N.Y. health board proposes consent waiver on circumcision rite


New York City health officials have proposed requiring that Jewish parents sign a consent waiver in order to use a controversial circumcision-related rite.

At a city Board of Health meeting on Tuesday, the department’s deputy commissioner for disease control, Dr. Jay Varma, proposed the waiver for the use of direct oral-genital suction, known as metzitzah b’peh. The form would indicate that parents are aware of the risk of infection.

The controversy over metzitzah b’peh was reignited in March after it came to light that an unidentified infant died Sept. 28 at Brooklyn’s Maimonides Medical Center from “disseminated herpes simplex virus Type 1, complicating ritual circumcision with oral suction,” according to the death certificate.

Health Department investigations of newborns with the herpes virus from 2000 to 2011 have shown that 11 infants contracted the herpes virus when mohels, or ritual circumcisers, placed their mouths directly on the child’s circumcision wound to draw blood away from the circumcision cut, according to a statement from the department. Ten of the infants were hospitalized, at least two developed brain damage and two babies died.

Varma said during the meeting, according to The New York Times, that two of the families whose babies contracted herpes after metzitzah b’peh was performed did not know it would be used. He added that since March, other families have called the department with concerns that their mohel would perform the rite.

A public hearing on the consent waiver proposal is scheduled for next month, with a vote by the board slated for September.

Last week, city Health Commissioner Dr. Thomas Farley called for an end to metzitzah b’peh and said that several hospitals, including those serving the haredi Orthodox Jewish community, have agreed to distribute a brochure that describes the risk of contracting the herpes virus from the practice.

The rite is not used in most Jewish circumcision ceremonies, but many in the haredi Orthodox community still adhere to it. Haredi leaders have resisted calls to replace direct oral suction with alternative approaches used by some mohels, such as the use of a sterile tube or gauze to take the blood from the circumcision wound.

The painful truth about teen mouth piercing


A pierced tongue may be the height of cool in some teen circles, but a new study by Israeli researchers suggests that skin piercings in the mouth may lead to an increased risk of oral health problems and even tooth loss.

The researchers from the School of Dental Medicine at Tel Aviv University (TAU), found that about 15 percent to 20 percent of teens with oral piercings are at high risk of both tooth fractures and gum disease. The resulting tooth fractures, combined with periodontal problems, can lead to anterior (front) tooth loss later in life.

High rates of fractures due to piercings are not found in other age groups, and cases of severe periodontal damage in teens without oral piercings are also rare, says Dr. Liran Levin, a dentist from TAU’s Department of Oral Rehabilitation, who conducted the study with partners Israeli army dentists Dr. Yehuda Zadik and Dr. Tal Becker.

Today, 10 percent of all New York teenagers have some kind of oral piercings, compared to about 20 percent in Israel and 3.4 percent in Finland.

Levin and his team carried out their initial study on 400 young adults aged 18-19. A review by Levin and Zadik, published in the American Dental Journal late last year, is the first and largest of its kind to document the risks and complications of oral piercings, drawing on research from multiple centers in America and across the world.

“There are short-term complications to piercings in low percentages of teens, and in rare cases a piercing to the oral cavity can cause death,” Levin said. “Swelling and inflammation of the area can cause edema, which disturbs the respiratory tract.”

He also warns that the most common concerns — tooth fracture and periodontal complications — are long-term, and can even lead in rare cases to death.

“There is a repeated trauma to the area of the gum,” Levin said. “You can see these young men and women playing with the piercing on their tongue or lip. This act prolongs the trauma to the mouth and in many cases is a precursor to anterior tooth loss.”

The study was based in Israel, and researchers questioned teens with piercings and without, asking them about their oral health, knowledge of risk factors associated with piercings, and about their piercing history, before conducting the clinical oral exams.

Ironically, Levin noted, the youngsters who opted for oral piercing were very concerned about body image, but seemed to be unaware of the future risks such piercings can cause.

According to Zadik, the best advice a parent can give a teen who wants a mouth piercing is to tell them to avoid it altogether. If your teen is insistent, however, then he warns that it is essential that piercing tools are disposable, and that all other equipment is cleaned in an on-site autoclave to help reduce infection.

After the procedure, he says the area should be rinsed regularly with a chloroxidine-based mouthwash for two weeks. And don’t play with the piercing, he warns. It should be cleaned regularly, and dental check-ups performed regularly. — Israel21c Staff