Disclaimer: 2010 edition

Transcription

1 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. 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 or dental professional. For more information, see the APP Brochure Troubleshooting For You and Your Healthcare Professional. Use of this brochure does not imply membership in the APP. A current list of APP members can be found at safepiercing.org. False claims of membership should be reported to the APP. The APP logo is the trademark of the Association of Professional Piercers. This brochure is licensed under the Creative Commons Attribution-Noncommercial-No Derivative Works License. To view a copy of this license, visit edition

2 Avoid cleaning with Betadine, Hibiclens, alcohol, hydrogen perozide, Dial or other harsh soaps, as these can damage cells. Also avoid ointments as they prevent necessary air circulation. Avoid Bactine, pierced ear care solutions and other products containing Benzalkonium Chloride (BZK). These can be irritating and are not intended for long term wound care. 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. RINSE thoroughly to remove all traces of the soap from the piercing. It is not necessary to rotate the jewelry through the piercing. Avoid submerging the piercing in unhygenic bodies of water such as lakes, pools, hot tubs, etc. Or, protect your piercing using a waterproof wound-sealant bandage (such as 3M Nexcare Clean Seals). These are available at most drugstores. A piercing may seem healed before the healing process is complete. This is because tissue heals from the outside in, and although it feels fine, the interior remains fragile. Be patient, and keep cleaning throughout the entire healing period.

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5 Isn t the Mouth DIrty? As the main portal for 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. How can we maintain health 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 Myeloperoxidase Lactoferrin Agglutinins Salivary peroxidase Immunoglobulins 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. The extremely high turnover rate of oral mucosa makes it one of the fastest healing sites in the body. Oral mucosa maintains its structural integrity through a system of continuous cell renewal in which cells are produced by division, migrate to the surface of the tissue, and replace the cells that are shed. The cellular turnover rate for oral mucosa of the cheek is 25 days compared to days for skin. Compared to many other body piercings, the relatively brief healing time of the average oral piercing provides a much shorter window of opportunity for exposure to infection. For instance, a tongue piercing usually heals in 6 8 weeks, compared to 6 9 months or longer for a navel piercing. The head and neck region houses a highly concentrated system of veins, arteries, and lymph vessels allowing for rapid transportation of anti-infective agents to attack infective agents in a swift manner. Infection rates for oral piercings are negligible when sterile equipment, proper aseptic protocol, and appropriate jewelry selection are combined with conscientious aftercare. This requires the education of both piercer and piercee to 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 the general public and those who seek to protect them. Only by supporting the dissemination of accurate information and the efforts of conscientious professionals can the risks of piercing truly be controlled. Making oral piercings illegal forces consumers who seek them to patronize unregulated, underground establishments. Since many individuals still desire oral piercings and intend to get them, it is far more constructive to provide sound information on how to choose a practitioner and specific guidelines on safe piercing procedures. 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 a 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. 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 (2 nd ed). C.V. Mosby Company (St. Louis) Staines N, Brostoff J and James K: Introducing immunology (2nd ed). C.V. Mosby Company (St. Louis) 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. 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 or dental professional. For more information, see the APP Brochure Troubleshooting For You and Your Healthcare Professional. Use of this brochure does not imply membership in the APP. A current list of APP members can be found at safepiercing.org. False claims of membership should be reported to the APP. The APP logo is the trademark of the Association of Professional Piercers. This brochure is licensed under the Creative Commons Attribution-Noncommercial-No Derivative Works License. To view a copy of this lisense, visit oral Piercing risks & safety MeAsures

