Table Clinic Paper on Oral Piercings

The following sample essay will focus on oral piercing, why it is done and how to care for it. Read the introduction, body and conclusion of the essay, scroll down.

Abstract Oral piercing is defined as penetration of jewelry into soft oral tissues including the lips, cheeks, tongue, and uvula. The broad acceptance of oral piercings among young people has raised the concern of dental and medical professionals due to the accompanying complications and risks to both oral and general health of the patient.

The wounds created during the process of piercing increases the risk of oral infection by allowing a large number of bacteria to enter the bloodstream. Additional bacteria can also be introduced into the wound through the handling of the jewelry.

During the healing process a patient should be advised by their dentist or hygienist to maintain meticulous oral health care in order to prevent infections and other serious complications. ORAL PIERCINGS 3 Infections Due to Oral Piercings According to the American Journal of Clinical Dermatology “Infection is the most common complication that occurs in up to 20% of all body piercings” (Holbrook, Minocha, and Laumann, 2012, p.

2). Individuals are getting oral piercings for many different reasons, but they may not take into account the long-term effects and /or potential risk of infection to their oral cavity and overall health.

Oral piercings are defined as penetration of jewelry into openings of soft oral tissues including the lips, cheeks, tongue, and uvula. According to Dr. Balzac in his article on oral piercings, “there are two types of tongue piercings dorsoventral and dorsolateral.

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” The dorsoventral is more common and the safer of the two types of tongue piercings. It involves inserting the jewelry from the top to the bottom of the tongue whereas, the dorsolateral piercing is made through the width of the tongue. Most piercers will not perform the dorsolateral piercing because of the heavily vascularized blood vessels which create a higher risk of trauma.

As for lip piercings, they can be placed anywhere on the lips, including the vermillion border which is where the lip tissue meets the skin. The most common site for lip piercings is the side of the lower lip near the corners of the mouth where the lips meet. There are other oral piercings such as; cheek piercings (known as dimples), and those in the frenum, (known as web piercings) (Balzac, n. d. ). These piercings are alternate forms and less common than the tongue and lip piercings. The uvula (appendix A) piercing is the least common due to the difficulty of performing the piercing. These piercings cause substantial risk to the health of an individual.

ORAL PIERCINGS 4 There are multiple reasons why individuals are getting oral piercings. In the Journal of Investigative & Clinical Dentistry, it states that “Dental health-care professionals need to be aware of the procedures and risks involved with oral piercings and the social and psychological reasons that lead people to engage in this practice, regardless of the risks” (Singh, and Tuli, 2012, p. 95). One of the reasons individuals get oral piercings is because they are associated with fashion trends. Some people may think that it is “cute” to get their lip pierced showing off a fashion statement.

Another reason is to signify self-expression. This is seen mostly in the teenage populations for the need to be seen or the need to stand out. Certain groups such as gothic might have specific piercings that play a part of the group’s identity. Gothic people tend to wear dark clothing, makeup, and have an abundance of oral piercings. Oral piercings tend to help certain individuals seek something different from normal, or an expression of art. Lastly, people may get oral piercings because of the perception of being daring or a risk taker. Oral piercings can portray the act of breaking the rules or rebelling.

This may be a way for the individual to stand out or seek attention, like they are “trouble” makers. The broad acceptance of oral piercing among young people has raised the concern of dental and medical professionals due to the accompanying complications and risks to their oral and general health. In 1998, the American Dental Association (ADA) issued a statement opposing the practices of intraoral and perioral piercing because of the risk of potential complications associated (2014). Although there are risks of potential complications with oral piercings, infection can occur instantaneously and progress to severe health problems.

According to the article Mouth Jewelry, Oral Piercings and Your Health, “There is a risk of oral infection associated with oral piercings due to the wound created, the vast amount of ORAL PIERCINGS 5 bacteria in the mouth, and the introduction of bacteria from handling the jewelry (Mouth Jewelry, Oral Piercings and Your Health, 2011). The tongue is covered with bacteria, and when pierced, that bacteria can get in the bloodstream and underlying tissues.

This process can cause serious infections (Appendix A). Unfortunately, tongue jewelry wearers may not be aware of a problem since the symptoms of infection, such as swelling, are similar to the aftereffects of piercings. Constantly playing with and manipulating jewelry once it’s been placed in the mouth increases the chances of getting an infection.

In the article Microbiological Findings at Tongue Piercing sites–Implications to Oral Health, signs of acute infection would include bleeding, inflammation, erythema, and heat. The symptoms of pain and inflammation from the initial trauma of the piercing can affect speech, chewing, breathing, and swallowing (Ziebolz, Proff, Hornecker, and Mausberg, 2012, p. 258). Acute infections of the oral cavity occurring over a long period of time result in a chronic infections.

The International Journal of Dental Hygiene states that “because of the vast variety of microorganisms in the oral cavity, it is not unlikely that infections and inflammation may occur at the perforation site. Therefore, it seems possible that the pierced site provides a permanent route of entry for microorganisms and may cause a localized or even a systemic infection anytime” (Ziebolz, Proff, Hornecker, and Mausberg, 2012, p. 258). It is important for the dental professional to be well educated on the complications and risks that can occur with oral piercings.

