10.59987/ads/2014.4.128-130
Objective. Specific regulations about education and training for body piercing licensure courses have to be considered due to the great increase in oral piercing practices. The aim of the present survey was to assess the local and systemic risk awareness in the practice of oral piercing and their prevention in a sample of Italian piercers.
Materials and methods. An anonymous 20-item questionnaire was administered to 30 body licensed piercers in a small town of central Italy. Licenses certificates were issued by Lazio Region after the completion of an approved training program for standard body piercing including 90 hours of course and a final examination as provided by regional law. The questionnaire surveyed on oral cavity anatomy, local and systemic risks as result of oral piercing, piercing maintenance and need of a dental visit.
Results. Response rate was 66.6%. Only 20% of respondents was aware about oral cavity anatomy and none had knowledge about tongue and gums anatomy. Only 10% enlightened the need of a dental visit and 30% was aware about piercingrelated temporary paralysis. The piercing maintenance was habitually proposed only by 40% of respondents.
Conclusion. The study participants showed a low level of awareness regarding the potential health risks of oral piercing. Poor knowledge of anatomy and local and systemic risks and poor awareness of the importance of piercing maintenance explanation.
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Annali di stomatologia
oral complications
Awareness of risks related to oral piercing in Italian piercers. Pilot study in Lazio Region
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Ann Stomatol (Roma)
L. Ottolenghi 
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oral complications
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Awareness of risks related to oral piercing in Italian piercers. Pilot study in Lazio Region
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                                                                                               Original article



    Awareness of risks related to oral piercing in Italian
    piercers. Pilot study in Lazio Region




                                                                                                  i
                                                                                                al
                                                                                             on
    Iole Vozza, DDS, PhD                                 level of awareness regarding the potential health
    Francesca Fusco, BSDH                                risks of oral piercing. Poor knowledge of anato-
    Ercole Bove, MD, DDS                                 my and local and systemic risks and poor aware-
    Francesca Ripari, DDS                                ness of the importance of piercing maintenance
    Denise Corridore, DDS                                explanation.




                                                                                   zi
    Livia Ottolenghi, DDS
                                                         Key words: oral piercing, oral health, oral complica-
                                                         tions.




                                                                     na
    Oral and Maxillo-facial Sciences Department,
    “Sapienza” University of Rome, Italy
                                                         Introduction




                                                           er
    Corresponding author:                                The practice of piercing has ancient origins. The main
    Iole Vozza DDS, PhD                                  purpose was to distinguish the roles played by each
    Oral and Maxillo-facial Sciences Department          member within the tribe, in order to regulate the rela-
    “Sapienza” University of Rome                        tionship between the various individuals daily and
    Via Caserta, 6


                                                     t   during ceremonies (1). Over the past two decades
    00161 Rome, Italy
    Phone: +390649976612
                                                  In     body piercing exceed from the limits of the typically
                                                         underground environment to become common prac-
    Fax: +390644230811                                   tice among youngsters and artists. Its recent spread
    E-mail:iole.vozza@uniroma1.it                        among young people rise the issue of potential health
                                                         complications (2). The international guidelines pay at-
                                       ni
                                                         tention especially on security measures and jewelry
                                                         materials, but there are no directions on piercing in
    Summary                                              terms of hygiene and maintenance (3), even though
                               io

                                                         in some country cardiopulmonary resuscitation, basic
    Objective. Specific regulations about education      first aid and blood borne pathogens trainings from an
    and training for body piercing licensure courses     agency-approved provider is required.
    have to be considered due to the great increase in   Oral piercing can be applied in different anatomical
                       iz



    oral piercing practices. The aim of the present      areas: lips, tongue, cheeks, uvula, lingual and labial
    survey was to assess the local and systemic risk     frenulum in decreasing percentage (4).
    awareness in the practice of oral piercing and       Complications of oral piercings have been discussed
          Ed




    their prevention in a sample of Italian piercers.    in literature and include local and general complica-
    Materials and methods. An anonymous 20-item          tion, with potentially severe health consequences.
    questionnaire was administered to 30 body li-        These include cross-infection (HIV, HCV, HAV, HBV
    censed piercers in a small town of central Italy.    and HSV), bacterial and viral problems (endocarditis,
    Licenses certificates were issued by Lazio Region    Focal Disease, Gingivitis, Lingual abscess), short and
    after the completion of an approved training pro-    long-term local issues related to piercings (ageusia,
IC




    gram for standard body piercing including 90         hypogeusia, gingival recession, diastema, chipping or
    hours of course and a final examination as pro-      dental fracture and scialorrhea) and allergic reactions
    vided by regional law. The questionnaire sur-        to the jewelry materials (2,5-8).
    veyed on oral cavity anatomy, local and systemic     As trend of body piercing grow in popularity, under-
C




    risks as result of oral piercing, piercing mainte-   standing the procedures’risks as well as medical
    nance and need of a dental visit.                    and psychosocial implications of wearing piercing
    Results. Response rate was 66.6%. Only 20% of        jewelry is important for health practitioners. It would
    respondents was aware about oral cavity anato-       be advisable for sanitary authorities to establish reg-
©




    my and none had knowledge about tongue and           ulating legislation for body piercing license. Some
    gums anatomy. Only 10% enlightened the need of       countries have already laid down different standards
    a dental visit and 30% was aware about piercing-     and technical criteria, which in certain cases have
    related temporary paralysis. The piercing mainte-    been appended to the legislation applied to hair-
    nance was habitually proposed only by 40% of         dressers’ shops and beauty salons, as well as to se-
    respondents.                                         curity measures applied in multiple fields to prevent
    Conclusion. The study participants showed a low      the transmission of infectious diseases. However, in

    128                                                                   Annali di Stomatologia 2014; V (4): 128-130
    Awareness of risks related to oral piercing in Italian piercers. Pilot study in Lazio Region


    other cases, specific regulations have been consid-               Results
    ered. European Standard UNI EN 18.10 on 10 th
    September 2002 focuses purely on sanitation stan-                 Twenty out of the 30 involved licensed piercers an-
    dards of sterilization and disinfection and on trade              swered the survey, with a response rate of 66.6%.
    regulations.                                                      The results of this survey are summarized in Figures




                                                                                                              i
    In Italy, despite the strong expansion of the tattoo              1 and 2.




