Metastatic Infection Following Ear Piercing Detected by FDG PET/CT

ABSTRACT

Ear piercing is currently a common practice. Although rare, ear piercing can cause systemic infections. We present a case of an 18-year-old woman who underwent FDG PET/CT for prolonged fever and bacteremia. FDG PET/CT showed multifocal FDG uptake at the site of piercing in the left ear, and in the spleen and left atrium and deep thigh vessel. The patient was diagnosed with an ear piercing infection with multiple metastatic infections.

Successful Regenerative Therapy of Periodontal Defects Associated With Tongue Piercing: A Clinical Report

Oral piercing habits are associated with various degrees of complications. Tongue piercing increases the risk of gingival recession and infrabony defects, subsequently leading to localized periodontitis. In the case presented, the patient had persistent swelling and suppuration around her mandibular anterior teeth attributed to tongue piercing jewelry that was placed approximately 12 years prior. Intraoral examinations revealed a localized deep pocket, purulent discharge, swelling, plaque accumulation, bleeding on probing, gingival recession, and teeth mobility. The patient was diagnosed with localized stage III, grade C periodontitis. Following full-mouth debridement and the placement of an extracoronal lingual splint, minimally invasive, papillae-sparing incisions were made, and regenerative therapy with bone allograft and collagen membrane was used to manage the infrabony defects. During the 18-month postoperative follow-up, complete soft-tissue healing was observed along with a significant reduction in pocket depth and the absence of bleeding on probing or suppuration. Radiographic evaluation showed evidence of bone fill. The reported case demonstrates how careful diagnosis and treatment planning are crucial for managing different periodontal defects and emphasizes the importance of proficient periodontal management, which can save teeth that would otherwise be extracted and replaced with implant therapy or fixed bridgework.

Impact of oral piercings on periodontal health - A systematic review

AIM

Evidence on the impact of oral piercings on periodontal conditions is scarce. Thus, the aim of this systematic review was to evaluate the influence of oral piercings on periodontal health.

MATERIALS AND METHODS

A systematic literature search was performed for studies published by 6 June 2023, using three electronic databases and a hand search. Clinical trials including ≥10 patients wearing ≥1 oral piercing and presenting data on probing pocket depths (PPDs) were considered. Primary outcomes were PPD, and secondary outcomes included clinical attachment loss (CAL), gingival recession, bleeding on probing (BOP), and plaque score (PI). A synthesis of results, using a vote-counting method, was applied.

RESULTS

From 131 titles identified, eight studies, published between 2007 and 2022, were included. Out of these were six cross-sectional studies and two case series. A total of 236 lip piercings and 236 tongue piercings in overall 408 patients were analyzed. In patients with tongue piercings, teeth adjacent to the piercing showed increased PPD (3 of 5 studies), more CAL (3 of 4 studies), more gingival recessions (4 of 4 studies) and a higher BOP (2 of 3 studies) compared with control teeth. In patients with lip piercings, teeth adjacent to the piercing demonstrated more gingival recessions (3 of 4 studies) compared with control teeth. Time since piercing placement was associated with localized periodontal destruction in patients with tongue and/or lip piercings (4 of 7 studies).

CONCLUSIONS

The available evidence from eight studies suggests negative effects of tongue piercings on several periodontal health parameters of adjacent teeth, while gingival recessions were frequently detected in patients with lip piercings.

Complications and Hazards Associated with Body Piercing: A Narrative Review

OBJECTIVES

The increasingly widespread practice of piercings is often accompanied by complications and hazards which are constantly increasing. Therefore, it seems necessary to pay attention to the non-negligible risks that these practices entail and to the possibilities of reducing them. Hence, this study was conducted to help raise awareness of the complications and hazards associated with body piercing as a growing type of body modification practice.

METHODS

Studies were searched in the PubMed database and the Google Scholar engine using the keywords, often in combination, including body piercing, body modification, complications, and infection. The searches were limited to post-2000. Studies without limitations on their types were included in this study.

RESULTS

The most important complications are infection, bleeding, trauma, allergy, and scarring. Infection is the most common complication which occurs in individuals after piercing. A wide spectrum of bacterial and viral infections may occur. Allergic manifestations are not uncommon, with the risk that sensitization thus acquired may have subsequent harmful consequences.

CONCLUSIONS

Educating people and health care professionals by conducting more studies to better understand the complications of body piercing can be a solution to reduce health problems related to body piercing.

Complications of Body Piercings: A Systematic Review

The practice of body piercing has been present in many cultures worldwide for centuries, whether for religious or spiritual reasons or as a form of self-expression. In recent years, body piercings have become increasingly popular in all genders, with the most common sites being the ears, mouth, nose, eyebrows, nipples, navel, and genitals. However, despite the widespread utilization of piercings, a comprehensive literature review of associated complications is lacking. This scoping review aims to summarize the literature regarding complications associated with cutaneous and mucosal piercings. Given that body piercing has become more prevalent in recent years and that studies have noted an increase in a variety of piercing-induced complications, it is of utmost importance that piercing salons have proper hygiene practices in place and that patients are aware of the multitude of potential complications that can arise.

