Oral Piercing

Oral Piercing

Also called: Tongue Piercing, Lip Piercing

Reviewed By:
Andrew M. Sicklick, D.D.S.

Summary

Piercing areas of the mouth – most commonly the tongue or lips – is a popular trend among adolescents and young adults. It involves inserting a piece of jewelry called a “barbell” (due to the shape) anywhere along the lips or near the front of the tongue. In some cases, the cheeks may also be pierced.

Most dentists discourage oral piercings due to a number of risks associated with the procedure. The most common are chipped teeth and infection. It is estimated that one in every five oral piercings results in infection, according to the Academy of General Dentistry. Additional risks include allergic reaction, excessive bleeding, gum and nerve damage, as well as difficulty speaking, breathing or eating. People with certain conditions (e.g., heart defects, allergies, immune system deficiencies) should not receive an oral piercing.

Prior to receiving an oral piercing, people are encouraged to check for certain sanitary practices at the facility performing the piercing. This includes use of an autoclave (pressurized device that uses high temperatures to sterilize equipment), gloves and a generally clean and tidy appearance. A piercing gun should not be used for oral piercings.

An oral piercing procedure typically does not include anesthesia. The spot to be pierced is marked with a pen, and a hollow needle inserted through it. A starter barbell is inserted into the hole, which is usually large enough to accommodate swelling in the area after the piercing. It should be exchanged for a smaller barbell after the site heals.

Pain and swelling are common after an oral piercing. The area may take four weeks or longer to completely heal, although the swelling usually goes down within the first few days. People recovering from a piercing may want to use certain mouth rinses, a new soft-bristled toothbrush, and avoid handling the jewelry in the mouth.

After a person has an oral piercing, care and maintenance of the area are important to avoid dental or medical complications. This includes proper dental hygiene, removing mouth jewelry at certain times (e.g., when eating), and selecting jewelry that will lessen the likelihood of infection and interference with the teeth and gums.

About oral piercing

Oral piercing involves piercing areas of the mouth, most commonly the tongue and the lips, although the cheeks may also be pierced. It has become a popular trend among adolescents and young adults. According to the Academy of General Dentistry (AGD), the number of people getting oral piercings continues to increase. As with other forms of body art (e.g., tattoos, other body piercing), oral piercing may be performed as a form of personal expression to enhance body image or for acceptance into a peer group.

A piece of jewelry called a “barbell” (based on its shape) is inserted through a hole made in the tongue or lip. It may be placed anywhere on the upper or lower lips. In the tongue, it is usually inserted vertically, midway across the width of the tongue, toward the front of the mouth. This avoids many of the blood vessels situated along the sides of the tongue, as well as the tissue connecting the underside of the tongue to the lower mouth. The cheek is usually pierced before or at the location of the first molars, to avoid ducts and glands.

Pierced sites (e.g., tongue, lip) typically swell in response to the puncture trauma. The area may remain swollen or become more severely swollen if the site becomes infected. Oral piercings are particularly susceptible to infection. The mouth is a warm, moist environment that normally has high levels of bacteria. Puncturing tissue inside the mouth provides an opportunity for bacteria to enter the bloodstream. This can lead to potentially serious infections elsewhere in the body.

Tongue jewelry is usually visible when people with oral piercings open their mouths. It may tap or rub against teeth when a person swallows, talks or chews food. A person with an oral piercing may need to relearn how to speak clearly due to the jewelry’s interference with normal oral function. When jewelry is permanently removed from the site, the hole will close. Mouth tissues generally heal quite quickly, compared to other areas of the body. 

Body piercing, including oral piercing, is an unregulated procedure. No national standards exist to regulate the facilities and people performing this procedure. Many piercing practitioners are unlicensed and do not have a medical background. Some facilities require parental consent for anyone under age 18 who wants an oral piercing, while others do not. In many cases, the piercing is performed by teens on each other. These amateur piercings are estimated to account for half of all piercings, according to the AGD. Piercing performed by an amateur, instead of a trained practitioner, increases the risk of unsanitary conditions, infection and a lack of post-piercing care guidelines.

