Oral piercing is an increasingly popular form of body modification, particularly among adolescents and young adults. Despite its aesthetic and cultural appeal, growing evidence indicates that oral piercings have been associated with a range of oral and periodontal complications. This literature review examines the effects of oral piercing on periodontal tissues and summarizes the associated risk factors and preventive measures. The available evidence demonstrates that tongue and lower lip piercings are most associated with periodontal damage due to chronic mechanical trauma and bacterial plaque accumulation around oral jewelry. The principal periodontal complications include gingival recession, gingival inflammation, clinical attachment loss, periodontal pocket formation, and localized alveolar bone loss. In addition, oral piercings have been linked to tooth fractures, enamel wear, mucosal lesions, infections, hypersensitivity reactions, and, in rare cases, systemic complications such as infective endocarditis. The severity of these complications is influenced by factors including the duration of jewelry wear, jewelry design and material, oral hygiene, smoking, and individual periodontal characteristics. Current evidence suggests that many of these adverse outcomes can be minimized through appropriate patient education, the use of biocompatible and well-fitted jewelry, meticulous oral hygiene, and regular dental examinations. Although the existing literature consistently reports an association between oral piercing and periodontal complications, further longitudinal studies are needed to better define long-term outcomes and strengthen evidence-based clinical recommendations.