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 dawned on me that a long time ago, I had planned on adding information about Thrush and 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 a number of years since I encounter a case of Thrush caused by the aftercare of a new piercing and even then it had more to do with the uses of harsh alcohol-based mouthwash and incorrect or overuse 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 and the attitude that if a little helps, a lot more will be even better. If you would look at my aftercare sheets from 1994, you would notice a number of suggested products that I would cringe at today if they were 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. At first, the standard suggestion was to dilute the mouthwash with distilled water and then as Biotene and other Antimicrobial or antibacterial alcohol-free Mouth Rinses became more readily available, Listerine left the industry completely. I remember having clients doing the Listerine challenge, their eyes tearing up and their face turning red as they swashed the burning liquid around their mouth for 30 seconds. However today we have much more pleasant and better options and I have to forewarn you that if a "piercer" reaches for a Listerine bottle or suggests using it, you need to be somewhere else.

I think the first case of Thrush I encounter 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 had only received a short explanation during my apprenticeship of Thrush and it was the first time I'd seen a case in person but I knew what it was. One of the biggest 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 great 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, use of an Antimicrobial or antibacterial mouth rinse is needed to reduce the likelihood of infection. The act of rinsing can, in fact, increase the risks 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 mouth created by the Candida Fungi. The 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 over uses of harsh anti-bacterial products, it allows the fungi to overgrow. The fungi will grow into creamy white or yellowish lesions or bumps on the tongue and cheeks, however, the lesions can also form on the gums, roof of the mouth, 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 fungi to spread into the esophagus causing pain and difficulty when swallowing making one feel like the food is lodged in the throat or mid-chest. Like any infection, it can spread to other parts of the body and can cause a fever. Since 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 break down of the natural bacterial balance on mucous membranes in the mouth, thus allowing the Candida fungi to overgrow. With piercings, uses of harsh mouthwashes and over rinsing will create decrease the amount of bacteria in the mouth and cause it to become unbalanced. However, in combination with other factors, the risks are higher. For example medical conditions, foods with high sugar and yeast content, smoking and 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 that 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, 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 like Biotene.
• Do not over rinse. You should only rinse between 4 to 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 more than 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 do this and also talk to your piercer about any other risks your medical condition may cause. With oral piercings, it is a good idea to bring Thrush up with your doctor or dentist and explain the use of mouthwash because it might be something they may not consider.
• Do not share jewelry with someone else or insert jewelry into the piercing if it has not been sterilized. This could introduce harmful pathogens into the piercing area and increase the likelihood of a creating an imbalance.
• If you smoke consider stopping during the healing or using the piercing as an incentive for quitting.
• Practice good dentinal hygiene and avoid putting unclean objects in your mouth.
• If you are sick or there is any strain on your immune system, delay getting the piercing until you are healthy
• Eating healthy, getting plenty of rest and reducing stress will all help your body fight off infection and speed up the healing.
• 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 lesions bumps and reveals raw red tissue and slight bleeding, it is highly likely that you have an outbreak of Thrush and it needs to be addressed. There are a number of home remedies on the internet including eating yogurt(see above) and softly brushing the affected area with a soft brush dipped in 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 returning the tissue to its normal PH balance and give the body the ability to fight off the overgrowth.

So, I would be more prone to side with caution and suggest 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 maybe needed to fight off the infection and return to the correct balance.