Dental Health and Oral Piercing
Piercing, like tattooing, is just one of today’s popular forms of ―body art and self-expression. Piercing may seem daring, cool and totally safe because some celebrities use piercing to flaunt their particular style or attitude. But piercing the tongue, lips, cheeks or uvula (the tiny tissue that hangs at the back of the throat) is not as safe as some would have you believe. That’s because the mouth’s moist environment—home to huge amounts of breeding bacteria—is an ideal place for infection.
An oral piercing can interfere with speech, chewing or swallowing. That may seem like a mere inconvenience until you consider that it may also cause:
These harmful effects can happen during the piercing, soon after, or even long after the procedure.
An infection can quickly become life threatening if it’s not treated promptly. For example, oral piercing carries a potential risk of endocarditis, an inflammation of the heart valves or tissues. Bacteria can enter the bloodstream through the piercing site in the mouth and travel to the heart, where it can colonize on heart abnormalities. This is a risk for people with heart conditions and, in the worst of cases, results in death.
After a piercing the tongue may swell. There have been reports of swelling serious enough to block the airway. And it’s very possible to puncture a nerve during a tongue piercing. If this happens, you may experience a ―numb tongue—nerve damage that is sometimes temporary, but can be permanent. The injured nerve may affect your sense of taste, or how you move your mouth. And damage to the tongue’s blood vessels can cause serious blood loss.
In addition, piercing jewelry can sometimes cause allergic responses to the pierced site. The jewelry can even get in the way of dental care by blocking x-rays.
Don’t pierce on a whim. The piercing will be an added responsibility to your life, requiring constant attention and upkeep. Talk to your dentist for more information
While piercing the tongue, lip, or cheek may be attractive to some, there are a number of health-related risks associated with oral piercing, including:
- Infections. The wound created by piercing, the vast amount of bacteria in the mouth, and the introduction of additional bacteria from handling the jewelry all work to increase the risk of infections.
- Transmission of diseases. Oral piercing is a potential risk factor for the transmission of herpes simplex virus and hepatitis B and C.
- Endocarditis. Because of the wound created by the piercing, there's a chance that bacteria could enter the bloodstream and lead to the development of endocarditis — an inflammation of the heart or its valves — in certain people with underlying (and often undiagnosed and without symptoms) heart problems.
- Nerve damage/prolonged bleeding. Numbness or loss of sensation at the site of the piercing or movement problems (for pierced tongues) can occur if nerves have been damaged. If blood vessels are punctured, prolonged bleeding can occur. Tongue swelling following piercing can be severe enough to block the airway and make breathing difficult.
- Gum disease . People with oral piercings — especially long-stem tongue jewelry (barbells) — have a greater risk of gum disease than those without oral piercings. The jewelry can come into contact with gum tissue causing injury as well as a recession of the gum tissue, which can lead to loose teeth and tooth loss.
- Damage to teeth. Teeth that come into contact with mouth jewelry can chip or crack. One study in a dental journal reported that 47% of people wearing barbell tongue jewelry for 4 or more years had at least one chipped tooth.
- Difficulties in daily oral functions. Tongue piercing can result in difficulty chewing and swallowing food and speaking clearly. This is because the jewelry stimulates an excessive production of saliva. Temporary or permanent drooling is another consequence of increased saliva production. Taste can also be altered.
- Allergic reaction to metal. A hypersensitivity reaction — called allergic contact dermatitis — to the metal in the jewelry can occur in susceptible people.
- Jewelry aspiration. Jewelry that becomes loose in the mouth can become a choking hazard and, if swallowed, can result in injury to the digestive track or lungs.
If you have decided to go through with the oral piercing procedure despite these risks, consider the following tips when looking for an oral piercing studio.
- Ask friends who have had their tongue, lips, or cheeks pierced — and have suffered no ill consequences — to recommend the name of the studio they visited.
- Visit the studio. Does the studio have a clean appearance, especially the area where the piercing is done? Ask if they use hospital-grade autoclaves for sterilization and/or use disposable instruments. Does the staff use disposable gloves?
- Ask to see the studio's health certificates.
