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Body Piercing FAQ
Body Piercing Frequently Asked Questions
Piercing Aftercare
Oral Piercing Risks
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Medical Considerations
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WHAT IS THE APP POSITION ON ORAL PIERCINGS?
There has recently been considerable sensationalized derogatory press regarding oral piercings. Unfortunately many of the pertinent facts are not being reported. A well-informed and discerning consumer is subject to far fewer dangers. When performed by a skilled and experienced professional using appropriate sterile, disposable instruments the risks are minimal and the procedure is instantaneous and essentially painless. Proper placement and the correct style and size of inert jewelry are absolutely critical.

Also vital is the cooperation of the piercee to care for the piercing adequately. Following the piercing the use of ice, rest, and elevation (just like with any wound) drastically diminishes the aftermath. An over-the-counter non-steroidal anti-inflammatory taken according to package instructions for the first few days can also help to keep swelling down. Most piercees report little or no bleeding and a minimum of swelling for a few days. Tongue and other oral piercings heal extremely quickly and uneventfully when all aspects are handled according to accepted practice.

Highly suggested for optimal safety is to replace the initial jewelry (which has some extra room to allow for the usual amount of initial swelling) with a snugger piece which fits closer to the body. There is then less chance of contacting the jewelry with the teeth and other oral structures. Also, balls made of acrylic can be worn inside the mouth to minimize risk of damage to the teeth. Further, a smaller ball can be worn on the underside of the tongue to reduce contact with the sublingual portion of the oral cavity. These and other precautions can be taken which bring risk of getting and wearing oral piercings to a negligible level.

Many of our colleagues have dedicated tremendous time and effort to become highly educated and skillful specialists. To disparage us and our field offhandedly without taking the details into consideration is not an accurate or helpful response. Particularly 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 what one should look for in a piercer. Please see our informational brochure Choosing a Piercer for details.

This organization of committed professionals upholds an extremely high standard of safety and hygiene. Members’ web sites can also be accessed for additional information.

If you would care to speak with a board member or if you have specific questions you would like for us to answer, please feel free to contact us.

WHAT IS THE APP POLICY ON PIERCING MINORS?
Regardless of any local legislation being more lenient, the following is an appropriate minimum standards policy on piercing minors:

For any piercing of a minor, a parent or legal guardian must be present to sign a consent form. Proof positive, state issued photo identification is required from the legal guardian, and a bona fide form of identification from the minor. In the event the parent has a different last name and/or address from the child, court documentation is needed to prove the relationship, i.e., divorce papers, or a remarriage certificate.

Under no circumstances is it acceptable or appropriate for a piercer to perform piercing on the nipples or genitals of an individual under 18 years of age.

WHAT IS THE APP POSITION ON STERILE GLOVES?
The APP mission is to promote and uphold minimal standards of safety and hygiene. As such, it is our official position that aseptic technique performed with clean disposable gloves is appropriate and acceptable. The above applies, except where sterile gloves are mandated by local laws. If a piercer wishes to use sterile gloves, naturally they may do so, but it is certainly not to be construed as required for a safe, hygienic piercing.

WHAT IS THE APP POSITION ON NAVEL PIERCING AND PREGNANCY?
Navel jewelry may be left in place; some women leave jewelry in during their entire pregnancy and delivery. If, during your pregnancy the piercing becomes uncomfortable, you can replace the jewelry with Tygon or PTFE, which are inert plastics (something like thick fishing line). These will bend and flex with your changing body, be more comfortable, and are safe to wear. Once your pregnancy is over, you can return to the jewelry.

Even long after the piercing is totally healed, it may or may not stay open without something in place. This varies from person to person. Wearing an inert plastic in the piercing will insure that it can be maintained.

In the event you elect to remove the jewelry entirely there is a chance it could be reinserted using an insertion taper even if the old jewelry wonÕt go back in readily. If it cannot be reinserted it is quite likely that it can be repierced.

As a side note, some women who lack sufficient tissue quantity or pliability for navel piercing prior to pregnancy are often well suited afterwards.

There is no special care that is required during pregnancy for healed piercings.

WHAT IS THE APP POSITION ON BREAST FEEDING AND WOMEN
In our collective, massive experience, we have no awareness of even a single case of a woman who wished to breast feed and could not as a result of having had a nipple piercing. The milk ducts are a multiplicity of little pore-like ducts. Therefore, the likelihood of closing them all off from a piercing of usual size is virtually nil.

Most women do remove their jewelry for breast feeding and we believe this to be appropriate. As a result, some milk may come from the site of the piercing during nursing, which is not harmful nor problematic. Some will use an insertion taper (a tool designed for this purpose) to facilitate reinsertion or to check regularly and make certain the holes are open.

There is no special care that is required during pregnancy for healed piercings.

WHAT IS THE APP POSITION ON BODY ART DURING PREGNANCY?
It is advisable to refrain from undergoing any and all body art procedures during a pregnancy, even just an ear lobe stretch. It is best to let your body focus on the important, complex and demanding task that it is handling already.

WHAT IS THE APP POSITION ON BODY ART FOLLOWING PREGNANCY?
We suggest that a three month waiting period be observed following delivery in order for the body to normalize and regain physiological and hormonal equilibrium before piercing.

Further, we suggest that a longer period be observed prior to nipple piercing. It is advisable and prudent to wait three months following the cessation of breast milk production before piercing of the nipples.

WHAT IS THE APP POSITION ON BODY PIERCING DURING NURSING?
With the exception of a 3-month post-partum delay we do not find it contraindicated to receive piercings (with the obvious exception of the nipples) during nursing. The body is not under the same type of demands as during pregnancy.

Further, we suggest that a longer period be observed prior to nipple piercing. It is advisable and prudent to wait three months following the cessation of breast milk production before piercing of the nipples.