6 oral Piercing risks & safety MeAsures traditional placement for lip and cheek piercings: Should be placed relatively perpendicular so the jewelry does not sit at a sharp angle. 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 commonly rapid and uneventful. Most of the concerns about oral piercings center on one of three areas: Position must be chosen so that the jewelry rests in a neutral spot inside the mouth. Post should be shortened to fit snugly once healing is done to minimize contact of jewelry with the teeth and gums. Fear of an unsafe procedure Cheek piercings should not be placed further back than the first molars to avoid parotid glands and ducts. Potential for damage to teeth and oral structures A strong light can be used to check the selected placement for vascularity and enervation (blood vessels and nerves). Risk of infection These potential hazards are diminished when the following steps are taken. Piercer to reduce risks of an unsafe procedure, you Must first select the right piercer, one Who: Is trained, 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 all applicable licenses and permits; Spore tests autoclave (sterilizer) regularly and can provide documentation; Uses appropriate sterile instruments and jewelry, and sterile disposable needles; A disc backing inside the mouth should not catch on the gums when speaking or eating. Jewelry must be accurately sized to the area. The longer jewelry that allows for initial swelling must be replaced with a shorter piece after swelling has dissipated to reduce the chance of harm to the teeth and oral structures. Quality jewelry in an appropriate material See the APP Minimum Jewelry Standards for detailed jewelry material and design specifications. The piercer must provide written and verbal guidelines to thoroughly explain aftercare protocol, including the use of antimicrobial alcoholfree mouth rinses and/or sea salt rinses. Check that threaded ends are on securely. Tighten them daily to insure that your jewelry stays in place. Avoid sharing plates, cups, and eating utensils. Wearing a smaller ball on the underside of the tongue helps to reduce jewelry contact with the sublingual portion of the oral cavity. Playing with oral jewelry is the most frequent cause of tooth and gum damage and should be avoided. PlAceMent Is available for follow-up and questions post-piercing, so any developing problems can be resolved before damage occurs. Proper placement is absolutely critical for health and comfort. JewelrY The potential for intra-oral damage from piercings 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: Jewelry must be the correct style for the anatomy and piercing placement; The risk of exposure to infection can be controlled during the piercing procedure by the use of sterile equipment and jewelry and rigorous adherence to aseptic technique. The piercing must be cared for properly to avoid infection during healing. Balls made of acrylic rather than metal can be worn on tongue barbells to minimize the risk of damage to the teeth. Takes the time to verbally instruct in proper care guidelines and provides written instructions; See the APP s Picking Your Piercer brochure for additional details and information. AftercAre traditional placement for a tongue piercing: Along the midline of the tongue, essentially in the center of the mouth; Approximately 3/4 back from the tip of the tongue; Use a new soft-bristled toothbrush and keep it clean. Don t chew gum, tobacco, fingernails, pencils, sunglasses, or other foreign objects that could harbor bacteria. Avoid undue trauma; excessive talking or playing with the jewelry during healing can cause the formation of unsightly and uncomfortable scar tissue, migration, and other complications. For detailed care information see the APP brochure: Aftercare Guidelines For Oral Piercings. What about swelling? When the piercing is performed properly and approved care guidelines are followed, most piercees experience little or no bleeding and a minimum of swelling for a few days. 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 toward the higher part of the upper palate where there is more room in the mouth); Allow small pieces of ice to dissolve in the mouth. Usually placed just in front of the attachment of the lingual frenulum (web under the tongue). Sleep with your head elevated above your heart during the first few nights. Take an over-the-counter, non-steroidal anti-inflammatory such as Ibuprofen or naproxen sodium according to package instructions.

