Tongue piercings carry real risks to your teeth, gums, and overall health. The American Dental Association explicitly advises against them, stating that the potential for negative health outcomes outweighs any cosmetic benefit. That position, first adopted in 1998 and reaffirmed as recently as 2021, reflects decades of clinical evidence linking tongue jewelry to dental damage, gum recession, bone loss, and occasionally serious infections.
What Happens Right After the Piercing
Swelling, bleeding, soreness, and pain are common during the first week. A longer barbell is placed initially just to accommodate the expected tongue swelling. Most of these symptoms resolve on their own, but in rare cases, things go wrong quickly. Ludwig’s angina, a severe infection of the floor of the mouth, has been reported as soon as three days after a tongue piercing. In one documented case, a 25-year-old woman developed this infection four days post-piercing and had to be intubated twice before fully recovering.
Bacterial infections after tongue piercing are uncommon overall. In one survey of 51 people with tongue piercings, three reported infections. Two other surveys, covering 47 and 122 respondents respectively, found zero bacterial infections. But the infections that do occur can be severe: abscesses in the tongue, swollen lymph nodes under the jaw, and tetanus have all been reported in clinical literature. The rarity of these complications doesn’t eliminate the risk; it just means most people get lucky.
Numbness and temporary taste loss also show up in the early period. These sensory changes usually fade, but they reflect the fact that a needle is passing through a muscle packed with nerve endings and blood vessels.
Damage to Teeth and Gums
This is where tongue piercings cause the most widespread, measurable harm. The metal barbell sits behind your lower front teeth, and every time you talk, eat, or fidget with the jewelry, it taps against enamel and gum tissue. Over months and years, that repetitive contact adds up.
Gum recession on the inside surface of the lower front teeth is the most well-documented consequence. Among people who wore long-stemmed barbells for two or more years, half developed recession on their lower central incisors. Receded gums don’t grow back. Once the tissue pulls away from the tooth, the root surface is exposed, leading to sensitivity, a higher risk of decay, and potentially the need for grafting procedures.
Tooth chipping is the other common issue. Enamel is hard but brittle, and a steel or titanium ball clicking against it thousands of times a day eventually causes chips and cracks, particularly on the back surfaces of front teeth where the damage isn’t immediately visible. Longer barbells make both chipping and gum recession significantly more likely.
Bone Loss Around Lower Front Teeth
Beyond soft tissue damage, tongue piercings are linked to changes in the bone that holds your lower front teeth in place. A radiographic study comparing people with tongue studs to those without found significantly more bone abnormalities around the lower front teeth in the pierced group. Interestingly, the correlation between how long someone had worn the stud and the severity of bone changes was weak, suggesting that even relatively short-term wear puts you at risk.
Bone loss in this area matters because it’s not reversible through normal healing. It weakens the foundation supporting your teeth and, combined with gum recession, can eventually compromise tooth stability.
Risk of Heart Valve Infection
One of the more alarming possibilities is infective endocarditis, an infection of the heart’s inner lining or valves. Piercing the tongue introduces bacteria from the mouth into the bloodstream, and in people with existing heart conditions (particularly congenital heart defects), those bacteria can settle on damaged or abnormal valves.
Case reports of endocarditis following tongue piercing are growing. One published case involved a patient with congenital heart disease who developed a heart valve infection caused by bacteria commonly found in the mouth. In a separate survey of piercing complications among people with congenital heart disease, 23% experienced piercing-related infections ranging from one week to three years after the procedure, and only 6% of those who had piercings took preventive antibiotics beforehand.
For someone with a healthy heart, this risk is very low. For anyone with a heart murmur, valve abnormality, or congenital heart condition, it becomes a genuinely dangerous gamble.
Metal vs. Plastic Jewelry
Some people switch to plastic or flexible jewelry (like Bioplast or Teflon) hoping to reduce dental damage. While softer materials are less likely to chip enamel, they come with a different tradeoff: bacteria cling to them far more readily. Lab research examining bacterial colonization on different tongue piercing materials found that plastic piercings accumulated significantly more bacteria than titanium or surgical steel. Under electron microscopy, the reason was clear. Metal piercings have smooth, polished surfaces, while plastic ones are rough and uneven, giving bacteria more places to attach and multiply.
Titanium and surgical steel showed the lowest bacterial adhesion across multiple species of oral bacteria tested. If you already have a tongue piercing and plan to keep it, metal jewelry is the better choice from a hygiene standpoint, though it’s worse for your enamel. There’s no material that eliminates both problems.
What About Speech?
One concern that turns out to be mostly unfounded is permanent speech impairment. A study comparing speech quality between people with long-term tongue piercings and those without found no statistically significant differences in any dimension of speech, whether reading aloud or speaking spontaneously. Barbell length and position didn’t matter either, and removing the piercing had no effect on speech performance. People adapt their articulation around the jewelry effectively enough that listeners can’t tell the difference. You may notice a brief adjustment period right after getting pierced, but lasting speech problems are not a realistic concern.
Why Dentists Push Back
The core issue with tongue piercings isn’t any single catastrophic risk. It’s the slow, cumulative damage that most people don’t notice until it’s too late to reverse. Gum recession develops gradually. Bone changes happen below the surface. Tooth chips start small. By the time these problems become obvious, the damage is done, and fixing it often requires dental procedures far more expensive and invasive than the piercing itself. The ADA’s position isn’t based on a handful of horror stories. It reflects a pattern of predictable, well-documented harm that plays out across a large percentage of people who keep tongue jewelry in for more than a year or two.