Thrush and Oral Piercings

I have been updating and changing my aftercare instructions, and the new versions can be found at the Aftercare Index Page. As I was writing the new oral aftercare instructions, it occurred to me that a long time ago, I had planned to add information about thrush but had never gotten around to it. So, for this installment of my Piercings Blog, I thought it was about time to cover Thrush and Oral Piercings.

It has been several years since I encountered a case of Thrush caused by the aftercare of a new piercing, and even then, it was more likely due to the use of harsh alcohol-based mouthwash and incorrect or excessive use of the product. However, under the right combination of illness, medication, and over-rinsing, when I first started piercing, there was a belief that the more effective the cleaning product, the more it would be, and the attitude that if a little helps, a lot more will be even better. If you were to look at my aftercare sheets from 1994, you would notice several suggested products that I would cringe at today if they were still being suggested. With oral piercings, it was Listerine, and it often led to longer healing times and increased chances for Thrush or other problems.

Weaning the industry off Listerine wasn't an overnight process. Initially, the standard recommendation was to dilute the mouthwash with distilled water. As Biotene and other Antimicrobial or antibacterial alcohol-free Mouth Rinses became more readily available, Listerine left the industry altogether. I remember clients doing the Listerine challenge, their eyes tearing up and their faces turning red as they swished the burning liquid around their mouths for 30 seconds. However, today we have much more pleasant and better options, and I must warn you that if a "piercer" reaches for a Listerine bottle or suggests using it, you should be somewhere else.

I think the first case of Thrush I encountered was a woman in her mid-twenties. She was a regular client and was a shining star when it came to aftercare and healing piercings. At this point, she had healed out a navel, nipples, an eyebrow piercing, and a few ear piercings without an ounce of trouble. So we were both surprised when these yellowish "Cottage Cheese" bumps started forming on her Tongue and Cheeks. At that point, I'd only received a brief explanation during my apprenticeship about Thrush, and it was the first time I'd seen a case in person, but I knew what it was. One of the most significant clues was that she was feeling a great deal of discomfort. On my suggestion, she went to her Doctor and got on medication after getting a long lecture on the harms of body piercings.

Thrush has generated a significant number of practices and suggested precautions to avoid, but the simple act of taking care of a healing oral piercing puts you at risk. Since the piercing is a slow-healing open wound, the use of an Antimicrobial or antibacterial mouth rinse is needed to reduce the likelihood of infection. The act of rinsing can increase the risk of Thrush by disrupting the normal balance of microorganisms in your mouth. This is the main reason that Listerine and harsh rinses are no longer suggested. 

What is Thrush?

Thrush is an infection of the mouth caused by the Candida Fungi. Candida is usually present in small amounts in the mouth and on other mucous membranes. When the balance of bacteria on these mucous membranes becomes unbalanced, for example, due to the overuse of harsh antibacterial products, it allows the fungi to overgrow. The fungus will grow into creamy white or yellowish lesions or bumps on the tongue and cheeks; however, the lesions can also form on the gums, the roof of the mouth, the tonsils, and the back of the throat. These "Cottage Cheese" bumps can bleed and be very painful or raw when they are scraped and brushed during brushing and other activities. The danger is that this can cause the fungus to spread into the esophagus, resulting in pain and difficulty swallowing, making one feel as though the food is lodged in the throat or mid-chest. Like any infection, it can spread to other parts of the body and cause a fever, as the infection can spread. I don't know how to stress how important it is to seek treatment as soon as possible if you feel that you have Thrush.

What Causes Thrush?

Thrush is caused by a breakdown of the natural bacterial balance on mucous membranes in the mouth, thus allowing the Candida fungi to overgrow. With piercings, the use of harsh mouthwashes and over-rinsing can decrease the amount of bacteria in the mouth, causing it to become unbalanced. However, in combination with other factors, the risks are higher. For example, medical conditions, foods high in sugar and yeast content, smoking, and certain medications. All of these should be considered before getting an oral piercing, especially if you have a history of Thrush and Yeast infections in your past.

High-Risk Medical Conditions:

• Uncontrolled Diabetes
• HIV infection
• Immune Deficiency Disorders
• Cancer
• Xerostomia(Dry Mouth)
• Sjögren's Syndrome
• Pregnancy
• Are prone to bacterial imbalances
• Those who have an impaired ability to fight off infections
• Those with poor dental health, poor dental care habits, or those with dentures

High-Risk Medications, Diet, and Habits:

• Antibiotics
• Birth Control Medications
• Corticosteroids
• Eating foods and drinks that are high in sugar and yeast, such as Beer, Bread, and Wine, can increase the growth of the fungi.
• Smoking
• Sharing eating utensils or using unclean utensils
• Overuse of antibacterial mouthwashes and rinses

How to reduce the risk of Thrush while healing an Oral Piercing:

• Do not use harsh Antimicrobial or Antibacterial Mouthwashes. Especially those with harsh active ingredients like alcohol. You should use an alcohol-free mouthwash, such as Biotene.
• Do not over-rinse. You should only rinse between 2 and 5 times a day. I know that in the past, I've suggested rinsing after ingesting anything other than distilled water, but rinsing for 30 seconds after meals and right before bed is even more effective.
• If you are on medications that put you at risk, you should consider delaying the piercing until you are no longer taking the medication and it is no longer in your system.
• If you have a medical condition that puts you at risk, talk to your doctor and discuss your risks with healing the piercing. Regardless of the piercing, you should also discuss any other risks your medical condition may pose with your piercer. With oral piercings, it is a good idea to discuss thrush with your doctor or dentist and explain the use of mouthwash, as it may be something they may not consider.
• Do not share jewelry with someone else or insert jewelry into a piercing that has not been sterilized. This could introduce harmful pathogens into the piercing area, increasing the likelihood of creating an imbalance.
• If you smoke, consider stopping during the healing or using the piercing as an incentive for quitting.
• Practice good dental hygiene and avoid putting unclean objects in your mouth.
• If you are sick or have a weakened immune system, consider delaying the piercing until you are healthy.
• Eating a healthy diet, getting plenty of rest, and reducing stress will all help your body fight off infections and speed up the healing process.
• Eating a couple of containers of Yogurt a day. Yogurt contains live beneficial bacterial microorganisms that can increase your body's ability to fight off yeast overgrowth. Especially the probiotic Lactobacillus acidophilus that produces lactic acid and creates an environment that is not hospitable to Candida fungi.

How can I tell if I have Thrush, and what to do about it?

If you brush or scrape the lesion's bumps and reveal raw, red tissue with slight bleeding, you likely have a thrush outbreak, which needs to be addressed. There are several home remedies available on the internet, including consuming yogurt (see above) and gently brushing the affected area with a soft brush dipped in a mixture of one part hydrogen peroxide to two parts warm water. However, I don't have experience in either or the combination of both in fighting off a Thrush infection. The key to treatment is restoring the tissue to its normal pH balance and enabling the body to fight off the overgrowth.

Therefore, I would advise caution and suggest that you contact your piercer and doctor. Especially if you have a preexisting medical condition, the infection spreads, or you don't see results within a few days. The use of an Antifungal may be necessary to combat the outgrowth and restore the correct balance.