Oral piercings can cause some unfortunate diseases, one of them being endocarditis. Endocarditis, also known as infective endocarditis, is an infection caused by the introduction of oral bacteria into the bloodstream where it travels to the heart (Friedman, 2014). Endocarditis causes inflammation of the heart and weakens the heart valves. In a study ORAL PIERCINGS 6 published in the Canadian Journal of Cardiology, it was noted that between 1960 and 1999, there were only 36 reported cases of endocarditis in people with normal hearts (Ramadan, et al. , 2000 Oct).

Those with pre-existing heart problems are more at risk for endocarditis because of the increased risk for infection. Common symptoms of endocarditis include fever, chills, nausea, decreased appetite, weight loss, and a full feeling in the upper part of the stomach.

More severe symptoms include enlarged spleen, swollen feet, legs, blood in urine, swollen stomach, and shortness of breath (Friedman, 2014). Signs and symptoms vary from person to person depending on the specific bacteria, fungus, or microorganism that they have been infected with. When diagnosing endocarditis a blood test should be performed to confirm what microorganism is responsible as well as an echocardiogram to see if the heart has been damaged.

Endocarditis caused by bacteria is treated by antibiotics until the infection is gone; this on average takes six weeks. Damage to the heart would require surgery to remove damaged heart valves and replace them with artificial heart valves.

Patients with artificial heart valves are usually prescribed antibiotics to be taken 1 hour prior to the dental treatment to prevent spread of bacteria to the heart preventing potential infection. This antibiotic premedication should be determined by the individual’s physician (Friedman, 2014). Another infection that can be caused by oral piercings is Ludwig’sAngina.

Ludwig’s Angina is a severe infection of the floor of the mouth and mandible caused by bacteria (Appendix A). The diagnosis is usually based on clinical observation where the head, tongue and neck will appear red and swollen. If these visual signs aren’t present, then there are other ways of diagnosis which include a CT scan or an MRI. Symptoms include swelling of the ORAL PIERCINGS 7 tongue, neck pain, and breathing problems. “Ludwig’s angina can lead to more serious complications including, airway blockage or sepsis, a severe inflammatory responds to bacteria” (Pietrangelo, 2012). Symptoms may vary from person to person.

It’s crucial to recognize and get treatment for this condition before serious complications occur. For severe inflammation, the first line of treatment in a patient with Ludwig’s Angina would be to clear the airway. This can be done by inserting a breathing tube through the mouth or nose into the lungs or by performing a tracheotomy.

Surgery is sometimes performed to drain excess fluids that are responsible for the severe swelling of the oral cavity. The most common cure for this condition is antibiotics to fight off the infection (Pietrangelo, 2012). When prescribed an antibiotic, it is essential to take the entire dose as prescribed to prevent bacterial resistance. Although infection can be a severe complication that can develop, there are other harmful effects that can occur with oral piercings.

People with tongue piercings may develop mouth ulcers from constant irritation. These ulcers can result in oral cancer if the area is constantly irritated over a long period of time. There is a need for more cell reproduction to replenish the cell population due to the damaged cells in the area of irritation. According to WebMD, with an increased cell production there is an increased chance of cell mutation or cancer cells (Friedman, 2014).

If the lesion is caught early, then it is more likely to be benign or non-cancerous and treated by surgical excision. On the other hand, if the lesion has not been detected for a long period of time, it has a higher chance of being malignant or cancerous. A malignant lesion can sometimes be treated and removed with surgery, radiation, and/or chemotherapy. This may ORAL PIERCINGS 8 or may not be life threatening, depending on how far the cancer has metastasized and how soon the cancerous lesion was detected and treated.

“Oral piercings are a potential risk factor for the transmission of diseases like herpes B and C, HIV, and the herpes simplex virus” (Academy of General Dentistry, 2010). These diseases can be transmitted via poorly sterilized instruments, the contamination of jewelry, and virus entering the piercing site. The transmission of disease is extremely rare via the oral piercing, but has been known to happen.

“Although any piercing is prone to infection or disease transmission, a recent study in the Journal of Adolescent Health (January 2011) found that stainless steel jewelry can accumulate more microorganisms than jewelry made from plastics such as Teflon (or polytetrafluoroethylene, PTFE)” (Academy of General Dentistry, 2010).

This study shows that there is a higher risk of infection and disease transmission when wearing metal jewelry. Pulpal sensitivity can occur from the contact between the galvanic currents in the stainless steel jewelry and other intraoral metals (Balzac, n. d. ). Other risks and complications can occur with oral piercings such as nerve damage, but is rare when compared to injury to teeth and gingival recession.

The penetration of the needle through the tissue can more often cause temporary but sometimes permeant nerve damage. The loss of taste and feeling can be part of this temporary or permanent nerve damage.

Injury to teeth can happen when teeth and jewelry come into contact with force (Appendix A). This can cause gingival recession, cracked, or chipped teeth. Stated by WebMD, “Forty- seven percent of people who have worn tongue jewelry for four or more years have chipped teeth” (Friedman, 2014). Gingival recession can cause hypersensitivity because of the exposed roots (Appendix A). The dentin, underlying the thin layer of cementum, can be ORAL PIERCINGS 9 exposed if there is recession and an individual is brushing too hard wearing away the cementum.