WHAT IS THE APP POSITION ON STUD GUNS?
It is the position of the Association of Professional Piercers that only sterile disposable equipment is suitable for body piercing, and that only materials which are certified as safe for internal implant should be placed in inside a fresh or unhealed piercing. We consider unsafe any procedure that places vulnerable tissue in contact with either non-sterile equipment or jewelry that is not considered medically safe for long-term internal wear. Such procedures place the health of recipients at an unacceptable risk. For this reason, the APP must strongly recommend that reusable ear piercing guns not be used for any type of piercing procedure.
While piercing guns may seem to be a quick, easy and convenient way of creating holes, they have major drawbacks in terms of sterility, tissue damage and inappropriate jewelry design. These concerns are addressed below.

Reusable ear piercing guns can put clients in direct contact with the blood and body fluids of previous clients.

Although they can become contaminated with bloodborne pathogens dozens of times in one day, ear piercing guns are often not sanitized in a medically recognized way. Plastic ear piercing guns cannot be autoclave sterilized and may not be sufficiently cleaned between use on multiple clients. Even if the antiseptic wipes used were able to kill all pathogens on contact, simply wiping the external surfaces of the gun with isopropyl alcohol or other antiseptics does not kill pathogens within the working parts of the gun. Blood from one client can aerosolize, becoming airborne in microscopic particles, and contaminate the inside of the gun. The next client’s tissue and jewelry may come into contact with these contaminated surfaces. There is thus a possibility of transmitting bloodborne disease-causing microorganisms through such ear piercing, as many medical studies report.

As is now well known, the Hepatitis virus can live for extended periods of time on inanimate surfaces, and could be harbored within a piercing gun for several weeks or more. Hepatitis and common staph infections, which could be found on such surfaces, constitute a serious public health threat if they are introduced into even one reusable piercing gun. Considering the dozens of clients whose initial piercings may have direct contact with a single gun in one day, this is a cause for serious concern. Babies, young children, and others with immature or compromised immune systems may be at higher risk for contracting such infection.
Additionally, it is not documented how often piercing guns malfunction. Some operators report that the earring adapter that holds the jewelry will often not release the earring, requiring its removal with pliers. These pliers, which contact contaminated jewelry immediately after it has passed through the client’s tissue, may be reused on multiple customers without full sterilization. Few, if any, gun piercing establishments possess the expensive sterilization equipment (steam autoclave or chemclave) necessary for such a procedure.

Piercing guns can cause significant tissue damage.

Though slightly pointy in appearance, most ear piercing studs are quite dull. Piercings must therefore be accomplished by using excessive pressure over a larger surface area in order to force the metal shaft through the skin. The effect on the body is more like a crush injury than a piercing and causes similar tissue damage. Medically, this is referred to as “blunt force trauma.” At the least, it can result in significant pain and swelling for the client, at the most in scarring and potentially increased incidence of auricular chondritis, a severe tissue disfigurement
.
Occasionally the intense pressure and speed of the gun’s spring-loaded mechanism is not sufficient to force the blunt jewelry through the flesh. In these cases, the earring stud may become lodged part way through the client’s ear. The gun operator, who may not be trained to deal with this possibility, has two options. S/he can remove the jewelry and repierce the ear, risking contamination of the gun and surrounding environment by blood flow from the original wound. Alternately, the operator can attempt to manually force the stud through the client’s flesh, causing excessive trauma to the client and risking a needlestick-type injury for the operator. How often such gun malfunction occurs has not been documented by manufacturers, but some gun operators report that it is frequent.

When used on structural tissue such as cartilage, more serious complications such as auricular chondritis, shattered cartilage and excessive scarring are common. Gun piercings can result in the separation of subcutaneous fascia from cartilage tissue, creating spaces in which fluids collect. This can lead to both temporary swelling and permanent lumps of tissue at or near the piercing site. These range from mildly annoying to grossly disfiguring, and some require surgery to correct. Incidence can be minimized by having the piercing performed with a sharp surgical needle, which slides smoothly through the tissue and causes less tissue separation. A trained piercer will also use a post-piercing pressure technique that minimizes hypertrophic scar formation.
Cartilage has less blood flow than lobe tissue and a correspondingly longer healing time. Therefore infections in this area are much more common and can be much more destructive. The use of non-sterile piercing equipment and insufficient aftercare has been associated with increased incidence of auricular chondritis, a severe and disfiguring infection in cartilage tissue. This can result in deformity and collapse of structural ear tissue, requiring antibiotic therapy and extensive reconstructive surgery to correct. Again, medical literature has documented many such cases and is available on request.

The length and design of gun studs is inappropriate for healing piercings.

Ear piercing studs are too short for some earlobes and most cartilage. Initially, the pressure of the gun’s mechanism is sufficient to force the pieces to lock over the tissue. However, once they are locked on, the compressed tissue cannot return to its normal state, is constricted and further irritated. At the least, the diminished air and blood circulation in the compressed tissue can lead to prolonged healing, minor complications and scarring. More disturbingly, the pressure of such tight jewelry can result in additional swelling and impaction. Both piercers and medical personnel have seen stud gun jewelry completely embedded in ear lobes and cartilage (as well as navels, nostrils and lips), even when pierced "properly" with a gun. This may require the jewelry to be cut out surgically, particularly in cases where one or both sides of the gun stud have disappeared completely beneath the surface of the skin. Such consequences are minimal when jewelry is custom fit to the client, allows sufficient room for swelling, and is installed with a needle piercing technique which creates less trauma and swelling.

