Complications of Oral Piercings

When a person is considering getting a piercing, they should be made aware they are exposing themselves to danger and there are risks to getting a piercing. The oral cavity is a warm, moist environment that contains millions of bacteria. These bacteria can then be transmitted to others without proper infection control measures or can migrate through the piercing wound into the bloodstream with multiple consequences. These and other complications from oral piercings can be categorized into 4 types^8,25,28

1. Complications that can occur at any time.

2. Complications that occur during the initial procedure of piercing.

3. Primary post-operative complications (short-term complications) that occur immediately following the piercing.

4. Secondary post-operative complications (long-term complications) that occur over time.

Complications that can occur at any time include:

• Transmission/development of Hepatitis B, C, D, E, G; tetanus; tuberculosis; herpes simplex; Epstein-Barr; HIV/AIDS; candidiasis; endocarditis; Ludwig’s Angina; brain abscess; cellulitis; bacteremia; infection at the piercing site (Figure 22)^3,8,21,23

Figure 22. Infection at the piercing site.

Figure 22. Infection at the piercing site.

• Allergic reactions.²³

• All or part of the jewelry can come loose, resulting in choking, aspiration or swallowing. Patients have reported swallowing jewelry more than once.²⁵

• Jewelry may interfere with speaking, chewing, or swallowing and may require adaptation to the placement.²⁰

• The need to remove jewelry that can interfere with diagnostic and therapeutic procedures. X-ray, ultrasound, and CAT and MRI images may be distorted by metal jewelry. Ferromagnetic jewelry could move and cause injury during an MRI. Electrical burns could occur during defibrillation or the use of electrocautery devices. Orofacial piercings worn during the administration of inhalation anesthesia could result in swallowing or aspiration, bleeding, trauma and edema. Hypoxia, laryngospasm and tongue bleeding have been reported after endotracheal intubation when tongue piercing jewelry was present. These occurrences demonstrate the importance of removing jewelry prior to such procedures.¹³

• Remove jewelry when wearing a mouth guard, which should be worn when participating in sports, especially contact sports. The increased blood flow, respiration rate and chance of bleeding from a contact injury increase the chance of infection in athletes. During sporting contact, jewelry can be dislodged and potentially inhaled. The jewelry may prevent proper fit and function of the mouth guard resulting in increased salivation which could lead to gagging, or inhibition of breathing or speech.¹

Complications that may occur during the initial piercing procedure include:

• Loss of consciousness or other medical emergency.²⁵

• Bruising, swelling, tenderness, and bleeding⁹

• The piercer’s lack of anatomical knowledge combined with poor pain control may cause a need to perform the procedure swiftly. This can lead to poor position of the piercing/jewelry.²⁵

Primary post-operative complications may include:

• Bruising, swelling, tenderness, bleeding and serous drainage.⁹

• Nerve damage.²¹

• Prolonged bleeding.¹³

• Excessive salivation/drooling.¹³

• Increased plaque/calculus formation (Figure 23).²

Figure 23. Calculus formation on jewelry.

Figure 23. Calculus formation on jewelry.

• Dentinal hypersensitivity.⁴

• Gingival inflammation.²

• Impaired/metallic taste.¹⁸

• Leaking of intraoral fluids through the piercing tract¹⁸

• Chemical burns from improper use of post-piercing care products. ¹

• Jewelry that is too small can cut off blood supply, causing nesting - where the jewelry sinks into the pierced tissue or embedding – where the skin grows over the jewelry causing the need for surgery.^18,25

• Too large/heavy jewelry can tear/traumatize the tissue as well as lead to more plaque/calculus accumulation.^14,18,25

Secondary post-operative complications may include:

• Over-scarring or the formation of keloids which may subside when the piercing is permanently removed or may require surgery.²⁵

• Pulpal sensitivity from galvanic currents.³

• Gingival recession/overgrowth (Figure 24).^2,16,17

Figure 24. Gingival recession.

Figure 24. Gingival recession.

• Chronic poor oral hygiene, heavy smoking and porous jewelry material can cause a shift from bacteria with a moderate periodontopathogenic potential to bacteria with a high periodontopathogenic potential.¹¹

• Periodontitis.⁹

• Periodontal/periapical abscesses.⁹

• Tooth abrasion/mobility/fracture/loss (Figure 25).^17,28

Figure 25. Tooth abrasion.

Figure 25. Tooth abrasion.

• Diastema or misaligned teeth.^6,7

• Damage to restorations/fixed porcelain prostheses.^12,15

• Deaths from herpes simplex, hepatitis and multiple brain abscesses associated with tongue piercing.^12,15