What is black hairy tongue?
Black hairy tongue is a temporary, harmless and fairly common condition in which the top of the tongue looks hairy. However, the substance on the tongue is not really hair and it’s not always black – it can be brown, green, white or other colors.
Little bumps on the top of the tongue, called filiform papillae, grow and collect food and bacteria, 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. The shedding process is called desquamation. If the papillae don’t fall off, they can grow as long as 18 millimeters (3/4 inch).
Black hairy tongue affects about 13 percent 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 older people.
Symptoms and Causes
What are the symptoms of black hairy tongue?
Usually, the tongue’s appearance is the only symptom, and it doesn’t hurt. Symptoms that appear in some cases include a burning, tickling or gagging sensation, bad breath and food not tasting the way it normally does.
What causes black hairy tongue?
Poor oral hygiene and/or a diet of soft foods can cause the problem, because the shedding process is helped by stimulation and abrasion to the top of the tongue. It can also be caused by excessive use of coffee, tea, tobacco or alcohol, certain medications, radiation treatment, dryness in the mouth and some kinds of mouthwash.
Diagnosis and Tests
How is black hairy tongue diagnosed?
In most cases, a doctor can make this diagnosis by looking at the tongue, and no tests are necessary. A doctor might order a biopsy – an examination of tissue removed from the tongue – if there’s any doubt about the diagnosis or concern that black hairy tongue is not the only problem.
When should I call a doctor about black hairy tongue?
You can try to deal with black hairy tongue yourself, for example, by brushing and scraping the tongue or drinking less coffee. If the condition persists, make an appointment with a doctor or a dentist. If you worry that one of your medications is causing your black hairy tongue, talk to your doctor before you stop taking something that has 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.
Management and Treatment
How can I manage and prevent 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. Other oral hygiene procedures, like brushing and flossing your teeth and regularly visiting a dentist, will also help.
Other ways of controlling black hairy tongue also are a matter of attacking the problem at its source:
- 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 doctor suspects that a medication is causing black hairy tongue, talk to your doctor about changing the medication.
If none of that works, how is black hairy tongue treated?
Black hairy tongue that persists after an improvement in oral hygiene and other attempts at managing it can be treated with antifungal medications, mouthwash or retinoids, which are drugs related to vitamin A.
Surgical treatment using a laser or electrical current is an option when nothing else has solved the problem.
Outlook / Prognosis
What is the long-term outlook for someone who has a black hairy tongue?
Preventing a recurrence of black hairy tongue might require a lifestyle change – possibly something as minor as making brushing or scraping the tongue part of your oral hygiene routine.