Potential complications of oral piercing

Most dentists discourage oral piercing because of a number of risks associated with the procedure. An oral piercing can lead to pain, swelling, drooling, scarring, loss of the sense of taste and tooth or gum damage. Specific complications of oral piercing include:

  • Infection. Infection can occur due to the use of unsterile equipment or the introduction of bacteria to the wound (e.g., touching jewelry in the tongue or lip with dirty hands). Infection is possible with all forms of piercing, but it is particularly common with oral piercings. It is estimated that one in every five oral piercings results in infection, according to the Academy of General Dentistry. Infection is particularly likely to occur in athletes due to increased breathing rates and blood flow from vigorous exercise.

    Infection can cause pain and swelling of the tongue, lip or cheek. A pus-like discharge may be present. If bacteria get into the bloodstream, other body areas may become affected. Specific infections of concern with oral piercing include:

    • Endocarditis. Bacterial infection that reaches the heart through the bloodstream. People with underlying heart problems are at risk for this condition after an oral piercing. Antibiotics are required to treat endocarditis.

    • Ludwig’s angina. Bacterial infection of the floor of the mouth that can cause swelling that obstructs a person’s airway. The infected area may need to be cut open and drained in order to treat this infection.

    • Other blood-borne diseases. A variety of blood-borne diseases may be transmitted during an oral piercing procedure. These include hepatitis, HIV/AIDS, tetanus and tuberculosis.

  • Chipped tooth. A common problem for people with oral piercings. This occurs when metal jewelry repeatedly comes into contact with teeth (or the porcelain or metal restorations in teeth). This can happen while a person is eating, sleeping, talking, playing with or chewing on the jewelry. Tooth fractures can affect the surface of a tooth (requiring a filling) or they may be deeper (requiring a root canal or tooth extraction). Damage caused to teeth by oral piercings is also known as a “wrecking ball fracture.” An oral piercing may also cause fractures in teeth that are too small to be seen, a condition known as cracked tooth syndrome.

  • Allergic reaction. People receiving a piercing may have an allergic reaction to the metal (e.g., nickel, brass) in the jewelry.

  • Problems with normal oral function. The presence of jewelry in the mouth can lead to an inability to speak clearly – making it especially difficult to pronounce certain sounds correctly, such as “S” and “T.” Oral piercing can also make it difficult to chew and swallow, which can lead to a nutritional deficiency.

  • Overproduction of saliva. Oral piercings can cause increased saliva production. This can lead to drooling and gagging, as well as difficulty breathing or speaking.

  • Gum damage. The gums may become inflamed or recede due to repeated contact with mouth jewelry. Severe gum disease (periodontitis) may develop in some patients. This may cause tooth loss if it is not identified and treated as quickly as possible.

  • Excessive bleeding. This may occur if a blood vessel or artery is pierced during the procedure.

  • Nerve damage. If nerves are injured during a piercing, a person may experience a loss of sensation (numbness) in the area.

  • Scar tissue. Scarring may occur and a mass or lump of scar tissue can develop on the tongue, cheek or lip after an oral piercing.

  • Chemical burns. This may occur due to the use of certain after-care products, such as mouth rinses that contain alcohol, phenol and hydrogen peroxide. These substances may result in chemical burns on tissue near the piercing.

  • Airway blockage. Difficulty breathing may occur due to abnormal swelling of the tongue as a result of oral piercing. Jewelry that becomes loose while in the mouth can also pose a choking hazard. Intestinal injury can result if the jewelry is swallowed. 

Patients with heart defects, immune system deficiencies or certain allergies may wish to avoid oral piercings due to the risks associated with the procedure.

A dentist should be consulted for any concerns involving the teeth, gums, tongue or tissue inside the mouth. In addition, patients who experience the following after an oral piercing should seek immediate medical attention:

  • Extreme swelling of the tongue, making breathing or speaking difficult

  • Excessive bleeding from the pierced area

  • Bleeding that occurs after the site has healed

  • Yellow or green discharge from the pierced site

  • Pain, tenderness or inflammation that becomes more severe

  • Growth of thickened tissue in the area

  • Persistent fever

Before the oral piercing procedure

Prior to receiving an oral piercing, a number of factors should be considered. These may reduce the risk of complications such as infection or an allergic reaction.