Postmortem Diagnosis of Invasive Disseminated Aspergillosis After Tongue Piercing

ABSTRACT

Severe fungal infections caused by highly invasive fungi such as Aspergillus are not easy to diagnose and often have a poor prognosis. In these cases, the nonspecific symptoms may make clinical diagnosis challenging, and consequently, the autopsy and postmortem histological investigations acquire a crucial role. We report the case of a young man in good health who died of septic shock 3 weeks after having had a tongue piercing. Intravitam investigations did not identify the etiology of the rapidly fatal infectious condition. The autopsy revealed flaccid organs of uniformly diminished consistency with abscesses and granulomatous foci with central necrosis. Histological examination showed the presence of septate mycotic hyphae, with a dichotomous 45-degree bifurcation, typical for Aspergillus , in all the examined organs, including the tongue. The molecular identification confirmed the presence of Aspergillus fumigatus. The observed macroscopic framework and the laboratory findings made it possible to diagnose pseudomembranous invasive tracheobronchial aspergillosis and to attribute the death to fatal invasive disseminated aspergillosis. The consistency and concordance of all the findings in our possession led us to suspect the practice of piercing as the triggering cause of the man's pathology.

Ear-piercing complications in children and adolescents

QUESTION

Ear piercing is one of the most common forms of body modification seen in children and adolescents presenting to my office. Parents of my younger pediatric patients inquire about potential post-piercing complications and risk factors associated with earlobe infections. What guidance should I give them? Also, are there any specific post-piercing complications to consider for older pediatric patients seeking second piercings in the upper cartilage area?

ANSWER

Piercing the earlobe or auricular cartilage continues to be a popular procedure among children and adolescents. Despite its widespread practice, improper aseptic piercing technique, insufficient training, and trauma to the soft tissue during high-pressure piercing (eg, use of spring-loaded ear-piercing instruments) can increase one's susceptibility to infections, bleeding, and microfractures. Other post-piercing complications include embedded earrings, keloids, hypertrophic scarring, and cutaneous hypersensitivity. Early recognition and treatment of infections and perichondritis secondary to transcartilaginous piercings can prevent the progression of severe ear deformities requiring reconstructive surgical interventions.

Health risks for body pierced community: a systematic review

OBJECTIVE

Body piercing is defined as the penetration of jewellery into openings made in different body areas. In the last decades, it has become increasingly common in the general population. The aim is to analyse the available literature about complications from body piercing for contributing to raise the awareness towards this issue and to plan and perform appropriate prevention interventions.

STUDY DESIGN

This is a systematic review.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to perform this systematic review; the protocol was registered with PROSPERO [CRD42020177972]. PubMed, Scopus and Web of Science were searched from database inception to April 2020, and articles in English language reporting a proven association between piercings and health risks were included, and their quality were assessed by adequate quality assessment tools.

RESULTS

A total of 4748 studies were found, and after duplicates removal and screening, 84 articles were included. Studies dealing with microbiological effects reported these complications both locally and at distant sites as a result of the spreading of the primary site infection: mastitis, endocarditis, glomerulonephritis, cephalic tetanus, viral hepatitis, HIV, cerebellar brain abscess and toxic shock syndrome. In addition, bleeding, gingival recession, dental injuries, contact dermatitis, granulomatous dermatitis, keloid, fibroma and basal cell carcinoma were reported.

CONCLUSIONS

Health authorities should promote educational campaigns to spread the knowledge on health risks related to piercings. Besides, piercers are often not adequately aware of all the possible adverse effects due to piercings because their professional training differs among countries. It is therefore advisable to provide periodical upgrade of their education in this field.

Factors associated with medical complications after body art among Israeli adults: a retrospective study

INTRODUCTION

Body-art, including tattoos and piercings, is steadily increasing world-wide but with relatively limited reporting of adverse outcomes. The objective of the present study was to identify correlates that would facilitate a preventative strategy to minimize adverse effects of body-art.

METHODS

We examined patterns of body-art, health risk and perceptions among 921 participants (54% female, mean age of 35; SD = 10.8) through in-person questionnaire.

RESULTS

A significantly lower frequency of those with body-art acknowledged that not all venues (parlors, clinics, etc.) are safe in terms of health and hygiene (84.7%t vs. 96.6%, p < .001) as compared to those without body-art. Similarly, knowledge of the need for a Ministry of Health certification was reported with lower frequency (77.2% vs. 94.5%, p < .001) among those with body-art. Those who experienced medical complications reported higher frequencies of smoking cigarettes and hookah as well as using ecstasy (MDMA). The risk of medical complication after body-art was 4 times higher in those who used ecstasy (OR = 3.97; CI 1.0-14.4; p < 0.05). In addition, it was more than 3 times higher for street or home tattooing as compared to studio or a licensed medical center (OR = 3.59; CI 1.32-9.76; p < .01), as well as almost 3 times higher among those who did not receive information before performing body-art (OR = 2.70; CI 1.05-6.92; p < .05) and who had somebody other than themselves decide on the body-art design (OR = 2.68; CI 1.00-7.19; p < .05).