Jewelry that fits too closely also increases the risk of infection because it does not allow for thorough cleaning. During normal healing, body fluids containing cellular discharge and other products of the healing process are excreted from the piercing. But with inappropriate jewelry, they can become trapped around the hole. The fluid coagulates, becoming sticky and trapping bacteria against the skin. Unless thoroughly and frequently removed, this becomes an invitation to secondary infection. The design of the “butterfly” clasp of most gun studs can exacerbate this problem. Again, these consequences can be avoided with implant-grade jewelry that is designed for ease of cleaning and long-term wear.

A further note on ear piercing studs:

Most ear piercing studs are not made of materials certified by the FDA or ASTM as safe for long term implant in the human body. Even when coated in non-toxic gold plating, materials from underlying alloys can leach into human tissue through corrosion, scratches and surface defects, causing cytotoxicity and allergic reaction. Since manufacturing a durable corrosion- and defect-free coating for such studs is extremely difficult, medical literature considers only implant grade (ASTM F-138) steel and titanium to be appropriate for piercing stud composition. Studs made of any other materials, including non-implant grade steel (steel not batch certified as ASTM F-138), should not be used, regardless of the presence of surface plating.

Misuse of ear piercing guns is extremely common.

Even though many manufacturers’ instructions and local regulations prohibit it, some gun piercers do not stop at piercing only the lobes, and may pierce ear cartilage, nostrils, navels, eyebrows, tongues and other body parts with the ear stud guns. This is absolutely inappropriate and very dangerous.

Although gun piercing establishments usually train their operators, this training is not standardized and may amount to merely viewing a video, reading an instruction booklet, and/or practicing on cosmetic sponges or other employees. Allegations have been made that some establishments do not inform their employees of the serious risks involved in both performing and receiving gun piercings, and do not instruct staff on how to deal with situations such as client medical complications or gun malfunction. Indeed, surveys conducted in jewelry stores, beauty parlors and mall kiosks in England and the US revealed that many employees had little knowledge of risks or risk management related to their procedure.

Considering that a large proportion of gun piercers’ clientele are minors or young adults, it is not surprising that few gun piercing complications are reported to medical personnel. Many clients may have been pierced without the knowledge or consent of parents or guardians who provide healthcare access. Therefore, the majority of the infections, scarring and minor complications may go unreported and untreated. Furthermore, because of the ease of acquiring a gun piercing and the lack of awareness of risk, many consumers fail to associate their negative experiences with the stud gun itself. They believe that, since it is quicker and easier to acquire a gun piercing than a manicure, gun piercing must be inherently risk-free. Often it is only when complications prove so severe as to require immediate medical attention that the connection is made and gun stud complications get reported to medical personnel.

Despite these pronounced risks associated with gun piercing, most areas allow gun piercers to operate without supervision. Recent legislation has begun to prohibit the use of guns on ear cartilage and other non-lobe locations, and the state of New Hampshire has made all non-sterile equipment illegal, but these changes are not yet nationwide. It is our hope that, with accurate and adequate information, consumers and the legislatures will understand and reject the risks of gun piercing in the interests of the public health.


References Cited Below*


WHAT IS THE APP POSITION ON PIERCING KITS?

As an association of dedicated, educated, highly experienced piercing professionals we are adamant that piercing kits for sale to the general public represent a serious potential health hazard. Much piercer education and training is necessary in order to perform a safe, sterile, accurate piercing. Simply providing such tools to an inexperienced consumer is a dangerous act of negligence.

The use of these piercing kits by untrained consumers results in significantly greater potential for the transmission of bloodborne pathogens and diseases than do piercings performed by skilled professionals.

An area of particular concern is that of underage individuals performing body piercings on themselves and their friends using readily available piercing kits sold through mail order, on the Internet, or by calling a toll free telephone number. Young people are particularly at risk because, without parental consent, minors are denied professional piercing services in virtually all states where legislation has passed. However, they can still obtain the kits and get pierced without their parents' consent or knowledge. Should an infection or other complication occur, no responsible adult will be on hand to oversee the situation or provide access to appropriate medical care.

Also of great concern is the possibly deadly potential for the contaminated needle to be reused on multiple people. Further, there are dangers of accidental needle sticks to others, since limited or no instructions are included for appropriate disposal of the used needle.

Through legislation, many states allow body piercing that is performed only by a trained, licensed professional in an environment that provides hospital sterilization and submits itself to health department inspections. Most states (43) currently have legislation regarding personal criteria for the piercer, requirements for the piercing establishment, and highly specific laws necessitating parental consent for the piercing of minors. The laws and guidelines, along with the efforts of the professional body piercing community provide those interested in receiving a body piercing with a safe, clean environment to do so, and with a piercing technician who has appropriate training and sufficient experience to be hygienic and proficient.

The nature of the piercing kits do not allow for any of these safety measures to take place. The kits can be purchased by anyone, which is the most relevant aspect of the eminent danger of piercing kits. Piercing kits are not purchased by licensed, experienced professional piercers, who already have access to such items and equipment through legitimate industry sources. Instead, they are purchased by those who either do not have access to an experienced piercer, or who do not have sufficient understanding of the issue to appreciate that sterility, skill and education are an integral part of the piercing procedure.

As professional piercers we want to keep the art of body piercing safe for all who give and receive piercings. We take our field seriously and understand that the risks can be substantially minimized with proper training, equipment, and sterilization. Over-the-counter piercing kits undermine all the work we and our legislators have done to protect the public health while allowing our art form to flourish.

Just say NO to piercing kits and those who sell them or use them.


