Dental and periodontal complications of lip and tongue piercing: prevalence and influencing factors

Authors


Eudoxie Pepelassi
Department of Periodontology
School of Dentistry
The University of Athens
2 Thivon Street
Athens 115 27
Greece
Email: epepela@dent.uoa.gr

Abstract

Background:  The aim of this study was to compare the prevalence of lip and tongue piercing complications and explore the effect of ornament time wear period, habits, ornament morphology and periodontal biotype on the development of complications.

Methods:  One hundred and ten subjects with 110 lip and 51 tongue piercings were assessed for abnormal toothwear and/or tooth chipping/cracking (dental defects), gingival recession, clinical attachment loss and probing depth of teeth adjacent to the pierced site. Piercing habits (biting, rolling, stroking, sucking) were recorded.

Results:  Wear time and habits significantly affected the prevalence of dental defects and gingival recession. Pierced site significantly affected dental defects prevalence, with greater prevalence for tongue than lip piercing. Wear time significantly affected attachment loss and probing depth. Attachment loss and probing depth did not significantly differ between tongue and lip piercings. Gingival recession was significantly associated with ornament height closure and stem length of tongue ornaments. Periodontal biotype was not significantly associated with gingival recession, attachment loss and probing depth.

Conclusions:  Dental defects prevalence is greater for tongue than lip piercing. Gingival recession is similar for tongue and lip piercing. Longer wear time of tongue and lip piercing is associated with greater prevalence of dental defects and gingival recession, as well as greater attachment loss and probing depth of teeth adjacent to pierced sites. Ornament morphology affects gingival recession prevalence.

Abbreviations and acronyms:
CAL

clinical attachment loss

CEJ

cemento-enamel junction

GI

gingival index

GR

gingival recession

PPD

probing pocket depth

Introduction

Body art practices, such as tattooing and body piercing, have recently gained popularity among young people.1,2 Body piercing is defined as the penetration of an ornament into openings made in the skin or mucosa.1 It is a very old body modification which in the past was a cultural practice but is today considered a fashion.

Intraoral and perioral sites are often selected for piercing with the tongue, lips and cheeks being the most commonly pierced sites. Oral piercing might start as early as adolescence and becomes more popular in college years.3

Oral piercing is not harmless since it entails local and systemic risks. It has been associated with early and late complications. Early complications mainly include pain,4,5 oedema,4,5 haemorrhage5 and inflammatory reaction5 at the pierced site. Severe complications have also been reported, such as Ludwing’s angina,2 cerebral abscess6 and endocarditis,7 and airway obstruction.8 Furthermore, the risk of hepatitis and HIV infection cannot be ruled out.5

Late complications are mostly topical and include abnormal toothwear and/or tooth chipping/cracking9,10 (Fig. 1 and 2), gingival recession10,11 (Fig. 3), localized periodontal destruction,10 cracked tooth syndrome,12 increased salivary flow,9 chewing, speaking and swallowing impairment,4 tissue overgrowth at the pierced site,13 ornament embedment in the tongue,14 generation of galvanic current9 and bifid tongue,15 increased concentration of periodontopathogenic bacteria at the pierced site16 and increased prevalence of Candida albicans colonization.17 In addition, ornament ingestion18 and allergic reactions have been reported.

Figure 1.

 Chipped maxillary central incisor due to oral piercing.

Figure 2.

 Chipped mandibular first molar due to oral piercing.

Figure 3.

 Lingual gingival recession due to tongue piercing.

Studies of the factors influencing oral piercing complications have focused on specific pierced sites separately, such as the lip10 or tongue.11 Comparisons between lip and tongue piercings in terms of complications have not been thoroughly undertaken.

The purpose of the present cross-sectional study was to: (1) assess the prevalence of lip and tongue piercing complications in the dental and periodontal tissues of a population derived from a non-dental setting; (2) compare the prevalence of complications between lip and tongue piercing sites; and (3) explore the possible effect of the ornament time wear period, habits and ornament morphology on the development of complications. The possible effect of the periodontal biotype on periodontal complications was also examined.

Materials and Methods

One hundred and ten subjects (52 males and 58 females) with age range 18 to 35 years (mean age 21.25 ± 3.55 years) were recruited from the subject pool of four local tattoo–piercing studios.

