Black hairy tongue


Black hairy tongue is also known as lingua villosa nigra.

Studies of dental and oral medicine patients report a prevalence of 1.2 to 11.3%.

Black hairy tongue is three times more common in males and females.

Its prevalence increases with advancing age, especially after age 60 years.

It is characterized by discoloration of the dorsal surface of the tongue and hypertrophied filiform papillae that are longer than 3 mm and wider than 2 mm, and that appear like hair growth on the tongue.

Painless disorder manifested by defective desquamation and hypertrophy of the filiform papillae of the tongue and revealed as an abnormal brown-black coating on the surface of the tongue.

Hypertrophied filiform papillae on the dorsum of the tongue, believed to be the result of an antibiotic-induced imbalance of native bacteria.

Although the tongue may appear black, it can also appear brown, or less, commonly yellow, green, blue.

Most patients with black hairy tongue were asymptomatic.

Associated with the use of antibiotic, psychotropic medications, dehydration, impaired salivation, trigeminal neuralgia, smoking, poor oral hygiene, alcohol and infections.

May be associated with Candida albicans and other chromogenic organisms and the use of bismuth and doxycycline.

Medications associated with black hairy tongue include: anti-biotics, antipsychotic drugs that causes xerostomia and some chemotherapeutic agents.

Patients who are edentulous, who have HIV, advanced cancer, graft versus host disease, trigeminal neuralgia, ALS, or chronic xerostomia, or receive recent radiation to the head or neck, are aaaan increased risk of black hairy tongue.

Proliferation of filiform papillae of the tongue that stain black from porphyrin producing bacteria or fungus.

The process may be caused by defective desquamation of the dorsal tongue, leading to accumulation of keratinized layers that elongate the filiform papillae.

These papillae accumulate bacteria, fungi, and residual food, coffee, tea, and tobacco.

Tongue discoloration may also be caused by porphyrin producing chromogenic, bacteria, or yeast.

Symptoms include nausea, bad breath and dysgeusia.

Diagnosis is usually made by visual inspection, but dermoscopy is sometimes used to evaluate the filiform papillae.

Kaopectate contains bismuth subsalicylate, as does Pepto-Bismol, and bismuth can stain the tongue black and is associated with black stools.

Black tongue may be associated with papillae hypertrophy.

Black tongue without papillae hypertrophy can be associated with tobacco abuse, crack cocaine smoking, lansoprazole, oral bismuth subsalicylate, methyldopa, minocycline, and hydroxychlorquine.

It is a benign process and treatment consists of providing reassurance to the patient, removing possible causes of factors, gentle debridement, with a toothbrush, or a scraper, and improved oral hygiene.

Treatment includes increased hydration, discontinuing smoking, brushing of the tongue with a tooth brush, surgical excision or application of 40% urea, topical retinoids or salicylic acid..

Treatment includes toothbrush scrubbing with or without toothpaste, baking soda or hydrogen peroxide, or applications of Retin-A gel (tretinoin) or 40% aqueous solutions of urea or papain.

Any known causative or associated factors should be eliminated.

It resolves  within days, two weeks with mechanical debridement and removal of precipitating factors.

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