Regarding Genital Piercings

Genital piercings are often assumed to be the most painful and easily infected of body piercings. Both the piercers who perform them and the clients who request them are sometimes reported to operate in questionable hygienic and ethical territory. However, these perceptions need not be reality. Due to the elastic and resilient nature of much of the genital tissue, as well as the protection from contamination offered by clothing, genital piercings often heal more quickly and with fewer complications than do other piercings. Furthermore, the act of piercing the genitals is for many clients a conscious act of reclaiming and redefining their bodies as a source of pleasure rather than of misplaced shame. Because genital piercings represent an integral facet of sexual freedom, it is important that they be available to adults who seek them. However, it is equally important that they be provided by an experienced, reputable professional in a clean, safe environment.

In the interest of public safety, the Association of Professional Piercers would like to clarify the facts about genital piercing and its risks. Our comments are based upon twenty years of professional experience, research and extensive clinical practice by several hundred exemplary piercers. While we are not ourselves doctors, we do work in conjunction with medical practitioners and researchers. We trust that our comments will be taken in the spirit intended, as an effort to round out the existing dialogue. With full and appropriate information, it is our hope that consumers will be better able to make educated choices about their bodies and the ways in which they choose to celebrate them. It is also our hope that those who seek to protect and regulate the health of the public do so circumspectly, without unduly limiting or denigrating free bodily expression in its many forms.

Some criticism of genital piercings focuses on the perceived risk of piercing nerve-laden genital tissue. There is also concern that genital tissue may be more susceptible to infection than are piercings of other body parts. Furthermore, it is possible that sexual contact can increase the threat of complications. When performed by a conscientious professional piercer using proper aseptic technique, the risks of complications from the piercing itself are minimal. When these conditions are paired with appropriate and thorough aftercare on the part of an educated client, negative consequences are extremely rare.

As with all piercings, genital piercings should only be performed on consenting, sober adults by a skilled and licensed (where applicable) practitioner. All piercing studios should be designed to provide a sanitary, controlled environment that conforms to appropriate local and state regulations, as well as to OSHA Bloodborne Pathogens standards. All tools, needles and jewelry must be sterile, and all needles must also be single-use. The practitioner must have specific knowledge of both aseptic technique and of the procedure at hand. He or she must also make every reasonable effort to maintain the physical and psychological comfort and safety of the client.

It is unquestionably true that some genital tissue contains much higher concentrations of nerve tissue than many other areas of the body. However, it is also true that this same tissue is physiologically designed to take increased abuse from friction, pressure and manipulation. Due to the rigors of childbirth, women’s genital tissue is by necessity well equipped to stretch, give and quickly repair itself, often with little pain or consequence. Both women and men describe the pain of the most common genital piercings as being similar in intensity to other body parts, and sometimes less so. The more advanced genital piercings (such as clitoris and ampallang) may be more intense, but these are usually performed only by the most experienced piercers who have greater technical and anatomical expertise. However, they tend to also be requested by, and are often limited to, clients who have already received and healed other piercings. Since anesthetics are not used in accepted practice, the continued existence of these piercings should attest to the manageability of the pain.

As to the risks of excessive bleeding or neurological damage from common genital piercings, these risks are minimized when piercings are performed by a skilled and educated piercer using accepted techniques. Piercing-specific anatomical knowledge coupled with inspection of the area should allow a qualified piercer to perform the common piercings without incident. Specialized tools and procedures have also been developed by industry professionals in order to most successfully and safely manage the piercing procedure. When properly employed, these further reduce the risk of unanticipated consequence.

The physiologic function of genital tissue requires that it be extremely elastic and vascular and therefore quick to heal. With few exceptions, genital piercings will heal within a month or two, while tougher tissue such as ear cartilage, navels and nostrils may take six months or longer. Because healing time is often so short, this implies a very small window of opportunity for infection to set in. Furthermore, genital tissue is not subject to frequent exposure and casual contact with the external environment and dirty hands the way other body parts may be. (Certainly an office worker lost in thought would not be toying idly with a labia ring as she might be with an earring or nostril ring.) Clothing further protects the piercing from airborne contaminants, which can be a cause of infection and irritation for facial piercings.

The predominant cause of contamination and infection for genital piercings is most likely unprotected sexual contact. Even in the case of monogamous partners, body fluids, unwashed hands and oral bacteria can easily lead to infection if introduced in a wound. Fortunately, this exposure is 100% preventable. In addition to explaining appropriate cleaning protocol, a responsible piercer will emphasize to the client that during healing, all sexual and oral contact must be made fluid safe, either through abstinence or the use of barriers such as condoms and dental dams. Furthermore, undue stress, abuse or manipulation of the piercing site and/or jewelry should be avoided during healing. Of course it is the responsibility of the client to follow through with these instructions after leaving the piercing studio. Providing the client with thorough written instructions and an invitation for follow-up care can greatly improve compliance and healing success.

In this discussion, it bears mentioning that the average genital piercing customer is a more informed consumer than the usual navel, ear or tongue piercing client. While often no more complicated from a piercer’s standpoint, genital piercings are a more advanced step in the mind of the piercee. Therefore those who elect to get them have usually already received and healed at least one other piercing, and are often more informed about the piercing process and aftercare. They are more likely to do advance research than are navel or facial piercing customers, and may be more likely to follow up with the piercer should questions or concerns arise. While of course genital piercings should never be done on anyone under eighteen (even with parental consent), these piercees are generally not eighteen-year-olds who are hiding the piercing and any consequences from their parents. In fact, these piercings are just as often being done on parents and other middle-aged adults, who are looking for new ways to appreciate their bodies and their relationships.

In short, genital piercings can be done safely and healed easily, provided the clients follow through with appropriate aftercare and abstain from unsafe contact. Since these clients are often the most educated and conscientious of the piercing clientele, compliance with suggested care is more likely than it is with other piercings.

