Policy on Intraoral/Perioral Piercing and Oral Jewelry/Accessories
The American Academy of Pediatric Dentistry (AAPD) recognizes the importance of educating the public and health professionals on the health implications of intraoral/perioral piercings and oral jewelry/accessories.
This policy was developed by the Council on Clinical Affairs and adopted in 2000. This document is a revision of the previous version, revised in 2011. The update included a new review of current dental and medical literature, including a search of the PubMed®/MEDLINE and Cochrane Central Register of Controlled Trials electronic databases through September, 2015 with the terms: oral jewelry, body piercing, and oral piercing paired with dental and oral piercing; fields: all; limits: within the last 10 years, humans, English, birth through age 99. Four hundred eighty-one articles matched these criteria. Because of so many papers identified through electronic searches, alternate strategies such as appraisal of references from recent evidence-based reviews, controlled clinical trials, and meta-analysis and hand searches were performed. This strategy yielded 85 manuscripts which were evaluated further by abstract. Papers for review were chosen from this list and from the references within selected articles.
The use of intraoral jewelry and piercings of oral and perioral tissues have been gaining popularity among adolescents and young adults. Intraoral jewelry or other oral accessories may lead to increased plaque levels, gingival inflammation and/or recession, caries, diminished articulation, and metal allergy.1-5 Oral piercings involving the tongue, lips, cheeks, and uvula have been associated with pathological conditions including pain, infection, scar formation, tooth fractures, metal hypersensitivity reactions, localized periodontal disease, speech impediment, Ludwig’s angina, hepatitis, and nerve damage.6-29 Specifically, gingival recession was evident in seven to 50 percent of all patients with lip piercing and six to 44 percent of patients with tongue piercing. Permanent tooth injuries were observed in 26 percent of patients with lip piercing and 37-46 percent of patients with tongue piercings.2-4 Lifethreatening complications associated with oral piercings have been reported, including bleeding, edema, endocarditis, and airway obstruction.6-33 Additionally, the use of dental jewelry (e.g., grills) has been documented to cause dental caries and periodontal problems.34,35 Unregulated piercing parlors and techniques have been identified by the National Institutes of Health as a possible vector for disease transmission (e.g., hepatitis, tetanus, tuberculosis) and as a cause of bacterial endocarditis in susceptible patients.1 Between January 1, 2002 and December 31, 2008, an estimated 24,459 patients presented to U.S. emergency departments with oral piercingrelated injuries.23 The annual average number of estimated emergency department visits was 3,494, with a range from 2,675 (in 2005) to 4,380 (in 2006).23
The AAPD strongly opposes the practice of piercing intraoral and perioral tissues and use of jewelry on intraoral and perioral tissues due to the potential for pathological conditions and sequelae associated with these practices.
- Durosaro O, El-Azhary R. A 10-year retrospective study on palladium sensitivity. Dermatitis 2009;20(4):208-13.
- Ziebolz D, Hildebrand A, Proff P, Rinke S, Hornecker E, Mausberg R. Long-term effects of tongue piercing – A case control study. Clin Oral Investig 2012;16(1):231-7.
- Plessas A, Pepelassi E. Dental and periodontal complications of lip and tongue piercing: Prevalence and influencing factors. Aust Dent J 2012;57(1):71-8.
- Hennequin-Hoenderdos NL, Slot DE, Van der Weijden GA. The incidence of complications associated with lip and/or tongue piercings: A systematic review. Int J Dent Hyg 2016;14(1):62-73.
- Reyes P. Hole-y mouth jewelry! Piercings could lead to anterior tooth loss. J Calif Dent Assoc 2008;36(9):651, 655.
- National Institutes of Health. Management of hepatitis C. NIH Consensus Conference Statement June 10-12, 2002. Available at: “https://consensus.nih.gov/2002/2002HepatitisC2002116html.htm”. Accessed June 29, 2016.
- American Dental Association. ADA statement on intraoral/perioral piercings and tongue splitting, Amended October, 2012. Available at: “http://www.ada.org/en/member-center/oral-health-topics/oral-piercing”. Accessed June 14, 2016.
- Stein T, Jordan JD. Health considerations for oral piercing and the policies that influence them. Tex Dent J 2012;129(7):687-93.
- Hennequin-Hoenderdos NL, Slot DE, Van der Weijden GA. The prevalence of oral and perioral piercings in young adults: A systematic review. Int J Dent Hyg 2012;10(3):223-8.
