As with any puncture wound or incision, oral piercings may cause pain,5, 11, 12 swelling,4, 5, 11-13 and infection.11, 12, 14 Other complications of intraoral and perioral piercings may include increased salivary flow;12, 15 gingival injury or recession;2, 11, 13, 16, 17 damage to teeth, restorations or fixed prostheses;2-4, 12, 13, 17, 18 lingual abscess;19 interference with speech, mastication or deglutition;3, 5, 11 oral lichenoid lesions;20 scar tissue and keloid formation;15, 21 and allergic contact dermatitis.22, 23 Because of the tongue’s vascular nature, prolonged bleeding may result if vessels are punctured during the piercing procedure.24 Purulent, unusual and/or colored discharges from oral piercings have also been reported.25
The technique for inserting tongue jewelry may abrade or fracture anterior dentition,3, 4, 12, 18 and digital manipulation of the jewelry may significantly increase the potential for infection.11, 13, 14 Airway obstruction due to pronounced edema4 or aspiration of jewelry poses another risk, and aspirated or ingested jewelry could present a hazard to respiratory or digestive organs.5, 13 Oral jewelry or ornaments 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.2, 13, 26 Studies have also shown that lip or tongue piercings can harbor periodontopathogenic bacteria,27, 28 and that piercing jewelry made of synthetic materials (e.g., polytetrafluoroethylene or polypropylene), rather than steel or titanium, have lower levels of bacterial colonization.29
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.30 Complications may arise either during the oral-piercing procedure, immediately after its completion, or over the long term (after initial placement).2
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.6 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.31 The infection progressed to fulminant hepatitis and subsequent death.