7 JewelrY quality (And other things to know) The surfaces and ends of body jewelry must be free of nicks, scratches, burrs, and polishing compounds. Suitable pieces have no irregular surfaces that could endanger the delicate healing tissue of a fresh piercing. Metal body jewelry should be polished to a smooth, mirror finish. If you wear jewelry that has a porous or uneven surface, the new cells that form during healing grow into the irregularities. Then, when the jewelry shifts or moves, these areas tear. As this cycle is repeated, scar tissue forms and healing is delayed. A faulty finish can also introduce bacteria into the wound and cause infection. Quality rings are annealed, which is a heat treatment that makes the metal more pliable. When rings can be opened or closed without the use of pliers it reduces the risk of damaging the metal. For thicker rings (especially in smaller diameters) the use of tools may be necessary. Tools should have brass jaws or be covered with tape or gauze to protect the jewelry from damage. Not all piercings have an entrance and an exit. Surface Anchors are very common now and the jewelry sits below the surface of the skin from a single point. The threaded top may be changed. Removing the base of the jewelry causes the loss of the piercing, so this is not normally done. See your piercer for assistance if the piece shifts or migrates. Gemstone settings must be of high quality; stones should be set securely into the metal, often in a prong or bezel setting. Some manufacturers use adhesives to attach the gem. If the stone falls out, which is common with lower-priced goods, the entire piece of jewelry will need to be replaced as the hole left by the missing gem can harbor bacteria and increase risk of infection. For information about jewelry and materials suitable for healed piercings, and for jewelry removal instructions see our brochure: Jewelry for Healed Piercings. Photos courtesy of Paul King, Threadless bar photo courtesy of Neometal, Surface anchor photo courtesy of Industrial Strength Body Jewelry, Diagram and text from The Piercing Bible by Elayne Angel, threading Threaded jewelry uses tiny screw threads for their closures. One side has male screw threads that fit into a female hole that is tapped (drilled out) with the matching thread pattern on the other. One or both ends unscrew. < Internally threaded jewelry is part of the APP standard for initial piercing jewelry: the part of the jewelry that passes through your skin is smooth, and the threads are on the removable end(s), such as balls, gems, or spikes. Internally threaded jewelry avoids any possibility of scraping your tissue with sharp threads, which is especially important with fresh piercings. < Alternatively, externally threaded jewelry has the screw pattern cut into the post, and this comparatively rough surface may be passed through the tissue to insert and remove the jewelry. < Threadless (or press-fit ) jewelry is an acceptable alternative that uses a pin coupling on the ornamental end, and there are no screw threads at all. Machining of the jewelry affects how it performs. Losing your jewelry can result in the closure of your piercing. Threaded ends should be checked for tightness daily with clean hands. If they come loose often, you may have a defective piece. See your piercer for options or a replacement part. If the ball on your captive ring comes off or is loose, you may need a new ball, or to have the tension on the ring adjusted. Jewelry should fit together well. Threaded attachments should fit completely onto posts without gaps. Threads on screwon ends and dimples on captive pieces should be centered for a proper fit. 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. 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. For more information, see a qualified piercer. Use of this brochure does not imply membership in the APP. A current list of APP members can be found at safepiercing.org. False claims of membership should be reported to the APP. The APP logo is the trademark of the Association of Professional Piercers. This brochure is licensed under the Creative Commons Attribution-Noncommercial-No Derivative Works License. To view a copy of this license, visit JewelrY for initial Piercings

8 nostril screw labret stud Choosing jewelry for a new piercing is obviously quite different from shopping for a ring to wear on your finger. Because body jewelry is worn inside a wound and is in contact with your internal tissues, only certain products are suitable. The look of the jewelry that is placed in your fresh piercing must be secondary to aspects that affect safety and compatibility with your body. The size, style, material, and quality of the initial piece of jewelry all affect your ability to heal. Remember that the piercing location is fixed, but the jewelry can be changed after you have successfully healed. Because the body jewelry industry is saturated with substandard products, piercers and clients alike may forget that cost alone should never be the key factor in your purchase. Consider the following when selecting body jewelry for a new piercing: circular barbell threadless curved barbell Must be of appropriate