Black Hairy Tongue

1 What is Black Hairy Tongue?

Black hairy tongue is a term that refers to a common, temporary but harmless oral condition that occurs in about 13% of the population.

Your tongue acquires an abnormal dark coating on the top surface, which results in a furry appearance.

This distinctive look of black hairy tongue is because of the deposition of dead skin cells on the tiny filiform papillae present on the tongue's surface.

These papillae, which are nearly 1mm in length normally, can become very long in severe cases, resulting in a hairy tongue.

In this hair-like mesh, food and other substances such as bacteria and yeast can get trapped and impart various colors to the tongue's surface.

It can occur at any age, but it is more common among older people.

Though black hairy tongue may look alarming, it resolves on its own without any treatment.

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2 Symptoms

The signs and symptoms of black hairy tongue include:

  • Black discoloration on the surface of your tongue, although the color may be brown, green, yellow, pink or white depending upon the specific cause and other factors, such as mouthwashes or even a candy.
  • A furry appearance of the tongue
  • Altered sense of taste or a metallic taste in mouth
  • Bad breath (halitosis)
  • Gagging or tickling sensation, if there is excessive growth of the papillae

Black hairy tongue is a temporary and harmless condition, even though its appears scary.

Consult your doctor if:

  • You are worried about the appearance of your tongue
  • Black hairy tongue persists even after maintaining good oral hygiene

3 Causes

The exact cause of black hairy tongue is not known.

Black hairy tongue usually results when the projections on the tongue called papillae become long and do not shed. This results in a hairy appearance of the tongue.

Food debris, bacteria, and yeast may accumulate on the papillae causing discoloration.

However, there are few potential causes that include:

  • Changes in the normal bacterial flora or yeast content of your mouth following a course of antibiotic treatment
  • Poor maintenance of oral hygiene
  • Dry mouth (xerostomia)
  • Use of medications containing bismuth, such as Pepto-Bismol
  • Regular use of mouth wash containing oxidizing agents, such as peroxide, or astringent agents, such as witch hazel or menthol
  • Tobacco use
  • Irritation from drinking hot beverages, such as coffee or tea
  • People having no teeth may have a soft diet that does not help the shedding of dead skin cells from the tongue

4 Making a Diagnosis

The diagnosis of black hairy tongue can be made by ruling out the presence of other conditions that may cause a similar discoloration to the tongue, such as:

  • Normal variations in the tongue color or pigment
  • Bad oral hygiene
  • Certain foods or medications that have caused stains on the tongue's surface
  • Fungal or viral infections
  • Inflammation of the lining of the mouth

Here is some important information that helps you in getting ready for your appointment, and to know what to expect from your doctor or dentist.

You can prepare a list of questions to ask your doctor or dentist, including:

  • What is likely the cause for the black discolored hairy appearance of my tongue?
  • What is the best treatment available?
  • Should I follow any restrictions?
  • Does the condition clear up on its own?
  • What kind of follow-up should I expect?

Your doctor or dentist may ask you questions related to your symptoms and oral hygiene practices, including:

  • When did you first notice the symptoms?
  • Does the condition bother you?
  • Do your symptoms occur occasionally or continually?  
  • How many times do you brush your teeth or clean your dentures?
  • How often do you use floss?
  • Which type of mouthwash do you use?
  • Do you drink lots of coffee or tea?
  • Do you use tobacco products?
  • What medications, herbal products or other supplements do you take?
  • Do you have the habit of breathing through your mouth?
  • Have you suffered any recent infections or illnesses?
  • Have you had any recent oral infections?

5 Treatment

Black hairy tongue causes no harm and thus does not require medical treatment.

Although it appears unattractive, it is a temporary and harmless condition.

Maintaining good oral hygiene and getting rid of factors that are known to cause this condition — such as use of tobacco or medications containing bismuth — help manage the black hairy tongue successfully.

Discuss with your doctor or dentist before discontinuing any prescribed medication.

6 Prevention

Most of the times, black hairy tongue may be prevented by practicing good oral hygiene measures.

While brushing your teeth, remember to clean the top surface of your tongue with a tooth brush.

Most people may experience gagging while doing this, which can be lessened by using a small brush and gradually moving towards the back of the tongue.

Various types of tongue cleaning devices or tongue scrapers are available.

7 Lifestyle and Coping

Lifestyle modifications are necessary in order to cope with black hairy tongue.

Follow these oral health tips to maintain good oral hygiene and to remove the tongue discoloration:

  • Brush your tongue: Gently brush your tongue whenever you brush your teeth to remove food debris, dead cells, and bacteria. Use a soft-bristled toothbrush or a flexible tongue scraper to do this.
  • Brush after eating or drinking: Brush your teeth at least twice in a day and ideally after every meal, using a fluoridated toothpaste. If brushing after every meal is not feasible, try to rinse your mouth with water.
  • Floss at least once a day: Proper interdental flossing can remove food particles and plaque stuck between your teeth.
  • Visit your dentist regularly: Get professional teeth cleanings and oral examinations done once every 6 months, which can help your dentist detect problems at an early stage and treat them. Your dentist can recommend the best schedule appropriate for your condition.