Tongue Piercings

Summary

• Comfortable: 3 days to 2 weeks
• Healing Time: 6 months
• Rinse frequently with warm salty water.
• Ask for your piercer's mobile phone number.
• Avoid putting anything dirty in your mouth and refrain from kissing and oral sex during the healing phase.
• Cold foods are best at first (e.g. ice-cream, milk shakes).
• Do not play with the jewelry against your teeth or press it into your gums.
• Never leave your jewelry out for more than a few hours during the first 6 months - the piercing may close.
• Take vitamin C and zinc to maximise your healing.
• To minimise swelling in the first few days, suck on ice-cubes and antibacterial/anti-inflammatory throat lozenges, and try not to talk too much.

Care Routine

• Day 1
  1. Advice
     Ask for the mobile phone number of your piercer. Misery is common during the first few days and you may worry about the swelling. I like to be available for re-assurance or advice.
  2. Bleeding
     The tongue has an excellent blood supply so expect some blood in your mouth during and just after the procedure.
  3. Pain
     You will experience some soreness for the first day or so. Paracetamol (e.g.Panadol, Tylenol) is an appropriate pain-reliever which may help you to sleep on the first night. Do not use aspirin as it promotes bleeding.
  
    Days 2 - 5
  1. Cold Drinks
     Keep a supply of iced water on hand and sip this as required to reduce discomfort and swelling. Sucking ice cubes will also help.
  2. Food
     At this stage it may be difficult to talk and eat because your tongue will be swollen. It is important to maintain your food intake during the healing period. High-calorie foods (e.g. milkshakes, ice-cream) will keep up your energy levels – if you do not eat enough, the healing process may be delayed. Cold foods are better tolerated than hot foods.You should avoid anything spicy, or stringy foods that may get caught on your new piercing.
  3. Mouthwashing
     • Rinse your mouth with salty water as often as you like. The correct proportion is 1/4 teaspoon of sea salt to 8 ounces (250mls) of bottled water. Sea salt can be purchased from supermarkets or delicatessans. Do NOT use iodised salt as the iodine slows healing.
     • Try sucking antibacterial/anti-inflammatory throat lozenges such as Difflam ® to reduce the swelling.
     • Use a disinfectant mouthwash after eating:
       • Biotene ®
       • Listerine ®:It should be diluted to a quarter of the usual strength – otherwise the mouthwash will destroy your naturally occurring enzymes and kill the exposed healing tissues.
       • Oral_B ®
       • Rembrandt ®
       • Tech 2000
     • If your tongue turns brown or green this is a sign that you should reduce the amount of mouthwash that you are using.
     • Do not use mouthwashes or toothpastes containing peroxide.
  4. Pain
     After the first day you should not need any more pain relief.
  5. Plaque
     Buy a new soft bristle toothbrush. If any plaque forms on the jewelry itself, gently remove it with a toothbrush.
  6. Swelling
     You may experience some swelling on Day 1, but the worst swelling occurs during Days 2-4. The swelling often feels much worse than it really is. Ice and cold drinks will help reduce swelling. Hot foods, spicy foods, talking a lot will tend to increase the swelling.
  7. Worry
     It is common to feel a bit depressed and anxious at this time. As a doctor I very occasionally supply the patient with two diazepam 5mg tablets and ask the patient to take a quarter of a tablet night and morning. Diazepam is a muscle relaxant and anti-anxiety agent. It helps relax the muscles of the tongue and relax the patient. You should not drive if taking diazepam. If you are in a drug rehabilitation program you should discuss taking diazepam with your sponsor or doctor.
  
   
• Days 6 - 14
  1. Changing Barbells
     Your initial barbell is usually longer than the your tongue is thick, to accommodate swelling. After 5 - 10 days most people will see their piercer to fit a shorter bar.
  2. Healing
     A tongue piercing should be very comfortable after 2 weeks. However the piercing is not permanent till 6 months have elapsed. Don’t play with or chew on your piercing as this can lead to the formation of scar tissue.
  3. Hygiene
     Avoid putting anything dirty in your mouth and refrain from kissing and oral sex during the healing period.
  4. Safety Check
     You should check that the ball is firmly screwed on to the barbell about once a week. Wash your hands with antibacterial soap before touching the piercing.
  5. Warning
     Never leave your piercing without jewelry for more than a few hours during the first 6 months! Even after this time a fully healed piercing may shrink, making it difficult to re-insert the jewelry.

Piercing Options and Jewelry Choices

• Suitable Positions
  
  1. Midline Piercings
     Correct Positioning is critical with tongue piercings. The correct place is in the midline, on the front third of the tongue far enough back so that the jewelry does not hit the teeth when speaking but not so far back that the piercing is stretched when swallowing or yawning. The further back the piercing the worse the swelling and pain during the first week.
  2. Side Piercings
     Piercings at the side of the tongue should only be undertaken by very experienced piercers.
  3. Horizontal Piercings
     These are very likely to cause nerve damage and are never recommended.

