Black Hairy Tongue

Black hairy tongue refers to a benign, temporary and painless oral disorder characterized by the appearance of a furry and darkened tongue. This unique appearance of a black hairy tongue is mostly caused due to excessive growth of bacteria in the oral cavity.

A black hairy tongue is frightful to look at and may become a cause for worry. However, it does not result in medical complications. The condition generally disappears on its own, without any medical treatment.

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A black hairy tongue does not mean that hair actually grows on the tongue. The upper section of a healthy tongue is normally velvety and soft to look at. The velvety appearance is because of the presence of tiny papillae on the dorsal surface. These papillae are referred to as filiform papillae. These papillae have a tendency to fall off at regular intervals. Later they grow again and then shed, forming a cyclic pattern. However, occasionally the papillae grow but the older cells do not fall off when the time comes. As a result, the papillae look like long threads on the tongue’s surface. When these strands become affected by bacterial activities or contamination, then they take on a blackish color. Hence the condition is known as black hairy tongue.

Symptoms of black hairy tongue

Some of the signs and symptoms of black hairy tongue are as follows:

  • The tongue may elicit a furry or hairy look
  • A few affected individuals may experience ticking sensations at the back portion on the roof of the mouth
  • Yellowish, blackish or brownish discoloration of the tongue
  • Serious instances of black hairy tongue may cause a gagging feeling in certain individuals
  • Nausea
  • A metallic or changed taste in the mouth
  • Most cases do not result in discomfort. However, when the papillae get affected by excess growth of Candida yeast, then it can lead to a burning sensation on the tongue. This burning feeling is known as  glossopyrosis
  • Halitosis or bad breath may occur when food gets stuck within the abnormally long papillae

It may be noted that even though black hairy tongue has an ugly appearance, it is often a harmless and temporary condition. One may consult a doctor if the signs and symptoms last for more than ten days, or if one is worried due to cosmetic reasons.

Causes of black hairy tongue

  • Black hairy tongue is caused due to the excessive growth of bacteria or yeast inside the mouth. The bacteria accumulate on the small circular protrusions called papillae, which can be found growing on the surface of the tongue. Instead of undergoing, the normal shedding process, the papillae continue to grow and elongate, forming thin hair-like protrusions. They have the capability to grow nearly fifteen times as compared to their normal length.
  • The normal color of the papillae is pinkish white. However, during the abnormal growth process, pigments from the drinks and food, and occasionally the yeast or the bacteria get trapped in the papillae, thereby discoloring the tongue. In a majority of the cases, the tongue is dyed black, while in a few cases, it can turn yellowish, brownish, greenish or an assortment of different colors.

Some underlying conditions and lifestyle habits can increase the risk to developing black hairy tongue. They are as follows:

  • Poor oral hygiene
  • Drinking excess amounts of tea or coffee
  • Smoking or using tobacco products
  • Antibiotics use which can disturb the balance of bacteria normally inhabiting the mouth
  • Intake of medications which contain the bismuth chemical. For example, Pepto-Bismol for stomach upset
  • Incidence rate of black hairy tongue is higher in men as compared to women
  • Dehydration
  • Decreased production of saliva
  • Radiation therapy of the neck or the head
  • Regularly use of mouthwash containing witch hazel, peroxide or menthol
  • Black hairy tongue is more commonly found to occur in HIV positive individuals and users of intravenous drugs

Black hairy tongue treatment

Black hairy tongue is a harmless condition that resolves on its own and hence does not typically require treatment. The condition can generally be resolved by following good oral hygiene and eradicating the risk factors that can potentially aggravate the disorder.

One may follow the steps given below to resolve a case of black hairy tongue:

  • The bacteria, dead cells and food fragments can be removed by gently brushing the tongue as well when brushing the teeth. One may either use a flexible tongue scraper or a toothbrush with soft bristles
  • The plaque and food particles stuck between the teeth can be removed by flossing at least once a day
  • Use fluoride toothpaste to brush the teeth at least two times a day. It may be particularly helpful if patients brush after drinking or every meal, or rinse the mouth with water post meals
  • Regular checkups at a dentist’s office can help in early detection of oral problems and thus aid in prevention of black hairy tongue
  • Persistent cases of black hairy tongue may be treated with antifungal drugs or antibiotics, so as to eliminate the excess yeast or bacteria
  • Laser or electro-surgery to clip off the abnormal papillae is recommended by doctors in severe instances of black hairy tongue.

Black hairy tongue pictures

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