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2C.2 Oral Piercings: Tongue

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This article is from the Piercing FAQ, by Anne Greenblatt with numerous contributions by others.

2C.2 Oral Piercings: Tongue

4 to 8 weeks

Tongue piercings are most commonly placed in the center of the tongue.
The tongue is comprised of muscles. The risks of nerve and blood
vessel damage are minimized when the piercing is placed in the
center. The large blood vessels of the tongue are usually to either
side and very visible on the underside. Very ocassionally are blood
vessels present in the center. Tongue piercings are not known to
affect the sense of taste; the papillae (tastebuds) are too
numerous. Taste buds that are displaced by the needle will turn white
and eventually shed.

Placement should be made with regard to the length of the tongue both
in its normal resting position in the mouth as well as when it is
extended. Placing the piercing through or just behind the natural
bend in the tongue is usually the most comfortable position for
speaking and eating. If placed too far forward, the bottom ball will
rub against the gums, causing gum irritation or even gum loss. If
placed too far back, the piercing will often swell excessively and be
uncomfortable and irritate the frenulum, if one is present.

The frenulum is the web of tissue which runs lengthwise along the
underside of the tongue and is usually present in most people to some
degree. If a frenulum is present the piercing should be made in front
of or to the side of it. Piercing through the frenulum often results
in scarring. If the frenulum is large, it may become irritated by the
jewelry enough to cause scarring. Wearing a smaller bottom ball can
reduce irritation. If the side or length of the frenulum impedes
appropriate placement, the piercee should consider having the frenulum
clipped by a dentist or oral surgeon.

The piercing should be as perpendicular to the tongue as possible. An
extremely slanted or crooked piercing creates stress on the entrances
which can result in prolonged healing and/or scarring. A slanted
piercing in which the top entrance is further back than bottom
entrance often pushes the bottom ball against the gums, causing gum
irritation or even bone loss.

The bottom of the mouth and the lower gums may become irritated from
pressure exerted by the bottom barbell ball. Shortening the barbell
usually alleviates irritation. If the ball continues to rub against
the gums a smaller ball should be worn. Over the long term, continued
pressure can cause gum loss and eventually bone loss beneath the
gums. Bone loss can also occur in front of the bottom teeth as the
barbell pushes the teeth forward. Bone loss is sometimes evident by an
indentation in the gums below the gumline. Usually, bone loss can
only be detected by x-ray and/or an examination performed by a

Chipping and cracking teeth are risks of tongue piercings. The risks
are greater if the teeth are already structurally weakened by large
fillings or caps. Wearing smaller balls, in addition to shortening the
barbell, is advised if the wearer accidentally bites down on the
barbell while eating. Most people play with their barbells between
their teeth. Over the long term, metal jewelry will hasten
deterioration of tooth enamel as the balls hit and scrape the
teeth. Plastic or acrylic balls will reduce the risk of damaging the
teeth but can break if bitten hard enough. Acrylic posts should not be
worn because of the risk of breakage.

Off-center tongue piercings using barbells must be carefully placed to
avoid severing large blood vessels. The risk of accidentally biting
down on the jewelry is greater. If the mouth is narrow, the piercings
should be slanted inwards on the bottom to prevent the balls from
rubbing against the gums.

Tongue piercings made through the front and side edges of the tongue
using rings have been successful for some people, but for most a ring
impedes eating and speaking. The risk of accidentally biting down on
jewelry is greater. A ring may rub against the gums, resulting in
irritation. If such a piercing is desired, the diameter of the ring
must be large enough to allow for swelling. A ring which is too small
in diameter will cause the piercing to migrate or scar. A smaller ring
may be worn after the piercing has healed.

Initial jewelry: Straight barbells in 14 to 10 gauge and 3/4" - 1" in
length; the barbell should be at least 1/4" longer than the thickness
of the tongue to accommodate swelling. During the first 24 to 48 hours
the tongue usually swells to almost twice its normal size. Swelling
should not impede breathing. If the barbell is too short, the balls
may start to nest or embed into the tongue. The barbell may be
shortened after the swelling immediately around the piercing has gone
down, usually after 2 to 4 weeks. Shortening the barbell usually
corrects speech or eating impediment. Many piercers do not use 14ga
because of the risk of tearing the piercing with frequent play.

Jewelry which is internally threaded at both ends allows for easy
insertion and removal. Externally threaded jewelry can irritate or
tear a piercing, even after the piercing has healed. Barbells with one
fixed ball should not be used; the bottom ball can adhere to the shaft
with plaque making removal difficult or impossible.

A slight depression usually forms under the top ball, particularly if
the tongue rests against the roof of the mouth. If the depression
covers more than half of the ball or forms a pocket around the ball,
the barbell is probably too short to accommodate swelling and / or the
piercing is slanted so that the top hole is further back than bottom

Tongue piercings stretch easily, particularly if the wearer plays with
his/her barbell. Frequently playing with the barbell by pulling the
barbell forward will cause the piercing to stretch forward and may
change the angle of the piercing.

Occasionally a piercing will develop excess granulation tissue, a
condition described as hypergranulation, during healing. Excess
granulation tissue is red or dark pink and often forms a raw-looking,
visibly layered bump that appears to erupt from the
entrance(s). Capillaries will grow into the tissue, and hence the
tissue will often bleed when disturbed. This condition is usually not
painful. Hypergranulation can result from:

- stress caused by playing with the barbell while the piercing is
- stress caused by excessive length of the barbell if the barbell
when the mouth is closed
- stress caused by the piercing being placed at an inappropriate
the piercing should be perpendicular to the tongue and not slanted
- chemical irritation caused by the alcohol in many mouthwashes or
overusing mouthwash or disinfectant, smoking, certain foods

The excess tissue sometimes recedes into the piercing one the
source(s) of irritation has been eliminated. Continue cleaning the
piercing as suggested by your piercer for the remainder of the healing

Because granulation tissue is very delicate, it can sometimes be
removed by wiping with a cotton swab or gauze sponge. Excess tissue
may also be excised by a dentist or oral surgeon. If hypergranulation
is persistent, the piercing may have to be abandoned.

Excess white or pale pink scar tissue can also form towards the end of
the healing process for the same reasons. Around the bottom entrance,
scar tissue may appear as a raised ring around the entrance. Around
the top entrance, scar tissue will often take the form of a hard bump
beneath the surface of the tongue. Scar tissue that forms after the
piercing has healed is usually the result of injury to the piercing or
an accumulation of plaque.

Some people have successfully treated hypergranulation and excess scar
tissue on oral piercings using an aspirin and water paste. This method
is not suggested; aspirin can easily damage delicate oral tissues.

Tongue barbells will collect plaque, usually on the bottom ball,
especially in the crevice between the ball and bar. Plaque traps
bacteria and can cause the jewelry to have a bad odor. A large
accumulation of plaque can irritate a healed piercing and result in
scar tissue. Daily use of an anti-plaque rinse is suggested to prevent
plaque build-up. To remove a build-up of plaque, remove and soak
jewelry in an antibacterial denture cleaner following the package

Check the tightness of barbell balls daily to prevent losing,
swallowing, or inhaling the jewelry. Ask your piercer if your barbell
is internally or externally threaded and if your barbell is threaded
at one or both ends. Ideally the threads should have least three
rotations and should fit securely.


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