CONCLUSIONS

A targeted informational-preventative program should be developed, informed by the risks highlighted in this study. In addition, it would be necessary to draft policies related to regulation and enforcement in order to more effectively manage body-art service provision. The Ministry of Health should supervise and guide tattooists and practitioners regarding the health risks of body-art and offer training and raise awareness among potential clients.

Risk factors for hepatitis C infection among adult patients in Kedah state, Malaysia: A case-control study

Hepatitis C infection is a global public health problem. This study was designed to identify the risk factors associated with hepatitis C infection among adult patients in Kedah state, Malaysia. A matched, hospital-based, case–control study was conducted at a tertiary hospital. Cases were adult (aged ≥ 18 years) patients with positive serology test results for hepatitis C virus antibody and detectable hepatitis C virus RNA from January 2015 to December 2018, and controls were age-, sex- and ethnicity-matched patients who were not infected with hepatitis C virus. Self-administered questionnaires were used to collect data on demographic characteristics and previous exposure to selected risk factors among the study participants. Associations between hepatitis C and demographic and risk factors were assessed using univariable and multivariable logistic regression analyses. A total of 255 case–control patient pairs were enrolled. The multivariable analysis indicated that having a history of blood or blood product transfusion before 1992 (adjusted odds ratio [AOR] = 6.99, 95% confidence interval [CI]: 3.73–13.81), injection drug use (AOR = 6.60, 95% CI: 3.66–12.43), imprisonment (AOR = 4.58, 95% CI: 1.62–16.40), tattooing (AOR = 3.73, 95% CI: 1.37–12.00), having more than one sexual partner (AOR = 2.06, 95% CI: 1.16–3.69), piercing (AOR = 1.71, 95% CI: 1.04–2.80), and having only secondary education (AOR = 1.92, 95% CI: 1.06–3.57) were independently associated with hepatitis C. No associations were found between health care occupation, needle-prick injury, surgical procedures, haemodialysis, acupuncture, cupping, or contact sports and hepatitis C infection. These findings demonstrate that hepatitis C risk is multifactorial. Having a history of blood or blood product transfusion before 1992, injection drug use, imprisonment, tattooing, having more than one sexual partner, piercing, and having only secondary education were associated with increased odds of hepatitis C.

Complications associated with intimate body piercings

Intimate body piercings involving the nipple and genitalia have increased in prevalence in both men and women. Despite this increase, there is a deficiency in the literature regarding the short and long-term complications of body piercings, including an increased risk of infection, malignancy, and structural damage to the associated tissue. Breast abscesses associated with nipple piercing can be mistaken as inflammatory carcinoma. Male genital piercings have been associated with urethral rupture, paraphimosis, urethral obstruction, scar formation, and squamous cell carcinoma, whereas female genital piercings may lead to a higher risk of pregnancy and sexually transmitted infections. There are additional problems related to piercings during pregnancy and thereafter. Nipple piercings can hinder breast feeding by inhibiting the milk letdown reflex, increasing nipple sensitivity, and causing discomfort to the infant. Removal of genital piercings during pregnancy could introduce bacteria into the piercing tract, but retaining the piercings could theoretically hinder childbirth. Prevention of complications is critical. Patients must understand the risks of piercings and disclose relevant medical conditions to the practitioner before the procedure. The piercings should be carried out in a hygienic and sterile manner. Finally, physicians should maintain a non-judgmental attitude to encourage patients to seek medical care for complications.

Genital myiasis associated with genital piercing. Case report

CONTEXT

Myiasis is caused by larval infestation that usually occurs in exposed wounds. Dermatobia hominis is the most common fly species responsible for this parasitic infection. Genital piercing is an ornamental practice used in certain social circles. At placement, it transverses the skin surface and, as such, may be related to complications.

CASE REPORT

We report a case of a 31-year-old man with a history of wound infection secondary to genital piercing who was exposed to an environment with flies, leading to myiasis. Mechanical removal and systemic antiparasitic drugs are possible treatments for myiasis. However, prevention that includes wound cleaning and dressing is the best way to avoid this disease.

CONCLUSIONS

Genital piercing can lead to potential complications and myiasis may occur when skin lesions are not properly treated.

Occurrence of Dental Injuries and Periodontal Complications in Tongue-piercing Jewellery Users

PURPOSE

Tongue piercing (TP) has been gaining in popularity, mainly among adolescents and young adults, and there has been a corresponding increase in reports of dental injury and adverse effects on periodontal tissue due to TP jewellery. The purpose of this study was to assess the type and prevalence of dental injury and periodontal complications in a group of Slovenian adolescents and young adults with TP in comparison with a control group.

MATERIALS AND METHODS

This case-control study included 17 subjects with TP (study group) and 28 subjects without TP (control group). Subjects were clinically examined for dental injuries, as classified according to Andreasen. Periodontal complications were evaluated using an estimation of clinical attachment loss (CAL) and gingival recession (GR). Differences in categorical variables were analyzed using the chi-squared or Fisher's exact test as appropriate. Differences between the groups in numerical variables were analyzed with the Mann-Whitney U-test. A multiple logistic regression model was built to test the association between dental injuries and TP when controlling for cofounders, namely age and gender of study participants. The significance level was set at α = 0.05 (two-tailed).