While the idea of genital piercings stirs up fears of sexual taboos and contagious diseases for some (particularly for those physicians who see only worst case scenarios), the reality is truly quite different. Genital piercings today are being performed on a wide variety of people of all ages, sexualities and professional backgrounds. When performed under hygienic conditions by ethical and educated piercers on clients who follow suggested aftercare procedures, they represent a safe and creative way to assert bodily ownership and redefine the acceptability of pleasure. It is the challenge of professional piercers and those who regulate them to assure that these piercings remain both safe and available to those who choose them.


*Pediatric Emergency Care. 1999 June 15(3): 189-92.
Ear-piercing techniques as a cause of auricular chondritis.
More DR, Seidel JS, Bryan PA.

International Journal of Pediatric Otorhinolaryngology. 1990 March 19(1): 73-6.
Embedded earrings: a complication of the ear-piercing gun.
Muntz HR, Pa-C DJ, Asher BF.

Plastic and Reconstructive Surgery. 2003 February 111(2): 891-7; discussion 898.
Ear reconstruction after auricular chondritis secondary to ear piercing.
Margulis A, Bauer BS, Alizadeh K.

Contact Dermatitis. 1984 Jan; 10(1): 39-41.
Nickel release from ear piercing kits and earrings.
Fischer T, Fregert S, Gruvberger B, Rystedt I.

British Journal of Plastic Surgery. 2002 April 55(3): 194-7.
Piercing the upper ear: a simple infection, a difficult reconstruction.
Cicchetti S, Skillman J, Gault DT.

Scottish Medical Journal. 2001 February 46(1): 9-10.
The risks of ear piercing in children.
Macgregor DM.

AFTERCARE

CLEANING SOLUTIONS
Use either one or both of the following solutions for body piercing:

- Packaged sterile saline solution* with no additives (read the label!) or non-iodized sea salt mixture: Dissolve 1/8 - 1/4 teaspoon of non-iodized (iodine free) sea salt into one cup (8 oz) of warm distilled or bottled water. A stronger mixture is not better! Saline solution that is too strong can irritate the piercing.
- Liquid anti-microbial or germicidal soap.*

CLEANING INSTRUCTIONS
1) WASH your hands thoroughly prior to cleaning, or touching on or near your piercing for any reason.
2) SALINE soak at least two to three times daily. Simply invert a cup of warm saline solution over.
the area to form a vacuum for a few minutes. The longer you soak, the better. For certain placements it may be easier to apply using fresh gauze or a cotton ball saturated with saline solution. A brief rinse will remove any residue.
3) SOAP no more than once or twice a day. While showering, lather up a pearl size drop of the soap to clean the jewelry and the piercing. Leave the cleanser on the piercing no more than thirty seconds, then rinse thoroughly to remove all traces of the soap from the piercing.
4) DRY with disposable paper products such as gauze or tissues, because cloth towels can harbor bacteria and catch on new piercings causing injury. Pat gently to avoid trauma.

WHAT IS NORMAL
- Initially: some bleeding, localized swelling, tenderness, or bruising.
- During healing: some discoloration, itching, secretion of a whitish-yellow fluid (not pus) that will form some crust on the jewelry. The tissue may tighten around the jewelry as it heals.
- Once healed: the jewelry may not move freely in the piercing; DO NOT force it. If you fail to include cleaning your piercing as a part of your daily hygiene routine, normal but smelly bodily secretions may accumulate.
- A piercing may seem healed before healing is complete. This is because piercings heal from the outside in, and although it feels healed the tissue remains fragile on the inside. BE PATIENT, and keep cleaning throughout the entire healing period.
- Even healed piercings can shrink or close in minutes after having been there for years! This varies from person to person; if you like your piercing, leave the jewelry in place.

WHAT TO DO
- Wash your hands prior to touching the piercing; leave it alone except when cleaning. It is not necessary to rotate the jewelry while healing except possibly during cleaning.
- Stay healthy. Get enough sleep and eat a nutritious diet. The healthier your lifestyle, the easier it will be for your piercing to heal. Exercise during healing is fine, just “listen” to your body.
- Make sure your bedding is kept clean and changed regularly. Wear clean, comfortable breathable clothing that protects your piercing while sleeping.
- Showering is safer than taking a bath, because bathtubs tend to harbor bacteria. If you would like to take a bath, clean the tub well before each use.

WHAT TO AVOID
- Avoid undue trauma such as friction from clothing, excessive motion of the area, playing with the jewelry and vigorous cleaning. These activities can cause the formation of unsightly and uncomfortable scar tissue, migration, prolonged healing, and other complications.
- Avoid the use of alcohol, hydrogen peroxide, Betadine, Hibiclens or ointment.
- Avoid over cleaning. This can delay your healing and irritate your piercing.
- Avoid all oral contact, rough play, and contact with others’ bodily fluids on or near your piercing during healing.
- Avoid stress and recreational drug use including excessive caffeine, nicotine, and alcohol.
- Avoid submerging the piercing in bodies of water such as lakes, pools, jacuzzis, etc. Or protect your piercing using a special waterproof bandage* such as Tegaderm, which is available at drugstores.
- Avoid all beauty and personal care products on or around the piercing including cosmetics, lotions, and sprays, etc.
- Don’t hang charms or any object from your jewelry until the piercing is fully healed.

Hints and Tips


Jewelry

- Unless there is a problem with the size, style, or material of the initial jewelry, leave it in place for the entire healing period. A qualified piercer should perform any necessary jewelry change that occurs during healing. See APP website for “Picking your Piercer” brochure.
- Contact your piercer if your jewelry must be temporarily removed (such as for a medical procedure). There are non-metallic jewelry alternatives.
- Leave jewelry in at all times. Even old, well-healed piercings can shrink or close in minutes after having been there for years! If removed re-insertion can be difficult or impossible.
- With clean hands or paper product, be sure to regularly check threaded ends on your jewelry for tightness. (“Righty-tighty, lefty-loosey”).
- Carry a clean spare ball in case of loss or breakage.
- Should you decide you no longer want the piercing, seek professional help in the removal of the jewelry and continue cleaning the piercing until the hole closes. In most cases only a small indentation will remain.

