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Oral Piercing Complications Among Teenage
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pyrig No Co t fo rP ORIGINAL ARTICLE ub lica tio n te ss e n c e Students
Leily Macedo Firoozmanda/Daniele Riêra Paschottob/Janete Dias Almeidac
Purpose: The aim of this study was to assess the use of oral piercings and their possible associated complications among students aged 14 to 18 years. Materials and Methods: A total of 927 students from private and state schools were invited to participate in this study. The participants were subjected to clinical examination, and a questionnaire was provided for collecting the following data: gender, piercing location, oral complications or alterations, and cleaning frequency. Results: Among the students who were analysed, 33 had oral piercings (3.6%); 69.70% were from state schools and 30.30% were from private schools. There was a slight predominance of males (54.55%) compared with females (45.45%). The tongue was the most common location for piercing (66.6%). The complications and alterations associated with the use of piercing were observed in 74.3% of the cases. Conclusions: In the population that was studied, oral piercing was observed in a small percentage of teenage students (3.6%) and there were local complications associated with its use. Key words: body piercing, dental plaque, infection Oral Health Prev Dent 2009; 7: 77–81.
esthetics has become an important issue over the past few years and has led to the development of new materials and techniques in dentistry. Body decoration has also gained influence (Chimenos-Küstner et al, 2003; Huber et al, 2003). Irreversible changes to the human body have been practised by ancient as well as modern civilizations for a variety of reasons. Some changes are made to express spiritual devotion or dedication to magic, to fulfil social demands, to make a personal state-
A
a
Department of Restorative Dentistry, São José dos Campos Dental School, São Paulo State University – (UNESP), São José dos Campos, São Paulo, Brazil.
b
São José dos Campos Dental School, São Paulo State University – (UNESP), São José dos Campos, São Paulo, Brazil.
c
Department of Biosciences and Oral Diagnosis, São José dos Campos Dental School, São Paulo State University – (UNESP), São José dos Campos, São Paulo, Brazil.
Correspondence: Leily Macedo Firoozmand, R Emílio de Menezes, 304 Monte Castelo – cep. 12215-020, São José dos Campos, São Paulo, Brazil. Tel: +55 12 39232727. Email: leilyfiroozmand@ hotmail.com; leily.fi
[email protected]
Vol 7, No 1, 2009
Submitted for publication: 31.12.07; accepted for publication: 14.01.08.
ment or to enhance individual sex appeal (Peticolas et al, 2000; Chimenos-Küstner et al, 2003; Huber et al, 2003). Some of these procedures such as skin tattooing, branding and body piercing that were used by ancient civilisations are commonly seen today, especially in developing countries (ChimenosKüstner et al, 2003). Body piercings, in particular, have been extended to all parts of the human body and can be found to be adorned by members of all socioeconomic groups. Of special interest to oral health professionals is the recent worldwide increase in intraoral piercings at sites such as the lip (Sardella et al, 2002; Chambrone and Chambrone, 2003), tongue (Botchway and Kuc, 1998; Bassiouny et al, 2001; Kretchmer and Moriarty, 2001; Sardella et al, 2002), cheek, frenum and uvula (Peticolas et al, 2000) (Fig 1). Depending on the piercing area, specific complications involving the hard and soft tissues have been observed, including tooth fractures (Botchway and Kuc, 1998; Bassiouny et al, 2001), gingival recession (Kretchmer and Moriarty, 2001; Sadiq, 2001; Sardella et al, 2002; Chambrone and Chambrone, 2003), tooth sensitivity and gingival trauma (Sardella 77
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Fig 1 Oral piercings located in different areas. (A) Lingual frenum and lower lip; (B) lower lip; (C) tongue (note the keloid formation around the piercing) and (D) tongue (note the development of a fissure in the tongue).
Table 1 The literature relating age (in year) and gender to the area of the oral piercing and complications Reference
Age/gender
Area
Botchway and Kuc (1998) Chambrone and Chambrone (2003)
22/M 19/F 23/F 21/M 23/M 19/F
Tongue Lower lip Lower lip Lower lip Tongue Lower lip
Kretchmer and Moriarty (2001) Brennan et al (2006)
22/M 18/M
Tongue Tongue
Bassiouny et al (2001) Sardella et al (2002)
Complications Fracture of a cusp of the right mandibular first molar Root sensitivity, local trauma and recession Recession defect Gingival pain and recession Tooth fractures involving enamel and dentine Dental hypersensitivity, gingival recession and abrasion of root surface Recession and radiographical bone loss Multiple tooth fractures
M: male; F: female.
