Oral Piercing and Oral diseases
Ahrens A. GSM*, Bressi T.**
* D.D.Private Dental Clinic in Nocciano, (Pe) – Italy,
** M.D. ENT Department, University hospital, Perugia, Italy
Summary:
The aim of this analysis is to show the effects of the application of oral and peri-oral piercing on the structures of the oral cable and the possible pathologies that could rise up to the succession of such a practice. In this context,we have pickedup data throughout the wholenational territory, thanks to the collaboration of some colleagues, to verify how many patients who are carriers of oral and peri-oral piercing andhow they were affected from the sought-after pathologies or presented alterations of the oral structures and of their functionality. Thus we present ten cases fromour own observation.
Introduction:
The practice of body piercing (including the oral and peri-oral piercing) has had a remarkable progress in the last few years. Although it is considered as a relatively an efficient practice, it is subject to a risk due to numerous complications. Therefore, the oral piercing undergoes a significant risk in relation to the composition of the oral flora and the conformation of the oral structures and especially the tongue piercing(positioned in the tongue’s body, anterior to the lingual fraenum) can
determine a wide spectrum of complications and local and systemic pathologies. The international study has already brought back a wide casuistry of complications related to the piercing of the auricular pavilion, the nose, the eyebrow, nipples and the genital organs, from which we can deduce how the greater part of such complications is the consequence ofa reaction against the metallic components of the piercing (is it in Gold, Steel, Nickel, Palladium or metallic alloy? ) with its evolutions (lichenoidi Reactions, cheratosis and desquamation, sarcoidal granulomatosis…); in such
casuistry there is also a meaningful percentage of complications related to pathogens (endocarditis ,chronic infections, cartilage necrosis etc...).With smaller percentage instead imputable complications to malpractice from part of the operator were found (Hepatitis B and C, damages to the vascular-nervous structures etc...). In the international studythere are little cases of complications from oral and peri-oral piercing, related to the greater part of damages of the dental and periodontal structures.
Materials and Methods
Thanks to the collaboration of some colleagues in the national territory to whomwe have sent a card for the collection of the data of our study, also we have supplied precise instructions on the operating modalities, we have analysed 10 subject bearers of oral and peri-oral piercing. In the detail we have subordinatedto visit 3 males and 7 females, all adults and whose age varies between18 and 34 years. All the subjects were bearers at least one piercing that interested oral and pre-oral structures, and for every patient we have recorded beyondsex and age, also the anatomical centre and year of insertion of the piercing.
We have found 8 piercing of the body and/or lingual fraenum and the 2 piercing of lips and/or the cheek. From the collection of these data we have estimated the presence of specific pathologies, complications and damages of
the dental elements and fo the periodontal structures. In this context we have searched the following pathologies:
1. lichenoidi reactions
2. Dermatitis and/or allergic stomatitis,
3. Candidosis
4. Cancer
5. Leukoplakia
6. Dysgeusia
7. Stomatodinia
8. Oral Lichen Planus
9. Teeth Fractures
10. gingival Recessions
11. lip Ipoesthesia,
12. traumatic Lesions of the Palate
Results
From the analysis of the data collected on the 10 patients we have found out very interesting resultsrepresented in the following diagrams1, 2, 3, 4,5
Tab.1 - Casuistry of pathologies for a single patient; andbetween parenthesis the year of insertion of the piercing .
