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In response to the recent popularity of tongue piercing, there has been a negative backlash from the Medical and Dental professions and the media. This is quite understandable considering the number of unqualified practitioners in the piercing industry and the disturbing lack of information among consumers. Tongue piercing has been categorically dismissed by many as "dangerous self-mutilation" citing the frightening prospects of everything from choking on jewelry to toxic shock syndrome. It is very easy to dismiss such a "radical" and "unnecessary" procedure with limited benefits, which may be difficult for most people to comprehend. Regardless of your perspective, people are still getting pierced. Why not get informed? In responsible, professional piercing practice, tongue piercings have one of the highest problem-free success rates of any popular piercing. Contrary to common speculation, tongue piercings do heal completely and are not prone to infection when correctly performed and maintained. As with any such minor procedure there are risks to be considered, however with correct methodology, proper sterilization, high-quality jewelry, and professional support during the healing process, these risks are minimal. In responsible, professional piercing practice, tongue piercing presents no major risk to health. Minor concerns are addressed and kept to an absolute minimum. Most common concerns are easily avoided or easily treated. The following will address every recently publicized hazard concerning tongue piercing, their causes, avoidance, and treatment. The Association of Professional Piercers has stated: "When properly performed, the procedure itself [oral piercing] takes only a few seconds, and involves minimal discomfort and often no blood. Healing is ordinarily rapid and is commonly uneventful. Unsafe, unethical, and uneducated piercers thrive in areas where complete, accurate information is not made available to both the general public and those who seek to protect them. Additionally, making oral piercings illegal forces consumers who still seek them to patronize unregulated, underground establishments. Only by supporting the dissemination of accurate information and the efforts of conscientious professionals can the risks of piercing truly be controlled. The APP is a non-profit organization dedicated to health, education and safety of piercers and the public. We are a group of committed professionals who uphold an extremely high standard of safety and hygiene. We support the development of appropriate regulations and standards to ensure the improvement of our art form and the continued safety of our clientele."
WHAT IS GOOD JEWELRY? The type used in tongue piercings is referred to as a "barbell" or "barbell stud", however most barbells on the market today do not come close to the correct standards. The highest quality piercing jewelry meets specific requirements similar to metal surgical implants used in bone repair or permanent tooth replacement. Materials such as 316LVM surgical stainless steel, 6AL4V Titanium, and suitable gold alloys are polished to a mirror finish. The threaded closure must be precision made to exacting standards; the internally threaded stem or "post" of the barbell accepts a fine threaded pin that protrudes from the ball itself. Additionally, in order to create a seamless locking closure the post is countersunk into the ball. These strict design standards offer maximum bioacceptability, as well as client safety and comfort.
Each section will address a specific concern observed in practice or reported by the media. Procedural disease transmission is highly unlikely when proper safety methods are used. These include new sterile needles, new jewelry, autoclave sterilization of instruments and stringently applied cross-contamination prevention in the work area. Reliable practitioners adhere to the strictest standards of sterilization hygiene; piercing specific protocols which can be verified through a number of sources including HEALTH CANADA at: www.hc-sc.gc.ca/hpb/lcdc/publicat/ccdr/99vol25/25s3 and various professional piercing associations, including the Association of Professional Piercers (US) at www.safepiercing.org. Infection is an obvious risk with any piercing. Infection in tongue piercing is rare, however, with a sterile piercing procedure and proper aftercare, assuming the client is in reasonably good health. Tongue piercings consistently heal faster than traditional earlobe piercings when properly executed and maintained. Responsible practitioners insist that their clients contact or visit them immediately should any hint of infection become apparent. A printed description of possible symptoms of infection should always be provided at the time of the procedure. Minor infections