RESULTS

Subjects with TP had 12.2 higher odds of dental injury (CI = 2.2-67.7, p = 0.004) compared with subjects without TP. Enamel fractures were more prevalent in the study group (p = 0.002). Frequencies of other dental injuries in the two groups were similar. GR was significantly associated with TP (p = 0.008), while differences in CAL between the groups were not statistically significant.

CONCLUSION

Subjects with tongue piercing had more dental injuries and gingival recession.

[Are nail polish, artificial nails and piercings allowed outside the surgical area?Recommendations for the perioperative policy]

- An increasing number of patients wear nail polish, artificial nails or have piercings.- There is uncertainty about the perioperative management of these items, especially when located outside the surgical area.- In the majority of hospitals, patients are urged to remove these items preoperatively, under the assumption that they might cause problems.- Frequently, however, these items cannot be removed straightforwardly.- Nail polish and artificial nails only very rarely cause perioperative problems and therefore do not need to be removed pre-operatively.- The same applies to most piercings, except when located in or near the respiratory tract, if they have sharp endings or if they might cause problems as a result of the perioperative positioning of the patient.- Providing adequate information to the patient, knowledge about removal of these items and documentation of agreed arrangements are all important.- A national guideline concerning perioperative policy is urgently required.

Hepatitis B Virus Infections and Associated Factors among Pregnant Women Attending Antenatal Care Clinic at Deder Hospital, Eastern Ethiopia

Background

Hepatitis B virus (HBV) infection is a serious public health problem worldwide. Reports have shown that 68,600 people die of HBV infection and more than 300,000 deaths due to liver cancer secondary to hepatitis B every year globally. Women who are infected with HBV can vertically transmit the infection to their infants. This study aims to determine the prevalence of HBV infection and associated factors among pregnant women.

Methods and Findings

A hospital-based cross-sectional study was conducted among pregnant women who attended antenatal care clinic (ANC) for routine pregnancy check-up between 18 March 2015 and 15 May 2015. Data were collected by face to face interview using a pre-tested questionnaire. Serum was withdrawn for each study subject and used to test for Hepatitis B Surface Antigen (HBsAg) by an enzyme linked immunosorbent assay (ELISA) test kit. Binary logistic regression analysis was used to examine the association between explanatory variables and outcome variable. The prevalence of HBV infection was found to be 6.9%. Interestingly, the history of abortion (AOR 10.9; 95% CI: 2.2–53.9), nose piercing (AOR 9.1; 95% CI: 1.34–61.79), surgical procedure (AOR 12.8; 95% CI: 1.68–97.06) and history of multiple sexual partners (AOR 16.8; 95% CI: 3.18–89.06) were significant predictors of HBV infection.

Conclusions

This study determined that the prevalence of HBV infection among pregnant women was 6.9%, implying that it is high-intermediate endemic area, which is important public health issue needs to be addressed. History of abortion, nose piercing, surgical procedures and multiple sexual partners were significantly associated with this viral infection. Accordingly we advocate that health education programs on the mode of HBV transmission, high-risk behaviors and methods of preventions should be instituted at antenatal care clinics to raise the awareness of mothers and limit the spread of infection. It is also advisable to implement nosocomial infection prevention strategies to prevent the transmissions of HBV through health care related activities such as surgical procedures. Furthermore, all pregnant women should be screened for HBV, treated if necessary to reduce their viral loads and their children vaccinated at birth with the single-dose hepatitis B vaccine to break the cycle of mother-to-child transmission.

Guided Tissue Regeneration Involving Piercing-Induced Lingual Recession: A Case Report

Recession on the lingual aspect of mandibular incisors may occur in patients with history of tongue piercing and other factitious traumatic habits. Treatment of these areas is challenging due to the site-specific anatomical features of the region. This case report presents a novel approach for a specific type of mandibular lingual defect caused by tongue piercing. A nonresorbable titanium-reinforced barrier membrane combined with an allograft and enamel matrix derivatives was used to promote regeneration of periodontal attachment. Reentry surgery for membrane removal was performed at 8 weeks. The time from initial surgery to final follow-up was 18 months.

Oral Jewelry and Piercing: Risks to Health

What appears to be a decorative fad, pursued by people of all ages, is, for the most part, an invasion of the body by poorly trained individuals. Simple-to-complex, the insertion of body jewelry is embarked upon on a whim with little concern for health, including the possibility of infection. Many of those who opt for piercings have outcomes that are unremarkable and relatively trouble free. Others, less fortunate, end up with irreversible scars, serious infections, torn anatomic structures and teeth that are fractured, disfigured or have drifted out of line.

