Oral and perioral piercings have been performed on the tongue, lips, cheeks and the uvula, presumably as a form of artistic or self-expression of identity or belonging. However, what the general public does not know is the adverse local and systemic complications associated with such practice that have been reported in the medical literature.

Like any other form of invasive procedures performed on the human body, a good working knowledge of the clinical anatomy of the sites involved like knowing where the major blood vessels and nerves are, is important for a safe practice. Furthermore, proper infection control protocol, if not adhered to, can result in serious infection.

The United States National Institutes of Health has identified piercing as a possible vector for bloodborne hepatitis (hepatitis B, C, D and G) transmission. It is conceivable that other serious conditions like HIV infection could be transmitted this way although this has not been reported in the literature.

Pain, swelling and bleeding are some of the immediate complications. The tongue is a highly vascular structure, and severe haemorrhage can occur if one of its major arteries is punctured during piercing. Haemorrhage and significant swelling of the tongue can lead to airway obstruction.

Localised infection and several cases of more serious life-threatening infections involving the head and neck that severely compromises the patient's airway have also been reported in the literature. Sometimes these adornment comes loose and aspiration of such foreign objects not only poses an airway problem but also risk injuries to the respiratory organs.

Other less adverse complications noted in the American Dental Association's (ADA) Position Statements on Intraoral/Perioral piercing and tongue splitting are: gingival injury, damage to teeth and restorations, interference with speech, mastication and scar formation.

Because of its potential for numerous negative sequelae, the ADA opposes the practice of intraoral/perioral piercing. Media report on these complications is rare, if at all. On the contrary, many media personalities are seen flaunting their intraoral, perioral and facial adornment. The public as well as health-care practitioners should be educated to provide appropriate guidance on this practice.

Dr Loh Fun Chee