can be treated quickly using an over-the-counter post-surgical oral rinse, such as a chlorhexidine gluconate rinse or a name brand product such as Amosan. Clients with infections are asked to keep in close communication with their Piercer and/or Doctor until all symptoms subside. In rare cases an oral antibiotic prescription is indicated. Best results are achieved when qualified piercers and doctors can work in tandem to best assess the clients needs. Major infections are usually a result of neglect - untreated minor infection exacerbated by inadequate aftercare information on the part of the practitioner. Dangerous infections are unheard of in responsible practice, and post-recovery incidence of infection is virtually unheard of after the usual 4-8 week healing period. Post-procedural disease transmission through unhealed piercings is a risk worth considering. STDs and other pathogens can be acquired via any unhealed opening in the skin. Basic "safer-sex" rules should be followed during the initial healing period, and responsible practitioners will always inform clients of these concerns. As correctly performed tongue piercings usually heal in 4-8 weeks, increased risk of disease transmission is only an issue during this time. Jewelry quality and proper sizing are essential to encourage rapid healing and prevent constant irritation or lesion of the pierced tissue. The risk factor for disease transmission via a professionally executed tongue piercing is no different than the risk following minor dental work or while wearing orthodontic braces. There should be no increased risk once a piercing has healed. No such cases have been documented to date. Swelling: Excessive swelling is usually caused by an aggressive or roughly executed procedure, inappropriate tools, jewelry and/or placement. An unskilled practitioner will also tend to use oversized jewelry in order to accommodate this excess swelling, thus contributing to other jewelry-related concerns outlined elsewhere in this report. In a correctly performed piercing the needle and jewelry should pass easily through the tongue with minimal tissue trauma, thereby minimizing both the extent and duration of post-procedural edema. Normal, localized swelling of 10 to 20 percent will last only a few days. Another secondary cause of excessive swelling is neglect, irritation or abuse of a new piercing, sometimes exacerbated by infection. With appropriate client information, responsible professional piercers keep these problems to a minimum and offer professional support when necessary. Bleeding can be a major concern with tongue piercing. The most frequent cause of severe bleeding is neglect on the part of an amateur piercing practitioner at the time of the procedure. Even if the volume or duration of bleeding is not dangerous, it is a source of discomfort and anxiety for the client. It is necessary to assess each client¹s anatomy on an individual basis, with prudent determination of the appropriate placement and careful examination for sublingual blood vessels. Large blood vessels are not usually found anywhere along the center line of the tongue. In a professionally executed tongue piercing, serious bleeding is extremely rare, and would only be due to the abnormal presence of a major blood vessel in the center-area of the tongue at a depth which would preclude visual identification. Even this would not usually result in loss of the piercing or risk to overall health. Responsible practitioners will encourage the client to monitor any bleeding and seek professional assistance when necessary. Nerve damage is a perceived risk with tongue piercing; however, it is unheard of in responsible practice. In correctly executed tongue piercing a hollow, beveled hypodermic needle not exceeding twelve gauge (externally) is used, creating a low risk of procedural nerve severance. In addition, the major nerves of the tongue are located bilaterally; therefore medial piercing placement is strongly encouraged and generally safe. Another possible cause of localized numbness, essentially minor nerve damage, is severe or prolonged infection; again, highly unlikely in responsible practice. Choking on jewelry would be a worrisome possibility if the jewelry were to break or unscrew at the wrong time. Good quality jewelry locks into place when properly installed. Responsible piercers encourage their clients to make conscientious jewelry choices, and will provide information and assistance to ensure proper installation and maintenance. Tooth and gum damage is a common occurrence with amateur tongue piercings. Inappropriately sized or badly finished jewelry is the primary cause. When the jewelry is too heavy or too long for the dimension/range of motion of the pierced tongue, fine motor control is diminished. This can create problems such as accidentally