Black hairy tongue

Not to be confused with Hairy leukoplakia.

Benign condition characterized by an overgrowth of tongue papillae

Black tongue

Black hairy tongue

Black Hairy Tongue (BHT) is a benign, temporary condition characterized by the overgrowth and discoloration of the papillae on the dorsal surface of the tongue. This condition results from the accumulation of keratinized filiform papillae, giving the tongue a black, brown, or dark green appearance. The condition is harmless but can cause bad breath, an unpleasant taste, and discomfort.

Epidemiology

Black Hairy Tongue is relatively rare but can affect individuals of all ages, particularly older adults. It is more common among:

• Men than women.
• Individuals with poor oral hygiene.
• Those who use tobacco products.
• People taking long-term antibiotics.
• Patients receiving radiation therapy to the head and neck.

Causes and Risk Factors

Black Hairy Tongue occurs when the normal shedding process of the tongue's filiform papillae is disrupted, leading to elongation and staining. Several factors contribute to this condition, including:

Poor Oral Hygiene

• Lack of regular brushing and flossing can allow bacteria, food debris, and dead cells to accumulate on the tongue.

Tobacco and Alcohol Use

• Smoking and chewing tobacco contribute to discoloration and bacterial growth.
• Excessive alcohol consumption can irritate the tongue and promote the condition.

Diet and Dehydration

• Diets low in fiber can reduce tongue friction, preventing normal exfoliation of papillae.
• Dehydration and dry mouth reduce saliva flow, allowing bacteria to thrive.

Medications

• Long-term use of antibiotics, especially tetracyclines, disrupts the oral microbiome, promoting BHT.
• Antipsychotics and antidepressants that reduce salivary production can contribute to the condition.

Other Contributing Factors

• Mouth breathing
• Radiation therapy (especially to the head and neck)
• Excessive coffee or tea consumption
• Fungal infections (e.g., Candida overgrowth)

Signs and Symptoms

The hallmark symptom of Black Hairy Tongue is the dark, overgrown filiform papillae on the tongue’s surface. Other symptoms may include:

• Discoloration – Typically black, brown, green, or yellow.
• Hairy or fuzzy texture – Due to elongated papillae.
• Bad breath (halitosis) – Caused by bacterial accumulation.
• Metallic or altered taste – Can be bitter or unpleasant.
• Gagging or tickling sensation – Due to papillae overgrowth.
• Burning sensation – Less common but may occur.

Diagnosis

Diagnosis of Black Hairy Tongue is clinical and based on visual examination of the tongue. Additional tests may be conducted if an underlying infection or systemic condition is suspected:

• Oral examination – Identifies characteristic elongated, discolored papillae.
• Tongue scraping test – To assess bacterial or fungal overgrowth.
• Salivary analysis – To evaluate salivary flow and pH.
• Culture test – If a fungal infection is suspected.

Differential Diagnosis

Other conditions that may resemble Black Hairy Tongue include:

• Oral Candidiasis – White patches caused by fungal infection.
• Hairy leukoplakia – White, corrugated patches caused by Epstein-Barr virus.
• Pigmented tongue – Can result from medications, heavy metal exposure, or systemic diseases.
• Geographic tongue – Irregular red patches with white borders.
• Lingual melanotic macule – Benign pigmentation of the tongue.

Treatment

Black Hairy Tongue is a self-limiting condition and often resolves with improved oral hygiene. Treatment focuses on:

Oral Hygiene Improvements

• Brushing the tongue twice daily with a soft toothbrush.
• Using a tongue scraper to remove debris and bacteria.
• Rinsing with an antiseptic mouthwash (e.g., chlorhexidine or hydrogen peroxide).
• Flossing and brushing teeth regularly to prevent bacterial buildup.

Lifestyle Modifications

• Stopping tobacco use to reduce staining and bacterial growth.
• Reducing coffee and tea intake to prevent further discoloration.
• Increasing fiber intake to promote natural exfoliation of the tongue.
• Drinking more water to maintain adequate hydration.

Medical and Pharmacological Treatments

In severe or persistent cases, additional treatments may include:

• Topical antifungal agents – If a fungal infection is suspected.
• Retinoids – To promote exfoliation in persistent cases.
• Salivary stimulants – To treat dry mouth-related BHT.

Prognosis

Black Hairy Tongue is a benign condition with an excellent prognosis. Most cases resolve with simple oral hygiene measures. Recurrence is possible if underlying causes are not addressed.

Prevention

To reduce the risk of developing Black Hairy Tongue:

• Practice good oral hygiene by brushing and scraping the tongue daily.
• Avoid smoking and tobacco products.
• Stay hydrated to maintain adequate salivary flow.
• Eat a fiber-rich diet to promote tongue exfoliation.
• Use alcohol-free mouthwash to avoid drying out the mouth.
• Regular dental visits to monitor oral health.

See Also

• Oral hygiene
• Tongue diseases
• Halitosis
• Oral candidiasis
• Leukoplakia

External links

Classification	ICD-10: K14.3 DiseasesDB: 31923
External resources	eMedicine: derm/639

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