Intraoral/Perioral Piercing and Tongue Splitting
As adopted by the ADA House of Delegates October 1998 and amended October 2004 and October 2012
Piercing and tongue splitting are forms of body art and self-expression in today’s society. However, oral piercings, which involve the tongue (the most common site),1-3 lips, cheeks, uvula or a combination of sites, and tongue splitting can be associated with a number of adverse oral and systemic conditions.
As with any puncture wound or incision, piercing and tongue splitting can cause pain,3-5 swelling,2-6 and infection4,5,7 Potential complications of intraoral and perioral piercings specifically are numerous, although available scientific literature is rather limited and consists mainly of case reports. Possible adverse outcomes secondary to oral piercing include increased salivary flow;5,8 gingival injury or recession,2,6,9-13 damage to teeth,1,2,5,6,14 restorations and fixed porcelain prostheses; interference with speech,1,3,4 mastication3,4 or deglutition;4 scar-tissue formation;8 and development of metal hypersensitivities.15,16 Because of the tongue’s vascular nature, prolonged bleeding can result if vessels are punctured during the piercing procedure.17 In addition, the technique for inserting tongue jewelry may abrade or fracture anterior dentition,1,2,5,7,14 and digital manipulation of the jewelry can significantly increase the potential for infection.4-7 Airway obstruction due to pronounced edema2-5 or aspiration of jewelry poses another risk, and aspirated or ingested jewelry could present a hazard to respiratory or digestive organs.3,6 In addition, oral ornaments can compromise dental diagnosis by obscuring anatomy and defects in radiographs. There have been reports of the jewelry becoming embedded in surrounding tissue, requiring surgical removal.6,9 It also has been speculated that galvanic currents from stainless-steel oral jewelry in contact with other intraoral metals could result in pulpal sensitivity.18
Secondary infection from oral piercing can be serious. Piercing has been identified as a possible vector for bloodborne hepatitis (hepatitis B, C, D and G) transmission.19,20 Cases of endocarditis also have been linked to oral piercing.21,22. In addition, the British Dental Journal reported a case of Ludwig’s angina, a rapidly spreading cellulitis involving the submandibular, sublingual and submental fascial spaces bilaterally, that manifested four days after a 25-year-old patient had her tongue pierced.23 Intubation was necessary to secure the airway. When antibiotic therapy failed to resolve the condition, surgical intervention was required to remove the barbell-shaped jewelry and decompress the swelling in the floor of the mouth. In another case, a healthy 19-year-old woman contracted herpes simplex virus, presumably through a recent tongue piercing. The infection progressed to fulminant hepatitis and subsequent death.24
Although reports describing the morbidity and mortality associated with tongue splitting are currently not available in the literature, the risk of complications secondary to surgical procedures (including pain, swelling and infection) is well known. Therefore, the Association recommends that its members discourage patients who request the procedure by educating them of the risks associated with this surgery.
Because of its potential for numerous negative sequelae, the American Dental Association opposes the practice of intraoral/perioral piercing and tongue splitting.
1. Firoozmand LM, Paschotto DR, Almeida JD. Oral piercing complications among teenage students. Oral Health Prev Dent 2009;7:77-81.
2. Levin L, Zadik Y, Becker T. Oral and dental complications of intraoral piercing. Dent Traumatol 2005;21:341-3.
3. Vieira EP, Ribeiro RAL, Pinheiro J, Alves SM. Oral piercings: immediate and late complications. J Oral Maxillofac Surg 2011;69(12):3032-7. Epub 2011 May 7.
4. Kapferer I, Berger K, Stuerz K, Beier U. Self-reported complications with lip and tongue piercing. Quintessence Int 2010;41(9):731-7.
5. Garcia-Pola MJ, Garcia-Martin JM, Varella-Centelles P, et al. Oral and facial piercing: associated complications and clinical repercussion. Quintessence Int 2008;39(1):51-9.
6. Hennequin-Hoenderdos NL, Slot DE, VanderWeijden GA. Complications of oral and perioral piercings: a summary of case reports. Int J Dent Hyg 2011;9:101-9.
7. Nedbalski TR, Laskin DM. Loss of a sewing needle in the tongue during attempted tongue piercing: report of a case. J Oral Maxillofac Surg 2006;64:135–7.
8. Venta I, Lakoma A, Haahtela s et al. Oral piercings among first year university students. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005;99:546-9.
9. Ziebolz D, Stuehmer C, van Nuss K, Hornecker E, Mausberg RF. Complications of tongue piercing: a review of the literature and three case reports. J Contemp Dent Pract 2009;10(6):E065–71.
10. Rawal SY, Claman LJ, Kalmar JR, Tatakis DN. Traumatic lesions of the gingiva: a case series. J Periodontol 2004;75(5):762–9.
11. Soileau KM. Treatment of a mucogingival defect associated with intraoral piercing. J Am Dent Assoc 2005;136:490–4.
12. Zadik Y, Sandler V. Periodontal attachment loss due to applying force by tongue piercing. J Calif Dent Assoc 2007;35:550–3.
13. Leichter JW, Monteith BD. Prevalence and risk of traumatic gingival recession following elective lip piercing. Dent Traumatol 2006;22:7-13.
14. Berenguer G, Forrest A, Horning G, Karpinia K. Localized periodontitis as a long-term effect of oral piercing: A case report. Compendium Cont Educ Dent 2006;27(1):24-7.
15. Kolokitha OE, Kaklamanos EG, Papadopoulos MA. Prevalence of nickel hypersensitivity in orthodontic patients: a meta-analysis. Am J Orthod Dentofacial Orthop 2008;134(6):e1-722.e12; discussion 722-3.
16. Fors R, Persson M, Bergstrom E, et al. Lifestyle and nickel allergy in a Swedish adolescent population: effects of piercing, tattooing and orthodontic appliances. Acta Derm Venereol 2012 Jan 26. doi: 10.2340/00015555-1305. [Epub ahead of print]
17. Hardee PSGF, Mallya LR, Hutchison IL. Tongue piercing resulting in hypotensive collapse. Br Dent J 2000;188:657-8.
18. DeMoor RJ, DeWitte AM, DeBruyne MA. Tongue piercing and associated oral and dental complications. Endod Dent Traumatol 2000;16(5):232-7.
19. National Digestive Diseases Information Clearinghouse: National Institutes of Health. What I need to know about Hepatitis B. Available at:“http://digestive.niddk.nih.gov/ddiseases/pubs/hepb_ez/#5.” Accessed 1/18/12
20. Hepatitis B Foundation. Prevention and Vaccination: FAQ. Available at: “http://www.hepb.org/patients/prevention_and_vaccination.htm”. Accessed 1/18/12.
21. Akhondi H, Rahimi AR. Haemophilus aphrophilus endocarditis after tongue piercing. Emerg Infect Dis [serial online] 2002 Aug. Available at: “http://www.cdc.gov/eid/article/8/8/01-0458.htm”. Accessed 1/18/12.
22. Yu CH, Minnema BJ, Gold WL. Bacterial infections complicating tongue piercing. Can J Infect Dis Med Microbiol. 2010 Spring;21(1):e70-4.
23. Perkins CS, Meisner J, Harrison JM. A complication of tongue piercing. Br Dent J 1997 Feb 22;182(4):147-8.
24. Lakhan SE, Harle L. Fatal fulminant herpes simplex hepatitis secondary to tongue piercing in an immunocompetent adult: a case report. J Med Case Reports 2008;2:356-60.