All tongue piercings swell — it's very normal. Other tongue procedures such as tongue splitting will result in similar tongue swelling. For most people this means that the tongue will swell to about 50% larger than its normal size (which is why fresh tongue piercings are usually done with a 3/4" bar, and when healed require a 1/2" bar) for two to seven days and then gradually returning to normal over three to five weeks. In addition, the lymph nodes in the area may become enlarged and tender during this healing period.
The piercing above was incorrectly pierced using an initial 1/2" bar, which was too short. The tongue swelled past the piercing, which then had to be removed by that piercer's competition (thanks to Kivaka for the photo).
This swelling is nothing to worry about in general, but it will negatively affect your speech, taste, and ability to eat during the initial healing period. You can help it by doing sea salt / saline rinses. In addition, if you do everything that involves your tongue (eating and talking) slowly and carefully, your "retraining" and healing will be quicker. If the full swelling continues past a week, you should definitely visit your piercer for a followup.
In very very very rare cases the tongue can swell enough to actually block the airway — this is known as "Ludwig's Angina" and occurs when the connective tissue, both in the tongue and in the surrounding area, becomes inflamed. If this occurs, seek immediate medical attention — if you don't you could DIE. One reader writes to describe their experiences with this,
- I got my tongue pierced and a day later I woke up haveing difficulty breathing and I drove to the hospital — luckily it's right down the road. They had to take the bar out, put tubes down my throat for the air to get in my lungs, and they put me on meds to make the swelling go down quicker... I was in the hospital for two days before they could take the tubes out of my throat. And stupid me then went a few weeks later and got my tongue re-pierced and this time it didn't happen... I was scared though LOL... but it's a really bad situation and my parents were ticked that it happened too.
It should also be noted that some drugs such as MDMA, amphetamines, and even magic mushrooms (albeit for peripheral reasons such as; chewing your tongue or inability to stop talking) can dramatically increase swelling.