Fibrous Histiocytoma-like Spindle-Cell Proliferation in the Nipple After Body-Piercing

We report the case of a 19-year-old pregnant woman who presented with a nipple tumor. The lesion consisted in a spindle-cell proliferation with histologic features similar to those of fibrous histiocytoma, with a highly vascularized stroma. Although it showed low mitotic activity, scattered marked atypical cells with prominent nucleoli were identified, thus raising concern about the benign nature of the tumor. Immunohistochemical evaluation revealed that the spindle cells were diffusely positive for vimentin, focally positive for CD68, and negative for all the other tested antibodies. The patient had a total excision of the lesion and she is free of disease after 30 months. To our knowledge this is the first reported case of a lesion of this type in the nipple after body-piercing.

Oral parafunctions, piercing and signs and symptoms of temporomandibular disorders in high school students

OBJECTIVE

The use of chewing-gum and piercing has become common among adolescents and might result in increased oral muscle activity and overloading. Aim To investigate the frequency of oral piercing and parafunctions in relation to symptoms of temporomandibular disorders (TMD) among adolescents.

MATERIALS AND METHODS

One hundred and twenty-four third level high school students, living either in a city or in a small town, enrolled in either science or media programmes, were included. The students completed a questionnaire regarding different parafunctions and symptoms of TMD. A clinical examination of the temporomandibular system and estimation of the tooth wear was performed in 116 students.

RESULTS

Chewing-gum was used by 86% of the students (25% with a daily use) and 14% had an oral piercing. The science students used more chewing gum than the media students (p = 0.008), while the media students had more piercings (p < 0.001). Symptoms once a week or more were reported with 39% for headache, 18% for clicking, 7% for facial pain and 6% for difficulty to open wide. Girls reported more headaches (p = 0.007) and more severe symptoms (p = 0.003), had more medical consultations and used more analgesics (both p < 0.05) and had more clinical signs (p = 0.01) than boys. Girls had more oral piercings and used more chewing gum than boys (both p < 0.05). The media students had more sick leave (p < 0.01) than the science students. Chewing-gum use was associated with headache (p < 0.01), with difficulty to open wide (p < 0.05) and with tenderness of the temporomandibular joints and muscles (both p < 0.05). Oral piercing was associated with headache and muscle tenderness (both p < 0.05) and daily nail biting with headache (p < 0.05) and tooth wear (p = 0.004).

CONCLUSIONS

There is an association between use of chewing gum, nail biting, oral piercing, and symptoms of TMD.

Transmission of Hepatitis B and C Virus Infection Through Body Piercing: A Systematic Review and Meta-Analysis

Hepatitis B and hepatitis C are 2 types of potentially life-threatening liver diseases with high infection rate. Body piercing represents a progressively popular sociocultural phenomenon which is also a potential exposure approach for hepatitis B virus (HBV) and hepatitis C virus (HCV). Conclusions from those researches with statistically risk assessment of body piercing on HBV and HCV transmission are contradictory.Systematically analyze the association between body piercing and the risk of transmitting hepatitis B virus and hepatitis C virus for general population. Make evidence-based recommendations to the current practice and wake up public awareness of this health-threatening behavior.Comprehensive and high sensitivity search strategies were performed to exhaustively search related studies before 15 January 2015 (MEDLINE, EMBASE, WANFANG, CNKI datasets for published literatures, and Google and Google scholars for related grey articles). Two authors identified relevant studies for the review, abstracted data, and assessed literature quality independently and critically according to the selection criteria and quality assessment standard. Odds ratio (OR) and corresponding 95% confidence interval (CI) were used to estimate risk of HBV and HCV infection in relation to body piercing status. Subgroup analysis and sensitivity analysis were conducted to examine the source of heterogeneity and test the robust of the results.A total of 40 studies were included in this systematic review (10 for Hep-B, 26 for Hep-C, 4 for both Hep-B and Hep-C), the pooled OR (95% CI) for the association between body piercing and transmission of HBV/HCV is 1.80 (1.18, 2.75) and 1.83 (1.27, 2.64), respectively. Subgroup analysis suggested that highest risk of body piercing related to hepatitis C infection was for former soccer and veterans with OR of 4.63 (2.65, 8.10), while strongest association between body piercing and hepatitis B was for samples derived from students/community with OR of 2.40 (1.44, 4.02).The current systematic review and meta-analysis suggests that body piercing is significantly associated with the transmission of HBV as well as HCV, having body piercing probably can increase the risk of getting infected. Evidence from this study strongly recommends that comprehensive and effective programs should be established to provide safer piercing practice.

Endocarditis and meningitis associated to nape piercing in a young female: a case report

Body piercing is a social phenomenon on the rise especially among young people. This procedure may be complicated by serious bacterial and viral infections. We report a case of Staphylococcus aureus infective endocarditis and meningitis arising from the site of a nape piercing, after its removal. A 21-year-old Italian female was admitted to hospital with neurological impairment and sepsis. A diagnosis of endocarditis associated with meningitis by S. aureus, complicated by septic emboli in the brain, retina, skin and kidney, was formulated on the basis of modified Duke's criteria. The likely port-of-entry was the site of a nape piercing, removed two months before. In view of the widespread practice of body piercing, provision of correct and timely information concerning the associated serious risks is now imperative. Such information should emphasise the option for antibiotic prophylaxis, and the importance of careful local hygiene, even after piercing removal.