- Vilchez-Perez MA, Fuster-Torres MA, Figueiredo R, Valmaseda-Castellon E, Gay-Escoda C. Periodontal health and lateral lower lip piercings: A split-mouth crosssectional study. J Clin Periodontol 2009;36(7):558-63.
- DeMoor RJ, DeWitte AM, Debuyne MA. Tongue piercing and associated oral and dental complications. Endod Dent Traumatol 2000;16(5):232-7.
- Price SS, Lewis MW. Body piercing involving oral sites. J Am Dent Assoc 1997;128(7):1017-20.
- Fors R, Stenberg B, Stenlund H, Persson M. Nickel allergy in relation to piercing and orthodontic appliances– A population study. Contact Dermatitis 2012;67(6):342-50.
- Inchingolo F, Tatullo M, Abenavoli FM, et al. Oral piercing and oral diseases: A short time retrospective study. Int J Med Sci 2011;8(8):649-52.
- Maspero C, Farronato G, Giannini L, Kairyte L, Pisani L, Galbiati G. The complication of oral piercing and the role of dentist in their prevention: A literature review. Stomatologija 2014;16(3):118-24.
- Berenguer G, Forrest A, Horning GM, Towle HJ, Karpinia K. Localized periodontitis as a long-term effect of oral piercing: A case report. Compend Contin Educ Dent 2006;27(1):24-7.
- Klevens RM, Hu DJ, Jiles R, Holmberg SD. Evolving epidemiology of hepatitis C virus in the United States. Clin Infect Dis 2012;55(Suppl 1):S3-9.
- Hennequin-Hoenderdos NL, Slot DE, Van der Weijden GA. Complications of oral and perioral piercings: A summary of case reports. Int J Dent Hyg 2011;9(2):101-9.
- Firoozmand L, Paschotto D, Almeida J. Oral piercing complications among teenage students. Oral Health Prev Dent 2009;7(1):77-81.
- García-Pola M, García-Martin J, Varela-Centelles P, Bilbao-Alonso A, Cerero-Lapiedra R, Seoane J. Oral and facial piercing: Associated complications and clinical repercussion. Quintessence Int 2008;39(1):51-9.
- DeBoer S, McNeil M, Amundson T. Body piercing and airway management: Photo guide to tongue jewelry removal techniques. J Am Assoc Nurse Anesth 2008;76(1):19-23.
- Golz L, Papageorgiou SN, Jager A. Nickel hypersensitivity and orthodontic treatment: A systematic review and meta-analysis. Contact Dermatitis 2015;73(1):1-14.
- Gill, JB, Karp JM, Kopycka-Kedzierawski DT. Oral piercing injuries treated in United States emergency departments, 2002-2008. Pediatr Dent 2012;34(1):56-60.
- Vieira EP, Ribeiro AL, Pinheiro Jde J, Alves Sde M. Oral piercings: Immediate and late complications. J Oral Maxillofac Surg 2011;69(12):3032-7.
- Levin L, Zadik Y. Oral piercing: Complications and side effects. Am J Dent 2007;20(5):340-4.
- Kloppenburg G, Maessen J. Streptococcus endocarditis after tongue piercing. J Heart Valve Dis 2007;16(3):328-30.
- Lopez-Jornet P, Navarro-Guardiola C, Camacho-Alonso F, Vicente-Ortega V, Yanez-Gascon J. Oral and facial piercings: A case series and review of the literature. Int J Dermatol 2006;45(7):805-9.
- American Dental Association. For the dental patient: The piercing truth about tongue splitting and oral jewelry. J Am Dent Assoc 2012;143(7):814.
- Martinello R, Cooney E. Cerebellar brain abscess associated with tongue piercing. Clin Infect Dis 2003;36(2):32-4.
- Pires IL, Cota LO, Oliveira AC, Costa JE, Costa FO. Association between periodontal condition and use of tongue piercing: A case-control study. J Clin Periodontol 2010;37(8):712-8.
- Kapferer I, Beier US. Lateral lower lip piercing--prevalence of associated oral complications: A split-mouth cross-sectional study. Quintessence Int 2012;43(9):747-52.
- Kapferer I, Beier US, Jank S, Persson RG. Randomized controlled trial: Lip piercing: The impact of material on microbiological findings. Pediatr Dent 2013;35(1):E23-8.
- Kapferer I, Beier US, Persson RG. Tongue piercing: The effect of material on microbiological findings. J Adolesc Health 2011;49(1):76-83.
- Hollowell WH, Childers NK. A new threat to adolescent oral health: The grill. Pediatr Dent 2007;29(4):320-2.