April 20, 2021
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Be careful with tongue piercing!

By: George Malkemus
February 19, 2021

As of January 28, 2021, tattoo and body piercing establishments in California have reopened after being mostly closed since the COVID-19 pandemic.  Oral piercing had been on the upswing until their closure in March of 2020. Many teens and young adults, as well as some older adults, have had this procedure and many are considering having mouth piercing now. 

Over the years, I have had many patients with tongue piercing. Most of them have not had problems, especially when the barbells have been short and made of plastic.  Some of the patients have had chipping of teeth, usually when the barbells have been longer and made of metal.  I have treated three patients, who have had serious dental problems because of their tongue bars.  They either severely broke teeth or severely damaged gums and bone supporting teeth. They eventually lost these damaged teeth and then they had to have dental implants to replace them. 

Some of the serious consequences from tongue piercing include:

Pain, inflammation and infection.

Damage to teeth, fillings and other dental work.

Injury or shrinkage of gums and bone.

Difficulty chewing or swallowing.

Greater saliva production.

Prolonged blood loss immediately after procedure.

Disease transmission, such as hepatitis. 

Need for orthodontic treatment due to repositioning the natural teeth alignment.

Tooth damage

 The tongue jewelry can chip or break a tooth or a filling. Tooth damage results from the wearer "playing" with the barbell by rubbing it along his/her teeth. Metal barbells are much more likely to cause tooth fracture than their plastic counterparts.  Tooth damage can be minimized by proper placement, the use of properly sized jewelry and avoiding playing with the piercing. 

Ten years ago, a 21-year-old woman with a beautiful smile cracked her upper left front lateral incisor due to biting down on her tongue barbell.  Root canal therapy, a fiber-reinforced post and a porcelain crown were necessary to fix the fractured tooth.  At age 23, she fractured the porcelain crown, again due to biting on her tongue barbell and so a new porcelain crown was placed.  Finally, at age 25, the barbell caused the tooth to break off at the gum line.  The tooth was extracted, and a beautiful dental implant was made as a replacement.  At that time, she decided to remove her tongue barbell and she has had no further problems. 

Gap between teeth

According to a study at the University of Buffalo in New York, playing with a pierced tongue barbell can lead to a gap between the front teeth.  By pushing the tongue barbell continually up against their front teeth, those with tongue piercing were likely to move the teeth apart.  Orthodontic braces work by placing continual force on teeth in the direction that they need to be moved to produce a correct alignment.  Force, over time, moves teeth.  Individuals with tongue piercing are tempted to play with their tongue barbell, placing unnatural forces on the teeth and consequently causing gaps or other problems to occur with teeth. 

Gum damage

A tongue bar can cause damage to the gums along the inside of the upper or lower front teeth, leading to gum recession.  Receding gums expose the roots of the teeth, causing sensitivity to temperature and periodontal disease with bone loss.  This can sometimes be corrected with periodontal surgery and a gum graft.  But if not corrected early, severe recession can lead to tooth loss. 

Several years ago, I treated 22-year-old male patient who rubbed the gums on the backside of his lower teeth with his tongue ring, causing severe gum infection, gum recession and bone loss.  He was referred to a periodontist, who attempted surgical gum grafting to save the teeth.  However, two years later, he ended up losing his lower front two central teeth.  Eventually with bone grafting, the placement of two dental implants and the removal of his tongue ring, he was in good health again.

Importance of dental check-up before tongue piercing

I recommend not having a tongue piercing.  However, if you do decide to get your tongue adorned, proceed carefully and have a dental examination and cleaning first.  

The goal is to examine your oral tissues and look for any signs of existing infection, such as gum disease or deep decay.  It is much safer having any infection removed from your mouth before proceeding with tongue piercing.  A prior infection in your mouth could interfere with your tongue’s healing when pierced.  Also, ask your dentist for a prescription strength mouthwash. Rinsing before you have the tongue piercing procedure will decrease the bacteria in your mouth and lessen the chance for infection.

During your dental examination, it is important to check for dental issues that could make dental piercing more dangerous. For example, if you are a tongue-thruster (when you swallow, your tongue pushes against your front teeth), the tongue bar could seriously damage your oral tissues or teeth.

Safe guidelines

If you decided to have a tongue piercing, please check out the piercing establishment carefully.  Pay particular attention to the following safe piercing guidelines:

• The business is licensed and reputable, with clean, well-lit rooms for procedures.

• Trained and experienced piercers [a member of the Association of Professional Piercers] use new gloves and new mask and a fresh disposable needle for each procedure (never go to an establishment that uses piercing guns — they are more difficult to clean and inflict greater tissue damage).

• An autoclave and ultrasonic cleanser for sterilizing instruments are on the premises.

• All of your questions and concerns are answered openly and directly. If you're unsatisfied or uncomfortable with the answers, then leave and try somewhere else. 


If I have not convinced you to forget about getting an oral piercing, please proceed with extreme caution. I want everyone to express their individuality, be safe, and have healthy teeth for a lifetime!


 Enjoy Life and Keep Smiling!


George Malkemus has a Family and Cosmetic Dental Practice in Rohnert Park at 2 Padre Parkway, Suite 200. Call 585-8595, or email info@  Visit Dr. Malkemus’ Web site at