The dentin contains thousands of tiny tubules that lead to the center of the tooth, which is where the nerve is located. This allows for stimuli to affect the nerve more readily, which creates sensitivity with hot, cold, or sweet foods. Not only can recession cause tooth sensitivity, but can progress in its more severe form to cause tooth mobility or tooth loss.

Cracked or chipped teeth then could result in trauma to the gingiva such as a laceration. This lacerated tissue could proceed to infection or ulcers from repeated irritation and trauma that could develop into oral cancer. Individuals are getting oral piercings for many different reasons, but they may not take into account the long-term effects and /or potential risk of infection to their oral cavity and overall health.

During the healing process, which is four to six weeks for tongue piercings and between one and two months for lip piercings, the individual should be advised by their dentists or hygienist to stay on top of their oral health care to avoid infections and other serious complications.

If an individual were to decide to proceed with oral piercings, there are essential steps to follow to maintain the piercing and keep it clean. According to Dr. Balzac in his article Oral Piercings, “to help protect your teeth it is recommended that the jewelry should be removed before each meal, as well as before bedtime and after the piercing has fully healed” (n. d. ).

Some piercing parlors sell plugs that can be placed in the hole when the jewelry is removed. After the tongue has healed following the piercing, remove the jewelry each night and brush it using the same brushing technique that teeth would be brushed. “Avoid things such as, alcohol, smoking or tobacco use, spicy foods, and hard and sticky foods” (Mouth Jewelry, Oral Piercings and Your Health, 2011). Use an antiseptic mouthwash after every meal to decrease the number of bacteria in the oral cavity.

Dr. Balzac ORAL PIERCINGS 10 suggests “removing the jewelry before any strenuous activity to avoid traumatic injury to the teeth from metal studs, which can lead to tooth fracture and chipping (n. d. ). So, if an individual were to insist on getting an oral piercing, as long as their mouth stays free of infection and their oral piercings do not interfere with normal function, there shouldn’t be any issue with having an oral piercing. The most important recommendation though, would be to see the dentist and/or hygienist regularly so they can evaluate the health of the oral cavity and the piercing.

Resources

1. Academy of General Dentistry. (2010). Piercing Warning. In Englewood Dental. Retrieved September 9, 2014, from http://englewooddental. com/piercing-warning. htm ORAL PIERCINGS 11 Academy of General Dentistry. (2010, March). Tongue piercing. In Delta Dental. Retrieved September 8, 2014, from http://www. deltadentalins. com/oral_health/tongue_piercing. html American Dental Association. (2014). Oral Piercings. In Mouth Healthy. Retrieved September 9, 2014, from http://www. mouthhealthy. org/en/az-topics/o/oral-piercings Balzac, F. (n. d. ).
2. Oral Piercing. In Consumer Guide to Dentistry. Retrieved September 9, 2014, from http://www. yourdentistryguide. com/piercing/ Friedman, M. (2014, May 22). Dental Health and Oral Piercing. In WebMD. Retrieved September 9, 2014, from http://www. webmd. com/oral-health/guide/oral-piercing? page=2 Holbrook, J. , Minocha, J. , &Laumann, A. (2012).
3. Body Piercing. American journal of clinical dermatology,13(1), 1-17. Mouth Jewelry, Oral Piercings and Your Health. (2011, December 12). In The Cleveland Clinic Foundation. Retrieved September 9, 2014, from http://my. clevelandclinic. org/health Pietrangelo, A. (2012, September 11). Ludwig’s Angina. In Healthline.
4. Retrieved September 9, 2014, from http://www. healthline. com/health/ludwigs-angina#Overview1 Ramadan, F. B. Beanlands, D. S. , & Burwash, I. G. (2000). Isolated pulmonic valve endocarditis in healthy hearts: a case report and review of the literature. The Canadian journal of cardiology, 16(10), 1282-1288. ORAL PIERCINGS 12 Singh, A. , & Tuli, A. (2012).
5. Oral piercings and their dental implications: a mini review. Journal Of Investigative & Clinical Dentistry, 3(2), 95-97. doi:10. 1111/j. 2041- 1626. 2011. 00108. x The piercing truth about tongue splitting and oral jewelry. (2012). Journal of the American Dental Association (JADA), 143(7), 814.
6. Ziebolz, D. , Hornecker, E. , & Mausberg, R. F. (2009). Microbiological findings at tongue piercing sites–implications to oral health. International journal of dental hygiene, 7(4), 256-262. Appendix A ORAL PIERCINGS 13 Uvula piercing Infection associated with an oral piercing ORAL PIERCINGS 14 Tongue piercing in an 18-year-old male without oral hygiene.
7. There is visible plaque and calculus deposition around the bar of the tongue. Individual with Ludwig’s Angina Picture of chipped #25 and #8 from an oral piercing and associated trauma ORAL PIERCINGS 15 Gingival recession lingual #24 and #25 from an oral piercing.