Oral piercing and oral complications

tongue piercing

Piercings have an ancient history stretching back to the Neolithic. Once considered unusual they have now become more common place. However, oral piercings are not without their complications with reports of pain, swelling, infection, bleeding, chipped teeth, gum damage, swallowing, and aspiration of the adornment.

The aim of the review was to examine the association between oral manifestations and the use of oral piercings.


A protocol for the review was registered in PROSPERO. Searches were conducted in the Cochrane Library, Medline/PubMed, Scopus, Embase, Web of Science, Virtual Health Library, OpenGrey and Google Scholar databases. Randomised clinical trials (RCTs), controlled clinical trials (CCTs), cohort studies, case- control studies, cross-sectional studies, and case series of oral piercings, jewellery, or expanders, with at least 10 patients were considered. Two reviewers independently selected studies extracted data and assessed study quality using criteria from the Joanna Briggs Institute (JBI). Event rate (ER) and 95% confidence intervals (CI) were used to measure outcomes. Meta-analyses were conducted, and the certainty of the evidence was assessed using the  GRADE approach.


  • 54 studies (36 cross-sectional, 14, case-control, 3 cohorts, one quasi-experimental) were included.
  • 27 studies were from Europe, South America 11, North America 8, Asia 4, Oceania 3 and one from Africa.
  • 39 evaluated tongue piercing, 29 lip piercing and 11 other locations (tongue or
  • lip frenulum and cheek).
  • Complications and consequences were usually self-reported using questionnaires and interviews.
  • Most studies did not report the timing of complications, when report it was either immediate, early (≤ 6 months) or late (> 6 months)
  • The most reported complication was pain 15 studies, infection (12), swelling (11), bleeding (10), and inflammation 9 studies.
  • The most reported alterations were in speech (18 studies) mastication, deglutition, or taste (16 studies), followed by problems related to plaque of calculus formation (13 studies).
  • Soft tissue or mucosal injuries related to oral piercings were described in 13 studies, Fibrous hyperplasia (8), mucosal atrophy (6), macules, ulcers, papules, nodules, and bruises (4); lesions on the hard palate (2); and one lichenoid reaction.
  • Periodontal issues (gingival recession, gingival injury, periodontitis, gingivitis and dental mobility) were reported in 38 studies.
  • Tooth damage (tooth fracture, chipping, dental hypersensitivity) was reported in 37 studies.
  • Event rate meta-analyses are shown in the table below
  No of studies Event rate (95% CI)
Gingival recession (GR) 26 32.9% (24.7% to 42.4%)
Non-specified dental damage (NSDD) 4 27.0% (7.4% to 63.0%)
Tooth chipping/enamel infraction 10 21.9% (11.3% to 38.1%)


  • Gingival recession and dental fractures were significantly associated with oral piercings but not tooth chipping or enamel infraction (see table)
  No of studies Odds ratio(95%CI)
Gingival recession 8 7.085 (4.252 to 11.805)
Dental fracture 7 3.293 (1.868 to 5.807
Tooth chipping/enamel infraction 3 2.234 (0.737 to 6.775)
  • Overall certainty of evidence was very low for all reported outcomes.


The authors concluded: –

Alterations, complications, and lesions were associated with oral piercings, of which gingival recession, dental fracture, and non-specific dental damage were the most prevalent associated manifestations. Gingival recession and dental fracture were associated with the use of piercings, and the odds of having these events were significantly higher among piercing users. The anatomic location of the piercings did not influence the results of the meta-analyses. However, the certainty of evidence was low for these outcomes. We recommend conducting studies with high methodological quality to improve the evidence.


A broad range of databases were searched for this review and while 54 studies were included the majority (36) were cross-sectional in nature with only 15 studies being considered to be of good methodological quality. 43 of the studies involved a clinical examination and complications were typically self-reported using questionnaires so recall bias could be an issue. The authors indicate that most of the studies demonstrated problems related to reporting and consideration of confounders or lack of information related to the piercings.  While the meta-analyses only included studies were outcomes were directly observed by clinicians a direct relationship between the oral complications and piercings cannot be ascribed because of the cross-sectional nature of the majority of included studies.  The review found that damage to periodontal health and tooth structure were the most commonly reported complication in patients with oral piercings however the quality of the evidence is of very low certainty.


Primary Paper

Passos PF, Pintor AVB, Marañón-Vásquez GA, Campos T, Abrahão AC, Ferreira DMTP, Maia LC, Primo LG, Visconti MA. Oral manifestations arising from oral piercings: A systematic review and meta-analyses. Oral Surg Oral Med Oral Pathol Oral Radiol. 2022 May 6:S2212-4403(22)00968-3. doi: 10.1016/j.oooo.2022.04.051. Epub ahead of print. PMID: 35773168.

Review protocol on PROSPERO

Other references

Dental Elf – 19th Feb 2015

Oral piercings-tooth and gum damage common suggests review

Picture Credits

Photo by Lorenzo Nafissi on Unsplash



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