An article in Monday's Sun about dental problems that can result from oral piercings listed angina as one of several complications noted by doctors. The malady referred to was not angina pectoris - chest pain caused by insufficent blood supply to the heart - but Ludwig's angina, a potentially fatal infection of the neck that can close off a patient's airway.
People who jab gold studs through their lips and pierce their tongues with silver bars aren't usual eager to hear a learned discourse on gum disease.
But Dr. John K. Brooks tries anyway: Oral jewelry, he tells them, can cost you a tooth.
"The patients I've been successful with are the ones that had pain and infection. They're much more ready to be convinced," the Mount Airy dentist says.
Brooks and two colleagues at the University of Maryland Dental School say there is growing clinical evidence that oral piercings increase the risk of gum disease, painful infections and tooth loss.
They present their case in the cover article of last month's issue of the Journal of the American Dental Association. "The profession does not advocate people wearing piercings," Brooks says, "and we want to discourage those people who wear piercings."
With professors Kenny A. Hooper and Mark A. Reynolds, Brooks' report on five patients who suffered gum loss and other dental problems were traced to their lip and tongue studs.
People who insist on wearing studs in their mouths "have to maintain exquisite oral hygiene, brushing and flossing," says Brooks. But even so, "there is no escaping that they will be at risk for damage to their gums and their teeth."
One of the subjects, a healthy 19-year-old with a barbell-shaped stud in her tongue, developed a case of worsening gum disease where the jewelry rubbed against the inside of a lower front tooth.
Another patient, a 24-year-old woman, came to the Dental School's clinic complaining of painful teeth. She has lost a significant amount of the gum in front of her lower front teeth, next to her lip stud. The dentist also found related bone loss. Warned of the damage, the woman agreed to quit wearing the lip jewelry, the journal article says.
The JADA paper is the latest of several that have appeared in the medical literature since 1997, raising alarms about the dental consequences of oral piercing. There have been no large-scale studies so far, and the warnings are based on reports of a few dozen individual cases.
The most common injuries are chips and fractures - in as many as 80 percent of the patients in one small survey cited by Brooks. Twenty percent of patients in another small survey had suffered at least some gum loss adjacent to their studs.
But that's not likely to come as news to many piercees.
"I chipped a tooth on it when I first got it," says Julia Racicot, 24, who works in the bookstore at the Maryland Institute College of Art (MICA) and has worn a barbell in the center of her tongue since she was 19.
But she removes the stud, cleans it regularly, and goes to the dentist every six months. "I don't have any gum disease or anything else," Racicot says.
At MICA, where students say you're likely to stand out if you don't have anything pierced, there are stories of students who aren't so lucky.
Racicot said she heard of one young man who complained that his labret (a lip stud) was "pulling down" his gum. "His dentist told him, 'I'll fix it for you for free if you'll take [the labret] out,' " Racicot says. The man took the dentist's advice and began warning others about the danger.
Reynolds, co-author of the JADA paper and a gum disease specialist, says the association between oral jewelry and gum disease seems clear: Gum loss occurs near studs, in places where young people without the jewelry rarely experience it.
How does this damage happen?
Brooks says the relentless wear and tear on the gums leads to chronic inflammation as the body tries to guard against infection, remodel and repair the tissues. The gum tissue breaks down and deeper down "you begin to have destruction of the tissues that hold the gum to the roots," he says.
Bacteria that live naturally in the mouth rush in, and their chemical byproducts create pockets behind the gums. More food and bacteria accumulate, adding to the damage. The consequences are pain, infection and tooth loss.
As if that weren't enough, the medical literature has reported cases in which oral piercings have led to hepatitis, tetanus, angina, heart-valve infections, brain and breast abscesses and inflammation of the sac that surrounds the heart.
The much-bestudded owner of a Baltimore body-piercing shop, who did not want to be identified in a "negative" article about piercing, says she has heard the stories. But no one she knows has had gum disease as a result of oral piercings, she says. And she couldn't quite imagine how it could occur.
"Cracking a tooth I would believe," she says, but with good hygiene, gum disease shouldn't be a problem. "When I brush my teeth, I brush my bar."
On the other hand, she says, "With some of these kids that can't leave their tongue ring alone. ... That's like any kind of abuse. The more you flick it around, the more you're going to have problems."