sterilization.) Ask to see their spore test results. A spore test is the only way to know the autoclave is working properly. If they don't run regular spore tests, don't let them pierce you!

DOES THE SHOP REUSE NEEDLES?

This is one of the most important things you MUST check. Does the studio resterilize used needles? Make sure you see the piercer place the used needle in a sharps container. NEVER let a piercer use a needle on you that was soaked in a liquid. All needles should be in individual packages and should be opened while you are present.

DOES THE STUDIO SEEM CLEAN?

Check it out! Is the piercing studio immaculate: the walls washed, carpet vacuumed? Are the staff bathed and neat? Is the restroom kept clean and tidy? If you feel they are not, walk out! Every good studio should have 5 separate areas: the counter, waiting room, piercing room(s), bathroom, and a separate sterilization room.

ASK YOUR FRIENDS WHERE THEY GOT PIERCED.

Here are a few questions you should consider: Does their piercing look like a piercing you would want? Did they have any problems or infection during healing? Was the staff at the piercing studio able to help them if they had any complications? Would they get pierced there again?

USE YOUR INSTINCTS.

If you don't feel comfortable with the studio or the piercer you should leave. Repeatedly we hear "I should have listened to my gut feeling." So listen to it! If the studio seems more interested in your money than your health that is a sign to leave the studio quickly.

ARE THEY PIERCING WITH EAR PIERCING GUNS?

If you are going to have a body piercing and the studio is using an ear gun, run away! Inform your health department! A number of states have made it illegal to use a gun on body piercings. Plastic ear guns can't be sterilized in an autoclave and therefore don't meet the criteria for APP piercers' use of sterile disposable equipment.

ASK QUESTIONS OF THE STAFF AND THE PIERCER.

When responding to questions do they seem knowledgeable? It takes a long time to learn what jewelry is optimal for each piercing. Ask the piercer how long they have been piercing and how they learned. It takes even longer to acquire the ability to correctly place and skillfully perform the piercing. Make sure the piercer is well-informed. Check to see any certificates or plaques the wall. Don't be mislead into believing piercing is easy. Look at his or her piercings and peruse their piercing photo portfolio. Do you like what you see? If not, leave. You can be injured by a poorly performed piercing!

CHECK THE STUDIO'S JEWELRY SELECTION.

There are lots of different types of piercings so there should be a variety of different types, styles and sizes of jewelry. The studio should not insist on a certain style because that is the only thing they have in stock!

When referring to size of jewelry there are two measurements. One is the width (of a ring) or length (of a bar) called the "diameter" of the jewelry. The other is the thickness of the jewelry, which is the "gauge." As a general rule; jewelry no thinner than 14 gauge should be used below the neck. This is because of a likelihood of migration and cutting. The smaller the gauge number the thicker the jewelry.

DO THEY HAVE AN AFTERCARE SHEET?

All professional studios should give you an aftercare sheet explaining how to take care of your piercing. Read this sheet BEFORE you have the piercing done! If it tells you to clean your piercing with ointment or hydrogen peroxide, the studio is clearly not keeping up with the industry standards and you should be concerned with the quality of piercing you would receive.

DOES THE STUDIO HAVE A LICENSE TO OPERATE?

Many cities and states do require that the studio have a license. In most cases the license means that the studio meets minimum requirements and has passed some sort of inspection. To find out if your area has established standards and inspections, call your local Health Department. If the studio is illegally unlicensed do take the time to report them. Chances are they are not performing safe, hygienic piercings and could be endangering the health of piercees in your region.

CHECK TO SEE THE STUDIO'S AGE REQUIREMENTS.

Many states have laws regarding the minimum age for piercing minors with parental consent. Even if the law allows it, many piercers feel certain piercings are not appropriate for minors. If the studio is more interested in making money than upholding sound morals and ethics use your judgment. Please understand the studio's right to enforce its own age limitations.

SEE THE PIERCING ROOMS AND SET-UP?

Ask if you can watch them set-up for a piercing. Even better is to ask to observe a piercing being done. (Not all piercing studios will let people watch, but you can ask.) At least make sure you can see them set up for YOUR piercing. During preparation the piercer should first wash and glove their hands. The equipment should be sealed in individual sterilized packages and placed on a tray. The piercer should change gloves if they touch anything in the room other than you and the sterile equipment. If you are not satisfied with the set up, walk away!