Comparison of single intra operative versus an intra operative and two post operative injections of the triamcinolone after wedge excision of keloids of helix

OBJECTIVE

To compare single intra-operative versus an intra-operative and two post-operative injections of triamcinolone after wedge excision of keloids of helix.

METHODS

The randomised controlled trial was conducted at the King Edward Medical University, Lahore, from January, 2011, to March, 2014, and comprised female patients over 14 years of age presenting with post-piercing keloids of helix not treated previously by any means and amenable to wedge excision. The subjects were divided into Group A who were given a single intra-operative injection of triamcinolone, and Group B who had an intra-operative and two post-operative injections of triamcinolone. Extra-lesional wedge excision of keloids was done, followed by infiltration of flaps and wound base with 0.5-1cc of triamcinolone 40mg/cc. Group B patients were given additional injections of triamcinolone at 1st and 2nd monthly visits. Both groups were observed for the evidence of hypertrophy or complications. Development of hypertrophy within one year of completion of treatment was considered recurrence.

RESULTS

The 70 patients in the study were divided into two equal groups of 35(50%) each. The mean age of Group A was 22.34±4.95 years and that of Group B was 22.88±4.22 years (p=0.624). The Mean size of the keloids was 2.54±0.516 cm(2) in Group A and 2.61±0.569 cm(2) in Group B (p=0.613). Recurrence rate in Group A was 3(8.5%) and 2(5.7%) in Group B (p= 0.64). The complication rate was 3(8.5%) in Group A and 8(22.8%) in Group B (p=0.10).

CONCLUSIONS

Single injection of triamcinolone was as effective as three in reducing recurrence with less complication rate.

Cutaneous signs of piety

It is important for dermatologists to be aware of cutaneous changes related to religious practices to help in their recognition and management. The anatomic location of cutaneous lesions associated with friction from praying varies based on religious practice. Allergic contact dermatitis from products and substances commonly used in worshipping also vary by religion. Some religious practices may render individuals prone to infections that manifest on the skin. Tattoos of godly figures also may adorn the body. Religious practices also have been implicated in cases of urticaria, köbnerization, and leukoderma. This article reviews the clinical presentation of some of the most common cutaneous changes that occur in individuals who practice the following religions: Christianity, Islam, Judaism, Hinduism, and Sikhism.

Medical tongue piercing - development and evaluation of a surgical protocol and the perception of procedural discomfort of the participants

BACKGROUND

A system providing disabled persons with control of various assistive devices with the tongue has been developed at Aalborg University in Denmark. The system requires an activation unit attached to the tongue with a small piercing. The aim of this study was to establish and evaluate a safe and tolerable procedure for medical tongue piercing and to evaluate the expected and perceived procedural discomfort.

METHODS

Four tetraplegic subjects volunteered for the study. A surgical protocol for a safe insertion of a tongue barbell piercing was presented using sterilized instruments and piercing parts. Moreover, post-procedural observations of participant complications such as bleeding, edema, and infection were recorded. Finally, procedural discomforts were monitored by VAS scores of pain, changes in taste and speech as well as problems related to hitting the teeth.

RESULTS

The piercings were all successfully inserted in less than 5 min and the pain level was moderate compared with oral injections. No bleeding, infection, embedding of the piercing, or tooth/gingival injuries were encountered; a moderate edema was found in one case without affecting the speech. In two cases the piercing rod later had to be replaced by a shorter rod, because participants complained that the rod hit their teeth. The replacements prevented further problems. Moreover, loosening of balls was encountered, which could be prevented with the addition of dental glue. No cases of swallowing or aspiration of the piercing parts were recorded.

CONCLUSIONS

The procedure proved simple, fast, and safe for insertion of tongue piercings for tetraplegic subjects in a clinical setting. The procedure represented several precautions in order to avoid risks in these susceptible participants with possible co-morbidity. No serious complications were encountered, and the procedure was found tolerable to the participants. The procedure may be used in future studies with tongue piercings being a prerequisite for similar systems, and this may include insertion in an out-patient setting.

[Complications of body piercing]

The trend of body piercing has grown in popularity in the past decade within the general population and especially among young adults. Complications of body piercing include local inflammation and infections, but severe complications are also possible and largely underestimated. People are usually not aware of the risks before making a piercing, and their medical history, medication and comorbidities are largely neglected by the people who realise the piercing. This article presents a review of the complications that a primary care physician may observe, for a patient who wishes to make a piercing, or presents complications due to the implementation of such a device.

Substantial bone loss in the mandibular central incisors area as a complication of tongue piercing: a case report

BACKGROUND

Along with the increasing popularity of oral piercings, the number of reported complications and side effects increases, too.

CASE REPORT

The aim of this report is to present a case of substantial bone loss in the area of the mandibular central incisors caused by lingual piercing and persistent bad habits. Dentist should be aware of potential complications associated with oral piercings and warn patients about them.

