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Tongue Piercing
What you don't know can hurt you

Body art, which uses the entire body as a canvas, has become very trendy. Techniques include tattooing and scarification, or deliberately making scars on skin. Jewellery piercing is also done in unexpected places, including the face, mouth, nipples, genitals and tongue.

Piercing is not new, but an ancient practice done in distant cultures and civilizations. Egyptian pharaohs did it to demonstrate royalty, Mayans to express spirituality, and ancient Romans pierced the nipples and penis to symbolize strength and courage. Those who choose body art today do so for many reasons. Body art can show cultural and religious identity, or a sense of style. It may be used to boost self-esteem, to rebel, to please friends or fit into a group. It may even enhance sexual pleasure.

These days, both adults and youth wear body art. Compared to forms such as tattooing, tongue piercing can be considered somewhat temporary. However, the dental community is very concerned about tongue piercing. Damage to the tongue, teeth and health can result.

Tools of the trade

To do a tongue piercing, a light is used to illuminate the tongue. Blood vessels are located, since the piercing must avoid them. The tongue is clamped and pierced in the front two-thirds section. A barbell is then inserted.

The barbell is simply a threaded stainless steel or titanium bar. Beads screwed on it at both ends hold it in place. The barbell may also be made of 14K gold or niobium, and beads can be plastic or metal. The barbell can be straight or curved, and measures a quarter to one inch in length.

After the piercing, the tongue swells. This subsides and healing occurs within about four weeks. Alcohol-based mouth rinses, dairy products, spicy or citrus foods, hard foods, smoking and oral sex should be avoided during this time.

Concerns about tongue piercing

Problems with body art in general, and tongue piercing in particular, can involve the person who is pierced, the one doing the piercing, and the barbell itself.

The ‘piercee’

Since having your tongue pierced is a type of surgery, it carries with it certain risks. The piercer should ask questions and take a complete medical history. Conditions such as hemophilia (a blood disorder) and medications such as blood thinners can cause uncontrolled bleeding. Immune system disorders, like hepatitis C, HIV or chronic liver disease, may mean that body piercing should not be done. Allergies to metal or other materials can also cause problems. In such cases, the piercer must consult with a doctor or dentist before continuing.

Prophylactic (preventive) antibiotics are required for anyone who has a pathological heart murmur. Those who have a murmur, but no knowledge of its status, should see their doctor beforehand.

Following certain guidelines reduces the risks of having a piercing done. For instance, carrying out post-surgical care instructions lowers the risk of infection. Replacing the first barbell with a smaller version once swelling has subsided cuts down on the chance of damage to teeth.

The piercer

The knowledge, training and standards of practice of tongue piercers are largely unregulated. Training programs range from a few weeks to a few months in length. There are no training standards for tongue piercing in Canada.

In today’s age of blood-borne infections such as HIV and hepatitis, safe practices are essential. Piercing studios should follow provincial guidelines for personal services (see sidebar). Make certain these standards are in place before getting any type of piercing. Ask about the piercer’s training and experience. Since the entire thickness of tongue muscle will be pierced, a risk of nerve and blood vessel damage exists. An inexperienced or uninformed piercer may not advise on or know how to handle infection. If you have any doubt about the competence of the piercer, stay away.

Barbell issues

A barbell in the tongue can cause tooth fractures. It is especially important to replace the initial barbell with a smaller one once swelling subsides. Barbells can also cause problems with speech. Breathing beads or the barbell itself into the lungs is also possible if a bead becomes loose.
Infections, allergic reactions, scarring and overgrowth of tissue in the tongue can also cause problems. Dental structures can be hard to see. If the barbell and beads are not cleaned properly, they can become locked together by a build-up of calculus in the threads. (This hard material, formed from saliva, food, minerals and plaque, can also attach to teeth.)
Some believe that the tongue completely heals after a tongue ring is inserted. One study of the pierced tongues of rats showed that there was no true healing of the channel, even after six months.

At the University of Alberta, a study was done on tongue piercings. Participants had worn barbells anywhere from a few months to seven years. The study suggested that although a false skin may form, inflammatory cells are just below the surface. With the slightest irritation or trauma, it can become inflamed and infected.

Oral sex is supposedly made better by the presence of the barbell. However, this would involve friction on the barbell, and possible irritation. Since it does not appear that the channel ever truly heals, blood or body fluids could enter a broken channel wall. Although safe sex using a condom is always important, it is particularly essential for those with a tongue piercing.

Recommendations

Since tongue piercings can cause many problems, dental health caregivers do not encourage them. However, if you do choose to have one done, keep the following in mind.

• Consider any health conditions that may affect recovery from piercing. Contact your doctor if you are uncertain.
• If you must pierce, use a piercer registered in accordance with local or provincial guidelines.
• Check with your local health unit to find out about any complaints lodged against the studio you are considering.
• Ask about the piercer’s training and experience.
• Insist on a tour of the studio to see the sterilization room. The environment of the piercing studio must be clean and hygienic.
• Piercers must wear gloves.
• Ear piercing guns must never be used.
• Needles must be sterilized before use and disposed of afterwards. Make sure this is done.
• All instruments used must be steam-autoclaved (sterilized).
• Gold-plated or gold-filled sterling silver are not appropriate materials to be used.
• Ask to be fully informed about how to take care of the piercing, and make sure you can consult with your piercer after the procedure.
• Eat soft foods to start, and avoid biting the barbell. (The risk is highest in the first two months.)
• Be extremely thorough with hygiene. To clean, the barbell should be removed and debris gently wiped away with a mild soap and water at least once a day. In addition, an antibacterial mouth rinse can be used daily. Watch for redness and any extra tissue around the barbell and piercing site.
• Be aware that the pierced site does not heal fully, and is at risk of irritation and inflammation. Safe oral sex must be practised, even if the site appears ‘healed.’
• If you suspect infection see your doctor, as serious infections can be fatal.
• Insert a smaller barbell as soon as your tongue swelling subsides.
• Never allow a scarred area to be re-pierced.
• Check regularly that the balls are screwed securely onto the barbell to avoid swallowing or breathing them into your lungs.

Talk to your friendly local dentist before you take the plunge and get pierced.