For Particular Areas

Navel
- A hard, vented eye patch (sold at pharmacies) can be applied under tight clothing (such as nylon stockings) or secured using a length of ace bandage around the body (to avoid irritation from adhesive). This can protect the area from restrictive clothing, excess irritation, and impact during physical activities such as contact sports.

Ear/Ear Cartilage and Facial
- Use the t-shirt trick: dress your pillow in a large, clean t-shirt and turn it nightly; one clean t-shirt provides four clean surfaces for sleeping.
- Maintain cleanliness of telephones, headphones, eyeglasses, helmets, hats and anything that contacts the pierced area.
- Use caution when styling your hair and advise your stylist of a new or healing piercing.

Nipple
- The support of a tight cotton shirt or sports bra may provide protection and feel comfortable, especially for sleeping.

Genital
- In most cases you can engage in sexual activity as soon as you feel ready. Comfort and hygiene are vital.
- During healing all sexual activities must be gentle. To increase comfort and decrease trauma, soak in warm saline solution or plain water to remove any crusty matter, prior to sexual activity.
- Use barriers such as condoms, dental dams, and Tegaderm, etc.* to avoid contact with a partner’s bodily fluids, even in long-term relationships.
- Use clean, disposable barriers on sex toys.
- Wash hands before touching on or near the piercing.
- Use a new container of water based lubricant.* Do not use your own saliva as a lubricant.
- After sex, an additional saline soak or clean water rinse is suggested.
- Prince Albert and Apadravya piercings can bleed freely for the first few days.
- If using soap, urinate after cleaning any piercing that is near the urethra. Each body is unique and healing times vary considerably. If you have any questions, please contact your piercer.

DISCLAIMER
These guidelines are based on a combination of vast professional experience, common sense, research and extensive clinical practice. This is not to be considered a substitute for medical advice from a doctor. If you suspect an infection, seek medical attention. Keep in mind that the removal of jewelry can lead to further complications. Be aware that many doctors have not received specific training regarding piercing. Your local piercer may be able to refer you to a piercing friendly medical professional. See the APP Brochure “Troubleshooting For You And Your Healthcare Professional”

*Consult your piercer, see Suggested Products below, or call (888) 888-1APP for current suggested products. This will allow us to keep current as advances are made in the field.


The use this information does not imply the piercer and/or company is an APP
member.

*Suggested Products
-Saline Solution: .9% sterile isotonic solution of "normal saline" or prepared saline
-Liquid anti-microbial or germicidal soap for cleaning: Provon or Satin or other fragrance free mild anti-microbial soap
-Waterproof bandage: Tegaderm, CleanSeals, Polyskin or other breathable, non-water permeable wound sealant bandage

Copyright © 2004, by the Association of Professional Piercers

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.

Body Piercing Troubleshooting

For You and Your Healthcare Professional

The following information is based on a combination of vast professional experience, research, extensive clinical body piercing practice, and common sense. It has been compiled with the input and assistance of medical professionals who are trained, experienced piercers.

For the Piercee

Choosing a Medical Professional

Medical personnel have tremendous knowledge and experience about issues relating to the human body, but may not have specific training about this unique
form of body art. " Care, Maintenance, and Troubleshooting for Body Piercing” is not yet a course of study for most medical professionals. As a piercee, you may have more
specific information about piercing than they do. It is up to you to make certain that your chosen medical professional has access to accurate information that will assist them in treating you.
Ask these questions before settling on a doctor or other practitioner:


Do they approve or disapprove of body piercing?
Does this doctor have prior experience treating piercings?
Do they have a trusted expert body piercer to consult with, or other resources for facts and information about piercing?
If the doctor has any questions would they be willing to call your piercer to discuss it?
You can save yourself an unpleasant, unprodutive experience by avoiding a physician who is disapproving, unwilling to learn, or does not feel comfortable with body piercings.

The following are facts about body piercing and body jewelry to share with your doctor in order to make certain your physician is apprised of important data that can assist in decision making about your care and course of treatment.

For the Medical Professional

Troubleshooting

What is normal?
Discoloration
• Can be reddish, brownish, pinkish, or purplish
• Can remain for many months with certain piercings, such as navels


Swelling/Induration
• Localized
• May be significant with oral piercings such as the lip or tongue, and may last several days immediately following the initial piercing


Excretion
• Exudate of plasma, dead cells, etc.
• Should not be copious in quantity, malodorous, or green
• Will form a small amount of crystalline-appearing crust on the jewelry at the openings of the piercing

Things to consider when treating a troubled
piercing or considering jewelry removal from
a piercing:

The majority of troublesome piercings can be resolved without the piercing being lost.
• Advice to simply “take it out” is likely to be met with resistance from the piercee, and if infected can lead to the formation of an abscess (see below)
• Changes in aftercare and/or jewelry size, style or material may resolve the problems for the piercee/patient
• Inappropriate placement can also be the cause of problems. In this case removal is often required, and if done timely will prevent further problems
• Even momentary removal of jewelry from a healing piercing can result in amazingly rapid closure of the piercing, and make reinsertion difficult or impossible

Ointments used for topical treatment are not preferred for body piercings:
• They are occlusive and can limit oxygen circulation to the area, tending to delay healing of this type of wound
• They leave a sticky residue that makes cleaning the healing tissue more difficult
• If necessary, gels, creams, or other water soluble products are preferred for topical application
• Signs of accumulative allergic reaction to ointments are papules and redness of surrounding tissue