The complication of oral piercing and the role of dentist in their prevention: a literature review

OBJECTIVES. The work report about the complications of oral piercing and the role of dentist in their prevention. MATERIALS AND METHODS. The authors conducted a systematic review of the literature through the Medline database by entering "oral piercing", "piercing and complications", "piercing and hygiene" as keywords. Articles published between 1988 and 2012 were considered. RESULTS. Oral piercing is linked to several potential complications. Many of them are due to scarce awareness of the risk, bad habits and inadequate oral care. CONCLUSIONS. The dentist should motivate patients with oral piercing to maintain a good oral care, provide instructions and conduct periodic inspections to secure their understanding and implementation in order to prevent complications.

A short educational intervention measurably benefits keloid-prone individuals' knowledge of prevention and treatment

BACKGROUND

The Internet is a commonly utilized health information resource that provides access to information of varying quality.

OBJECTIVE

We sought to evaluate the use of the Internet as a health information resource within a keloid patient population and the effects of an educational intervention on patient knowledge about keloids.<BR>

METHODS

A consecutive convenience sample of subjects completed a questionnaire on keloid-related Internet use and on personal and family history of keloids. Participants listened to a short educational intervention on keloid-related topics followed by assessment of relevant knowledge at baseline, immediately postintervention, and 3 months after the intervention.

RESULTS

Among 40 participants, 55% reported having used the Internet to obtain keloid-related information. Subjects who had used the Internet to obtain keloid-related information had baseline knowledge similar to those who had not. When subjects were assessed immediately and 3 months postintervention, the intervention improved knowledge that not all raised scars are keloids, that keloids are not cancerous, and that certain areas of the body are more prone to keloid formation. The proportion of subjects who reported being less likely to obtain piercings or tattoos because of the intervention was 80% and 75%, respectively.

LIMITATIONS

This study was performed at a single academic center.

CONCLUSION

The Internet is a commonly used information resource for keloid-prone individuals, but keloid-related knowledge was not greater among Internet keloid-related information seekers. A very short educational intervention benefits keloid-prone individuals by improving knowledge about keloid prevention and treatment and by discouraging them from obtaining piercings and tattoos.

[Local complications of lip and tongue piercing -- report of the cases]

Piercing, which is the form of puncturing parts of the human body and creating openings where jewelry can be worn, is together with tattoos, body drawings or make-up, one of the oldest way of decorating of the human body. Piercing can be performed in each part of the body. In the recent years face piercing (nose, eyebrows, lip region) and in the oral cavity (tongue, lips, cheek, mentolabial sulcus, labial frenulum) is becoming particularly popular. The procedure of piercing itself may potentially lead to serious systemic and local complications. The aim of the study was to present three clinical cases of the patients who referred to the Dental University Clinic in Krakow for the treatment of lesions on the oral mucosa after piercing. Clinicians who examine patients with such body decorations should pay particular attention to the sites which can be injured by the jewelry. Medical staff should also make patients realize the risk of general complications after piercing. This will allow on the early removal of the jewelry and prevention of possible complications.

Body art practices and health risks: young adults' knowledge in two regions of southern Italy

BACKGROUND

In the past several decades the number of individuals, particularly young adults, acquiring body art has increased very seriously in occidental society. In order to verify young adults' practices and knowledge of the risks related to body art, an investigation was conducted among university freshmen in Bari (Apulia Region) and Naples (Campania Region), both in Southern Italy.

METHODS

The study was carried out during the period 2008-2010 through an anonymous questionnaire distributed to 3,868 people selected among 26 Degree Courses of the University of Bari and Naples Parthenope. The two regional samples were matched for age and sex.

RESULTS

On the whole, 84.4% declare to know the infectious risks associated with body art practices, but only 4.1% of them correctly identified the infectious diseases which can be transmitted through these procedures; while 59.2% of the sample declared that non-infectious diseases can occur after a tattoo or a piercing, but only 5.4% of them correctly identified allergies, cysts, bleeding and scars. The possible occurrence of infectious and non-infectious diseases has been acknowledged by most students in Apulia region (89.7 versus 79.1% and 64.8 versus 53.6% respectively). In this Region, of the 1,001 (32.4%) pierced and 597 (19.8%) tattooed youths 23.4% reported complications. Campania region youths reported a greater number of complications than Apulia did (30.3 versus 13.1%) and they also purchased more frequently their tattoos or piercings in unauthorized facilities (35.3% versus 15.9%).

CONCLUSIONS

With regard to the knowledge of health risks associated to body art, it has been registered a higher awareness of infectious than non-infectious diseases. Information about freshmen's knowledge and practices could help in effective planning of health promotion strategies.

Oral piercing and its complications in two Serbian youths: a case report and review of the literature

OBJECTIVE

Historically, wearing adornments on pierced body parts has been associated with many cultures as manifestations of religious or cultural identities. Currently, its use has a broad acceptance among young people. In the oral cavity, the most common sites for piercings are the tongue and lower lip.

