Getting your tongue or lips pierced? Don’t be surprised when your dentist is unhappy about it.

Body piercing is a popular form of self-expression. Oral piercings or tongue splitting may look cool, but they can be dangerous to your health. That’s because your mouth contains millions of bacteria, and infection and swelling often occur with mouth piercings. For instance, your mouth and tongue could swell so much that you close off your airway or you could possibly choke if part of the jewelry breaks off in your mouth. In some cases, you could crack a tooth if you bite down too hard on the piercing, and repeated clicking of the jewelry against teeth can also cause damage. Oral piercing could also lead to more serious infections, like hepatitis or endocarditis.

These piercings can do damage to your teeth and gums, a new study warns.

“Our study found that many people with oral piercings had deep pockets and gaps around their teeth, and receding and bleeding gums,” said study author Dr. Clemens Walter, a professor at University Medicine Greifswald in Germany. “These are all signs of periodontitis, also called gum disease, which can lead to tooth loss.”. Walter and his colleagues analyzed eight studies that included 408 people with a combined 236 lip piercings and 236 tongue piercings. In all, 1 in 5 had more than one oral piercing. The participants reported having their piercings ranging from one month to 19 years, and most folks wore metal jewelry in their piercings.

The studies compared teeth and gums next to the piercings with areas elsewhere in the mouth. Researchers reported that 3 in 5 studies found deeper pockets around teeth next to tongue piercings, and 3 in 4 found wider gaps between teeth; 2 in 3 found bleeding gums, and four studies looking for receding gums found it in all four. In addition, 3 of 4 studies looking at lip piercings revealed receding gums in the area.

The study review was presented at a meeting of the European Federation of Periodontology, in Copenhagen. Research presented at meetings is typically considered preliminary until published in a peer-reviewed journal. “The findings suggest that oral piercings, especially in the tongue, negatively affect the adjacent teeth and gums,” Walter said in a meeting news release. “In those with tongue piercings, damage was particularly notable around the bottom two front teeth, called the mandibular incisors, which are important for biting and chewing food.” The likelihood of tooth and gum damage appeared to increase with time, he added. His advice: “People with tongue and lip piercings should remove them to protect their teeth and gums from further damage,” Walter said.

About 5% of young adults have oral piercings, with the tongue being the most common site. Women are about four times more likely to have an oral piercing than men, according to the study authors. Previous research has yielded similar findings. Researchers on the new study urged dentists to tell their patients about the risk of complications from wearing oral piercings.

If you pierce your tongue, lips, cheeks or uvula (the tiny tissue that hangs at the back of the throat,) it can interfere with speech, chewing or swallowing. It may also cause:

• Infection, pain and swelling. Your mouth is a moist environment, home to huge amounts of breeding bacteria, and an ideal place for infection. An infection can quickly become life threatening if not treated promptly. It’s also possible for a piercing to cause your tongue to swell, potentially blocking your airway.
• Damage to gums, teeth and fillings. A common habit of biting or playing with the piercing can injure your gums and lead to cracked, scratched or sensitive teeth. Piercings can also damage fillings.
• Hypersensitivity to metals. Allergic reactions at the pierced site are also possible.
• Nerve damage. After a piercing, you may experience a numb tongue that is caused by nerve damage that is usually temporary, but can sometimes be permanent. The injured nerve may affect your sense of taste, or how you move your mouth. Damage to your tongue’s blood vessels can cause serious blood loss.
• Excessive drooling. Your tongue piercing can increase saliva production.
• Dental appointment difficulties. The jewelry can get in the way of dental care by blocking X-rays.

If you already have piercings:

• Contact your dentist immediately if you have any signs of infection—swelling, pain, fever, chills, shaking or a red-streaked appearance around the site of the piercing.
• Keep the piercing site clean and free of any matter that may collect on the jewelry by using a mouth rinse after every meal.
• Try to avoid clicking the jewelry against teeth and avoid stress on the piercing. Be gentle and aware of the jewelry’s movement when talking and chewing.
• Check the tightness of your jewelry periodically (with clean hands). This can help prevent you from swallowing or choking if the jewelry becomes dislodged.
• When taking part in sports, remove the jewelry and protect your mouth with a mouthguard.
• See your dentist regularly, and remember to brush twice a day and floss daily.
• Of course the best option is to consider removing mouth jewelry before it causes a problem. 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.

Complications of Oral Piercing

As with any puncture wound or incision, oral piercings may cause pain, swelling, and infection. Other complications of intraoral and perioral piercings may include increased salivary flow; gingival injury or recession; damage to teeth, restorations or fixed prostheses; lingual abscess; interference with speech, mastication or deglutition; scar tissue and keloid formation; and allergic contact dermatitis. Because of the tongue’s vascular nature, prolonged bleeding may result if vessels are punctured during the piercing procedure. Purulent, unusual and/or colored discharges from oral piercings have also been reported.

The technique for inserting tongue jewelry may abrade or fracture anterior dentition, and digital manipulation of the jewelry may significantly increase the potential for infection. Airway obstruction due to pronounced edema or aspiration of jewelry poses another risk, and aspirated or ingested jewelry could present a hazard to respiratory or digestive organs. Oral jewelry can compromise dental diagnosis by obscuring anatomy and defects in radiographs. There are also reports of the jewelry becoming embedded in surrounding oral tissues, requiring surgical removal. Studies have also shown that lip or tongue piercings can harbor periodontopathogenic bacteria, and that piercing jewelry made of synthetic materials (e.g., polytetrafluoroethylene or polypropylene), rather than steel or titanium, have lower levels of bacterial colonization.

Oral piercing complications are relatively common. According to one systematic review, gingival recessions were identified in up to 50% of individuals with lip piercing and in 44% of those with tongue piercing; tooth damage was also seen in 26% of individuals with tongue piercings. Complications may arise either during the oral-piercing procedure, immediately after its completion, or over the long term (after initial placement).

Several case reports in the published literature have described severe or life-threatening complications related to oral piercing. In one case, a 25-year-old British woman developed Ludwig’s angina, a rapidly spreading cellulitis involving the submandibular, sublingual and submental fascial spaces bilaterally, four days after receiving a tongue piercing.

Intubation was necessary to secure the woman’s airway, and when antibiotic therapy failed to resolve the condition, surgical intervention was required to remove the barbell-shaped jewelry and decompress the swelling in the floor of the mouth. In another case report, a healthy 19-year-old woman contracted herpes simplex virus, presumably through a recent tongue piercing.28 The infection progressed to fulminant hepatitis and subsequent death.

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Armin Abron, DDS, MS