Inappropriate aftercare is one of the most common
causes of a distressed piercing:
• Alcohol, hydrogen peroxide, Betadine, Hibiclens and/or ointment(s) are all inappropriate products for body piercing aftercare
• Over-cleaning can irritate piercings and delay healing
• Daily mild, non-iodized sea-salt or normal saline soaks and/or cleaning with a liquid anti-microbial or germicidal soap once or twice a day is suggested for body piercings*
• Daily mild non-iodized sea-salt or normal saline rinses and/or antimicrobial or antibacterial alcoholfree mouth rinses, 4-5 times a day is suggested for oral piercings*


Jewelry: Materials
• Acceptable materials for wear in body piercings include:

High quality surgical implant grade stainless steel (specifically 316LVM ASTM F-138)

Niobium

Titanium (specifically Ti6A4V ELI, ASTM F-136)

Solid 14k or 18k white or yellow gold

Solid platinum

Dense, low-porosity plastic such as Tygon or PTFE
• Appropriate jewelry has no nicks, scratches, burrs or irregular surfaces that might endanger the tissue
• Safety pins and other household objects are never put into piercings by professional body piercers
• Some piercers use inferior jewelry that contains too much nickel or other irritating alloy resulting in a “metal allergy” (see Allergic Reactions)
• Sutures are not an appropriate size or material for wear in body piercings


Jewelry: Size/Style

• Jewelry in a healing piercing should be of appropriate length or diameter. Too tight/small jewelry will not allow for air and blood circulation, some movement during cleaning, and for the expulsion of normal exudate from the wound. It may imbed, and can increase the possibility of swelling and other complications
• Jewelry in a healing piercing should be of an appropriate gauge (thickness). Too thin of a gauge, and the jewelry may be perceived by the body as a splinter, worked towards the surface and eventually ejected


Jewelry: Xrays, MRIs, and CT Scans
• Metal body jewelry will result in an opaque density on x-rays, but will not otherwise affect visibility on film
• Nipple piercings are unlikely to obstruct visibility of any pathology on thoracic x-rays if both frontal and lateral views are taken
• Appropriate body jewelry is non-magnetic, and as such does not need to be removed for MRI procedures* unless it is located in the region being examined
• Gold jewelry is much more thermal-conductive than steel
• There is no need to cut body jewelry for removal – see Jewelry Removal Tips
• Even momentary removal of jewelry from a healing piercing can result in amazingly rapid closure of the piercing, and make reinsertion difficult or impossible


Placement:
• Problem: Piercing is placed too shallow or the jewelry is too small (gauge/thickness)
• Cause:

Result of poor initial piercing placement
Inappropriate jewelry selection (length/diameter)
• Result: Body will work the jewelry towards the surface and eventually be ejected
• Indications:
Jewelry can be seen through the tissue
Jewelry encompasses less than 1/4-5/16” of tissue
Tissue is red and indurated across the entirety of the piercing and its placement very superficial
• Treatment: Removal of jewelry prior to ejection is preferable. If jewelry is removed the holes close up and scarring is minimized. If the jewelry is allowed to come through the surface by itself a split scar may remain


• Problem: Piercing is placed too deep or the jewelry is too small (length/diameter)
• Cause:

Result of poor initial piercing placement (most common)
Delayed complication of swelling
Poor/inappropriate aftercare
Inappropriate jewelry selection (length/diameter)
• Result: (includes but is not limited to):
Prolonged healing time
Impossible to heal
Unnecessary/unusual scarring
• Indicators: (with Ring)
Ring is unable to lay flat comfortably
The tissue takes up more than 1/3 of the ring’s circumference
• Indicators: (with Barbell):
Barpost can’t seen at either end of the piercing
Beads/Ends of the jewelry pinch or actually imbed in the tissue
• Treatment: Replacing of small jewelry for appropriately sized jewelry. Removal of jewelry to allow healing of too-deep piercing. Can be repierced at a later date

Infected Piercing:

• Problem: Piercing has been contaminated by pathogenic microorganism(s)
• Causes:

Most Common: Piercee has touched piercing with dirty hands or otherwise contaminated piercing (exposure to bodily fluids, dirty water, etc.)
Piercing done with inappropriately sterilized tools, needles, jewelry
Piercing done with unclean, ungloved, and/or contaminated gloved hands
• Indicators:
Piercing exudes thick, green, malodorous pus
Piercing and surrounding area is warm/hot to the touch (more so than other skin)
Piercing site is swollen, red, and painful
• Treatment:
Increased mild sea salt soaks (for minor infections)
Oral/topical antibiotics, as prescribed by a physician
Removal of jewelry in the presence of an infection may result in an abscess. In the event there is a localized, draining infection, quality jewelry should be left in place to allow for passage of matter to the surface
• Complications:
Abscesses are usually site specific. An exception is the chest where the duct system can result in the abscess being formed inches away from the piercing site.

Allergic Reactions:

• Problem: Metal Allergy
• Cause: Inferior Jewelry used (contains too much nickel or other irritating alloy)
• Indications:


Tissue appears to “retreat” from the offending metal

Patient may present with complaints of itching, burning and/or tenderness

S/he may feel virtually no discomfort, even though the piercing seems highly inflamed

In addition to localized dermatitis, the opening to the piercing may appear significantly larger than the size of the jewelry

Redness where the jewelry rests on the surface of the skin

Granulation tissue will be visible

• Solution/Treatment: Change to an appropriate biocompatible jewelry such as Titanium; or a dense, low-porosity plastic such as Tygon or PTFE


• Problem: Product Sensitivity
• Cause: Aftercare products are inappropriate, or the piercee has a product allergy or sensitivity
• Indications:


Delayed healing, localized irritation

Tissue surrounding (up to several inches away) the piercing is red, seeping, or contact dermatitis is present

Expansion of the piercing channel

• Treatment: Discontinue current care regimen in favor of milder products and/or less care


Compounded problems: Any one of the above problems can make additional or secondary problems more likely; i.e. an allergic reaction to an inappropriate metal can make a piercee more vulnerable to infection or a reaction to cleaning products. One should be aware when trying to evaluate a troubled piercing, that multiple causes may be affecting it. In addition, overall health and stress level can be crucial to the healing process and should be evaluated and treated as a potential cause for complications with a healing piercing.


