- Continuing Education
Dental Implications and Recommendations for the Dental Team
Dental Implications and Recommendations for the Dental Team
A patient with an oral piercing may present for treatment. Having the knowledge and skills to treat such a patient will provide for a better treatment experience. Asking about oral piercings (and any complications) on the medical or dental history will alert you to the presence of oral piercings.9,27
If a patient has a new, unhealed piercing, recall this is essentially an open wound and, therefore, a conduit for infection. 9 Consider reappointing the patient far enough in the future to assure the piercing is completely healed. Remind the patient to follow aftercare instructions and provide them, if necessary. The APP’s aftercare brochure is downloadable at www.safepiercing.org.
The oral exam should include inspection of jewelry and the surrounding area.9 Have the patient remove jewelry to avoid catching on the jewelry or having it interfere with a complete oral inspection or any radiographic procedures.13 For panoramic radiographs, all jewelry above the neck should be removed. Cheek and labret jewelry should be removed for periapicals and bitewing radiographs because of their location in relation to film placement and tube head. The need for jewelry removal during local anesthesia is at the discretion of the oral healthcare professional. The mandibular block is one injection for which tongue jewelry removal may be prudent. When the tongue is anesthetized, there is increased possibility for tooth damage from the jewelry until the anesthesia has completely disappeared.19 Consider having sterile, non-metal temporary type jewelry (sometimes called retainers) available or asking the patient to bring to avoid having the piercing tract begin to close (Figure 21).
Figure 21. Temporary plastic jewelry.
During the oral exam, observe for signs of complications listed in Table 1. Remind the patient clicking, tapping, rubbing or biting the jewelry should be avoided. Jewelry that is properly fitted and tightened is also important to avoid long-term damage.
Table 1. Signs of Piercing Complications.
|Allergic reactions||Loose or ‘nested’ jewelry||Over scarring|
|Gingivitis/periodontitis||Gingival recession/overgrowth||Diastema/misaligned teeth|
|Pulpal sensitivity||Periodontal/periapical abscess||Abrasion/fractures|
|Tooth mobility||Damage to restorations|
Offer instructions on home care for the piercing. 26 The oral exam may offer ideas for individualized instruction and the following suggestions may provide general guidelines:
A clean, soft-bristled toothbrush (regularly replaced and properly stored) should be used to gently clean the jewelry and surrounding area. As healing is complete, the jewelry can be removed for more thorough cleaning. Consider having a toothbrush used only for cleaning the jewelry. 11
Brush teeth and tongue and use a non-alcohol or saline rinse after every meal.
Avoid clicking the jewelry against the teeth or gums.4
With clean hands, check the tightness of jewelry to avoid choking, swallowing or inhaling dislodged jewelry.26
Remove the jewelry and wear a mouth guard when participating in sports.1
Know and look for signs of infection or other complications.
Routine dental care both at home and professionally is important for optimum oral health.
Provide written information.
It is a good idea to have at least a basic working knowledge of how to remove oral piercing jewelry. In the event of an emergency, the jewelry could interfere with emergency procedures and the patient may be unable to remove the jewelry for themselves. The APP’s brochure “Jewelry for Healed Piercings” is available from www.safepiercing.org and is a good reference. A sample of removal techniques are presented here. Occasionally a specialized tool is needed to remove an oral piercing. Having a sterile Ring Expanding Pliers available is prudent (Figure 26).
Figure 26. Ring expanding pliers.
These pliers may be needed to spread a ring open enough to get the bead out. Place the head of the pliers inside of the ring and slowly squeeze on the handle to spread the jaws open, widening the ring just enough to pull the ball out (Figure 27).
Figure 27. Ring expanding pliers being used to expand ring.
On a fixed bead ring, the bead is attached to one side of the ring. Grasp the ring on each side of the bead, pull gently and one end will pop out of the bead. Push one end away from you and pull the other end toward you to open the ring like a spiral. The beadless variation also opens by twisting (Figure 28).
Figure 28. Fixed bead ring.
The bead or captive piece of a captive ring is held in by the tension of the ring. Grasp the ring with one hand near the bead, and with the other hand grasp the bead itself. Gently pull the ring and bead in opposite directions and the bead should pop out of the ring. To remove it, twist the ring a little (as in opening a bead ring) and rotate the jewelry to slide it out (Figure 29).
Figure 29. Captive bead ring.
Barbells and their variations have threaded end(s) that can be unscrewed. Like most threaded objects, they tighten to the right and loosen to the left (Figure 20).
Figure 20. Barbell with internal threading.
While oral piercings are the fashion, they are not without consequences.9 If the dental health care professional is in a position to play an active role in the decision to get an oral piercing, educating the patient about the risks and consequences so they can make an informed decision may result in the decision not to pierce.22 Patients should be aware the decision to pierce should not be made on a whim. It is a procedure that requires constant care.4,25 Encourage those patients under the age of 18 to speak with parents before getting a piercing. Parents should be aware body piercing may be associated with an increase in other risky behavior such as smoking.24 For patients who have poor oral hygiene or a high caries rate, oral piercings should be strongly discourage as the patient may be less likely to care for the piercing properly.18 A professional piercer will further educate the patient and require the following:
Bring valid photo identification, even if you are clearly over the age of majority.
Be completely sober.
Have eaten within 4 hours.
If possible, avoid taking aspirin or other blood thinners.
Have addressed potential health issues, e.g., if you require antibiotics prior to dental work, see your doctor.