RESULTS

Pain, swelling and infection are the most serious consequences associated with this procedure. Several complications may be associated with this practice with the most frequently observed being halitosis, periodontitis, tooth fracture, glossitis, and the formation of abscesses. Other adverse outcomes include mucosal or gingival trauma, increased salivary flow, and interference with speech, mastication and swallowing.

CONCLUSION

This article presents case reports on lip and tongue piercings and literature review highlights of this procedure. Special attention is given to complications and dental implications associated with such a practice.

Lifestyle and nickel allergy in a Swedish adolescent population: effects of piercing, tattooing and orthodontic appliances

The aim of this study was to estimate the prevalence of life-style practices in adolescents and their association with nickel allergy. Upper secondary school pupils (n = 4,376; 15-23 years) were patch-tested for nickel aller-gy, follow-ing completion of a questionnaire (answered by 6,095). Almost 86% girls and 21% of boys reported piercing. More girls (6%) than boys (3%) had a tattoo. Twenty-six percent of the girls and 18% of the boys were regular smokers. Vegetarian/vegan diets were reported by 20% of girls and by 6% of boys. Piercing, female gender, and vocational programme increased the risk of nickel allergy, whereas orthodontic appliance treat-ment prior to piercing reduced the risk of nickel allergy. Pupils in vocational programmes had the highest prevalence of nickel allergy. Lifestyle behaviours are interconnected and cluster in subgroups of adolescents. Female sex, piercing and choice of educational programme are prominent lifestyle markers. A trend shift is observed, where more girls than boys report tattooing.

Lateral lower lip piercing--prevalence of associated oral complications: a split-mouth cross-sectional study

OBJECTIVE

To investigate via a split-mouth cross-sectional study the prevalence of gingival recessions associated with lateral lower lip piercing in a population obtained from a nondental setting.

METHOD AND MATERIALS

A split-mouth study was performed in a sample of 47 patients with one lateral lower lip piercing. Teeth in direct contact with the intraoral closure of the stud were defined as test teeth; contralateral teeth were selected as controls. Clinical examination included full-mouth plaque and bleeding indices, probing depth, recession, clinical attachment level, periodontal biotype, evaluation of hard tissues, occlusal trauma, stud characteristics, and mucosal inspection and palpation.

RESULTS

Midbuccal recession was noted in four test teeth compared with one control tooth (8.5% and 2.1%, respectively; P = .250). The canine and first premolars were the most affected. Tooth chipping occurred in one test tooth and no control teeth. Plaque levels were significantly higher in test than control teeth (P < .001).

CONCLUSION

Lateral lower lip piercing is associated with significantly higher plaque accumulation on adjacent teeth. A small percentage of lateral lower lip piercings may cause tooth chipping or buccal recession in adjacent teeth.

Dental and periodontal complications of labial and tongue piercing

Piercing is the practice of puncturing some parts of the body to apply ornamental objects. The presence of oral and perioral piercings are a risk factor for many acute and chronic complications, such as chipping of the dental enamel, periodontal lesions and infection. The aim of this study is to assess the prevalence of lip and tongue piercing complications in the dental and periodontal tissues in a sample of young adults. Twenty-five adult patients were examined (test group: 11 males and 14 females with an average age of 23.4+/-3.6 years) who had had a minimum of one labial or tongue piercing for at least 1 year and were compared with 25 subjects (control group: 11 males - 44 percent, and 14 females - 56 percent) without any lingual or labial piercing. A questionnaire was compiled for each patient and a clinical examination was performed. The following parameters were examined by the same operator: abnormal toothwear, tooth chipping or cracking, clinical attachment loss (CAL), probing pocket depth (PD) and gingival recession (GR, classified by using Miller s classification). The data were analyzed using X2 or Fisher s exact test for small numbers and non-parametric Mann-Whitney or Kruskal-Wallis tests to examine for differences in continuity; the level of significance was p less than 0.05. According to the results found in the present study the prevalence of abnormal tooth wear and tooth chipping was higher in the subjects with labial or lingual piercing. Moreover, patients with tongue or labial piercing exhibited a higher GR in comparison to control subjects without any oral piercing. No differences were observed between the two groups as regards CAL and PD. A significant association between the duration of piercing and dental defects was found in the group of patients with piercings with greater prevalence of tooth and periodontal defects in the group of 13 subjects who had had the piercings for a period less than or equal to 4 years.

Health considerations for oral piercing and the policies that influence them

With the increase in popularity of piercings, the health care professional needs to be aware of the complications that can occur due to lack of regulations of the piercing establishments. Due to lack of training of piercing professionals and lack of enforcement of sterilization procedures, infection and life threatening complications can arise. Complications include, but are not limited to, hemorrhage, nerve damage, gingival recession, HIV, tongue swelling, tooth fracture, Bactermia, Ludwigs angina, increase salivary flow, jewelry aspiration, and localized infection. Texas requires an individual to be 18 years of age to receive a piercing. However, Texas does not regulate the piercing establishment or the artist providing the services. Oral health care providers should be aware of the lacking regulations of piercing studios so they can be more vigilant of oral complications that may occur.