The subject inclusion criteria were the presence of intra and/or perioral piercing. The exclusion criteria were as follows: known systemic disease or condition; need for medication that could affect the periodontal tissues; pregnancy or lactation; indication for antibiotic prophylaxis; simplified gingival index (GI) ≥0.30; periodontal defects (clinical attachment loss, periodontal pockets or gingival recession); abnormal toothwear and/or tooth chipping/cracking in teeth non-adjacent to pierced sites; and dental restorations (fillings, crowns, bridges) or high frenum attachment in teeth adjacent to pierced sites. In cases of abnormal tooth wear and/or tooth chipping/cracking, the subject was asked about the circumstances under which this occurred. Information on possible oral piercing complications was given and removal of oral piercings was advised.

Each subject signed an informed consent form prior to enrolment in the study. The study was conducted in accordance with the Helsinki Declaration of 1975, as revised in 2008 and was approved by the Ethics and Research Committee of the School of Dentistry, The University of Athens, Greece.

Questionnaire

Each subject filled a questionnaire on demographic data, medical and dental history, additional piercing in non-oral locations, oral piercing procedure, reason for oral piercing, time wear of oral ornament, awareness of oral piercing consequences and risks for general health, teeth and gingiva, occurrence of early and late oral piercing complications, ornament removal, ornament care and piercing habits (biting, rolling or sucking the ornament, striking the ornament on the adjacent to teeth).

Clinical examination

Each patient was subjected to a clinical examination at the Department of Periodontology, School of Dentistry, The University of Athens. The presence of ulcer (Fig. 4) or tissue overgrowth (Fig. 5) at the pierced site was documented. The following parameters were documented for each tooth: decay; abnormal toothwear and/or tooth chipping/cracking; GI;19 clinical attachment loss (CAL); probing pocket depth (PD); and gingival recession (GR). GR was classified by using Miller’s classification.20 Decay was assessed clinically by using a dental explorer (Asa Dental #0701-12). GI, CAL, PD and GR were assessed at 6 sites for each tooth by using a 15 mm calibrated periodontal probe (PCPUNC015; Hu-Friedy, Chicago, IL, USA). For each tooth adjacent to a pierced site, one CAL, PD and GR value was recorded; the worst CAL, PD and GR value of the dental surface adjacent to the piercing. Whenever more than one tooth adjacent to a pierced site was affected, the measurements concerning the tooth with the worst complications were documented. The periodontal (or gingival) biotype was assessed visually and classified into thin/pronounced scalloped and thick/flat biotype.21 The height of the ornament closure in relation to the cemento-enamel junction (CEJ) of the adjacent tooth and the stem length of the tongue ornaments were also recorded. The ornaments were classified in response to their location into lip (side and middle) and tongue (not tongue frenum) ornaments, in response to wear time (≤12 months, 13–36 months, >36 months) and in response to the height of the ornament closure (coronal to the CEJ, at the CEJ level, apical to the CEJ of the adjacent tooth). Tongue ornaments were classified according to the length of their stem into short (<1.59 cm) and long (≥1.59 cm) stem length ornaments11 (Fig. 6 and 7). The stem length of the tongue ornaments was measured by using calipers. All clinical measurements were performed by the same examiner (AP).

Figure 4.

 Ulcer at the piercing site.

Figure 5.

 Tissue overgrowth at the base of the tongue due to piercing.

Figure 6.

 Long stem length tongue ornament.

Figure 7.

 Size of a long stem length tongue ornament compared to a periodontal probe.

Statistical analysis

Data were described by ornament item. Continuous variables were expressed as mean ± standard deviation or median (Q1 – Q3) for normally and non-normally distributed variables respectively. Categorical variables were expressed as percentages. X2 or Fisher’s exact test for small numbers were used to check for associations between categorical variables. Non-parametric Mann–Whitney or Kruskal–Wallis tests were applied to examine for differences in continuous variables between two or more groups. Results were considered significant at the 5% significance level. The Bonferroni correction was used to adjust p-values for multiple testing. Statistical analysis was performed with the statistical package STATA 9.0 (Stata, College Station, TX, USA).

Results

Table 1 presents the subject characteristics in terms of piercing. The ornaments were located in the lower lip-side (58 ornaments), lower lip-middle (34 ornaments), upper lip-side (14 ornaments), upper lip-middle (4 ornaments) and tongue (51 ornaments). Seventy-eight subjects (71%) presented with piercing in more than one oral site. There were no subjects with piercing on both the tongue and the middle of the lower lip. Self-reported oral piercing complications were as follows: inflammation (53 subjects); GR (21 subjects); dentine hypersensitivity (21 subjects); increased salivary flow (15 subjects); taste change (11 subjects); generation of galvanic current (5 subjects); and deposits accumulation (34 subjects). Self-reported immediate post-piercing procedure complications were postoperative pain (in 93 pierced sites); chewing impairment (in 79 pierced sites); speaking impairment (in 54 pierced sites); ornament swallowing (in 78 sites); and severe haemorrhage (in 7 sites).