In general, it is best to visit a reputable piercing facility. It is important to note whether the establishment appears clean and tidy – especially in the area where piercings are performed. Piercing practitioners should always wash their hands prior to each procedure. In addition, people considering an oral piercing may wish to observe or ask questions about the following:

  • Autoclave for equipment sterilization. An autoclave is a pressurized device that uses extremely high temperatures to sterilize equipment. All nondisposable needles and instruments used for piercing the body should be sterilized in an autoclave.
  • Single use needles. When disposable needles are used for oral piercing, a fresh needle in sterilized packaging should be used for each procedure. Facilities that reuse their needles (without autoclave sterilization) should be avoided because this practice can spread infection. Used disposable needles should be immediately disposed of in a special container.
  • No piercing guns. These devices, commonly used in retail environments to pierce ears, should be avoided for oral piercings because they are difficult to sterilize (e.g., in an autoclave) and may crush and further damage the skin and other tissues.
  • Clean work stations. Countertops, sinks and drawer handles that may be used during an oral piercing should be cleaned with disinfectant or a bleach solution after each piercing.
  • Use of gloves. Disposable gloves should be worn during the procedure to prevent the spread of germs. Gloves should be discarded and new gloves put on if other items are touched during the procedure (e.g., the telephone).
  • Appropriate jewelry. Using surgical-grade stainless steel can help prevent allergic reactions to certain metals used as jewelry (e.g., nickel, brass). Other alternatives include titanium, 14- or 18-karat gold, niobium or platinum. Jewelry should be contained in sterilized packaging prior to a piercing.

In addition, people considering an oral piercing may ask a facility about possible side effects of the procedure and what type of care is necessary while the area is healing. If piercing facility staff members do not answer questions, another facility should be considered.

People considering oral piercing should have up-to-date hepatitis and tetanus immunizations to prevent transmission of these diseases during a procedure. A booster shot from a physician may be necessary prior to obtaining an oral piercing.

During the oral piercing procedure

The use of anesthetic during an oral piercing is uncommon. When it is used, it is most likely to be in the form of a topical application because injectable anesthetic is available only by prescription.

An oral piercing is typically performed as follows:

  • An indelible ink pen is used to mark the spot to be pierced. For tongue piercings, that spot is made on the upper surface of the tongue, usually toward the front of the mouth and midway across the width of the tongue.
  • For tongue piercings, a clamp is used to hold the tongue still. The clamp is positioned such that the area to be pierced is exposed.
  • A hollow needle is inserted through the marked spot on the lips, cheek or tongue. For tongue piercings, it is most often inserted vertically, from the upper surface of the tongue to the tongue’s underside. The lips may be pierced at any location. The cheeks are typically pierced near the first molars.
  • The needle is removed, and a temporary “starter” barbell inserted in its place (without a ball at the insertion end). The starter barbell is usually large (e.g., half an inch, or 1.6 centimeters) to accommodate swelling after the procedure. If a large barbell is not used initially, the jewelry may become embedded in the lip or tongue during swelling.
  • Once the starter barbell shaft is inserted, a ball-shaped tip is screwed onto the end already inserted through the lip or tongue. This ball-shaped tip may be secured on the starter barbell with pliers.
  • For tongue piercings, the clamp holding the tongue is removed.

In some cases, the pierced area may need to be compressed with clean cotton gauze for up to 30 minutes to stop bleeding.

After the oral piercing procedure

It is common to experience some pain, swelling and a clear or white discharge in the area of an oral piercing after the procedure. In most cases, the swelling goes down after a few days and does not affect breathing or swallowing. However, it may take three to four weeks (or more) before the area is completely healed.