Pathology / Patient / Pz 1 (1999) / Pz 2(1998) / Pz 3
(2000) / Pz 4
(1999) / Pz 5
(2001) / Pz 6
(2002) / Pz 7
(2003) / Pz 8
(2001) / Pz 9
(2002) / Pz 10
(2001)
Lichenoid reactions / 0 / 0 / 0 / 0 / 0 / X / 0 / 0 / X / 0
Dermatitis and/or allergic Stomatitis / 0 / 0 / 0 / 0 / 0 / 0 / 0 / X / 0 / 0
Candidosis / X / 0 / X / 0 / 0 / 0 / 0 / 0 / 0 / 0
Cancer / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0
Leukoplakia / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0
Disgeusia / X / X / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0
Stomatodinia / 0 / 0 / X / 0 / 0 / 0 / 0 / 0 / 0 / 0
Oral Lichen Planus / 0 / 0 / 0 / 0 / 0 / 0 / X* / 0 / 0 / 0
Dental fractures / X / X / X / X / X / X / 0 / X / 0 / X
Gingival recession / X / X / X / X / X / 0 / 0 / 0 / X / 0
Lip ipoesthesia / 0 / 0 / 0 / X / 0 / 0 / 0 / 0 / 0 / 0
Trauamtic lesions of the palate / 0 / X / 0 / 0 / 0 / 0 / 0 / X / 0 / 0
* the Patient reports that he was affected before the insertion of the piercing
Tab. 2
Pathology / % / Positive / NegativeLichenoid reactions / 10 % / 90 %
Dermatitis and/or allergic stomatitis / 10 % / 90 %
Candidosis / 20 % / 80 %
Cancer / 0 % / 100 %
Leukoplakia / 0 % / 100 %
Disgeusia / 20 % / 80 %
Stomatodinia / 10 % / 90 %
Oral Lichen Planus / 10 % / 90 %
Teeth fractures / 80 % / 20 %
Gingival recessions / 60 % / 40 %
Ipoestesia labiale / 10 % / 90 %
Trauamtic lesions of the palate / 20 % / 80 %
Tab.3 localization of the teeth fractures in eightpatients
Localization / % / q.ty / % / Dx / SnFrontal group / 8 / 100%
Upper frontal group / 5 / 62.5 %
Lower frontal group / 3 / 37,5 %
Posterior group / 6 / 75 % / 3 (50 %) / 3 (50 %)
Upper posterior group / 2 / 33.33 % / 1 (50 %) / 1 (50 %)
Lower posterior group / 4 / 66.66 % / 2 (50 %) / 2 (50 %)
Legenda: Frontal group extension 1.3 - 2.3 e 4.3 - 3.3
Posterior group extension 1.4 - 1.8, 2.4 - 2.8, 3.4 -.3.8, 4.4 - 4.8
Tab.4 localization of the gingival recession in 6 patients
Localization / % / q.tà / % / Dx / SnFrontal Group / 6 / 100 %
Upper frontal group / 1 / 16.66 %
Lower frontal group / 5 / 8.33 %
Posterior group / 3 / 50 %
Upper posterior group / 1 / 33.33 % / 1 (100 %) / 0
Lower posterior group / 2 / 66.66 % / 1 (50 %) / 1 (50 %)
Tab.5 anatomic localization of the piercing
Localization / % / q.tà / % / ? / ?tongue / 7 / 70 % / 5 / 2
Lingual frenum / 1 / 10 % / 1 / 0
Lower lip / 2 / 20 % / 1 / 1
The Pathologies which we have studied present limited percentages of value not exceeding 20 %, in our casuistry, with the exception of the values related to the teeth fractures and to the gingival recessions presenting an elevate value of percentage (respective 80 % and 60 %). It’s worth mentioning that we have to put on the presence, in 20 % of the cases, of an infection from Candida Albicans rebelled subsequently to the insertion of the tongue piercing, as reported from the patients. Relatively it was low the case of lichenoidi reactions and dermatitis and allergic stomatitis, related essentially to a hypersensitivity from the material of the same piercing. Furthermore, the cases of brought back Dysgeusia and Stomatodinia from the patients, always have to estimate with the benefit of the doubt, cause the conditions reported by the patient, but undoubtedly related to thoseclinical pictures.
Moreover the accent stressed on those 20 % of traumatic lesions to cargo of the hard palate, introduced like a tumour hurting to the touch, edematosous, localized to the level of the median line of the hard palate, in its front portion (palatal wrinkles), whose nature is related to the presence on the tongue’s body of the piercing that, in the movements of phonation and swallowing, (for excessive dimension) perhaps goes to exercise repeated micro- traumas.
Discussion
The results of our study on the 10 patients we have visited, were confirmed from various authors who have evident cases of gingival recession and loss of bone support, reasonably related to the traumatic action of the piercing similar to that of the phenomenon of allergic nature which is related to the metallic components of the piercing i.e. that the percentage of the teeth with obvious traumatic lesions from contact with the piercing like crown fractures, crown abrasions, fractures of the enamel. Currently, excluded our two cases, do not come brought back cases of Candid sovra-infection from and/or others members of the oral flora in the site of insertion of the piercing.
The association between tongue and/or lip piercing and the insurgence of flogistic and necrotic phenomena of the periodontal tissue, with the loss of gingival attack, recession and reducing, if not loss, of the bony member, already has been demonstrated from the studies of Brooks JK ET al. (1), which reported gingival recessions and muco-gingival defects in 5 patients bearers of piercing.
In 2000 Folz ZJ (2) carried to the attention 3 cases of complications post-piercing and in the 2003 Chambrone L and Chambrone (3) and O' Dwyer JJ, Holmes A in 2002 (4) they confirmed like main complication post-piercing to the oral level the gingival recession in proximity of the knurl of the piercing, classifiedthe degree of the scale of Miller (extension of the defect beyond the splice mucus-gingival without signs of loss of inter-dental bone).