et al, 2002) (Table 1). In addition, speech impairment, interference with mastication and swallowing, aspiration, infection, allergic responses (metal hypersensitivity), hyperplastic or scar tissue formation, haematoma, neuroma and prolonged bleeding have also been reported. The aim of this study was to assess the use of oral piercings among teenage students. The research hypotheses were: (1) there is a high prevalence of teenage students wearing oral piercings and (2) oral piercings are associated with local complications related to their use. 78
MATERIALS AND METHODS A total of 927 students from private and state schools in São José dos Campos, São Paulo, Brazil, aged 14 to 18 years were invited to participate in this study. Informed consent was obtained from the parents of all students who participated in this study. The study was approved by the Ethics Committee of the São José dos Campos Dental School. The following data were collected from all students: gender, piercing location, oral complications or alterations associated with the use of piercing Oral Health & Preventive Dentistry
Variable
Areas and complications
10 (30.3) 5 (15.1)
23 (69.7) 10 (30.3)
11 2 0 2
18 (54.5) 7 (21.2) 1 (3.1) 7 (21.2)
(33.3) (6.1) (0) (6.1)
*
N = 33.
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13 (39.4) 5 (15.1)
7 (21.2) 5 (15.1) 1 (3.0) 5 (15.1)
Total n (%)
Oral piercing location* Tongue Lower lip Others Complications/alterations* Swallowing the jewellery Fractured teeth Local inflammation Gingival recession Scarring/keloid formation Bacterial plaque Tongue fissure No complications
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Females n (%)
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Males n (%)
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School* State Private Cleaning frequency* Daily Weekly Fortnightly Never
Prevalence of oral piercing
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Table 2 Distribution of the 33 students wearing oral piercing according to school and cleaning frequency
pyrig No Co t fo r P et al Firoozmand ub lica tio Table 3 Piercing location and complications observed t ess c e n in 39 piercing areas from 33 students en n (%)
26 (66.60) 10 (25.70) 3 (7.70) 1 2 3 4 4 7 8 10
(2.60) (5.10) (7.70) (10.25) (10.25) (17.90) (20.50) (25.70)
*
N = 39.
and cleaning frequency. Subjects underwent extraoral palpation and intraoral examinations and were interviewed for the analysis of habits and general health. Intraoral clinical examination was performed by visual evaluation of oral tissues and tooth, with special attention to piercing-related complications such as tooth fractures, gingival recession, infections and other alterations. Gingival tissues were considered to have inflammation when the colour of the mucosa was red and when spontaneous bleeding was seen.
RESULTS Thirty-three (3.6%) of the invited students who had oral piercing agreed to participate in this study. Twenty-three (69.7%) of the students were from state school (13 males and 10 females) and ten (30.3%) were from private school (5 males and 5 females). There were 18 (54.55%) males and 15 (45.45%) females with age ranging from 14 to 18 years (mean of 16 years, 1 month and 24 days ± 1.03 years). The distribution of the participants according to school, cleaning frequency and gender is presented in Table 2. The tongue was the most common site for oral piercing (66.6%) and 18.18% (6/33) of the students had more than one piercing, thus a total of 39 piercings were looked at (Table 3). Some complications that were associated with the use of oral piercings were observed. Tongue fissure was the most common alteration (20.5%) Vol 7, No 1, 2009
(Table 3). More than one associated complication was observed in some areas.
