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Glenn D. Braunstein, M.D. Headshot

Drilling Down on Body Piercing Health Issues

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As a canvas for self-expression, the human body has few limits: Just walk into any coffee house or hip lounge and you will see patrons with tongues adorned with metal studs, earlobes "gauged" (plugged) with holes the size of quarters, maybe even a neck or temple bedazzled with microdermal anchors.

Microdermal anchors, also called single-point piercings or microdermal piercings, are relatively new and look as if jewelry is screwed directly into the body. The piercing includes a titanium anchor that is implanted with a dermal punch or needle underneath the skin, with a protruding step into which interchangeable jewelry can be screwed.

And to think parents once freaked out over Mohawks and pink hair? Well, like it or not Mom and Dad, piercings from head to toe -- and pretty much everywhere in between -- have gone mainstream. No longer just a fashion or social statement of gangs, bohemians and cults, an estimated 36 percent of Americans, more women than men, sport at least one piercing somewhere other than an earlobe. For young adults -- those dubbed Millennials -- that number is one-in-four, according to a recent Pew Research study. Other research suggests the figure is as high as 56 percent for those between the ages of 17 and 25. Just because body piercing is popular, though, doesn't mean it's risk-free or well regulated.

Complications Minor, Sometimes Serious

Complications -- usually minor but sometimes serious and on rare occasion, life threatening -- occur in 17 percent to 35 percent of all body piercings, research shows. Problems most often are the result of a lack of experience or hygienic practice of the practitioner, materials used or a lack of proper aftercare by the recipient. Also, each piercing site on the body carries its own specific set of potential risks. Overall, the most common issues are: infection, allergic reactions, swelling, bleeding, scarring, pain and slow healing time.

Infection occurs in up to 20 percent of piercings. Typically, it is minor and localized at the site of the piercing. But in rare instances infection spreads to the entire body and can lead to life threatening complications, such as a brain abscess or endorcarditis (an infection of the inner lining of the heart).

The navel is among the sites at greatest risk for infection because of increased skin moisture and the friction caused by rubbing against clothes. Tongues also are more infection-prone, due to of the high levels of bacteria in the mouth. Between 2002 and 2008, an estimated 24,459 patients visited emergency rooms with oral piercing-related injuries, mostly infection and mucosal overgrowth.

Chips, Wrecking Ball Fractures

A small amount of blood is normal with any piercing, but hemorrhaging can be a serious, albeit infrequent, complication. This risk is greatest with penile and tongue piercings, because these appendages have numerous small blood vessels.

The most common complications connected to tongue piercings, however, are the bane of dentists: receding gums (gingivitis) and chips and fractures of teeth. Chips and fractures are caused by the pervasive habit of knocking, clacking, biting, clenching, or tapping jewelry against the teeth. Other issues include, eating problems, speech impediment, drooling, taste loss and scarring. It's not unusual for the tongue to swell after being punctured, but in some cases the tongue swells so much that it can cut off breathing. In rare instances, a doctor may have to pass a breathing tube through a patient's nose until the swelling goes down. No surprise, piercing ornaments have also been accidentally ingested. Those with oral piercing must learn to chew differently to avoid biting on the piercing. Tongue-piercing balls can easily get caught between teeth and cause damage. Dentists often refer to this as the wrecking-ball fracture. Both tongue and nasal piercings can also become embedded and require surgical removal.

A recent Mayo Clinic study among college students suggests that a tongue piercing may prove to be more trouble than it's worth. About half the participants who had tongue piercings eventually let them close.

Piercings of the ear cartilage can result in disfigurement if serious infection develops. The cartilage can collapse, leaving a "cauliflower ear" appearance. Repair requires delicate plastic surgery and accompanying treatment that can involve steroid injections. Plastic surgery also may be the remedy when it comes to restoring earlobes that have been stretched and gauged with large holes from ear expanders. This will depend, in part, how big the holes are.

Other site specific hazards: The Prince Albert, the most common male genital piercing that perforates the urinary meatus and corona, may affect urinary flow; nasal piercings may cause septal hematomas, edema and extra mucous formation.

Trendy -- and Historic

Despite the recent explosion of body piercing among youth, men, women and children have practiced piercing across the globe for thousands of years. Even some of today's seemingly extreme, alternative trends have historic roots. Ancient Mayans, for example, stretched their earlobes to accommodate gauges and ear expanders, also called earplugs. In Zulu culture, earplugs were part of a coming-of-age ceremony, symbolizing a child's ears opening to an adult understanding of life. Lip piercing was embraced by Alaskan Eskimos up to the late 19th century to exhibit social status.

One liability early piercing aficionados didn't worry about was setting off airport metal detectors. While their modern-day counterparts are likely aware of that potential scenario, they may not know that piercings also can interfere with medical procedures. Jewelry left in place during an MRI, for example, can distort the image or even injure the patient. It can disrupt or cause burns during surgery with electrocautery, a procedure that uses an electrical current and can create difficulty with the placement of medical devices such as a cervical collar or urinary catheter. Patients should remove jewelry before these procedures, but in cases of emergencies, removal can pose difficulty for medical personnel: removing microdermal anchors is challenging because an incision is required to take out the implant.

Athletes should remove jewelry before playing contact sports. Wearing a mouth guard and tongue jewelry is hazardous, warns the Academy of General Dentistry. Jewelry can interfere with the mouth guard and cause excessive saliva and gagging or hinder breathing or speech. Women are advised to remove navel piercings during pregnancy. Abdominal distension can cause rejection of the jewelry, migration and stretch marks.

Other well-known potential risks of body piercing include: transmission of blood borne infections like hepatitis; scarring, including keloids and allergic reactions. The most prevalent allergic reaction is to nickel, though silver jewelry can cause poisoning in which leaching of silver salts discolors the skin. Skin tears, caused by jewelry catching on objects like clothing, are common, too.

Care in Personal Choices

Who shouldn't undergo the piercing needle? Those with compromised immune systems or who take blood-thinning medication should refrain from body piercing, as they are at a higher-risk for infection or bleeding. Pregnant women or those seeking to get pregnant, should refrain, as well. Those with heart conditions may be advised against piercing, though opinions on this vary, so be sure to check with your cardiologist.

After assessing the risks, if you still decide to get pierced, don't do it yourself. This isn't a haircut. Find an experienced professional. Unlike some countries in Europe, regulations here vary from state to state, even county to county. In Los Angeles, piercers must hold a county health permit, administer client questionnaires, be vaccinated, receive blood-borne pathogen training and maintain sanitary conditions; here piercers may perform microdermals. But in several states, including Florida, Nevada and New Jersey they may not. Medical boards in those jurisdictions have declared dermal punches, the tool most commonly used in the procedure, to be medical equipment that may only be used by physicians. Minors legally may not get body piercings without written parental consent in 31 states, including California.

But for those of age, only you can decide whether body piercing is a pain worth the gain. Beauty, as we all know, is in the eye of the beholder. As I've written regarding tattoos, while I offer no moral nor aesthetic judgment to would-be piercers, they should just be aware that today's trendy practices change in a blink. And while most piercings will close over time, there are medical risks to sticking needles and objects in the body and these may leave long, even a lifetime of regrets for a passing fancy.