biting the jewelry while eating, or constant clicking of the jewelry against the teeth while speaking. These may eventually result in chipped or fractured teeth. These concerns can easily be diminished through proper jewelry sizing, skilled placement, and complete aftercare instruction. Clients presenting thin or damaged tooth enamel should be discouraged from being pierced. Responsible practitioners will provide only suitable jewelry to their clients, insist on safe piercing placement and provide detailed information on these risks and their avoidance. Although these concerns are occasionally noted even in the context of responsible practice, the damage can often be traced to misuse of alcohol, drugs, or a nervous habit such as intentional, repeated biting of the jewelry. Enamel loss, primarily on the back of the teeth, is another common occurrence that exists as a result of low quality jewelry or badly maintained tongue piercings. Porous or poorly polished jewelry material can act like sandpaper, slowly degrading tooth enamel over months or years. Additionally, improper placement of the piercing may also exacerbate to this effect. Installing and maintaining a properly sized, finely polished "barbell" in an appropriately placed piercing will eliminate this problem completely. Clients should be properly informed by their practitioner in order to decide when jewelry changes are appropriate. Excessive salivation resulting in stress of the salivary glands may be of genuine concern with new tongue piercings. Most often this is a temporary problem prevalent only during the early stage of the healing period. Symptoms will subside with time. This problem can be minimized with proper sizing of the jewelry, most importantly the sublingual component. An oversized ball on the underside of the tongue may overstimulate the salivary ducts, even during periods of rest or inactivity. Again, the importance of proper jewelry sizing in responsible practice is paramount. Keloiding or hypertrophic scar tissue: The formation of visible scar tissue around a tongue piercing may be a result of a number of factors. Most cases are the result of improperly finished jewelry, or persistence of a low-grade infection in the piercing for a prolonged period. Such problems are uncommon in responsible practice, and can be easily identified and quickly remedied should they occur. Fortunately, this type of scar tissue is not as static as typical keloid tissue, and is easily reabsorbed or released by the body once the irritating factor is eliminated. Permanent, dense, cross-fibrous scarring (true keloiding) is highly unusual and is not observed in responsible practice. Migration of a healthy tongue piercing along the center of the tongue toward the tip over a period of many years has been observed. This is a result of the tapered shape of the tongue and a process of normal tissue regeneration allowing a foreign object passage to an area of least resistance. No scar tissue, discomfort, enlargement of the piercing, or lesion is observed. This change in placement can be slowed or eliminated with properly fitted jewelry, placing less leverage or resistance on tissues during normal activity. If the client becomes aware of risks or discomfort associated with the new placement of the piercing after migration, steps can be taken to alter jewelry size or remove the piercing permanently if need be. The piercing may then be safely reapplied at a new, more suitable location, if the client so desires. Prolonged or excessive healing time (more than 8 weeks) has been observed in conjunction with one or more of the following; recurring purulence even with usual treatment for minor localized infection, recurring swelling, distention or visible dilation of the pierced area, recurring minor bleeding, recurring pain or localized numbness. In responsible practice, these results are highly unusual. Assuming the piercing has been carried out responsibly and professionally, and properly cared for, this type of problem is most often a result of an acute or chronic (pre-existing) health problem which may be known or unknown to the client. Health problems include any chronic immune dysfunction, temporary immune suppression such as flu or injury, or factors such as drug and alcohol abuse, dietary deficiencies, etc. Responsible piercers will interview and screen all clients and discourage any piercing for those who may not heal efficiently. The Connecticut Brain Abscess Case in winter of 2002 was aggressively touted by the media as evidence of the serious risks involved in choosing to receive a piercing, even when doctors involved in the case stated that they were not sure of the cause. In addition, the bacteria at the root of the young woman¹s illness was an organism commonly found in the ears, nose, throat, and other areas of the