Table 1.   Subject characteristics concerning piercing (n = 110)
Parametersn%
  1. n = number of subjects.

  2. % = % of subjects.

Piercing procedure
 Piercing studio9081.8
 Self performed1412.7
 Jewellery store54.5
 Medical doctor10.9
Reason for piercing
 Cosmetics 7063.7
 Concept, self-expression2623.7
 Sexual76.3
 Social grouping43.6
 Peer pressure/fashion32.7
Awareness of oral piercing consequences for:
 General health
  Yes3229.1
  No7870.9
 Teeth
  Yes8173.6
  No2926.4
 Gingiva
  Yes5650.9
  No5449.1
Piercing location
 Only oral piercing3935.5
 Oral and non-oral piercing7164.5
Ornament removal
 Yes5550
 No5550
Reason for ornament removal
 Dental visit1211
 Physical exercise109
 Ornament cleaning3330
Method of ornament cleaning
 Antimicrobial solution1917.3
 Brushing1412.7

Table 2 shows the percentage of teeth adjacent to pierced sites that presented dental defects in terms of abnormal toothwear and/or tooth chipping/cracking (32.3%) and GR (39.7%), as well as the mean CAL and PD values of teeth adjacent to pierced sites. In 67 pierced sites (41 lip, 26 tongue; 41.6%), the adjacent tooth had CAL ≥1 mm, where the mean CAL was 3.4 (± 1.66) mm. In 20 pierced sites (9 lip, 11 tongue; 12.4%), the adjacent tooth presented CAL ≥2 mm with mean CAL 5.35 (± 1.66) mm. In 15 pierced sites (6 lip, 9 tongue; 9.3%), the adjacent tooth presented PD >3 mm with mean PD 4.42 (± 1.22) mm. A PD of ≥5 mm was found in 5 teeth adjacent to pierced sites (2 lip, 3 tongue) with mean PD 5.75 (± 1.79) mm.

Table 2.   Dental and soft tissue defects in the pierced site, GR, CAL and PD by group of time wear
ParametersIn totalTime period of wearp-value
(n = 161)≤12 m (n = 58)13–36 m (n = 61)>36 m (n = 42)
(n%)(n%)(n%)(n%)
  1. * = p-values were obtained by using Kruskal–Wallis test.

  2. ** = p-values were obtained by using X2 test.

  3. n = number of ornaments.

  4. % = % of ornaments.

  5. = clinical attachment loss.

  6. = probing pocket depth.

  7. m = months.

Dental defects
 No109 (67.7)48 (82.8)39 (63.9)22 (52.4)0.004**
 Yes 52 (32.3)10 (17.2)22 (36.1)20 (47.6)
Soft tissue defects     
 No 61 (37.9)37 (63.8)18 (29.5) 6 (14.3)<0.001**
 Ulcer 88 (54.7)20 (34.5)39 (63.9)29 (69.1)
Tissue overgrowth12 (7.5)1 (1.7)4 (6.6) 7 (16.7)
GR
 No 97 (60.3)44 (75.7)37 (60.7)16 (38.1)0.001**
 Yes 64 (39.7)14 (24.1)24 (39.3)26 (61.9)
 Mean ± SDMean ± SDMean ± SDMean ± SD 
CAL (mm)†2.04 ± 1.601.5 ± 1.11.9 ± 1.42.9 ± 2.1<0.001*
PD (mm)‡2.46 ± 0.932.2 ± 0.82.4 ± 0.82.8 ± 1.1<0.001*

The mean time wear period was 30.3 (± 30.9) months (range 1 to 144 months). Ornaments are presented by group of time wear in Table 2. The time period of ornament wear affected the prevalence of soft tissue defects at the pierced site, dental defects and soft tissue defects in the pierced site and GR as well as CAL and PD values (Table 2). Prevalence of dental defects for time wear ≤12 months was statistically significantly lower than for >36 months (p = 0.001 and p < 0.001, respectively) and for 13–36 months (p = 0.02 and p = 0.001 respectively). Prevalence of GR recession was significantly lower for time wear ≤12 months than for >36 months (p < 0.001) and for 13–36 months than for >36 months (p = 0.02). CAL values were significantly greater for time wear >36 months than for ≤12 months (p < 0.001) and 13–36 months (p = 0.002). PD values for time wear ≤12 months were significantly lower than for >36 months (p = 0.003) and marginally significantly lower than for 13–36 months (p = 0.06). Soft tissue overgrowth at the pierced site was observed only at the base of the tongue in subjects with tongue piercing.