- Are all the needles, as well as the studs, hoops, and barbells, kept in sterilized packaging?
- Are all staff members involved in the piercings vaccinated against hepatitis B? They should be.
A pierced tongue can take four to six weeks to heal. Pierced lips take between one and two months to heal. During this healing period, here's what you should do:
- Avoid alcohol, spicy foods, and hard and sticky foods.
- Don't smoke or use tobacco-based products.
- Brush after every meal and rinse with a mouthwash, such as Listerine.
- Rinse your mouth frequently with warm salt water.
- Eat soft foods. Consult with your dentist about taking vitamins to promote faster healing.
- Make an appointment with your dentist if you suspect a problem or have a concern. It is critical for dentists to check your teeth, gums, tongue, and soft tissues for early signs of any problems.
Warning Signs After an Oral Piercing
If you notice any of the following warning signs after getting an oral piercing, contact a health care professional right away:
- Yellow or green discharge from the piercing site (Note: A whitish or clear discharge is normal)
- Scarring or thickened tissue that builds up and darkens around the piercing site
- Increased redness, pain and tenderness, or swelling at the piercing site
- A pimple-like abscess on the piercing site
- Bleeding or tearing after the initial healing of the piercing
- A low-grade fever that is persistent in the days following piercing
There are two types of tongue piercing:
Dorsoventral: The more common and safer of the two types, dorsoventral tongue piercing involves inserting the jewelry from the dorsal (top, middle) to the ventral (underneath, bottom) surfaces of the tongue. The piercing is commonly made in the middle of the tongue and requires the avoidance of major blood vessels during the procedure. Barbells are the most frequently used form of jewelry (see below) for this type of tongue piercing. Once the piercing is made, the barbell studs are placed on the top and bottom surfaces of the tongue, where they are each attached to an end of a stainless-steel post that extends through the piercing.
Dorsolateral: This type of piercing is made through the width of the tongue (e.g., from right to left), with the barbell studs located on the top of the tongue at the lateral borders, maintaining the position of the barbell post across that width. However, because of the vascularity of the tongue (heavily composed of blood vessels), this type of oral piercing is not considered a safe procedure and most professional piercers will not perform it.
The most common site for lip piercing is the side of the lower lip near the corners of the mouth where the lips meet; however, piercings can be made anywhere near the area of the lip known as the vermillion border (where the pink/red lip tissue meets the facial skin).
Though less common than tongue or lip piercings, cheek piercings (known as "dimples") and those in the frenum (known as "web" piercings) are alternative forms of oral piercing. Among intra-oral/peri-oral areas, the uvula is probably the least common site due to the difficulties related to performing the piercing and placing the jewelry.
Oral Piercing Jewelry
Types of jewelry for oral piercing include barbells, rings, and labrettes. The most popular form of jewelry for dorsoventral piercing, barbells are also used in dorsolateral piercing, in which they are placed dorsally, curve down toward the ventral side of the tongue and resurface on the dorsal side. Rings can also be used for the tongue when the piercing is made near the tip or lateral edges of the tongue. Rings are often worn encircling the edge of the lip. Labrettes are worn at piercing sites of the lip area, such as the natural indentation of the chin, found just below the lips, known as the labiomental groove – similar to lip piercings seen among some indigenous peoples of Brazil and Africa.
Complications from Oral Piercings
The broad acceptance of oral piercing among young people has raised the concern of dental and medical professionals due to the accompanying complications and risks to oral and general health. In fact, in 1998 the American Dental Association (ADA) issued a statement opposing the practices of intra-oral and peri-oral piercing and tongue splitting, a procedure that splits the front of the tongue into two pieces, resulting in a "forked" appearance.
Because the mouth contains millions of bacteria, infection is a possible and common complication of oral piercing. There are many other potential complications of oral piercing.
If you have suffered an adverse reaction to an oral piercing, you may experience a number of common symptoms:
Pain, swelling, infection, an increased flow of saliva, drooling and injuries to the gum tissue.
Taste loss, chipped or cracked teeth, tooth loss, severe and difficult-to-control bleeding, blood poisoning and blood clots.
Tongue swelling, which, in extreme cases, can close off the airway and restrict breathing.
