Black Hairy Tongue

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

The “hair” is actually overgrown papillae. These are the little bumps on your tongue that contain your taste buds. The papillae can grow, but they usually fall off — like a layer of skin being shed — before they do. This shedding process is called desquamation. If they don’t fall off, they can grow as long as 18 millimeters (three-quarters of an inch). The hairlike projections can trap food, bacteria and dead skin cells. This is where the color comes from.

Symptoms of black hairy tongue

Usually, a tongue that looks like it’s covered in black or brown hairs is the only symptom. It usually doesn’t hurt. Symptoms that appear in some cases include:

• Bad breath
• Burning, tickling or gagging sensation
• Changes in the way food tastes

Black hairy tongue causes

The two most common causes of a hairy tongue are poor oral hygiene and a diet of soft foods. This is because the papillae need friction to fall off. Imagine hard foods or a toothbrush on your tongue, scraping off the hairlike growths.

Other things linked to a black tongue are:

• A condition called trigeminal neuralgia
• Certain medicines, like antibiotics and antidepressants
• Certain cancer treatments, like chemotherapy and radiation therapy
• Drinking lots of coffee and tea
• Dry mouth
• Having a condition that weakens your immune system, like cancer or HIV
• Heavy alcohol use
• Mouthwashes that contain peroxide
• Tobacco use

Risk factors

Anyone can get a black hairy tongue. But it’s more common in males over the age of 65.

How doctors diagnose this condition

In most cases, your healthcare provider can make a diagnosis by looking at your tongue. You likely won’t need tests.

Your healthcare provider might order a biopsy — an examination of tissue removed from your tongue — if there’s any doubt that black hairy tongue isn’t the only problem. But this is extremely rare.

How is it treated?

Black hairy tongue treatments include:

• Improving your oral hygiene: The first thing you should do to get rid of this condition is improve your oral hygiene. After brushing and flossing, use a tongue scraper or toothbrush to clean your tongue.
• Starting medications: If improvements in oral hygiene don’t help, you may need medicine. If you have an overgrowth of bacteria or fungi on your tongue, you may need antibiotics or antifungals. Other treatments include retinoids.
• Stopping medications: You may need to stop taking medicines that are causing a hairy tongue. But only do so if your healthcare provider tells you that it’s OK.
• Surgery: Traditional or laser surgery is an option when nothing else has solved the problem. But this is a rare last resort.

When should I see my healthcare provider?

You can try dealing with black hairy tongue yourself. Options include brushing and scraping your tongue or drinking less coffee. Talk to a healthcare provider if the condition persists after you change your habits.

If you worry that one of your medications is causing it, talk to your healthcare provider. They’ll let you know whether it’s safe to stop taking the medicine.

What can I expect if I have this condition?

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 involves making minor changes to your day-to-day routine, like cleaning your tongue daily.

Symptoms of a hairy tongue usually 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.

Can this be prevented?

Black hairy tongue is usually preventable. 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. Brush your teeth twice a day, floss once a day, and visit your dentist for routine exams and cleanings.

To reduce your risk of a hairy tongue:

• Cut back on coffee, tea or alcohol
• Change the foods you’re eating if they’re playing a role
• Stop using tobacco, if you do
• Talk to your healthcare provider about changing any medications you suspect may be causing your hairy tongue
• Use a mouthwash that doesn’t use peroxide or another oxidizing agent

Which STD causes hairy tongue?

Sexually transmitted diseases don’t cause hairy tongue. But conditions that leave you with a weakened immune system can increase your risk. HIV and cancer are examples.

Can hydrogen peroxide cause black hairy tongue?

It can. Mouthwashes that contain oxidizing agents like peroxide are linked to this condition. Gargling with hydrogen peroxide can also increase your risk.

What is the difference between black hairy tongue and oral hairy leukoplakia?

It’s worth noting that hair-like projections in black hairy tongue can come in lots of colors. Usually it’s black or brown, but the overgrown papillae may be tan, yellow or green.
If the hair is white, though, it may be hairy leukoplakia. This is a different diagnosis. Unlike black hairy tongue, this can be a sign of a virus.