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Body Modifications

Body modifications, such as tattoos, piercings, and branding/scarification, have been used by humans for thousands of years. While acceptance of these practices varied in different cultures, their social acceptance has been growing globally and in the United States. Oral health professionals should be familiar with body modifications and understand their possible local and general complications, implications for patient assessment and treatment, and strategies to minimize risks. Unfamiliar with this topic? Read on!

Body Modifications

Body modifications, such as tattoos, piercings, and branding/scarification, have been used by humans for thousands of years. While acceptance of these practices varied in different cultures, their social acceptance has been growing globally and in the United States. Oral health professionals should be familiar with body modifications and understand their possible local and general complications, implications for patient assessment and treatment, and strategies to minimize risks. Unfamiliar with this topic? Read on!

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Growing Prevalence

In 2016, approximately one in three Americans had a tattoo—a 20% increase from 2012. Nearly four in 10 Millennials had at least one tattoo and one in four had a piercing in a place other than earlobes, according to a 2010 Pew Research Center report. The majority of Americans feel comfortable with seeing individuals with tattoos in various professional roles.

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Sclera Tattooing

Eyeball tattooing, specifically corneal tattooing, is an ancient practice that has specific medical indications for patients with congenital eye defects, such as aniridia (absence of the iris), cataracts, and scars due to traumatic injury to the eye. This complex surgical procedure can be safely performed by trained ophthalmologists and can result in improved appearance, although ocular function is not restored. On the contrary, cosmetic sclera tattooing is performed by self-taught tattoo artists without anesthesia in a nonmedical environment.

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Scarification

This is the practice of creating permanent scars by cutting, burning, or branding images, words, or patterns in the skin. It can be performed by cutting with scalpel or knife, hot or cold branding (using liquid nitrogen), thermo- and electro-cautery, and moxibustion (placing incense on the skin and allowing it to burn until it is extinguished in the underlying layers). Performed without anesthesia and with intentionally prolonged healing time, this procedure requires remarkable pain tolerance.

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Tongue Bifurcation

Also known as tongue split­ting, forking, or bifid tongue, this modification involves separating the tongue anteriorly into two parts of various length, to resemble a snake’s tongue. This procedure can be done by cutting with a scalpel or laser beam along the midline and cauterizing or suturing the edges to prevent reattachment. The American Dental Association advises against tongue bifurcation as an invasive and dangerous procedure performed for nonmedical reasons.

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Tongue Piercing

Tongue piercings can have serious complications and implications for oral health care. They have been associated with rare but serious complications including cerebellar abscess; infective endocarditis; local infections; and increased incidence of tooth injuries, such as enamel fissures, fractures, and gingival recession, especially in the mandibular lingual incisor area.

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Importance of Documentation

Assessment and documentation of the status of orofacial modifications should be performed as part of the comprehensive intra- and extraoral examination and include the location, description, and condition of sites and surrounding hard and soft tissues. Photographic documentation is advisable for future comparison. Familiarity of the oral health professional with typical post-procedural healing time and potential adverse reactions ensure safety and create an environment of respect and candor in the dental setting.

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Diagnostic Concerns

The routine removal of all metal objects and jewelry in the field of view of a diagnostic image is essential. In panoramic imaging, a metal object obscures anatomy and potential pathology in its own location, and creates an enlarged ghost image on the contralateral side.

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