body. Remarkably, no questions came to light regarding the qualifications (or absence of) of the patient¹s piercing practitioner, the general health of the patient other than her pierced state, or whether correct piercing aftercare guidelines were followed. If it were somehow certain that the piercing had caused the illness in this unique case, it must be considered that the number of tongue piercings performed in North America has now entered the millions. This fact alone makes it a relatively safe procedure. Other Cases: Some other more extreme case scenarios have been reported or speculated upon by various health professionals. Many of these are based purely on speculation, or in some cases are a result of a complete absence of responsibility or common sense on the part of the "piercer" and/or the "piercee". Consequences such as Toxic Shock Syndrome, stroke, partial amputation of the tongue, lingual or facial paralysis, are simply never observed in common practice and therefore will not be addressed here. No such cases have been documented to date. A NOTE ABOUT LIP and CHEEK PIERCINGS Many commonly documented placements are discouraged in responsible practice: Any placement of jewelry through the lip or cheek where it would frequently contact the gumline or the teeth during normal activity are not recommended. Eventual tooth and gum damage is likely. Many of the standards outlined previously in this report apply to lip, labret, and cheek piercings as well. Such piercing presents no major concerns when proper procedure, placement, and appropriate jewelry are used. Special attention is given to the angle of placement through the lip in order to minimize jewelry contact with teeth and gums. With proper aftercare and professional support, if necessary, the resulting success rate is high and risks minimal. The preceding information on TONGUE PIERCINGS is based on many years of hands-on experience and documentation of thousands of our own piercings, and the ongoing exchange of information with other reputable piercing practitioners. For further information for you or your patients, feel free to contact us at your convenience. You may also request copies of our information pamphlet directed to the general public, PIERCING BASICS: What You Should Know. BLACK SUN STUDIO is interested in maintaining open communication with professionals in the medical/dental field, to address your concerns, educate the public, and challenge negative stigma about piercing in general. We are also compiling a list of "piercing friendly" health practitioners in the Montreal area. We are interested in documentated cases resulting in permanent injury for research purposes. We support intelligent industry-specific regulation of our trade to improve public safety and de-stigmatize those who are pierced and the indusrty in general. BLACK SUN STUDIO is Montreal¹s only internationally recognized piercing specialist offering safe, professional piercing services from a private studio, meeting standards set by Health Canada and The Association of Professional Piercers. The author of this document, Pierre Ferguson-Black, is the owner and founder of BLACK SUN, a member of the APP, and has been a professional piercer since 1990. BLACK SUN is regularly featured by major media, and participates in numerous documentaries and research projects.
Credits and references: Institutional References: 1.The Association of Professional Piercers, www.safepiercing.org. 2.Health Canada, www.healthcanada.ca Media: 1.Boardman, R, and R. A. Smith, DDS. "Piercing: Dental Implications of Oral Piercing."CDA Journal Mar. 1997: 200-207. 2.Cobb, D. S., DDS, MS, G. E. Denehy, DDS, MS, and M. A. Vargas, DDS, MS. "Adhesive Composite Inlays for the Restoration of Cracked Posterior Teeth Associated with a Tongue Bar.".Practical Periodontal Aesthetic Dentistry Oct. 1998: 453-460. 3.Croll, T. P., DDS. "'Wrecking ball' dental fractures: Report of 2 cases." Quintessence International 1999: 275-277. 4.Davies, R. "Is it good for you?" Shared Vision Magazine Oct. 1996: 9-11,35. 5.Farah, C.S., BDSc, and D.M. Harmon, BSc. "Tongue Piercing: Case Report and Review of Current Practice." Australian Dental Journal 43:6 (1998): 387-389 6."Le perçage de la langue, une automutilation dangereuse." Science Presse 9 Apr. 1999: 10. 7.Lucart, H, and A Scherer. "Don't Stick That in Your Mouth!" Dentalnotes September (1995). 8."Pierced tongue leads to brain infection." CDA News Jan.-Feb. 2002: 10. 9."'Sa langue percée a failli la tuée' ." Le Journal de Montréal 21 Jan. 2002: 286-5259 (514-). 10."Tongue piercing can be fatal." Ottawa Citizen 29 July 1999: A9. 11.Volkman, S. "Oral Piercing." dental hygiene student, Normandale Community College, Bloomington MN 12."Why A Tongue Stud's a Dud." Cosmopolitan Feb. 1998: 182. |
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