IS THE STUDIO RECOGNIZED BY THE APP?

All APP Piercers will have a certificate that should be hanging on the studio's wall. The certificate has an expiration date on it; make sure it is current. For a list of APP Piercers you can check out our members section or call 1-888-888-1APP. If you find a studio that claims to have an APP Piercer and is not on this list please call and let us know.

ORAL PIERCING RISKS & SAFETY MEASURES

The Association of Professional Piercers would like to present a number of facts in order that consumers, health care workers, and other concerned parties may properly educate themselves about oral piercing before making any decisions or judgments. A well-informed and discerning consumer is subject to far fewer dangers than one with incomplete or inaccurate information.

When properly performed, the piercing procedure itself takes only a few seconds, and involves minimal discomfort and often no blood. Healing is ordinarily rapid and is commonly uneventful.

Most of the concerns about oral piercings center on one of three areas:

Fear of an unsafe procedure
Potential for damage to teeth and oral structures
Risk of infection

These potential hazards are generally easily controlled when the following steps are taken.

PIERCER

To reduce risks of an unsafe procedure, you must first select the right piercer, one who:

Has appropriate training; is skilled, experienced, clean and professional;
Practices safe piercing technique and cross-contamination control;
Works in a hygienic environment that conforms to relevant local and/or state regulations;
Follows OSHA Bloodborne Pathogens standards;
Has obtained all applicable licenses and permits;
Spore tests autoclave (sterilizer) regularly and can provide documentation;
Uses appropriate sterile instruments and jewelry, and sterile disposable needles;
Takes the time to verbally instruct in proper care guidelines and provides written instructions;
Is available for follow-up and questions post-piercing, so any developing problems can be resolved before damage occurs.

See CHOOSING A PIERCER or download the PDF of the brochure for additional details and information.

JEWELRY

The potential for structural damage from tongue and oral piercing can be dramatically reduced by wearing appropriate jewelry. Complications may result if the jewelry is inappropriately sized, improperly placed, or poorly manufactured. Things to consider:

Correct style of jewelry for the particular anatomy and piercing placement;
Jewelry accurately sized to the area -The initial, longer jewelry that allows for usual swelling should be replaced with a shorter piece after swelling has dissipated, as this has less chance of negatively impacting the teeth and other oral structures.
Surgical implant grade jewelry -See the accepted APP Minimum Jewelry Standards for detailed jewelry material and design specifications.
Balls made of acrylic can be worn on tongue barbells to further minimize the risk of damage to the teeth.
Check that threaded ends are on securely. Tighten them each day to insure jewelry stays in place.
A smaller ball can be worn on the underside of the tongue to reduce contact with the sublingual portion of the oral cavity.
Piercees should be strongly cautioned that playing with the jewelry excessively is frequently the cause of reported tooth and gum damage and should be avoided.

PLACEMENT

Proper placement is absolutely critical to the health and comfort of the piercee.

Traditional placement for a tongue piercing:

Along the midline of the tongue, essentially in the center of the mouth;
Often approximately 3/4" or so back from the tip of the tongue;
Commonly placed with the top a little further back than the bottom (This allows the top of the jewelry to lean slightly back, away from the teeth, and towards the higher part of the upper palate where there is more room in the mouth);
Usually placed just in front of the attachment of the lingual frenulum (web under the tongue).

Traditional placement for lip or cheek piercings:

Should be placed relatively perpendicular to the area to avoid having the jewelry rest at a sharp angle.
Position should be chosen so that the jewelry rests in a neutral spot within the mouth.
Post should be shortened to fit snugly once healing is done to minimize contact of jewelry with the gums or teeth.
Place cheek piercing no further away from the mouth than the first molars to avoid parotid gland and ducts.
A strong light can be used to check the selected placement for vascularity and enervation (blood vessels and nerves).

AFTERCARE

The risk of exposure to infection can be controlled during the piercing procedure by the use of sterile tools, jewelry and needle, and a thorough understanding and implementation of aseptic technique. Entirely vital for avoiding infection during healing is the cooperation of the piercee in caring for the piercing properly.

