Humans often exhibit a compulsive urge to set themselves apart from others, employing various means. They include jewelry, distinctive attire, hairstyles, and even body modifications like body piercings and tattoos. Oral piercings and tattoos offer unique avenues for self-expression, enriching the diverse spectrum of personal adornment and individuality.
History of oral piercings
Body piercing involves puncturing a section of the human body to create an opening for wearing jewelry. Oral piercings on the lips and tongue were historically found in certain indigenous cultures in Africa, the Americas, and the people of the Middle East. They were considered a symbol of social status, fertility, protection from evil spirits, or a religious ritual. During 1970–1980, piercings were viewed as symbols of rebellion and behavioral issues, often associated with smoking, alcohol and drug abuse, and aggression. Modern perceptions have shifted, recognizing them as forms of artistic expression and self-expression and challenging stereotypes.
Positions of oral piercings
From traditional cultural practices to modern fashion statements, oral piercings come in a surprising variety of forms.
| Tongue piercings | |
| Midline | A piercing right at the midline of the tongue (most common) |
| Side | A piercing on the right or left to the middle of the tongue |
| Snake eyes | Two piercings horizontally through the tip of the tongue |
| Frog eyes/Venom | Two piercings horizontally through the sides, between the middle and the tip of the tongue |
| Lip piercings | |
| Labret | A single piercing (from outside of the mouth to the inside of the mouth) under the center of the bottom lip, right above the chin. It also has side variants |
| Vertical labret | A single piercing through the top of the bottom lip and one directly under the bottom lip |
| Ashley | A single piercing through the center of the bottom lip and exits through the back of the lip |
| Medusa | A single piercing right above the cupid's bow in the indented portion of the upper lip (philtrum) |
| Jestrum | A piercing with two holes, one through the philtrum, and the other through the center of the top lip |
| Monroe | A single piercing directly above the left side of the upper lip |
| Madonna | A single piercing directly above the right side of the upper lip |
| Cyber bites | A combination of Medusa and labret |
| Angel bites | A combination of Madonna and Monroe |
| Snake bites | A piercing on both sides just under the lower lip |
| Shark bites | Two piercings on both sides just under the lower lip |
| Canine bites | A combination of angel bites and snake bites |
| Dolphin bites | Two piercings directly under the center of the bottom lip |
| Spider bites | Two side lip piercings just under the right or left of the bottom lip |
| Dahlia | A piercing on both corners of the lips |
| Horizontal | A single piercing directly on the surface of the bottom lip, creating a horizontal design |
| Frenulum piercings | |
| Labial frenulum (connects lips to the gums) | |
| Frowny | A piercing through the mandibular (lower) frenulum |
| Smiley | A piercing through the maxillary (upper) frenulum |
| Lingual frenulum | A piercing on the frenulum which connects the floor of the mouth to the underside of the tongue |
| Cheek piercings | |
| Dimple | A piercing through the natural indentation of the cheek (on one or both sides) penetrating the mucosa inside the mouth |
| Cheekbone | Piercings through the upper part of the cheek, near the cheekbone |
| Teardrop | Piercings on the lower part of the cheek, creating a teardrop-shaped effect |
| Horizontal | Piercings horizontally through the cheek, typically parallel to the mouth |
| Uvula piercings | A horizontal piercing on the uvula (a fleshy extension at the back of the soft palate that hangs above the throat) |
Types of piercing jewels
Studs - metal stem with a sphere on one end and a smooth flat disk on the other
Closed rings (seamless rings)
Unclosed rings (circular barbells or horseshoes) - sphere at one or both ends
Barbells - curved or straight stems and a sphere on each end.
Internally threaded jewelry is more commonly used, although some studs may utilize a magnetic force that is ten times stronger than a conventional magnet to hold their parts together. These jewels are made of metals like stainless steel, titanium, niobium, gold, platinum, or non-reactive inert plastics such as Tygon or Teflon.
Complications of oral piercings
Like any surgical procedure, it's important to acknowledge the inherent risks associated with piercings. Complications can occur immediately after, soon after, or long after the piercing, with possible deleterious effects on hard and soft oral tissues. There are both oral and systemic complications to oral piercings.
The oral complications are excessive post-operative bleeding and pain, ulceration, erythema, temporary dysgeusia (metallic taste), numbness, oral abscess, edema leading to airway risk, difficulty in eating, tasting and swallowing food, hypersalivation, sialadenitis, bone loss and dehiscence, hypertrophic scarring in oral mucosa, and rejection, migration or aspiration of piercings.
The long-term dental complications include tooth fracture, abrasion, tooth hypersensitivity, tooth mobility, gingival recession, and electro galvanism (difference in electrical potential between dissimilar metals in the oral cavity). Oral piercing was also found to be associated with the symptoms of temporomandibular joint disorders (headache, muscle tenderness).
