The decision to "pierce" is often a personal statement signifying self-expression, fashion trends, risk-taking or daring, with no formal religious or societal purpose. If you are a young person interested in oral piercing or a parent with a child who is considering it, you deserve to know as much about oral piercing as you can learn prior to undergoing or allowing it.
Despite its esthetic qualities, oral piercing poses some serious health risks and can result in a number of complications.
Basics of Oral Piercing
Oral piercing sites for jewelry placement include the lips, cheeks, frenum (a fold of mucous membrane and soft tissue extending from the floor of the mouth to the midline of the undersurface of the tongue) and uvula (a cone-like projection from the posterior edge of the middle of the soft palate). However, the most common site for oral piercing is the tongue.
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.