• Suitable Types
  1. Bar bells
     Internally threaded bar bells are better as they cause less damage when changing jewelry. If the bar is externally threaded, be very sure that no threads are exposed and avoid taking the jewelry in and out. Ask whether a range of balls and accessories is available as people like to wear different balls at different times e.g. fluoro balls when night-clubbing, clear balls at work. Jewelry is also available that is flesh coloured and inconspicuous.
  2. Captured bead rings
     Rings are sometimes used at the side of the tongue but are not recommended as a first tongue piercing.
  
   
• Suitable Sizes
  1. Gauge
     Only 14 gauge or heavier jewelry should be used. Smaller gauges will migrate out through the tongue and be very uncomfortable to wear.
  2. Initial Barbell Length
     5/8" to 7/8"
     16mm to 22mm
  3. Eventual Barbell length
     7/16" to 5/8"
     11mm to 16mm
  
   
• Suitable Materials
  Surgical Stainless Steel, 18 carat gold, titanium, niobium.
   
• Changing Jewelry:
  It is best to change jewelry during the two weeks, but this is best done by a professional piercer. After that time it should be easy to change jewelry yourself.

Other Issues

• Alcohol
  Drinking alcohol decreases your co-ordination and increases the risk of biting your jewelry and cracking a tooth. If you do drink, choose low alcohol beverages such as beer or cider. Any drink with more than 10% alcohol is likely to hurt and will impair the healing process.
   
• Aspiration
  Be aware that with tongue piercing, aspiration is a risk if the ball unscrews from the barbell and roles back down your throat into your windpipe. The ball may then lodge in your lungs. This is a medical emergency: Call an ambulance.
   
• Bacterial Infections
  
  1. Infections are uncommon with tongue piercings. Avoid putting anything dirty into your mouth (e.g. chewing pens and fingernails).
  2. Even though your mouth harbours more bacteria than any other part of your body, the washing action of your saliva and the enzymes it contains improves healing.
  3. Refrain from kissing and oral sex during the healing period.
  4. Symptoms of infection include increased pain, increased redness and an increase in the amount and thickness of the discharge. The infected discharge is usually thick and yellow, green or grey and may have an unusual odour. Consult with your physician or piercer and do not remove the jewelry until you seek advice.
  
   
• Cleaning
  Expect to see white material collecting around the balls of your barbell. This is a sign of healing. Gently clean this material away with a soft toothbrush. Never use undiluted mouthwash or alcohol to clean your piercing. These will kill the healing flesh.
   
• Mouthwashes
  I advise against the use of mouthwashes such as Listerine. After several days of frequent use the tongue surface usually turns green or brown and looks decidedly unhealthy. Please just use plain salty water.
   
• Smoking
  Smoking is used as a method of cooking food. Smoked tongue is a delicacy in some cultures. Smoking your own tongue is your own personal choice. I cannot recommend it. Smoking slows healing by suppressing your immune system and blood circulation. 
• Teeth
  
  1. The most obvious risk of tongue piercing is chipped or broken teeth. This usually occurs through biting the bar bell, especially in new piercings with the initial longer bar bell. To minimise the risk, change to the shorter barbell before Day 14. Acrylic balls may reduce the risk as well.
  2. Most common is loss of the enamel at the back of the teeth through repeated rubbing by the jewelry.
  3. The most serious risk is loss of teeth through bone resorption. Repeated pressure on the teeth or the bone of the jaw supporting the teeth results in destruction of the bone. Eventually the tooth socket dissolves and the tooth falls out. Ask your dentist to Xray the front teeth when you have your annual check up.
  
   
• Viral Infections
  
  1. Viruses such as Hepatitis A, B, and C, and HIV can penetrate any piercing that has not healed.
  2. These viruses may be present in the blood, saliva, semen, sweat and vaginal secretions of infected persons.
  3. Risky activities include:
     • Kissing
     • Oral Sex
     • Sharing cigarettes, joints, bongs, drug-taking paraphenalia, drink bottles, wind instruments, whistles.
  4. No data is available on the risk of viral transmission where tongue piercings, healed or unhealed, are present.
  5. Practice safe sex at all times.
  
   
• Vitamins
  Studies have shown that vitamin C and zinc promote wound healing. Aim for about 1000-1500 mg vitamin C and 100 mg zinc daily. Note that these amounts are not available in multivitamin tablets. Ask at your pharmacist or health-food store for advice on suitable products. If you are taking any medications, ask your pharmacist to make sure there are no interactions between them and the vitamin C and zinc you intend to take. For example, vitamin C can delay the absorption of the contraceptive pill - they should be taken at different times.