The mean GR depth for affected teeth adjacent to ornaments was 2.67 (± 1.02) mm. Respective values for time wear ≤12, 13–36 and >36 months were 2.65 (± 1.58) mm, 2.73 (± 1.55) mm and 2.11 (± 1.22) mm. There were no statistically significant differences among them.

Ten (15.6%) GR defects were Miller Class II with mean depth 4.3 (± 1.15) mm. The wear time was between 13 to 36 months for 4 defects and >36 months for 6 defects. The rest, 54 (84.4%), were Miller Class I defects.

All piercing habits, except sucking, were statistically significantly associated with the presence of dental defects (Table 3). For lip piercing, sucking was positively associated with the presence of GR (Table 3).

Table 3.   Defects by piercing habits
HabitsDental defects
No (n = 109)Yes (n = 52)x2, p-value
n (%)n (%) 
  1. * = Restricted to lip piercing.

  2. n = number of ornaments.

  3. % = % of ornaments.

Biting
 No39 (81.3)9 (18.2)0.02
 Yes70 (62.0)43 (38.0)
Rolling
 No102 (72.9)38 (27.1)<0.001
 Yes7 (33.3)14 (66.7)
Striking
 No 97 (70.8)40 (29.2)0.04
 Yes12 (50.0)12 (50.0)
Sucking
 No75 (67.6)36 (32.4)0.96
 Yes34 (68.0)16 (32.0) 
 GR*
 No n = 70Yes n = 40x2, p-value
 n (%)n (%) 
Sucking
 No44 (73.3)16 (26.7)0.02
 Yes26 (52.0)24 (48.0) 

The presence of GR was statistically significantly associated with the height of the ornament closure in relation to the CEJ of the adjacent teeth (Table 4). In the presence of GR, for 84.1% of the ornaments the height of the closure was at the CEJ level. In the absence of GR, for 43.9% of the ornaments the height of the closure was apically to the CEJ level (Table 4). The mean CAL values differed significantly between the closure group at the CEJ level and the closure group coronally to the CEJ, as well as between the closure group at the CEJ level and the closure group apically to the CEJ (p = 0.0001, for both comparisons). These associations applied for PD values as well (p = 0.0001 and p = 0.004, respectively) (Table 4). In terms of screw cap material, 158 (98.1%) ornaments had metal screw cap; the rest (3; 1.9%) had acrylic screw cap. Therefore, exploration of the possible effect of ornament screw cap material was not feasible.

Table 4.   GR, CAL and PD by height of the ornament closure in relation to CEJ and by periodontal biotype
ParametersHeight of the closure in relation to CEJp-valuePeriodontal biotypep-value
Coronal (n = 36)At the (n = 75)Apical to (n = 50) Thin (N = 70)Thick (N = 40)
n (%)n (%)n (%)N (%*)N (%*)
  1. * = p-values were obtained by using Kruskal–Wallis test.

  2. ** = p-values were obtained by using Mann–Whitney test.

  3. *** = p-values were obtained by using X2 test.

  4. n = number of ornaments.

  5. % = % of ornaments.

  6. N = number of subjects.

  7. %* = % of subjects.

  8. † = clinical attachment loss.

  9. ‡ = probing pocket depth.

GR
 No33 (33.7) 22 (22.44)43 (43.9)<0.001***37 (52.9) 27 (67.5)0.13***
 Yes3 (4.8)53 (84.1) 7 (11.1)33 (47.1)13 (3.5)
 Mean ± SDMean ± SDMean ± SD Mean ± SDMean ± SD 
CAL (mm)†1.2 ± 0.5 2.7 ± 1.81.6 ± 1.3<0.001***2.1 ± 0.22.1 ± 0.30.36**
PD (mm)‡2.0 ± 0.62.8 ± 1.12.3 ± 0.7<0.001*2.4 ± 0.12.4 ± 0.10.78**

The periodontal biotype was not statistically significantly associated with the presence of GR, CAL and PD values (Table 4). For tongue piercing, the presence of GR was statistically significantly associated with long stem length (Table 5). The pierced site (lip, tongue) was associated with the presence of dental defects but it was not associated with the presence of GR, PD and CAL values (Table 6). For GR defects, all lingual defects were associated with tongue piercings and all buccal defects with lip piercings. PD and CAL values did not differ significantly between the tongue and lip piercing groups (z = 1.8, p = 0.06 and z = 1.5, p = 0.12 respectively) (Table 6).

