Oral piercings have become a popular form of body art and self-expression, especially among adolescents and young adults. While these modifications can be esthetically pleasing to some, they come with a list of dental health considerations that should not be overlooked. This article will delve into the dental implications of oral piercings, including common complications and professional recommendations for those already having oral jewellery.

The Popularity and Placement of Oral Piercings

Oral piercings typically involve the tongue, lips, cheeks, or other soft tissues within the mouth. The tongue is the most common site for these piercings. Common forms of oral jewellery include:

  • studs
  • barbells
  • rings
  • hoops

made from materials like:

  • stainless steel
  • gold
  • titanium or
  • synthetic substances.

There are two primary forms of oral piercing:

  • intraoral piercing: describes a piercing in which both ends of the oral jewellery (device or apparatus) reside in the oral cavity, as seen with tongue piercings.
  • perioral piercing: describes a piercing in which one end resides in the oral cavity and the other end penetrates the skin surface in the perioral region (e.g., the cheek, upper or lower lip, chin or associated tissues).

While these adornments are often seen as a form of individual expression or cultural practice, they pose several risks to oral health that need careful consideration.

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Common Complications Associated with Oral Piercings

Immediate Complications

  1. Swelling and Bleeding: The initial piercing process can cause significant swelling and bleeding due to the high vascularity of oral tissues.
  2. Pain and Infection: As with any puncture wound, pain is an immediate consequence. Infections are also common due to the rich bacterial environment in the mouth.

Long-Term Complications

  1. Tooth Damage: The constant presence of metal jewelry can lead to chipped or fractured teeth.
  2. Gingival Recession: Jewelry can rub against gums causing them to recede over time.
  3. Soft Tissue Injuries: Lacerations and scarring are frequent issues.
  4. Embedded Jewelry: Sometimes jewelry can become embedded in surrounding tissue requiring surgical removal.
  5. Hypersalivation: Increased salivary flow is another frequent side effect.
  6. Airway Obstruction: Swelling or aspiration of jewelry poses serious risks.

Severe Health Risks

  1. Ludwig’s Angina: A severe infection that spreads rapidly through the floor of the mouth.
  2. Infective Endocarditis: Bacterial infection affecting heart valves which could be life-threatening if not treated promptly.

Tongue Splitting

Tongue splitting involves severing the tongue into two pieces creating a forked appearance. It is a relatively less common oral modification, but is more dangerous. This procedure carries significant risks including severe bleeding, infection, nerve damage, and long-term complications such as difficulty speaking or eating.

Given its invasive nature and potential for severe complications without any medical benefits, cosmetic intraoral/perioral piercing and tongue splitting are advised against by dental professionals.

Oral Jewelry: Tooth Gems, Dental Grills, and Tooth Tattoos

In recent years, several types of oral jewelry have become used as contemporary forms of oral body art and self-expression, such as:

  • Tooth gems involve attaching precious stones like diamonds or precious stones) directly onto teeth
  • dental grills also called “grillz” or “fronts”, are removable devices covering teeth often made from gold or silver adorned with jewels and placed on anterior teeth. These were popularized in music videos during the 1980s, and their use has continued over time, especially in the Black population.
  • tooth tattoos (decorated porcelain crowns with ink or color designs that are placed on the dentition)
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Although these forms may seem less invasive compared to piercings, they still pose risks such as:

  • Enamel erosion
  • Plaque accumulation
  • Potential allergic reactions due to materials used
  • interference during dental procedures making accurate diagnosis difficult at times.

Dental Considerations for Patients with Oral Piercing or Jewellery

Dentists commonly encounter and treat patients, particularly younger adults, with various forms of oral piercing or oral jewellery, and this will increase more in the comings days. Few dental considerations to keep in mind for such patients:

  • Piercings of the tongue and other oral sites are associated with increased risk of tooth fracture, chipping or wear/abrasion, gingival recession and potentially traumatic lacerations.
  • Pierced individuals are also at increased risk of infection due to the vast number of bacterial species in the oral cavity.
  • Oral jewelry or ornaments can compromise dental diagnosis by obscuring anatomy and defects in radiographs.
  • There are reports of the jewelry becoming embedded in surrounding oral tissues, requiring surgical removal by dentists.
  • 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.
  • The patient must be educated that the tongue’s anatomic location, high vascularity and proximity to diverse oral microflora and biofilms present significant potential risks for viral infection or transmission of pathogenic organisms. Additionally, tongue splitting is typically performed in a non-sterile setting (e.g., body-piercing parlor or similar establishment).
  • Dental patients with an oral piercing or split tongue should keep their piercing site clean by brushing twice daily using fluoride toothpaste alongside flossing regularly; and using an alcohol-free mouthwash.
  • They should avoid playing with oral-piercing jewelry touching/pulling on them excessively.
  • They should monitor their oral cavity for signs of infection, including swelling, pain, tenderness or unusual discharges with an offensive odor – and report to the dentist immediately.
  • All forms of intraoral or perioral jewelry (e.g., tongue barbell, lip ring, or stud, etc.) should be removed before participating in athletic and other physical activities, particularly contact and collision sports.
  • Regular check-ups post-piercing ensure early detection/prevention/management strategies against possible complications arising out due usage/wear-and-tear over time.
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While oral piercings might offer an appealing way to express individuality or cultural identity, they come ladened potential hazards significantly impacting one’s overall well-being adversely. These are invasive procedures with negative health sequelae that outweigh any potential benefit.

Note: The American Dental Association (ADA) advises against the practices of cosmetic intraoral/perioral piercing, tooth gems/jewellery and tongue splitting, due to the increased risk of negative health outcomes.


  • Dr Nupur Shrirao is a consultant prosthodontist and a grammar Nazi! Besides dentistry, she enjoys giving stage performances and radio jockeying with All India Radio.

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Dr Nupur Shrirao is a consultant prosthodontist and a grammar Nazi! Besides dentistry, she enjoys giving stage performances and radio jockeying with All India Radio.

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