DISCUSSION The data do not support the research hypothesis that there is a high prevalence of teenage students wearing oral piercings. However, the results support the research hypothesis that oral piercings are associated with local complications related to their use. In this study, the use of oral piercings was 3.6% (33/927) among students aged 14 to 18 years. Oral piercings were more common among students from state schools (69.7%) than those from private schools (30.3%), and there was a slight predominance of males (54.55%) over females (45.45%). In private school, the proportion of males and females with oral piercings was the same, whereas in state school the proportion of males was higher (Table 2). Students who accepted to participate in this study informed that some of their peers refused to participate. Unfortunately, the authors did not have access to the exact number of students wearing piercing who could not participate in the study. In Brazil, subjects of this age are required to get their parents’ permission to wear a piercing, but some have pierced their body without their parents’ consent. In this way, the authors suppose that some parents are unaware of their childrens’ piercing. As presented in Table 2, 54.5% of the students were aware of the importance of daily cleaning (33.3% females and 21.2% males), and 21.2% had never cleaned 79
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their piercing area (15.1% of males and 6.1% of females). It seemed that females are more aware of oral health than males from a younger age. Data regarding oral hygiene, gingival status and dental caries have been reported to be the same among poor and rich children, with no statistically significant differences between these groups (Taani, 2002). A metal stud fixed in the tongue, lip or other oral structures can impair cleaning, with consequent repercussions on oral health. At this critical age, dental plaque can promote demineralisation of the dental surface resulting in caries (Ferreira and Mendes, 2005), or may affect the periodontal structures causing gingival recession (Kieser et al, 2005; Leichter and Monteith, 2006), pain sensitivity and bone loss. Thirteen students reported the presence of sub- and supragingival plaque and calculus associated with the use of a tongue stud. In this study, bacterial plaque was observed around the oral piercings in 17.90% of the students, with 10.25% of the students presenting gingival recession in the surrounding area of the piercing and 7.70% showing local inflammation. This was evident in subjects who had piercing in the lower lip where the authors had noticed gingival recession in the anterior mandibular teeth area. When the metal stud is located in the lower lip, complications usually affect the anterior mandibular teeth (Chambrone and Chambrone, 2003), but when the stud is located in the tongue, the complications are found in the anterior mandibular teeth (Botchway and Kuc, 1998) and posterior teeth (Botchway and Kuc, 1998; Bassiouny et al, 2001). A metal stud in the lower lip is usually related to gingival recession, whereas tongue piercing is associated with injuries to the teeth (Mayers et al, 2002). Fractured teeth due to oral piercing (tongue piercing) have been reported in the literature (Peticolas et al, 2000; Huber et al, 2003), and they were also observed in this study (5.10%). During anamnesis and clinical examination some students complained of an uncomfortable sensation because of oedema formation. Speech impairment, especially during the first few days after piercing, was reported by the participants, in agreement with the literature (Botchway and Kuc, 1998; Peticolas et al, 2000; Chimenos-Küstner et al, 2003), and this was mainly noted in the case of tongue piercing. Reports of clinical cases in the literature show that most of the patients presenting with complications associated with the use of oral piercings are young. Studies have shown that oral piercing is a body adornment used in modern society by individu-
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pyrig No Co t fo rP ub lica tio als who wish to make a personal statement (Peticn t olas et al, 2000; Chimenos-Küstner ete al, 2003). ss e n c e Some of the reasons proposed to justify the use of oral piercing are fashion, rebelliousness, differentiation, sexual reasons, and ethnic and tribal influences (Peticolas et al, 2000; Chimenos-Küstner et al, 2003; Vënta et al, 2005). The use of tobacco and illicit drugs and a state of depression have been found to be more prevalent among university students who use oral piercings compared with students who do not use piercings (Vënta et al, 2005). A limitation of this study was that the tobacco habit was not evaluated. Future studies should consider tobacco use for accurate data interpretation. The use of piercing has also been associated with systemic complications such as contact dermatitis in the presence of metal (Garner, 2004) and endocarditis (Dubose and Pratt, 2004). Mayers et al (2002) found a significant incidence of medical complications among students using oral piercing. Oral piercing is generally performed without anaesthesia or infection control. The piercers are usually unlicensed and self-trained, and have little clinical and anatomical knowledge (Levin et al, 2005). Furthermore, only a few piercers are aware of the risk of bacterial endocarditis in vulnerable individuals (Stead et al, 2006). In this research, oral piercing was found mostly in the tongue (66.6%) and lower lip (25.7%). According to De Moor et al (2005) and Leichter and Monteith (2006), the presence of tongue and lip piercings implies a major risk for direct and indirect damage to both soft and hard oral tissues. The local complication related to the movement of the metal stud in tongue piercing was tongue fissure (20.5%). Bassiouny et al (2001) recommended to advise the patient to take special care of the piercing area and jewellery by removing the jewellery daily, cleaning it with detergent and then wiping it with alcohol, as well as cleaning the piercing area (tongue) with a brush and using antiseptic mouth rinse. These instructions are necessary as only 54.5% of the students in this study clean the piercing area daily and 21.2% had never cleaned the area. Of these 21.2% who had never cleaned the piercing or the piercing area, only one student did not present any associated complication. It is very important to emphasise that hygiene is fundamental to health maintenance and that its absence can promote medical alterations such as systemic bacterial infections (Mayers et al, 2002). Effective health education can assist teenage students in their decision-making about a variety of body art issues such as health risks and permanence Oral Health & Preventive Dentistry
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