Black Hairy Tongue

What is black hairy tongue?

Black hairy tongue is a temporary, harmless and fairly common condition in which the top of your tongue looks hairy. However, the substance on your tongue isn’t really hair and it’s not always black — it can be brown, green, white or other colors.

Little bumps on the top of your tongue — called filiform papillae — grow and collect food, bacteria and dead skin cells, which provide the color. The papillae are usually about 1 millimeter (1/32 inch) long and they’re supposed to fall off, like a layer of skin being shed, before they grow. This shedding process is called desquamation. If the papillae don’t fall off, they can grow as long as 18 millimeters (3/4 inch).

How common is black hairy tongue?

Black hairy tongue affects about 13 % of people at some point in their lives, according to the American Academy of Oral Medicine. It happens in all population groups, but is more common in men and in people over the age of 65.

What are the symptoms of black hairy tongue?

Usually, your tongue’s appearance is the only symptom, and it doesn’t hurt. Additional symptoms that may appear in some cases include:

• A burning, tickling or gagging sensation.
• Bad breath.
• Changes in the way your food tastes.

What causes black hairy tongue?

The two most common causes of black hairy tongue include poor oral hygiene and a diet of soft foods. This is because the shedding process requires stimulation and abrasion to the top of your tongue. Common black hairy tongue causes include:

• Drinking lots of coffee and tea.
• Tobacco use.
• Heavy alcohol use.
• Certain medications.
• Radiation therapy.
• Dry mouth.
• Some types of mouthwash.

What does a black tongue indicate?

Most of the time, a black hairy tongue just means you need to improve your oral hygiene at home. However, in some cases, the condition may be caused by an overgrowth of bacteria or fungi. In these instances, your healthcare provider can prescribe antibiotic or antifungal medications.

How is black hairy tongue diagnosed?

In most cases, your healthcare provider can make a diagnosis by looking at your tongue. Generally, no tests are necessary. Your healthcare provider might order a biopsy — an examination of tissue removed from your tongue — if there’s any doubt about the diagnosis or concern that black hairy tongue isn’t the only problem.

How do you get rid of black hairy tongue?

Black hairy tongue treatment usually involves improving your oral hygiene at home. If that doesn’t help, then your healthcare provider may prescribe medications — or in severe cases, recommend surgery.

Oral hygiene

If you have black hairy tongue, the first thing you should do is take steps to improve your oral hygiene. After brushing and flossing your teeth, be sure to clean your tongue thoroughly with a toothbrush or tongue scraper.

Medications

If black hairy tongue still persists after an improvement in oral hygiene, it can be treated with antibiotics, antifungal medications, mouthwash or retinoids (drugs related to vitamin A).

Surgery

Traditional or laser surgery is an option when nothing else has solved the problem.

How long does it take for black hairy tongue to go away?

In most cases, black hairy tongue symptoms will go away on their own in about one to two weeks. If your symptoms last longer, schedule an appointment with your healthcare provider to discuss treatment options.

How can I reduce my risk for black hairy tongue?

Brushing your tongue with a toothbrush or using a tongue scraper can remove the papillae and the food debris that might be caught in them. You should also brush your teeth twice a day, floss once a day and visit your dentist for routine exams and cleanings.

There are also some things you can do to reduce your risk for black hairy tongue. For example:

• Cut back on coffee, tea, tobacco or alcohol.
• Change your diet.
• Change your mouthwash — use one that doesn’t use peroxide or another oxidizing agent.
• If you or your healthcare provider suspects that a medication is causing black hairy tongue, talk to your healthcare provider about changing the medication.

What is the long-term outlook for someone who had black hairy tongue?

Once you figure out what caused black hairy tongue, you can take steps to treat it and reduce the risk of it happening again. Often, this just involves making minor lifestyle changes, such as cleaning your tongue daily.

When should I see my healthcare provider?

You can try dealing with black hairy tongue yourself, for example, by brushing and scraping your tongue or drinking less coffee. If the condition persists, make an appointment with your healthcare provider. If you worry that one of your medications is causing black hairy tongue, talk to your healthcare provider before you stop taking something that’s been prescribed for you.

It’s also worth noting that black hairy tongue comes in different colors — and if it’s actually a white hairy tongue, it can be caused by something called hairy leukoplakia. This can be a sign of a virus.

A note from Cleveland Clinic

Black hairy tongue looks and sounds terrifying. But the condition is generally harmless and easy to treat. If you’ve tried home remedies and nothing is working, schedule a visit with your healthcare provider. They can determine what’s causing the condition and find ways to keep your tongue healthy.