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Piercing is becoming a more prevalent form of body art and self-expression in today’s society. However, oral piercings, which involve the tongue (the most common site), lips, cheeks, uvula or a combination of sites, have been implicated in a number of adverse oral and systemic conditions.

Common tongue piercing process

Patients typically undergo piercing procedures without anesthetic. In tongue piercing, for example, a barbell-shaped piece of jewelry typically is placed to transverse the thickness of the tongue at the midline in its anterior one-third using a needle.

Initially, a temporary device longer than the jewelry of choice is placed to accommodate postpiercing swelling. The free end of the barbell stem then is inserted into the hole in a ventral-dorsal direction. The recipient grasps the free end of the shank between the maxillary and mandibular anterior teeth and screws the ball onto the stem. The barbell also can be placed laterally, with the studs on the dorsolateral lingual surface. In the absence of complications, healing takes four to six weeks.

Tongue splitting as body art

Tongue splitting is considered by some to be a form of body art. The process literally splits a person’s tongue into two pieces, creating a “forked” appearance. Reports in the public press indicate that various primitive techniques are used by lay people for splitting tongues. For example, without anesthesia, a scalpel may be used followed by a cauterizing pen, or fishing line may be threaded through the pierced tongue and pulled forward, severing the anterior aspect. Individuals regularly pull the two tongue pieces apart to maintain the split so it does not “heal” back together. Once healed, additional surgery may be required to repair the “split” should the individual decide reversal is desired.

In lip or cheek piercing, jewelry position (usually a labrette) is determined primarily by aesthetics with consideration to where the jewelry will rest intraorally. Once position is determined, a cork is usually placed inside the mouth to support the tissue as it is pierced with a needle. The needle is inserted through the tissue and into the cork backing. The needle then is replaced with the labrette stud, and the disc backing is screwed into place. Healing time can range from weeks to months.

Symptoms of tongue piercing and splitting

Common symptoms following piercing and tongue splitting include:

  • pain,
  • swelling,
  • infection and
  • increased salivary flow.

Potential complications of intraoral and perioral piercings are numerous, although available scientific literature is rather limited and consists mainly of case reports. Possible adverse outcomes secondary to oral piercing include increased salivary flow; gingival injury or recession; damage to teeth, restorations and fixed porcelain prostheses; interference with speech, mastication or deglutition; scar-tissue formation; and development of metal hypersensitivities.

Because of the tongue’s vascular nature, prolonged bleeding can result if vessels are punctured during the piercing procedure. In addition, the technique for inserting tongue jewelry may abrade or fracture anterior dentition, and digital manipulation of the jewelry can significantly increase the potential for infection.

Airway obstruction due to pronounced edema or aspiration of jewelry poses another risk, and aspirated or ingested jewelry could present a hazard to respiratory or digestive organs. In addition, oral ornaments can compromise dental diagnosis by obscuring anatomy and defects in x-rays. It also has been speculated that galvanic currents from stainless-steel oral jewelry in contact with other intraoral metals could result in pulpal sensitivity.

The National Institutes of Health has identified piercing as a possible vector for bloodborne hepatitis (hepatitis B, C, D and G) transmission. Disease transmission (e.g., hepatitis B, tetanus, localized tuberculosis) has been associated with ear piercing, and cases of endocarditis have been linked to both nose and ear piercing.

Secondary infection from oral piercing can be serious. A recent article in the British Dental Journal reported a case of Ludwig’s angina, a rapidly spreading cellulitis involving the submandibular, sublingual and submental fascial spaces bilaterally, that manifested four days after the 25-year-old patient had her tongue pierced. Intubation was necessary to secure the airway. When antibiotic therapy failed to resolve the condition, surgical intervention was required to remove the barbell-shaped jewelry and decompress the swelling in the floor of the mouth.

Because of its potential for numerous negative sequelae, the American Dental Association opposes the practice of intraoral/perioral piercing and tongue splitting.

From the American Dental Association