During recovery from a piercing, the following may help reduce pain and the risk of infection:

  • Mouth rinse. An antibacterial mouth rinse may be used after meals to help prevent infection. The mouth rinse should not contain alcohol, which can irritate the site. A warm saltwater rinse every four hours may help ease pain in the area. The rinse should be swished around inside the mouth for up to one minute.
  • New toothbrush. Using a new toothbrush after a piercing can help reduce the possibility of introducing bacteria into the mouth from an old toothbrush. Toothbrush bristles should be soft to avoid aggravating the area.
  • Avoid handling jewelry. Touching jewelry in the mouth increases the risk of infection. Skin that may come into contact with the jewelry should be washed with antibacterial soap prior to touching the area.
  • Avoid irritating products. Anything that may irritate the wound while it is healing should be avoided. This includes certain foods (e.g., spicy, hard or sticky foods), beverages (e.g., alcohol) and tobacco (e.g., smoking). Soft foods should be eaten until the pain and swelling subside.

After the area has healed, the temporary (larger) barbell should be removed and replaced with smaller-sized jewelry. This lessens the likelihood that food particles or bacteria can enter the pierced opening.

Lifestyle considerations with oral piercing

After a person has an oral piercing, proper care and maintenance of the site is important. This can help prevent complications that may develop in the area, including infection and tooth or gum damage.  

Practicing good hygiene can help prevent infection. For people with oral piercings, this includes:

  • Brushing the teeth, tongue and jewelry after every meal. This prevents food particles or bacteria from entering the body through the pierced opening. Anytime jewelry is removed from the mouth, it should be brushed with a toothbrush to remove any unseen plaque. Flossing is also required daily.
  • Using antiseptic mouth rinse. This should be swished inside the mouth for about a minute after every meal.
  • Avoiding unsanitary contact. Jewelry in the mouth should never be touched with unclean skin. Hands should be washed with antibacterial soap before handling mouth jewelry.  

To prevent inadvertently chipping teeth, jewelry can be removed prior to eating or sleeping. Mouth jewelry can usually be removed for short periods of time without the hole closing. Plugs may be used to prevent the hole from closing when jewelry is removed for longer periods of time.

Jewelry should also be removed before engaging in sports activities, especially those that require a mouth guard. Jewelry may become dislodged during vigorous activity and pose a choking hazard or cause intestinal damage if swallowed. Gagging can occur due to increased saliva production when mouth jewelry and a mouth guard are worn at the same time.

In addition, athletes with oral piercings face an increased risk of infection due to increased blood flow and risk of bleeding, which may spread infection more quickly. The presence of perspiration and dirt near an open wound (such as an oral piercing) also increases the risk of infection.

The type of jewelry selected can also be important. People with oral piercings may want to consider the following:

  • Jewelry material. Acrylic (rather than metal) jewelry may lessen the likelihood of tooth and gum damage. People with allergies should avoid jewelry made of those compounds (e.g., nickel, brass) they have had an allergic reaction to in the past.
  • Jewelry length. Jewelry with a shorter shaft (e.g., less than half an inch, or between 1.2 and 1.5 centimeters) can help prevent food or bacteria from entering the pierced hole, and may be less likely to get in the way of the teeth, which may cause tooth damage or speaking difficulties.

Jewelry in the mouth can block the transmission of x-rays, so it should be removed before dental examinations.

Questions for your doctor about oral piercing

Preparing questions in advance can help patients to have more meaningful discussions regarding their conditions. Patients may wish to ask their doctor the following questions related to oral piercing:

  1. Do I need to remove my mouth jewelry prior to a dental examination or x-ray?
  2. Are my dental problems caused by my oral piercing?
  3. How can I avoid these problems in the future?
  4. Will changing to acrylic jewelry (instead of metal) reduce or prevent these problems?
  5. What special cleaning methods do you recommend for my oral piercing?
  6. Is there a particular type of mouth rinse you recommend for me?
  7. Are there other ways I can prevent complications due to my oral piercing?
  8. Do you recommend that I remove my mouth jewelry before eating or sleeping?
  9. What signs may indicate the area has become infected?
  10. Should I see a dentist or my family physician if the area becomes infected?
  11. Will scar tissue that develops as a result of my oral piercing affect my dental health?
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