title: Gingival recession is likely associated with tongue piercings.
abstract: METHODS
  A convenience sample of 60 subjects (27 male; 33 female) with tongue piercings (case group) and 120 subjects (43 male; 77 female) without tongue piercings (control group), ranging in age from 13 to 28 years, were identified from a mix of races living in a geographic area of low socioeconomic status in Brazil. Subjects were recruited from school groups and university centers between January 2008 and March 2009. For each case, 2 controls were selected on a consecutive basis from the same school according to criteria that included age, gender, smoking, and previous orthodontic treatment. Exclusion criteria included individuals with systemic diseases that might compromise the immune system, as well as antibiotics within 3 months or other medications that could affect the gingival tissues.
  
  
  METHODS
  The key study factor was the use or nonuse of tongue piercings (jewelry). The analysis compared periodontal parameters, such as the occurrence, location, and severity of gingival recession, in subjects with and without tongue jewelry.
  
  
  METHODS
  Gingival recession in the anterior lingual mandibular region was assessed as the primary outcome measure. The study sample was divided according to the presence or absence of gingival recession as well as the severity (1-2, 3, and ≥ 4 mm) of gingival recession.
  
  
  RESULTS
  The average age of subjects was similar in the case and control groups (18.9 versus 17.7 years, respectively). Fractures of the anterior teeth were present significantly more frequently in cases than controls (26.7% versus 11.7%, respectively; P < .011). The overall frequency of gingival recession was significantly higher in the case group than the control group (80.0% versus 34.2%, respectively; odds ratio [OR] = 7.71, P < .0001), reflecting primarily corresponding differences involving the anterior lingual mandibular region (55.0% versus 10.0%). Average gingival recession in the anterior lingual mandibular region was significantly higher in cases than in controls (0.19 6 0.28 mm versus 0.01 6 0.03 mm, respectively, P < .001). Subjects with tongue jewelry were 11 times more likely to exhibit recession in the anterior lingual mandibular region than subjects without piercings (OR = 11.0, 95% confidence interval [CI] 5.02-24.09, P <.001). The severity of recession in this region was also significantly higher (calculated using an ordinal scale) in cases than in controls (P < .001). The final multivariate logistic regression model for occurrence of gingival recession included the variables tongue jewelry (yes/no), age, male gender, and the presence of bleeding on probing in the anterior region. Subjects with tongue jewelry exhibited an 18 times greater chance for the occurrence of gingival recession in the model (adjusted OR = 18.06, 95% CI 6.66-48.95, P < .001).
  
  
  CONCLUSIONS
  The use of tongue jewelry was found to be strongly associated with the occurrence and severity of gingival recession in the mandibular anterior lingual region.
authors.affiliation: Department of Periodontics, University of Maryland, School of Dentistry, 650 West Baltimore Street, Baltimore, MD 21201, USA. mreynolds@umaryland.edu
authors.forename: Mark A
authors.initials: MA
authors.lastname: Reynolds