length or diameter for your unique anatomy and the placement of the piercing. Jewelry that is too tight does not allow for air and blood circulation or for the expulsion of normal secretions from the piercing. Ill-fitting jewelry increases the likelihood of swelling, embedding, and other complications if too small, or catching and excessive trauma, if too large. Must be of an appropriate gauge (thickness). The body may treat jewelry that is too thin in gauge like a splinter, resulting in migration or rejection. Must be of a style suited to your build and the location of the piercing. Rings are best for some areas, straight or curved bars for others, and specialty jewelry such as a nostril screw or labret stud for specific placements. Of the numerous materials available, few have been proven appropriate for wear in fresh body piercings. Some metal alloys (mixtures) have been approved based on medical usage (often as medical implants) and have specific designations that represent a precise standard for the alloy and its quality as determined by the American (now International) Society for Testing and Materials Standard (ASTM) and/ or the International Standards Organization (ISO). Other materials, such as gold and obsidian (natural glass) have a long history of use in piercings dating back hundreds and sometimes thousands of years. Should be able to withstand the heat and pressure of autoclave sterilization. Should be inert and compatible with the body so it doesn t cause irritation, allergy, or infection. Mill test certificates (or mill certs ) are documents that provide evidence of a specific grade of metal with an ASTM or ISO code designation. These are provided to jewelry makers by the manufacturers of the raw materials. Some jewelry companies also have biocompatibility testing done by independent labs. Your piercer may have copies of these certificates available for you to review. You don t need to understand what the numbers mean, but the document should warrant that the metal is one of the grades listed below. It is not possible to know whether the piece of jewelry you re buying is from the batch indicated on the paper, but the presence of documentation listing the appropriate materials means that your piercer is more likely to be purchasing from reputable sources and is conscientious about their jewelry quality. SURGICAL STEEL is made of a variety of alloys. Many of them are used for body jewelry, but only a few specific grades are proven biocompatible: steel that is ASTM F-138 compliant or ISO compliant; ISO (6,10, or 11) compliant; or (EEC [European] Nickel Directive compliant. > How measurements are taken on a straight barbell, captive bead ring, and a curved bar. surface Anchors JewelrY MAteriAl The material worn in a healing piercing: JewelrY size And style fixed bead ring TITANIUM is a lightweight metal that is ideal for people with concerns about nickel sensitivity. This material can be anodized to create jewelry of different colors without affecting the safety. Look for implant certified titanium (Ti6Al4V ELI) that is ASTM F-136 compliant or ISO compliant, or commercially pure titanium that is ASTM F-67 compliant. NIOBIUM has been widely used by piercers with good results for many years. It is very similar to titanium, but does not have an implant-grade designation. Like titanium, niobium can be anodized to produce different colors. (And, unlike titanium, it can be anodized black.) Anodized niobium and titanium may fade due to body chemistry or when worn in friction-prone areas, but this is not harmful. GOLD (yellow or white) is appropriate for initial piercings if it is 14k or higher, nickel-free, and alloyed for biocompatibility. Gold higher than 18k is too soft for body jewelry because it can easily be scratched or nicked. Gold plated, gold-filled, or gold overlay/vermeil jewelry is not acceptable for fresh piercings. All of these involve coating a base metal with a layer of gold. The gold surface (which is very thin measured in millionths of an inch) can wear or chip off. PLATINUM is a heavy precious metal that is extremely inert and excellent for wear in body piercings. However, body jewelry in this material is rare and very expensive due to the high cost of the material and greater difficulty in manufacturing jewelry from it. BIOCOMPATIBLE POLYMERS (plastics) including Tygon Medical Surgical Tubing S-50HL or S-54HL, PTFE (Teflon ), or Bioplast are considered suitable for new piercings. Tygon is a bio-compatible medical tubing that is highly flexible. It should be changed every few months as it stiffens and discolors from extended wear. PTFE, a white plastic, is widely accepted within the industry. Bioplast was created specifically for piercings and is similar to PTFE, but comes in an array of colors and shapes. These may be worn as a substitute for metal jewelry. With new polymer products coming into the marketplace, check that the product you are purchasing, if not listed above, is USP VI compliant. These can be sterilized in an autoclave. Glass Fused quartz glass, lead-free borosilicate, and lead-free soda-lime glass are inert and considered safe for initial piercings. They can also be sterilized in an autoclave.

