Abstract. Intraoral and perioral piercings, most commonly of the tongue and lip, are associated with a substantial burden of local and, less frequently, systemic complications. Meta-analytic data indicate that approximately one-third of individuals with oral piercings exhibit gingival recession, and comparable proportions demonstrate dental fracture or wear. Systematic reviews consistently identify piercing-adjacent teeth as showing greater recession and periodontal compromise than control teeth. Early complications include hemorrhage, edema, and infection; chronic sequelae are dominated by mechanical trauma to hard and soft tissues. The American Dental Association advises against oral piercing. This review summarizes the epidemiology, pathogenesis, clinical presentation, and management of piercing-related oral complications.
Epidemiology
Oral and perioral piercings are most prevalent among adolescents and young adults, with a marked female predominance in most series; the tongue and lower lip are the most frequently pierced intraoral and perioral sites. In a 2022 systematic review and meta-analysis encompassing 54 studies, Passos et al. reported pooled event rates among pierced individuals of 33% for gingival recession, 34% for dental fracture, 34% for tooth wear/abrasion, and 22% for tooth chipping, although the certainty of evidence was graded as very low [1]. A 2023 systematic review by Difloe-Geisert et al., including eight studies (236 lip and 236 tongue piercings in 408 patients), found that teeth adjacent to tongue piercings showed more gingival recession than control teeth in all four comparative studies assessing this outcome, with similar findings for lip piercings in three of four studies [2].
Etiology and Pathogenesis
Chronic mechanical trauma is the principal driver of late complications. Metallic jewelry in continuous or habitual contact with teeth and periodontium produces microtrauma to enamel (chipping, cracked-tooth syndrome, abrasion) and to gingival tissues, with lingual recession classically associated with tongue barbells and facial/buccal recession with lip studs [2,3]. Parafunctional habits — clicking or interposing the device between teeth — amplify these forces. Jewelry surfaces also serve as plaque-retentive niches, favoring localized gingivitis and caries risk. In the immediate post-piercing period, the tongue’s rich vascularity predisposes to hemorrhage and edema, while the resident polymicrobial flora creates a portal for local infection; case reports document rare but serious events including Ludwig’s angina, cerebral abscess, and infective endocarditis in susceptible individuals [3,4]. Metal ion release and hypersensitivity reactions constitute an additional, less common mechanism of mucosal pathology.
Clinical Presentation and Diagnosis
Early findings (days to weeks) include pain, swelling, prolonged bleeding, and localized infection; airway compromise from lingual edema and jewelry aspiration or ingestion are rare emergencies. Late findings (months to years) include localized gingival recession adjacent to the device, enamel fissures and cusp fractures (frequently of mandibular anterior teeth and premolars with tongue piercings), tooth hypersensitivity, hyperplastic or lichenoid mucosal tissue responses, and embedding of the device [3,4]. Examination should document jewelry type, length, and material; probing depths and recession (Cairo/Miller classification) at adjacent teeth; and fremitus or wear facets suggesting parafunctional contact. In a systematic summary of 83 published cases, tooth fracture and periodontal defects accounted for the majority of reported late complications [4].
Management
Management is primarily preventive: patient counseling consistent with ADA policy, which advises against intraoral/perioral piercing given a risk profile that outweighs benefit [5]. For patients who retain piercings, harm-reduction measures include substituting shorter barbells and polymer (e.g., PTFE/bioplast) components after healing, eliminating parafunctional habits, meticulous device hygiene, removal during sports, and recall intervals permitting longitudinal monitoring of recession and tooth integrity. Established recession may require mucogingival surgery (e.g., connective tissue grafting) contingent on device removal; fractured or worn teeth are restored per standard operative and prosthodontic principles. Definitive resolution of an ongoing traumatic etiology requires permanent removal of the device, which should be recommended whenever attributable pathology is identified [2,3].
For a patient-friendly overview, see our companion guide, Oral Piercings and Your Smile. Related reading: warning signs of gum disease and our preventative care program.
References
- Passos PF, Pintor AVB, Marañón-Vásquez GA, et al. Oral manifestations arising from oral piercings: a systematic review and meta-analyses. Oral Surg Oral Med Oral Pathol Oral Radiol. 2022;134(3):327-341.
- Difloe-Geisert JC, Müller JS, Weiger R, Walter C. Impact of oral piercings on periodontal health — a systematic review. Int J Dent Hyg. 2024;22(1):24-34.
- 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 Hyg. 2016;14(1):62-73.
- 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;9(2):101-109.
- American Dental Association. Oral piercing/jewelry. ADA Oral Health Topics. Available at: ada.org/resources/ada-library/oral-health-topics/oral-piercing-jewelry.
This article is provided for educational purposes only and does not constitute medical or dental advice. Clinical decisions should be individualized in consultation with a qualified dental professional. If you have concerns about an oral piercing or related symptoms, please contact Fridman Family Dental Care in Valencia, CA at (661) 254-3700.