Table 5.   Dental defects, GR, CAL and PD by stem length group
ParametersStem length*p-value
Dental defectsShort (n = 38)Long (n = 13)
n (%)n (%)
  1. * = Restricted to tongue piercing.

  2. ** = p-values were obtained by using Mann–Whitney test.

  3. *** = p-values were obtained by using X2 test.

  4. n = number of tongue ornaments.

  5. % = % of tongue ornaments.

  6. † = clinical attachment loss.

  7. ‡ = probing pocket depth.

No21 (55.3)6 (46.2)0.57***
Yes17 (44.7)7 (53.8) 
GRn (%)n (%) 
No23 (60.5)4 (30.8)0.06***
Yes15 (39.5)9 (69.2)
 Mean ± SDMean ± SD 
CAL (mm)2.2 ± 0.33 ± 0.70.16**
PD (mm)2.6 ± 0.22.7 ± 0.20.40**
Table 6.   Pierced site and defects per time period of wear
Pierced siteIn total (irrespective of time wear)Time wear ≤12 monthsTime wear 13–36 monthsTime wear >36 months
DDGRCAL (mm)PD (mm)nDDGRCAL (mm)PD (mm)nDDGRCAL (mm)PD (mm)nDDGRCAL (mm)PD (mm)n
nnMean ± SDMean ± SDnnMean ± SDMean ± SDnnMean ± SDMean ± SDnnMean ± SDMean ± SD
NoYesNoYesNoYesNoYesNoYesNoYesNoYesNoYes
  1. * = p-values were obtained by using Mann–Whitney test.

  2. ** = p-values were obtained by using Fisher’s exact test.

  3. *** = p-values were obtained by using Kruskal–Wallis test.

  4. CAL = clinical attachment loss.

  5. PD = probing pocket depth.

  6. n = number of ornaments.

  7. DD = dental defects.

  8. GR = gingival recession.

Lip822870401.9 ± 1.32.3 ± 0.71102862681.5 ± 0.92.2 ± 0.73436133341.8 ± 1.42.3 ± 0.84918911162.5 ± 1.52.5 ± 0.827
Tongue272427242.4 ± 2.02.7 ± 1.2512041861.6 ± 1.32.3 ± 0.92439482.4 ± 1.42.8 ± 1.1124115103.7 ± 2.73.3 ± 1.515
p-value0.006**0.20**0.12*0.06* 0.92**0.90**0.85*0.35* 0.002**0.03**0.06*0.17* 0.01**0.64**0.22***0.08*** 

Stratification of data in relation to the time period of ornament wear revealed that for wear time ≤12 months, the presence of dental defects, GR, PD and CAL values were not statistically significantly associated with the pierced site. For time wear between 13 and 36 months and ≥36 months, there was statistically significant association between the pierced site and dental defects with greater prevalence of defects for the tongue group. The same applied for GR for time wear between 13 and 36 months with greater prevalence of GR in the tongue group (Table 6).

Discussion

The present cross-sectional study assessed the complications of intraoral and perioral piercing on the dental and periodontal tissues in a group of 110 subjects with mean age 21.25 (± 3.55 years). A total of 161 pierced sites were evaluated with mean time of ornament wear 30.3 (± 30.9) months. Most subjects had more than one intraoral and perioral pierced site, therefore the ornament instead of the patient was the unit of statistical analysis.

For most subjects the piercing procedure was performed in a piercing studio (81.8%), while only one subject had the piercing performed by a medical doctor. The present findings are in accordance with results by Garcia-Pola et al. 22 who found that 80.8% of piercing procedures were performed in a piercing studio and by Kieser et al.23 who reported that only 9.3% of subjects had their piercing performed by a medical doctor or dentist. Cosmetics was the main reason for piercing in the present study which is consistent with Garcia-Pola et al.22 It is important to note that less than one-third of the present pierced subjects cleaned the ornament regularly. The present study revealed that a significant percentage of pierced subjects were not aware of the oral health consequences of piercing and were better informed of the possible piercing consequences for teeth rather than the gingiva.