9 tools JewelrY emergencies Ring Expanding Pliers/Ring Opening Pliers Can be used to spread a captive ring open enough to get the bead in or out. Place the head of the pliers inside of the ring and slowly squeeze on the handle to spread the jaws open, widening the ring just enough to pull the ball out Mishaps occur on occasion, even with quality pieces. To minimize the likelihood of losing your jewelry, check threaded ends regularly for tightness, and see to it that captive beads are inserted properly. If you lose a ball, a temporary measure may prevent your jewelry from falling out until you can obtain a replacement: Ring Closing Pliers Can be used to close the gap on a captive ring that was opened too wide by Ring Expanding Pliers, or if you are inserting a bead that is smaller than the one that was previously in the ring retainers Most piercers offer a selection of retainers: Some are specific to a particular type of piercing, while others can be used in a variety of placements Retainers can be worn to conceal piercings Retainers can be worn to keep piercings open when metal jewelry must be removed, such as for sports or medical care Eraser Use a small piece of clean pencil eraser and cut it to the desired size and shape. Press it onto the end of a barbell post or between the ends of your empty captive ring to keep jewelry in place Band-Aid or surgical tape Apply it to your jewelry and/or body in a way that keeps the piece from falling out *For oral piercings such as tongue and lip, initial jewelry must be downsized once swelling is gone. See the APP brochure: Oral Piercing Risks and Safety Measures for more information. Photos courtesy of Paul King, Neometal, and Industrial Strength Body Jewelry, Text from The Piercing Bible by Elayne Angel, MedicAl or dental Procedures Many health-care workers insist that you remove body jewelry for all procedures or tests, especially when the area in question is adjacent to a piercing. If you think it may be difficult to put jewelry back in once it is removed, take precautions to preserve your piercing: Discuss your piercing with your doctor or dentist prior to scheduling an appointment in which the presence of your jewelry may be an issue Your piercer may be able to supply recommendations for practitioners who are knowledgeable about piercing, or help you to educate your own and perhaps your jewelry can stay Inquire about whether you will be permitted to wear a non-metallic replacement when you must remove metal from your body Obtain a retainer before your appointment and arrange for an insertion if you will need help If you cannot get a retainer in advance, a sterile floss threader (available in a dental office) or sterile tubing from a catheter needle (available in a hospital) can function as a retainer JewelrY reinsertion After removal If the hole is still open and hasn t shrunk too much, a piercer can use a tool called an insertion taper to insert jewelry in the channel without repiercing. Initially, you may need to wear a smaller jewelry gauge if the hole is too tight to immediately put back in your prior size. Disclaimer: These guidelines are based on a combination of vast professional experience, common sense, research, and extensive clinical practice. These suggestions are not to be considered a substitute for medical advice from a doctor. Use of this brochure does not imply membership in the APP. A current list of APP members can be found at safepiercing.org. False claims of membership should be reported to the APP. The APP logo is the trademark of the Association of Professional Piercers. This brochure is licensed under the Creative Commons Attribution-Noncommercial-No Derivative Works License. To view a copy of this license, visit JewelrY for healed Piercings

10 If you like the body jewelry you re wearing, it fits properly*, and is of high quality, then it can be worn indefinitely. But the form and function of initial body jewelry are all about safety, so your choices are limited. After your piercing has healed, you have countless options and it should be safe to replace your jewelry when all of the following conditions are met: It is not tender The minimum initial healing time has passed Your piercing is no longer secreting and getting crusty The size, material, quality, and style (along with the weight and finish) contribute to whether a piece of jewelry is suited for daily wear in the body. Some are acceptable for only a few hours of dress-up fun. JewelrY insertions It is customary for a piercer to put new jewelry in for free or to charge a small fee when you make a purchase. They can help you to select the right size and type of jewelry for your anatomy, and they have a sanitary environment with access to appropriate tools if needed. If putting in new jewelry at home: Make sure the piercing site, your hands, the jewelry, and your work area are clean Soak your piercing and/or lubricate the jewelry to facilitate removal and insertion, because piercings are often tight Never try to force or push your jewelry in; this can tear your tissue If jewelry doesn t go in easily, visit a piercer for assistance Quickly replace any jewelry that causes