August 2008

“These modifications are now culturally acceptable,” says Paul J. Vankevich, assistant professor of general dentistry, “but they are inconsistent with optimal oral health.” Photo: iStockphoto


Dental School expert warns against the health risks of oral piercing

By Jacqueline Mitchell

The Lizardman, as he calls himself, has spent more than ten years and $250,000 transforming his appearance from human to reptile. A former philosophy student and current sideshow attraction, the 34-year-old Lizardman has embarked on a life-long body modification project involving extensive tattoos on his face and body, Teflon horns implanted above his eyebrows, multiple piercings, a surgically bifurcated tongue and four front teeth filed into sharp points.

Though the Lizardman may be an extreme case, dentists are seeing more and more and patients with piercings in the tongue, lips or face. These patients present special problems that oral health care providers may need to address, from systemic disease to excess wear on the teeth and gums. “These modifications are now culturally acceptable,” says Paul J. Vankevich, assistant professor of general dentistry, “but they are inconsistent with optimal oral health.”

The side effects of oral piercing range from ludicrous—drooling, spitting while speaking, difficulty pronouncing words clearly—to life-threatening infections and blood-borne illnesses. The human mouth is home to 600 species of bacteria and each square millimeter of the tongue’s surface contains 108 of the little buggers.

Piercing the tongue or lips (normally done without benefit of anesthetic) gives these pathogens easy entry into the blood stream, which may cause local or systemic infection. This is especially dangerous with respect to infective endocarditis, an infection that may occur when bacteria in the bloodstream lodge in the heart. Before performing oral surgery, dentists often prescribe antibiotics to patients at risk for the condition.

A 2008 study published in the Journal of Adolescent Health found that among the 51 percent of U.S. university students who have body piercing, 19 percent reported medical complications, including infections ranging from common bacteria like staphylococcus and streptococcus—both of which can be deadly if left untreated—to viruses like hepatitis and HIV.

Oral piercing also poses a risk for nerve damage, scar tissue, allergic reaction to the metal jewelry. The jewelry itself can cause myriad problems. People who wear barbells—a double-ended piece of jewelry worn through the midline of the tongue—often tap or rub the metal ball against the teeth causing excess wear to the enamel. This behavior can also irritate the gums and cause them to recede.

Moreover, patients might bite down on the barbell accidentally, especially while chewing or sleeping. Vankevich estimates up to 80 percent of patients with a tongue barbell will crack or break a tooth. Oral jewelry also poses a choking hazard.

One study found a link between body piercing and other risky behaviors such as smoking, drinking and recreational drug use. Just as dentists routinely advise patients to avoid smoking and chewing tobacco, dentists should warn their younger patients about the dangers of oral piercing.

“Wouldn’t it be nice if someone told them preemptively told them not to do it?” asks Vankevich, who overheard his own son’s pediatrician advise the boy against body piercing.

However, not all health-care providers take the same stand against these modifications. In the Lizardman’s case, an oral surgeon split his tongue and another dentist filed his otherwise healthy teeth into sharp points. “Is it professionally and ethically appropriate for dentists to do this? I don’t think so,” says Vankevich.

Still, the bulk of oral piercings are not done by dentists or physicians but by lay people who are often self-taught or who informally apprentice in tattoo and piercing studios.

A 2003 survey found that 35 states regulated tattoo and piercing studios. These regulations vary widely; some enforce only a minimum age for piercing, while others emphasize business practices over hygiene and safety. Only Massachusetts and Alaska require knowledge of anatomy and physiology. Only Texas and Florida have prohibited the practice of tongue splitting.

Vankevich wonders if professional piercers all practice state-of-the art infection control—particularly with respect to infective endocarditis—and if they are qualified to handle intra- or post-operative complications.

The ADA has officially opposed intraoral piercing and tongue splitting since 1998. But that doesn’t mean dentists can ignore the trend.

“One way or another,” says Vankevich, “these patients are going to end up on our doorstep.”

Jacqueline Mitchell may be reached at

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