Volume 2(1): 1000107 J Interdiscipl Med Dent Sci ISSN: JIMDS, an open access journal Research Article Open Access Dannan et al., J Interdiscipl Med Dent Sci 2014, 2:1 http://dx.doi.org/10.4172/jimds.1000107 Case Report Open Access Interdisciplinary Medicine and Dental Science *Corresponding author: Dr. Aous Dannan, Department of Periodontology, Faculty of Dentistry, Witten/Herdecke University, Witten, Germany, Tel: +49-(0)2302- 1795268; E-mail: aousdannan@yahoo.com Received November 25, 2013; Accepted January 17, 2014; Published January 20, 2014 Citation: Dannan A, Gassmann G, Wolf-Dieter G (2014) Treatment Strategy for Correction of Periodontal Defects Associated with Tongue Piercing: A Case Report. J Interdiscipl Med Dent Sci 2: 107. doi: 10.4172/jimds.1000107 Copyright: © 2014 Dannan A, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited Abstract Intraoral piercing has increased in popularity in the last few years. This type of jewelry has been associated with periodontal and muco-gingival defects such as attachment loss and gingival recession. This case report described a 25-year-old female presented to the clinic of Periodontics at Witten/Herdecke University in Witten, Germany, with a tongue stud placed through the mid-dorsum of her tongue. The lower left central (LL1) and lower right central (LR1) incisors exhibited 6 mm and 5 mm lingual probing depth, 4mm and 3.5mm lingual recession respectively and localized radiographic bone loss in the mid-half of the roots. The treatment strategy FRQVLVWHG RI UHPRYDO RI WKH WRQJXH SLHUFLQJ SURIHVVLRQDO SURSK\OD[LV RUDO K\JLHQH LQVWUXFWLRQV DQG DQ RSHQÀDS VXUJHU\ RI WKH OLQJXDO anterior region of the mandible with the application of enamel matrix derivative (EMD) and bone graft material. Results: At the 1-, 3- and 7-month recall visits, the patient’s oral hygiene has been improved, and the attachment loss appears to have stabilized. It is clear that the tongue piercing might be a risk factor for local periodontal complications. Treatment Strategy for Correction of Periodontal Defects Associated with Tongue Piercing: A Case Report Aous Dannan 1,2 *, Georg Gassmann 2 and Wolf-Dieter Grimm 2 1 Department of Periodontology, Faculty of Dentistry, Syrian Private University, Damascus, Syria 2 Department of Periodontology, Faculty of Dentistry, Witten/Herdecke University, Witten, Germany Keywords: Enamel matrix derivative; Lingual piercing; Localized periodontitis; Oral hygiene Introduction In recent years, body piercing has become increasingly fashionable for purely esthetic reasons. e emergent interest in body adornment has stimulated a marked increase in the practice of intraoral and peri- oral piercing. e most commonly pierced oral sites are the tongue and lip (81.0% and 38.1%, respectively) among people with nontraditional body piercing [1]. Health care practitioners have recognized various adverse incidents associated with the piercing of oral structures. In a survey of 438 pediatric dentists, nearly one-fourth acknowledged treating patients for oral piercing-related complications [2]. Since 1997, at least 34 patients have been documented as having gingival recession and attachment loss attributable to oral piercing [1-14] e tongue is usually pierced at the midline, typically in the median lingual sulcus, although piercings may also be performed on the dorsolateral lingual surface anterior to the lingual fraenum. e principal type of jewellery used in tongue piercings is barbells, which consist of a bar with a ball screwed onto each end. Tongue piercings are the most commonly reported cause of damage to the dentition. In 1997, Di Angelis [13] rst suggested that tongue piercings may result in abnormal tooth abrasion that may lead to cold sensitivity in the lower rst molar teeth caused by cracked-tooth syndrome. Teeth may be injured during speaking or masticating or by biting the barbell or hitting it against the teeth. Increasing numbers of case reports have pointed to oral piercings as a signicant factor in gingival trauma. Gingival recession has been especially correlated with lip studs or labrets [1,4,15,16] and frequently occurs on the labial aspect of the lower central incisors [3,4,16-21]. Gingival recession, particularly on the lingual aspect of the mandibular anterior teeth, has also been associated with tongue piercing [3,4,16,17]. A positive correlation has been demonstrated between the prevalence of gingival recession due to tongue and lip piercing and duration of wear. According to Campbell and others [3], lingual recession of gingiva is observed aer 2 years of wear of a tongue piercing. Long- stem barbells signicantly increase the prevalence of lingual recession. In 2006, Leichter and Monteith [17] reported an increased incidence and severity of buccal recession with lip piercing and duration of wear. Jewellery-associated recession frequently develops as a narrow, cle- like defect on the lingual and buccal aspects of the mandibular incisors [17] with recession depths of 2–3 mm or more oen extending to or beyond the level of the mucogingival junction [3]. Patients with lingual piercings may also be at risk of developing signicant loss of periodontal attachment that may lead to tooth loss [17]. Severe attachment loss can develop even when gingival recession is minimal [3]. In this report, we presented a case of lingual piercing associated with localized gingival recession and attachment loss at the lingual surface of the anterior lower incisors. A complete treatment strategy was also described with a 10-month follow up. Case Description A 25-year-old woman was referred by her dentist for a periodontal management of localized isolated areas of bone loss lower anterior teeth at the Department of Periodontology, Faculty of Dentistry at Witten/Herdecke University in Witten, Germany in February 2009. She was a diabetic patient but her medical blood records were under control and she seemed to be totally healthy without any accompanying complications. She was a past smoker. e clinical examination revealed a dome shaped barbell stud piercing in the tongue (Figure 1). e tongue stud has been in place for approximately 2 years. An initial clinical and radiographic evaluation was performed. A periapical radiograph revealed localized horizontal bone loss associated with teeth #31 and #41 (Figure 2). Clinical evaluation of the same area illustrated isolated 6 mm and 5 mm lingual probing depths respectively as well as 4 mm and 3.5 mm lingual recession respectively (Figure 3). e presence of slight supragingival plaque and calculus was noted in this sextant, but no other sites displayed loss of attachment. Grade (I)