Body piercings have increased tremendously in popularity in recent years. For oral piercing, late complications include gingival trauma and localized periodontitis. The purpose of this cross-sectional study was to investigate the prevalence and contributing factors of gingival recession associated with labial piercing. The test group included 50 subjects with lower-lip studs. Nonpierced controls were matched according to gender, age and smoking status. Clinical examination included plaque and bleeding indices, probing depth, recession, clinical attachment level, width of keratinized gingiva, periodontal biotype, insertion of frenula, evaluation of hard tissues, trauma of occlusion, characteristics of the stud, radiographs and photographs. Gingival recessions were noted on teeth opposite the stud in 68% of the test group compared with 4% of the controls. Localized periodontitis was recorded in 4% of test subjects. Time since piercing and the position of the stud in relation to the cemento-enamel junction were significantly associated with the prevalence of buccal recessions. There were no significant associations between piercing and abnormal tooth wear. The prevalence of gingival recessions is associated with labial piercing. The position of the intra-oral disc and time since piercing are associated with a greater prevalence of gingival recession. A narrow width of keratinized gingiva is associated with increased buccal recessions.