accounts for an increase in patients with oral piercing complications. Maintenance and cleaning of jewelry must be stressed at every dental appointment, as well as assessment of the oral cavity for adverse clinical manifestations of the piercing.1 It is the obligation of the dental hygienist to inform patients about the warning signs of infection, care, and long-term effects of oral piercings.8
Bacteria introduced into the mouth from daily activities have the potential to create an infection. Common warning signs of infection/rejection include yellow or green discharge from the piercing site, thickened tissue, sensitivity, pain, edema, inflammation, abscess, bleeding, and low-grade fever.9 Instructions on how to care for an infected piercing include flushing the area with water, cleansing the area frequently, and in the case of severe symptoms, visiting an emergency room. Toxic shock syndrome can occur from an infected oral piercing and can be fatal, and patients should be made aware of this if they present with an infected oral piercing. Infection caught early is easiest to treat, so patients should be mindful of what to look for and how to correct the problem immediately.10
Patients should avoid a few activities after receiving a piercing, such as swimming, drying the piercing inappropriately, sleeping on the piercing, applying makeup to the piercing site, and tanning.
Swimming is not recommended because standing pools can harbor bacteria, and the harsh chemicals can irritate the piercing site. If swimming cannot be avoided, the patient should use a waterproof patch to ensure the area stays clean, and then wash the area thoroughly afterward. When drying, piercing patients should avoid using towels that can transfer lint to the piercing. It is recommended that they dry the area with air or pat the area with a fresh paper towel.
Sleeping on a labial or buccal piercing can cause irritation, migration, or rejection of the piercing. They might also catch on the pillow and be pulled out. Hygienists should suggest patients change pillow covers frequently to ensure a clean environment for the piercing. Makeup should not be applied to the piercing site, and if used should form a wide circle around the piercing to avoid irritation and infection.
Tanning should also be avoided because it can burn the skin and irritate the piercing, and the chemicals in tanning lotion can be harmful to the piercing.11
Side effects of healing
Normal side effects of healing include but are not limited to crusting, irritation, slight swelling, and bleeding. Bleeding is often the case with perforation of a lingual blood vessel but can occur anytime during the healing process from touching, picking, drinking alcohol, or taking a blood-thinning pain reliever. Crusting is normal and should not be picked at; it should be removed only after it has been soaked in cleansing solution and becomes soft enough to avoid tearing the skin. Assessment of the patient's diet can assist with this as acidic and spicy foods will cause discomfort and irritation.12
Swelling of the area can be treated with an anti-inflammatory and ice; however, ice should not be used for longer than 15 to 20 minutes, and the wait is 45 minutes before icing again.10 If the swelling overcomes the piercing, the patient should return to their piercer to prevent further difficulties such as airway obstruction.9
Smoking needs to be addressed at every appointment but is especially pertinent to patients with oral piercings. Hygienists should recommend they cut back on the number of cigarettes they smoke in a day but not to quit entirely until after the piercing is healed. This is suggested because smoking cessation side effects include dry mouth and coughing, which could affect the healing of the piercing.10
Long-term effects of oral piercings need to be stressed to patients as these will require time and money to correct. Damage to teeth is the most common long-term side effect from oral piercings, such as chipping, tooth abrasion, and fracture of cusps. Local gingival recession is also common.12
Overall, oral piercings can be a way for individuals to express themselves and enjoy their bodies. The history, types of oral piercings, complications, warning signs of infection, and dental professional obligations are all vital information for dental hygienists. It is important that patients be advised of the risks associated with oral piercings, and that hygienists guide patients on how to care for their piercings.8 Maintenance should be stressed as well as the warning signs of infection. Possible long-term effects will need to be addressed during the clinical exam. RDH
Tori Abner, Zaida Franco, and Bader Alqahtani received bachelor of science degrees in dental hygiene from the University of Southern Indiana.
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