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Workplace policies are the best way for practices to control appearances in the workplace. A well-rounded uniform policy, which stipulates what is and not acceptable in relation to piercings and tattoos and also personal hygiene, is useful to set the standard.

Generally, the requirements in the policy must be reasonable. For example, a policy may prohibit an employee from showing tattoos with offensive symbols, or large and obvious facial piercings, but it would likely be unreasonable to prohibit an employee from having any piercings or tattoos at all. If an employee then breached the policy, the practice could address it as a disciplinary matter.

Using the available evidence to support a position is important when framing local policies. For example, there is a significant literature regarding the health risks of piercings including metal allergies, local infections and scarring.

Piercings make the facial skin harder to clean, increases the risk of acquiring unwanted infection for the staff member concerned, as many dental procedures (including using a triplex syringe) generate large amounts of splashing and some of that will be deposited onto the facial skin. Hence, facial piercings which cannot be covered by either supplied PPE or an approved waterproof covering are not acceptable.

The current recommendation from NHMRC infection control guidelines and Hand Hygiene Australia for ‘bare below the elbow’ addresses the wearing of jewellery on the fingers, hands and wrists, and the use of false fingernails from the standpoint of infection control as a uniformly applied international best practice. This is another example of where the practical elements of wearing such items can directly impact on occupational health. Likewise, there is
extensive literature around adverse oral health impacts from lip and tongue piercings.

For instance, tongue and lip piercings are associated with the risk of gingival recession, and tongue piercings are associated with tooth fractures, so a staff member wearing those in a clinical setting runs counter to contemporary best practice in oral health, and may give confusing messages to patients who are being told why they should not wear these.