                                                                                                            al
    and piercing phenomenon, there is no methodical
    regulation of the matter. The only relevant national
    legislation dates back to 1998 and is represented by              Anatomical knowledge




                                                                                                         on
    the “Guidelines issued by the Ministry of Health for
    the execution of tattoos and piercings in safety”.                Only 4 out of 20 respondents (20%) showed aware-
    (Notes N. 2.8/156 of 5 February 1998 and n.2.8/633                ness of oral anatomy, while the remaining 16 de-
    of 16 July 1998). The objective of these guidelines is            clared they had not discussed the issue during the
    to prevent improvised operators or malpractice (9). In            training course. All the respondents (100%) were un-




                                                                                                   zi
    fact, although the tattoo and piercing are not medical            aware of tongue and gums anatomy, the topic having
    practices, their execution is extremely delicate and              not been addressed during the training course.
    requires appropriate safeguards in hygiene standards




                                                                                    na
    (10). Requirements for licensees, education and
    training of piercers, number of hours to attend and               Piercing-related risks, maintenance and dental visit
    topics to be discussed during the course, are taken
    by the Region of residence. This leads to a not uni-              Only 6 out of 20 (30%) declared to habitually explain




                                                                        er
    form preparation of piercers/tattooists throughout the            to their customer spiercing-related risks and mainte-
    country. In Lazio Region the training is based on 90              nance instructions. Methods of maintenance such as
    hours of course (Regional Law 4796/1998) while, for
    example, in Tuscan Region the hours to attend are
    600 (Regional Law 28/2004).


                                                             t
    The goal of this work is to assess the awareness of
                                                          In
    risks in the practice of oral piercing and their preven-
    tion in a sample of Lazio Region-based piercers.
                                                  ni
    Materials and methods

    In September 2013 an anonymous 20-item survey
                                    io

    was administered to 30 body piercers (both sexes,
    aged between 27 and 42 years old) living and working
    in the Province of Latina, Lazio Region. The question-
    naire collected data on oral cavity anatomy, local and
                           iz



    systemic risks as result of oral piercing and piercing
    maintenance. All piercers were licensed by a certifi-
    cated Lazio Region training course, that includes the
          Ed




                                                                      Figure 1. Knowledge of anatomy, risks and maintenance of
    attendance of 90 hours and a final examination, as
                                                                      oral piercing among operators.
    provided by regional law. Each piercer answered the
    questions at his own office and the considered vari-
    ables were:
    - knowledge of the anatomy of oral cavity, tongue
        and gingivae;
IC




    - knowledge of the methods of sterilization and
        blood-borne infections (HIV, HCV and HBV);
    - details on local piercing-related risks such as:
        ageusia, hypogeusia, endocarditis, allergic reac-
C




        tions to the materials used, lingual abscesses,
        gum disease, gingival recession, tooth chipping or
        fracture, diastema and hypersalivation;
    - details on piercing maintenance through mouth-
©




        washes rinses, antiseptic gels or creams, brush-
        ing of piercing bar and need of a dental visit.
    At the end of the survey we distributed to all partici-
    pants an explanatory brochure containing a brief de-
    scription of the potential complications, modes of
    piercing maintenance and the advice for a dental visit            Figure 2. Knowledge of systemic risks related to piercing
    at least once after piercing.                                     among operators.


    Annali di Stomatologia 2014; V (4): 128-130                                                                            129
    I. Vozza et al.


    mouthwash rinses, antiseptic gels and creams and          cessity that emerges from the results of the present
    piercing barbrushing, were explained by 8 out of 20       pilot survey is to operate in order to improve the
    operators (40%), whereas the remaining 12 habitually      health-related contents of tattoo artists and piercers
    omitted this step (60%).                                  course, and to increase information regarding these
    Dental visit was recommended by 2 respondents             issues in schools among youngsters. Due to its po-




                                                                                                            i
    (10%) while the remaining 18 (90%) stated they had        tential risks it is important for oral health care profes-




                                                                                                          al
    never thought about recommending a dental visit.          sionals to become familiar with the characteristics of
                                                              each type of piercing in order to act accordingly (14).
                                                              How can users be aware of piercing-related health is-




                                                                                                       on
    Systemic and local risks related to piercing              sues if the operators themselves are unaware? Fur-
                                                              ther research in this area is necessary. The sustain-
    With regard to blood borne viral infection, knowledge     ability of the collected data needs to be established in
    and understanding (11) was encouraging: the whole         further studies with a greater samples.
    sample (100%) declared they had dealt extensively




                                                                                             zi
    disinfection and sterilization methods and HIV cross-
    infections during the training course, 90% (18 out of     References
    20) reported to be aware of HCV infection risk and




                                                                             na
    80% (16 out of 20) claimed to be aware of HAV and          1. Choe J, Almas K, Schoor R. Tongue piercing as risk factor
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                                                                  a mini review. J Investig Clin Dent. 2012 May;3(2):95-7.




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                                                        t
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IC




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©




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    130                                                                            Annali di Stomatologia 2014; V (4): 128-130
