Body piercing has been practiced since ancient times and has seen an increase in popularity in recent times. Intra-oral and perioral sites are included with tongue, lip and cheek being commonly chosen with studies suggesting a mean prevalence of 5.2%.

The aim of this review was to assess the literature for information concerning the incidence of complications from lip and/or tongue piercings to accurately assess the magnitude of the risk faced by individuals with these piercings.

Methods

Searches were conducted in the Medline/PubMed, Cochrane CENTRAL and Embase databases. Two reviewers independently selected studies. Human observational studies (cross-sectional, cohort, case-control or case series) of oral and or peri-oral piercings located in lip and/or tongue were considered. Only those in English or Dutch were included. Risk of bias was assessed by two reviewers using either the Institute of Health Economics (case series) or Newcastle–Ottawa Scale (NOS). Two reviewers extracted data and meta-analysis was conducted.

Results

• 15 studies (7 case-controls, 8 case series) involving 831 patients were included.
• Study size ranged form 15-126 patients with an age range of 12-43 years.
• Of the 7 case-control studies 5 were considered to be at low risk of bias, 2 at moderate risk and 2 at high risk.
• One of the case series studies was considered to be at low risk of bias, 2 at moderate risk, 3 high risk and 2 at very high risk.

	Lip piercings	Tongue piercings
Number	351	411
Gingival recession %	41.8%	43%
Tooth damage %	36.8%	24.3%

• Of 40 patients with lip and tongue piercing 38% had gingival recession.
• The relative risk (RR) of gingival recessions and tooth damage with piercings are shown in the table below

	Lip piercings	Tongue piercings
Gingival recessionRR (95%CI)	4.14 (1.54 to 11.13)	2.77 (1.99 to 3.85)
Tooth damageRR (95%CI)	1.33 (0.74 to 2.41)	2.44 (1.35 to 4.41)

Conclusions

The authors concluded:

Within the limitations of this study, the following conclusions can be drawn. The frequency of post-piercing complications depends on piercing location in relation to the oral cavity. Piercing may cause tooth chipping or cracks as well as buccal recession in the teeth that are in direct contact with the stud closure. A significant relative risk was revealed between tongue piercings and an increased incidence of enamel fissures, enamel fractures and gingival recessions (especially in the lingual region of the mandibular incisors). Both lip and tongue piercings were highly associated with gingival recession. From the dental perspective, the popularity of oral and peri-oral piercings is a cause for concern in light of the number of oral complications and risks.

Commentary

This is the third in a series of systematic review by this group on the effects of oral piercings. Understandably only observational studies are available to address this question and the authors recommend that these results should be treated with caution. Two key issues are the potential for selection bias and the failure to address other potential confounders which could impact on gingival recession or tooth damage and both issues are raised by the authors in their discussion.

Links

Hennequin-Hoenderdos NL, Slot DE, Van der Weijden GA. The incidence of complications associated with lip and/or tongue piercings: a systematic review. Int J Dent Hygiene DOI: 10.1111/idh.12118

Hennequin-Hoenderdos NL, Slot DE, Van der Weijden GA. The prevalence of oral and peri-oral piercings in young adults: a systematic review. Int J Dent Hyg. 2012 Aug;10(3):223-8. doi: 10.1111/j.1601-5037.2012.00566.x. Review. PubMed PMID: 23046008.

Hennequin-Hoenderdos NL, Slot DE, Van der Weijden GA. Complications of oral and peri-oral piercings: a summary of case reports. Int J Dent Hyg. 2011 May;9(2):101-9. doi: 10.1111/j.1601-5037.2010.00504.x. Review. PubMed PMID: 21481183.