Campbell (5) then demonstrated as the tongue is an important trigger factor in the development of the gingival recession in association to teeth trauma of molars, highlighting also an important correlation between complications and the length of the piercing.
In the 2002 Akhondi H. and Rahimi AR (6) reported a case of endocarditis from Aemophilus aphrophilus in a woman of 25 years with progressed piercing ofthe language to confirmthe previous ones and turns outof Krause H. ET to. (7) that hasalready placed in the 2000 the attention on 273 patients bearers of piercing and of which 47 introduced complications of local character comprised in a phantom that went from the formation of cheratitis and temporary infections up to the cartilage necrosis and alterations of the sensibility, while to systemic character allergies and cases of hepatitis were found mostly.
Recently in (2003) also Friedel JM ET too. (8) reported a case of infectious endocarditis following to the insertion of a tongue piercing, to indicate as the particular composition of the oral flora is a risk upgrade in case of such practice, confirming what reportedalso from Shacam R et al. (9) in 2003. Furthermore, the study of Kretchmer MC and Moriarty JD (10) shows the evidence that the presence of lip piercing is source of a continuous one trauma for the periodontal tissue, beyond that to be an ulterior habitat for the formation of plaque and tartar. S.Perez Cachafeiro ET to. (11) have introduced, in 2003, an interesting study on the complications of the piercing, indicating the oral level scialoadenitis and Angina of Ludwig, while to the systemic level they indicate the endocarditis, the cerebellar abscess, the poststreptococcic glomerulonephritis ecc…
Fromthe above analysis it is clear, thatthe practice of the oral piercing, even though relatively sure relating to the risk of systemic and local infections and to the risk of iatrogenic damages, presents a high degree of risk to the level of the oral cable for the insurgence of periodontal pathologies like gingivalrecession, due to the pressure and to the trauma exercised from the same piercing on the periodontal tissue, and for the dental structures because it isable to determine, in aparticular way the tongue’s piercing, a series of repeated micro traumas, loading the dental elements with consequent flaws or fractures of the enamel of the borders incisal and of the cuspids of the molars.
It is important to notethat the fractures and the recessions insurged, in the patients we examinated, in 12 cases with piercing positioned from more than two years, only 2 cases with a piercing positioned from less of two years. (Tab.6) We suppose that the insurgence of the fractures and of the recessions, due to the traumatic action of the piercing, is conditioned from the time of the insertion.
Particular attention has to be set, according to us, to the two the cases of infection from Candid Albicans and at the same time to the two cases of traumatic lesions in the palate because both the conditions could evolve in serious complications. In fact, the recent researches have underlined a potential aetiopathogenetic systematic role for some biotypes of candida because they can catalyse the formation of carcinogenetic nitrosamine; concerning the traumatic lesions it is by now assessed that the going on in the time of traumas could determine the formation of a fibroma with possible cancerous evolution.
To the patients affected by Candidosis, subjected to collecting with buffer and crop on Sabouraud culture to have the clear confirmation of the diagnosis, we have administered a therapeutic topic with nistatina and amfotericina B for 15 days, that is 5 days beyond the remission of the symptoms (stomatodinia, disfagia, disgeusia) and we subsequently, have invited the patients to the removal of the piercing. We remember that if not dealt and in immunodepressed patients the infection could stretch until it involves all the Digestive Apparatus or determines systemic infections.
The patient affected by Stomatitis presented a chronicized picture characterized by a diffused redness of the oral cable, loss of the thread-like tongue’s papillas and erosions. We have administrated the patient with the removal of the piercing and with a pharmacological treatment with oral rinses with clorexidina at 0.2 % and beclometasone spray.
The patients with traumatic lesions of the palate have been invited to the removal of the piercing and to follow an antibacterial program prophylaxis.
Tab.6
Year of insertion / n° fractures - recessions / 1998 / 1999 / 2000 / 2001 / 2002 / 2003Fractures / 1 / 2 / 1 / 3 / 1 / 0
Recessions / 1 / 2 / 1 / 1 / 1 / 0
Conclusion
Form the results of our research we consider that is very important to sensibilize the operators who provide the piercing mainly to the possible complications that could emerge. At the same time to furnish greater indications to their customers. In this context, it is an opportunity to invite the sanitary operators to follow with better attention the progress of this trend to piercing and to apprise the subject holders with better attention to prevent the insurgence of more or less serious complications and finally to invite them to a more attentive prevention.
Bibliography
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