Problems during dental examinations and the taking of X-rays due to the presence of oral piercing jewelry.
Pulpal sensitivity potentially stemming from contact between galvanic currents in stainless steel ornaments and other intra-oral metals.
Gingival recession (gum recession) when the post or button of the stud hits and rubs against the gum tissue, causing the tissue to recede.
Tooth fracture resulting from the post striking the side(s) of a tooth, causing the tooth to fracture or chip.
While infection is a possibility with any opening in skin or oral tissues, there is an especially high risk of infection at the site of an oral piercing due to the high concentration of bacteria and other micro-organisms found in the oral cavity. This risk is also increased by touching the site or the jewelry with unsanitary hands, consuming unsanitary food or liquid and contact with foreign objects.
One possible sign of infection is swelling of the tongue, which is common after a puncture. Swelling of the tongue can restrict or stop breathing, which in rare cases, will require the insertion of a breathing tube through the patient's nose until the infection passes. Excessive rubbing of a barbell on the gums can also lead to infection and gum recession. See your dentist at the first sign of an infection.
Another serious, if nonexclusive, risk of oral piercing is contracting blood-borne infections such as HIV (human immunodeficiency virus) and hepatitis if the person performing the piercing does not use a fresh needle or completely sterilize all used needles and instruments in an autoclave.
Rare but potentially fatal outcomes of infections resulting from oral piercing include Ludwig's angina, which is a bacterial infection of the floor of the mouth, and endocarditis, which occurs when bacteria travels through the piercing hole into the bloodstream and infects the heart.
Treatments for Oral Piercing Complications
In the absence of complications, healing of a tongue piercing takes about four to six weeks; with lip or cheek piercings, healing can take weeks or months. When complications occur, treatment options range from the use of antibiotics for infections to intubation for cases in which rapid swelling causes the airway to close. People wishing to close an infected piercing permanently should wait until the infection heals before removing the jewelry. Once individuals stop wearing the jewelry, they may be left with a small indentation, hole or scar tissue at the site of the piercing.
In cases where individuals who underwent tongue splitting wish to have the procedure reversed, surgery may be required. Although there is a lack of evidence in the scientific literature detailing the extent of morbidity and mortality associated with tongue splitting, the risk of complications involved in the surgical procedure necessary to repair the split is well established. For that reason, the ADA recommends that dentists who are members of the association discourage patients who express an interest in undergoing tongue splitting and educate them about the risks associated with this form of oral surgery.
Care and Maintenance of Oral Piercings
If you decide to proceed with oral piercing, there are essential steps to follow to maintain the piercing and keep it clean. Keep the following considerations in mind:
Barring complications, most people will be able to remove the oral jewelry only for a short period of time without the hole(s) closing. "Aftercare" guidelines from the Association of Professional Piercers note that even piercings that have been in place for years can shrink or close once they are healed.
To help protect your teeth, dentists recommend removing the ornaments each time you eat, as well as when you sleep. Some piercing parlors sell plugs that you place in the hole when you remove your jewelry.
After your tongue has healed following the piercing, remove the jewelry each night and brush it just as you brush your teeth.
Use an antiseptic mouthwash after every meal.
Consider removing the jewelry before any strenuous activity to avoid traumatic injury to the teeth from metal studs, which can lead to tooth fracture and chipping.
Other Considerations for Oral Piercings
From a high risk of infection and other complications to the extra time required for daily care and maintenance, there is a lot to consider before undergoing oral piercing. The selection of jewelry is important and, if done properly, will add to your costs.
Oral piercing jewelry should be made of inert, non-toxic metal substances such as gold (14 or 18 karat), surgical stainless steel, titanium or niobium. People that are highly allergic or have sensitive skin should avoid piercing jewelry containing nickel. Costume jewelry or the use of a safety pin in the opening is not an acceptable alternative since either can predispose the pierced site(s) to allergic reactions and infections. If the additional cost ($35 to $100) represents an obstacle to obtaining proper jewelry, then oral piercing may be especially prohibitive for you. In any case, you are strongly encouraged to consult with your dentist before undergoing any oral piercing procedure.