irritation, itching, swelling, or redness, no matter how much you like the way it looks. AlternAtive MAteriAls In addition to the materials commonly used for fresh body piercings, healed piercings may tolerate (or even thrive with) jewelry crafted of alternative materials including horn, bone, wood, amber, stone, and others created by Mother Nature. Sometimes referred to as natural or organic jewelry, these materials have been worn in piercings throughout the ages and all around the globe. Additionally, there are man-made options such as certain types of plastic (including acrylic and silicone) and glass. Like all body jewelry, these products vary in quality and wearability. Choose your jewelry to suit your lifestyle as well as your budget and aesthetic preferences: Many alternative materials are fragile compared to metal, so jewelry with pointy or narrow areas or in thin gauges may be easily broken They may not be safe to wear during sports or sleep, and should be removed for bathing and swimming Adornments that are extremely heavy will seldom be appropriate for everyday wear Etched, twisted, or matte finish items have the potential to cause irritation Cracks, pits, and uneven surfaces are not uncommon in natural materials, and they may encourage the growth of microbes, so keep an eye on the health of your piercing JewelrY removal Even momentary removal of the jewelry from a healed piercing may result in rapid shrinkage of the piercing, and make reinsertion difficult or impossible. Most holes shrink fairly rapidly and can continue to do so over time. Over the ensuing weeks, the area will stabilize and the channel is apt to remain in whatever state it has achieved within a month or two smaller, or fully closed. Carefully consider whether you are truly done with a piercing before leaving the hole empty. Reinserting jewelry in a piercing that has shrunk can be more painful than the original stick but if a hole is still present and can be stretched, then repiercing is not usually appropriate. If the initial placement was correct, relocating the piercing is undesirable. If you end up with a piercing complication, it is not better to take out your jewelry now and try to get it reinserted or repierced later. Scar tissue, delayed healing, and other issues can occur from repiercing after unnecessarily abandoning a piercing. there Are several PriMArY styles of body JewelrY And MAnY variations on those styles. for removal PurPoses they Are: TYPE 1: Rings that are held together by tension and require bending and/or the removal of a dimpled ball or other captive piece FIXED BEAD RING (also continuous or seamless ring) On a fixed bead ring, the bead is attached to one side of the ring. Grasp the ring on each side of the bead, pull gently and one end will pop out of the bead. Push one end away from you and pull the other end toward you to open the ring like a spiral. The beadless variation also opens by twisting. CAPTIVE JEWELERY (also segment ring, captive tube, and other captive ornaments) The bead or captive piece of a captive ring is held in by the tension of the ring. Grasp the ring with one hand near the bead, and with the other hand grasp the bead itself. Gently pull the ring and bead in opposite directions and the bead should pop out of the ring. To remove it, twist the ring a little (as in opening a bead ring) and rotate the jewelry to slide it out of the piercing. Note: Pliers may be needed to open and/or close captive jewelry depending on material, diameter, gauge, and jewelry quality. (See Tools on reverse side.) TYPE 2: Pieces that have threaded ends that must be unscrewed THREADED JEWELRY (straight, curved, and circular barbell; J-curve, labret stud, screw-on-ball ring, flesh tunnel, and surface bar) Barbells and their variations have threaded ends that can be unscrewed. Like most threaded objects, they tighten to the right and loosen to the left. TYPE 3: Pieces that press together and pull apart PRESS-FIT JEWELRY (commonly threadless barbells and curved bars) The pieces simply pull apart. If you are trying to remove jewelry that will not unscrew counterclockwise as expected, you may be dealing with a press-fit piece. TYPE 4: Pieces that are free-standing, held in by gravity, other jewelry, or with an O-ring; they simply slide out or come off FREE STANDING (single [or non-] flare plug/eyelet, nipple shield, shaped ear ornament, eyebrow retainer) These pieces are easily removed by simply sliding them out. Remove O-ring or additional jewelry as needed. If the piece doesn t move easily, a little bit of lubricant may be helpful. TYPE 5: Pieces that stay in because of their shape and (may) require some pressure to remove HELD IN BY SHAPE (nostril screw, septum retainer, double-flare plug/eyelet, notched septum piece, shaped ear ornament) These pieces are held in by virtue of their shape. Over time they may become loose. Some may require the assistance of a piercer for removal. HELD IN BY SHAPE (surface anchors) Surface anchors have become very popular. The tiny L-shaped jewelry base that is inserted into the tissue remains in place, though generally the ornament is threaded and can be changed.