Jewelry Removal

There are three basic styles of body jewelry and many variations on those styles. The three styles are a bead ring (fig.A), captive bead (fig.B), and circular barbell/barbell (fig.C).

There is never any need to cut body jewelry for removal. Even momentary removal of jewelry from a healing piercing can result in amazingly rapid closure of the piercing, and make reinsertion difficult or impossible. Removal of jewelry in the presence of an infection may result in an abscess. In the event there is a localized, draining infection,quality jewelry should be left in place to allow for passage of matter to the surface.

Fig. A

On a bead ring,the bead is attached to one side of the ring. To open the ring for removal, simply twist the ring open. Grasp the ring on each side of the bead, pull gently and one end will pop out of the bead. By pushing one end away from you and pulling the other end toward you to open the ring like a spiral.

Fig. B

On a captive bead ring, the bead is held in by the tension of the ring. Grasp the ring with one hand as close to the bead as you can and with the other hand grasp the bead. Gently pull the ring and bead in opposite directions and the bead should snap out of the ring. Twist the ring a little (as in opening a bead ring) and rotate the jewelry to remove the ring.

Fig. C

Barbells and circular barbells have threaded ends which can be unscrewed.Like most threaded objects,they tighten to the right and loosen to the left.On this type of jewelry one or both of the ends will come unscrewed.

Ring Expanding Pliers or External Snap Ring Pliers can be used to spread a ring open enough to pop a bead in or out.Place the head of the pliers inside of the ring and gently squeeze on the handle to spread the jaws outward,opening the ring just enough to pop the ball out.

Please refer to the APP Aftercare Guidelines sheets (oral or body & facial) for detailed information on the approved and accepted means of optimally caring for healing piercings.

DISCLAIMER
These guidelines are based on a combination of vast professional experience, common sense, research, and extensive clinical practice. This is not to be considered a substitute for medical advice from a doctor. Be aware, however, that many doctors have no specific training or experience regarding piercing and may not be educated on how to best assist you.

Copyright © 2000, by the Association of Professional Piercers, any changes or deletions are strictly prohibited and must be approved in writing by the APP.

IMPORTANT HEALTH CONSIDERATIONS

(From the APP Manual, Pg. 36, containing important information for both piercees and piercers)

Sometimes it is inappropriate to perform even the most standard piercing. A piercer should politely refuse to perform a piercing that could be dangerous, ill suited, unsuccessful, or for which they are not trained. The following are examples for which a second opinion, in some cases from a piercing-friendly physician, may be needed before proceeding:

An individual with heart valve disease (such as mitral valve prolapse) should consult their physician for prophylactic antibiotics
An individual has a heart murmur, diabetes, hemophilia, auto-immune disorder, or other medical condition(s) that may negatively influence the piercing procedure or the healing process
There is an obvious skin or tissue abnormality that may include but is not limited to rashes, lumps, bumps, scars, lesions, moles, freckles, and/or abrasions
The client wants to pierce irregular or surgically-altered anatomy, or the client is unsuited due to occupational, recreational, or environmental factors
Surface-to-surface, or other frequently unsuccessful (commonly rejected by the body) piercings
The client has impending plans to become pregnant and wishes to get a nipple, navel, or other piercing
It is advisable to refrain from piercing during pregnancy to allow the body to focus on the important, complex, and demanding task that it is handling already

PIERCING AND HEART CONDITIONS

It is our suggestion that a piercer not pierce any client who has a pre-existing heart condition without a doctor’s consent and proof of a preventive antibiotic. These pre-existing heart conditions include but are not limited to:

-Any client with an artificial (prosthetic) heart valve.
-Any client with damaged (scarred) heart valves caused by a medical condition, i.e. rheumatic fever.
-Any client with congenital heart defects or heart valve defects such as MVP (Mitral Valve Prolapse)- Heart Murmur, Valvular Stenosis, Valvular Regurgitation, or Atresion of one of the valves.

Risks
The major risk for those clients with heart conditions is Bacterial Endocarditis. This is a serious infection of the heart's inner lining (endocardium) or the heart valves. This can damage or even destroy your heart valves. Although rapid diagnosis, effective treatment, and prompt recognition of complications can lower the risk of mortality, prevention is still the best option.

The American Heart Association (AHA) indicates that taking your prescription prophylactic antibiotics one hour before receiving a piercing or Etching will provide an effective prophylaxis against infection.

***
The AHA also has a downloadable Bacterial Endocarditis Wallet Card available on their website at www.americanheart.org.

Prevention is Key
If you have to take antibiotics before seeing the dentist for a routine teeth cleaning, you need to see your doctor and ask him or her about taking antibiotics before receiving a body piercing. (Piercing is much more invasive than getting your teeth cleaned.)

After you speak with your doctor, we suggest that you bring in a note from your doctor approving your piercing, as well as the filled prescription of antibiotics.
We care about you and your health and wellbeing, and want every piercing to be safe and fun!

Thanks to Nicole Brown of Budo Studio for researching this topic and providing information to the APP

Many Thanks to the APP for usage of these articles. For more info please visit: http://www.safepiercing.org/
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