The high prevalence of postoperative pain and the low prevalence of postoperative severe haemorrhage found in the present study was in accordance with Garcia-Pola et al.22 The percentage of subjects who reported complications is higher in the present study than in the Kieser et al. study.23 Inflammation was the most frequently self-reported complication for the present subject population. The present findings on increased salivary flow rate, as self-reported, are in accordance with the findings of Ventäet al.3 who objectively assessed salivary flow.

In the present study, almost one-third of teeth adjacent to pierced sites presented abnormal toothwear and/or tooth chipping/cracking and more than one-third of teeth adjacent to pierced sites presented with GR. Prevalence of abnormal toothwear and/or tooth chipping/cracking was greater for tongue than lip piercing, although prevalence of GR was similar for tongue and lip piercing. Vilchez-Perez et al.24 demonstrated that prevalence of GR, abnormal toothwear, tooth fractures and cracks was higher at the pierced than the unpierced side of the lip. Leichter and Monteith25 and Kapferer et al.10 reported greater GR prevalence in subjects with lip piercing than in unpierced subjects. Both Kieser et al.23 and Kapferer et al.10 failed to find a significant association between piercing and abnormal toothwear. In the present study, the time period of ornament wear affected the condition of the soft tissues at the pierced site and the condition of the dental and periodontal tissues of teeth adjacent to the pierced sites, as statistically significant differences (in the prevalence of dental, soft tissue and periodontal defects) were detected among the three time wear periods (≤12 months, 13–36 months, >36 months). A significant association between time wear and buccal GR has previously been reported by Kapferer et al.10

For the affected sites, the mean GR depth found in the present study (2.65 mm) was similar to that reported by Campbell et al. (2.53 mm).11 Most of the recession defects were Miller Class I defects; only a few were Miller Class II. The percentage of Miller Class II defects (15.64%) found here is consistent with that reported by Leichter and Monteith25 for Miller Class II and III defects (18.7%).

In the present study, there was a significant positive association between the stem length of the tongue piercing and the presence of GR, which is consistent with results by Campbell et al.11

The present findings of the existence of an association between the presence of GR and ornament closure in relation to the CEJ of the adjacent teeth are in accordance with previous findings by Kapferer et al.10 Furthermore, the present findings and the results by Kapferer et al.10 are consistent in the absence of a significant association between the periodontal biotype and the prevalence of GR.

The present findings of the effect of piercing habits on dental defects and GR cannot be compared to previous findings since, to the authors’ knowledge, this question has not yet been addressed in the literature.

The present study has limitations, mainly concerning the lack of an unpierced control subject group, which would have allowed for comparisons of abnormal toothwear, tooth chipping/cracking, gingival margin level and CAL.

Dentists should inform patients, especially younger patients, of oral piercing consequences for teeth and the gingiva, and advise them to avoid or remove oral piercings. In cases where the patient chooses oral piercings despite being advised to the contrary, it is the dentist’s responsibility to educate the patient on proper ornament care and regular professional oral monitoring. The patient should be informed that the longer the wear time, the greater the chance to present with oral complications and that piercing habits increase the possibility of developing dental defects and GR. Pierced patients should be recalled frequently to ensure early detection of possible dental or periodontal complications. The dentist should document the existence of piercings and their characteristics concerning location, wear time, habits and long tongue piercing stem length. Long wear time increases the possibility of both dental defects and GR. Dental defects are more frequent with tongue piercing, whereas GR is similarly frequent for tongue and lip piercing. Long stem length tongue ornaments have a greater potential to cause GR.

Conclusions

Within the limitations of the present study, the following conclusions could be drawn: approximately one-third of teeth adjacent to pierced sites present abnormal tooth wear and/or tooth chipping/cracking or GR. The prevalence of abnormal tooth wear and/or tooth chipping/cracking is greater for tongue than lip piercing. The prevalence of GR is similar for tongue and lip piercing. Longer wear time of tongue and lip piercing is associated with greater prevalence of abnormal tooth wear and/or tooth chipping/cracking and GR, as well as greater attachment loss and probing pocket depth of teeth adjacent to pierced sites. The stem length of the tongue ornament and the height of the ornament closure in relation to the CEJ of the adjacent teeth affects the prevalence of GR.

Ancillary