11 localized Piercing PiMPle A single pustule occurs adjacent a piercing often in a recurrent cycle symptoms: Small, slightly elevated pustule Red and inflamed, but contained locally May be tender, itch, or burn, though some are painless Secretes pus and/or blood when drained or popped treatment: Treat as a minor localized infection Over-the-counter antihistamines can diminish itching and inflammation Warm saline soaks or hot compresses several times daily; these should be continued daily for two weeks after the problem seems resolved Light localized massage may help break up the pocket and prevent it from refilling If recurrences continue, a culture may be needed to identify the invading microorganism so you can prescribe medication to target the problem Piercings And X-rAYs, Mris, And cat scans Metal body jewelry will result in an opaque density on MRI and x-ray, but will not otherwise affect visibility on film Metal body jewelry causes visible interference and should be removed for CAT scans if in the area of examination Nipple piercings are unlikely to obstruct visibility of pathology on thoracic x-rays if both AP (or PA) 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 (use a strong hand-magnet to test) Even momentary removal of jewelry from a piercing can result in amazingly rapid closure of the channel, and make reinsertion difficult or impossible Non-metallic retainers can often be used to safeguard the patency of a piercing; sterile tubing from a catheter needle can be used as an emergency retainer * Please refer to the APP brochures: Aftercare Guidelines for Body Piercings (or Oral Piercings) for detailed information on the suggested care of healing piercings. hypergranulation tissue Excess granulation tissue is most common on piercings of navels, nostrils, outer labia, and the mucosal surface of lips--though it may also occur on other piercings treatment: The same treatments used on infants umbilical granulomas may be used for piercing-related hypergranulation tissue: silver nitrate, electrocautery, or liquid nitrogen; a ligature technique can be used if the lesion is pedunculated Some affected piercings do heal successfully, but if the problem proves intractable after treatment, the piercing should be abandoned compounded ProbleMs Any one of the above problems can make additional or secondary problems more likely; i.e. an allergic reaction to a particular jewelry material or care product can make a piercee more vulnerable to secondary infection. Multiple causes are sometimes responsible for complications; i.e. ill-fitting jewelry and poor aftercare. In addition, overall health and stress levels can impact the healing process and should be evaluated and dealt with as a potential cause for piercing complications. Disclaimer: The suggestions contained in this brochure are not to be considered a substitute for medical advice from a doctor; they are simply intended to assist you and your healthcare provider in troubleshooting problematic piercings. The information is based on a combination of vast professional experience, common sense, research, and extensive clinical practice, along with input from piercingfriendly medical professionals. Your local piercer may be able to refer you to a piercing-friendly medical professional if necessary. Use of this brochure does not imply membership in the APP. A current list of APP members can be found at safepiercing.org. False claims of membership should be reported to the APP. The APP logo is the trademark of the Association of Professional Piercers. This brochure is licensed under the Creative Commons Attribution-Noncommercial-No Derivative Works License. To view a copy of this license, visit body Piercing troubleshooting for You And Your healthcare ProfessionAl

12 for the Piercee: choosing A MedicAl ProfessionAl Medical personnel have tremendous knowledge of the human body but often do not have specific training about this unique form of body art. As a piercee, you may have more information about the suggested care and maintenance of piercings than they do. It is up to you to make certain that your chosen medical professional has access to facts that will facilitate your treatment. To save yourself from a bad experience, ask the following questions before settling on a doctor or other practitioner. Is this healthcare professional: Accepting of body piercings? Experienced in treating problem piercings? Willing to consult with a trusted expert body piercer, or seek other resources for information about piercing? for the Piercee: when to see A doctor inappropriate AftercAre is one of the Most common causes of A distressed Piercing: Alcohol, hydrogen peroxide, Betadine, Hibiclens, harsh soaps, and/or ointment(s) are not appropriate products for the care of a healing ear or body piercing. Over-cleaning and using strong products can irritate piercings and delay healing. 