The piercer must thoroughly explain aftercare protocol, including providing written and verbal guidelines detailing the use of antimicrobial alcohol-free mouth rinses and sea salt rinses.
Don't share plates, eating utensils, cups, and such.
Replace your toothbrush and make sure to keep it extra clean during healing.
Keep dirty fingers, pencils, sunglasses, and other foreign objects away from the mouth and face.
Avoid excessive talking, playing with the jewelry, and all oral sexual contact during healing.

See ORAL PIERCINGS AFTERCARE or download the PDF brochure for detailed care information.

WHAT ABOUT SWELLING?

Most piercees report little or no bleeding and a minimum of swelling for a few days when the piercing is performed properly and approved care guidelines are followed.

Gently sucking on chipped or shaved ice can diminish swelling during initial healing
Elevation of the head above the heart while sleeping (use several pillows) may minimize initial overnight swelling
The use of over-the-counter nonsteroidal anti-inflammatory such as Ibuprofen taken according to package instructions may limit the extent of initial swelling.

ISN'T THE MOUTH DIRTY?

Although often cited, this concern may not be as valid as expected.The extremely short healing time of the average oral piercing provides a much smaller window of opportunity for exposure to external infection than do many other common piercings. For instance, a tongue piercing usually heals in 4 6 weeks, compared to 6 9 months or longer for a navel piercing.

As the main 'entry portal' for any material entering the body, the oral cavity is exposed to a variety of toxins, bacteria, and other noxious substances on a near-constant basis. Drinking or eating anything contaminated with disease-causing microbes can potentially cause illness and infection. Breathing air that contains airborne pathogens may lead to other types of systemic disease. Why then are we relatively healthy despite this continual microbial assault? The answer lies in the design of the oral cavity and its defensive strategies.

Salvia contains numerous antimicrobial factors that directly attack and deactivate harmful microbes. Among them:

Lysozyme
Lactoferrin
Salivary peroxidase
Myeloperoxidase
Agglutinins
Immunoglobulins ('antibodies')

Because saliva is produced only within the oral cavity, the mouth is at a distinct advantage over other parts of the body when it comes to warding off infection. Oral mucosa has an extremely high 'turnover rate' which makes it one of the fastest healing sites in the body. This fast turnover rate allows oral mucosa to maintain its structural integrity by a system of continuous cell renewal in which cells are produced by cell division, migrate to the surface of the tissue, and replace those cells which are shed. Cellular turnover rates for oral mucosa of the cheek is 25 days compared to 52-75 days for skin.

Because the head and neck region houses a highly concentrated system of veins, arteries and lymph vessels allowing for rapid transportation of these anti-infective agents, infectious agents can be attacked and dealt with in a swift manner.

When a piercing in the oral cavity is performed, infection rates are negligible when sterile equipment, proper aseptic protocol and appropriate jewelry selection are combined with conscientious aftercare. This requires the education of both the piercer and the client, and with cooperation can ensure a safe and successful experience.

INFORMATION IS THE KEY

Unsafe, unethical, and uneducated piercers thrive in areas where complete, accurate information is not made available to both the general public and those who seek to protect them. Making oral piercings illegal forces consumers who still seek them to patronize unregulated, underground establishments. Only by supporting the dissemination of accurate information and the efforts of conscientious professionals can the risks of piercing truly be controlled.

To disparage the efforts of a burgeoning profession without full and appropriate information is not an accurate or helpful response. Since many individuals still desire oral piercings and intend to get them, it is far more constructive to provide accurate information and specific guidelines on safe piercing procedure and how to choose a practitioner.

The APP is a non-profit organization dedicated to health, education and safety of piercers and the public. We are a group of committed professionals who uphold an extremely high standard of safety and hygiene. We support the development of appropriate regulations and standards to ensure the improvement of our art form and the continued safety of our clientele.

For more information please contact the Association of Professional Piercers (APP)

REFERENCES

1. Department of Cariology, Institute of Dentistry, University of Turku (Finland): Salivary peroxidase systems and lysozyme in defense against cariogenic microorganisms. Lenager-Lumikari (1992)

2. Ten Cate AR: Oral histology: Development, structure, and function (2nd ed). C.V. Mosby Company (St. Louis). 1985

3. Staines N, Brostoff J and James K: Introducing immunology (2nd ed). C.V. Mosby Company (St. Louis). 1994.