BACKGROUND In the previous decade, a notable increase in body adornment through tattooing and piercing has been a cause for concern among both dental and medical professionals. The author reports on the clinical consequences of wearing oral jewelry, specifically periodontal injury that requires surgical intervention. She also presents a general literature review of dental and medical consequences of wearing oral jewelry. CASE DESCRIPTION A 20-year-old woman with a tongue piercing had severe periodontal recession in lingual aspect of the mandibular incisal area proximal to the location of the oral jewelry. The author used a connective tissue graft to correct the defect via root coverage and an addition to the gingival width. CLINICAL IMPLICATIONS Wearing intraoral jewelry can lead to the development of severe mucogingival defects and necessitates careful and comprehensive periodontal evaluations on a regular basis to monitor attachment loss and damage to dental structures. Patients must be educated about these risks through counseling, patient information brochures and individual case documentation.