The systemic complications are allergies to metals, endocarditis (rare), cellulitis, Ludwig’s angina, toxic shock syndrome, and cross-transmission of Hepatitis B, C, or D, HSV, and HIV. Oral piercings produce radiopaque regions and should be removed before undergoing X-ray procedures.
Oral piercing can leave fibrosis underneath after removal and chronic irritation due to oral piercing may also lead to non-healing ulcers. Additionally, they may interfere with dental procedures by increasing the risk of complications, such as excessive bleeding or injury to the oral tissuesDr. Balakrishna R. N., MDS, Consultant Maxillofacial Surgeon, Chennai, India
History of oral tattoos
Tattoos have always held significance in various religions as ritual tools and cultural traditions. Tattoos need not be limited to the skin. For instance, Ramnaamis, a sect of Hindus in North India, tattoo their entire body, including the tongue and inside of the lips. Tribes in Southeast Asia, particularly the Thai people, often tattoo sacred Buddhist texts on the inner surface of their lips. Nowadays, tattoos are also viewed as an artistic form of self-expression, like piercings.
Consideration for oral tattoos
Oral tattoos can be either on the lower labial mucosa (inside of the lower lip), edge of the mouth (permanent lip liner), palate (roof of the mouth), gums or cheek. The lower labial mucosa is the most commonly tattooed intraoral site, and it is considered unique as it is not readily visible. Intraoral tissues are one of the most painful sites to have tattooed.
Intraoral tattoos fade at a faster rate due to ink fading compared to tattoos on the skin's surface due to the action of saliva, the inability of ink to adequately penetrate the mucosal membrane, and the rapid turnover of cells in the oral cavity. The higher pigment rejection rates in the oral cavity and elasticity in the lips make it challenging to work with. Because of these issues, many tattoo artists typically advise against getting intraoral tattoos.
The healing process for an oral tissue is usually quicker than for a regular tattoo because the oral mucosa heals faster than skin. Still, it is important to follow proper post-operative instructions to ensure optimal healing and minimize complicationsDr. Balakrishna R. N., MDS, Consultant Maxillofacial Surgeon, Chennai, India
Complications of oral tattoos
Oral tattoos present significant health risks like infection, swelling, and scarring. Periodontal disease or inadequate oral hygiene could elevate the risk of infection due to the patient's increased bacterial presence in the oral cavity.
Tattoo inks comprise various components, including metallic salts, carbon, aluminum, oxygen, azo pigments, and polycyclic compounds. Intraoral tattoos may trigger an allergic reaction associated with the red mercuric sulphide (cinnabar), often resulting in cell-mediated delayed hypersensitivity reactions. There are reported cases of carcinoma of the lips arising from tattoos.
Granulomatous reactions may occur when the immune system tries to isolate foreign substances like tattoo ink. Lichenoid reactions resembling lichen planus, showing as small papules that can merge into rough, scaly plaques also manifest if the patient has an immunogenic reaction to the tattoo ink.
Patient education and awareness on oral piercings and tattoos
The American Dental Association discourages cosmetic oral piercing, considering them invasive procedures associated with adverse health effects that outweigh potential benefits. Studies show varying levels of awareness among the public and dental professionals regarding the risks associated with oral piercings. Empirical information and inconsistent recommendations are common among dental practitioners, highlighting the need for standardized education and guidance on oral piercing risks.
The US Food and Drug Administration (FDA) actively monitors safety reports and enforces regulations on the manufacturing of tattoo ink. However, tattoo ink products are not approved by the FDA for skin injection, since they are considered cosmetics. While tattoos have historical roots, there are no elaborate studies regarding their behavior in oral mucosa. Vigilance and patient education about potential risks are essential.
Consulting with a dentist before getting an oral piercing or tattoo is highly recommended. Following a tattoo or piercing, a liquid diet for 24 hours is advised, slowing the transition to soft foods. To alleviate swelling, ice and over-the-counter anti-inflammatory medications can be used.
Spicy or hard foods, smoking, alcohol, and caffeine should be avoided for a week. 0.12% chlorhexidine mouthwash should be used three to four times a day after the initial 24-hour period for piercing. Chewing gum, tobacco, fingernails, or other foreign objects like pencils or playing with oral jewelry should not be done to avoid potential trauma. The piercing should be cleaned daily with a soft toothbrush.
Ensure your surgeon is board-certified and experienced in the specific procedure you want. Pay attention to any unusual symptoms or signs of complications and seek medical attention if needed. Fever, unusual swelling, pain, pus discharge, any bad smell are some of the warning signs patients should look after these proceduresDr. Balakrishna R. N., MDS, Consultant Maxillofacial Surgeon, Chennai, India
For monitoring the healing progress of tattoo/piercings and addressing any potential complications promptly, regular check-ups with dentists are essential.
Oral piercings and tattoos offer unique avenues for self-expression and aesthetics but come with potential risks and complications. It's essential to weigh these factors carefully and seek professional guidance before undergoing such procedures. Additionally, maintaining proper aftercare is crucial for minimizing adverse outcomes and ensuring optimal oral health.
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