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.* Rinsing with mild non-iodized sea salt and/or antimicrobial or antibacterial alcohol-free mouthwash, 4-5 times a day is suggested for oral piercings.* normal healing Piercings MAY have the following characteristics: Discoloration: reddish, brownish, pinkish, or purplish; can remain for many months on navel, surface, and other piercings. Excretion: exudate of interstitial fluid, dead cells, etc. that forms a small amount of crystalline-appearing crust at the openings of the piercing; should not be copious, malodorous, or green. Visit a doctor immediately if you have problems with your piercing and you: ointments Are not Preferred for topical treatment of Piercings: Experience severe redness, swelling, or pain from the piercing They are occlusive and limit oxygen circulation to the area, which can delay healing of this type of wound. Have red streaks coming from from the piercing site Take steroids or have a chronic illness or other health condition Have symptoms that last for a week or get worse Experience fever, chills, nausea, vomiting, dizziness, or disorientation for the Piercee And the MedicAl ProfessionAl: important Piercing facts When piercings are properly performed and cared for, complications such as irritation or allergy are far more common than infection. Even momentary removal of jewelry from a piercing can result in rapid closure of the channel, and make reinsertion difficult or impossible. Simply taking out the jewelry may not resolve the problem, and if an infection is present, removal can lead to a more serious problem--the formation of an abscess. Most piercing complications can be handled without the piercing being lost. Changing aftercare and/or jewelry size, style, or material often resolves problems. A piercing is a unique type of wound because it is intentional, and healing must take place around a foreign object. This information is intended to familiarize you with piercing complications you might encounter, and the treatments found to be most efficacious. in the event that You diagnose A localized Piercing infection: Important: removing jewelry in the presence of an infection may result in an abscess. Quality body jewelry or a retainer of an appropriate size, style, and material should be left in place so the infection can drain Isotonic saline soaks and/or hot compresses can encourage drainage Bactroban (Mupirocin) cream or gel (not ointment) has been found to be effective for topical treatment of bacterial infections Swelling/Induration: localized; may be significant with oral piercings such as the lip or tongue, and usually lasts for several days following the initial piercing. If you experience a problem that is beyond the scope of your piercer, the following facts can assist you and your healthcare provider in decision-making about the best care and treatment. Have a large amount of discharge that is thick, green, yellow, or gray and smells bad for the MedicAl ProfessionAl: troubleshooting Piercing ProbleMs 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. MigrAtion/reJection If the jewelry moves closer to the surface or the tissue gets narrower between the openings of a piercing, this is termed migration. If the piercing migrates past a point of remaining viable or comes all the way to the surface, this is termed rejection. For safety and longevity, a piercing should have at least 5/16 inch (almost 8 mm) of tissue between the entrance and exit holes. A body piercing should be abandoned if the tissue between the entry and exit progressively gets smaller or thinner over time plus any of the following: The skin between the openings is flaking or peeling, red or inflamed, and/or hard and calloused-looking There is 1/4 of tissue or less between the openings Just a thin filament of nearly transparent tissue is left, and the jewelry can be seen through the skin contact dermatitis MetAl AllergY or Product sensitivity A skin sensitivity or allergy can be induced by a cleaning product or inferior jewelry that contains too much nickel or other irritating alloy symptoms: Red, itchy rash surrounds the piercing or covers a large area (up to several inches away) The opening to the piercing may appear significantly larger than the size of the jewelry Tenderness, though sometimes there is no discomfort Skin eruptions below the piercing (where soap suds run during bathing) clearly demonstrate contact dermatitis caused by a cleaning product treatment: Topical or oral benadryl or other antihistamine Advise a change to a different jewelry material such as titanium, if nickel sensitivity is suspected, or an approved inert plastic. See the APP brochure: Jewelry for Initial Piercings. Discontinue current care regimen in favor of a milder cleaning product