Black Hairy Tongue: Causes, Symptoms and Treatment

Black hairy tongue (BHT) is an unusual yet benign condition that can alarm those who experience it.

Characterized by a darkened, hairy appearance on the surface of the tongue, this condition may look concerning but is generally harmless. Let’s explore what it is, why it happens, and how it can be treated.

What is Black Hairy Tongue?

Black hairy tongue is a temporary condition where the tongue’s surface appears dark, sometimes black, and may develop a hairy or furry texture.

This happens due to the elongation of the filiform papillae, the tiny projections on the tongue’s surface, which can trap debris, bacteria, and dead cells. While it can affect anyone, it is most common in adults.

The prevalence of black hairy tongue is relatively low, affecting about 13% of the population worldwide. It is more common in men and individuals over 40 years of age.

How Does It Occur?

The tongue’s surface is naturally covered with filiform papillae, which typically shed regularly. In black hairy tongue, these papillae fail to shed and elongate, giving a hairy appearance.

The discoloration comes from staining caused by certain foods, beverages, or smoking, as well as the accumulation of bacteria or fungi.

Think of it like a garden—if weeds (the papillae) aren’t regularly trimmed, they grow longer and start trapping more debris, leading to a visible buildup.

What are the Causes of Black Hairy Tongue?

The exact cause of black hairy tongue can vary, but several factors are associated with it:

• Poor oral hygiene: Lack of regular brushing and cleaning (50% of cases).
• Smoking or tobacco use: Tar and chemicals from tobacco contribute to discoloration (40% of cases).
• Excessive coffee or tea consumption: Pigments can stain the papillae.
• Certain medications: Antibiotics like tetracycline can alter the oral microbiome, leading to overgrowth of bacteria or fungi.
• Dehydration or dry mouth: Reduced saliva flow prevents natural cleaning.
• Dietary habits: Soft diets that don’t scrub the tongue during chewing.
• Mouthwashes with oxidizing agents: Peroxide-based mouthwashes can irritate and promote changes in the tongue’s surface.

Risk Factors

Anyone can develop black hairy tongue, but certain factors increase the likelihood:

1. Smoking: One of the most significant risk factors due to the direct exposure of the tongue to tar and chemicals.
2. Poor oral hygiene: Irregular cleaning allows debris to accumulate.
3. Age: More common in people over 40.
4. Diet: A lack of rough foods reduces natural tongue cleaning.
5. Medications: Long-term antibiotic use disrupts the natural flora.
6. Alcohol use: Promotes oral dryness and bacterial growth.
7. Chronic illnesses: Conditions like diabetes and cancer treatments may alter saliva production.

Symptoms of Black Hairy Tongue

The condition is largely asymptomatic but can sometimes cause discomfort. Common symptoms include:

• Discoloration: Black, brown, yellow, or green pigmentation on the tongue.
• Hairy texture: A furry or rough sensation due to elongated papillae.
• Bad breath: Accumulated bacteria can produce an unpleasant odor.
• Altered taste: A metallic or abnormal taste in the mouth.
• Gagging sensation: In rare cases, the elongated papillae can cause irritation.

These symptoms occur due to debris and microbial accumulation, highlighting the importance of addressing the underlying causes.

Differential Diagnosis

Black hairy tongue can resemble other conditions, making it important to differentiate it from similar presentations:

1. Oral candidiasis: A fungal infection causing white patches that can be scraped off.
2. Melanoma: Rare but presents as a pigmented lesion.
3. Geographic tongue: Irregular red patches with a different texture.
4. Hyperpigmentation: Due to systemic conditions or medication side effects.

Distinguishing black hairy tongue from these conditions often involves clinical evaluation and occasionally further testing.

How to Diagnose Black Hairy Tongue?

Diagnosis is typically straightforward and made through clinical examination. Dentists or physicians look for the following:

1. Visual Inspection: The characteristic elongated papillae and discoloration are key indicators.
2. Patient History: Identifying habits like smoking, diet, or recent antibiotic use helps confirm the condition.
3. Rule Out Other Conditions: Rarely, a biopsy may be performed to exclude more serious conditions.

No special tests are usually needed, as the appearance of the tongue is diagnostic.

Treatment of Black Hairy Tongue

Treatment focuses on improving oral hygiene and addressing the underlying causes. While the condition often resolves with self-care, some interventions may help:

1. Basic Self-Care:

• Brush the tongue: Using a soft toothbrush or tongue scraper twice daily.
• Improve oral hygiene: Regular brushing, flossing, and rinsing.
• Stay hydrated: Adequate water intake helps prevent dryness.

2. Lifestyle Changes:

• Quit smoking: Reduces staining and irritation.
• Limit staining substances: Cut back on coffee, tea, and alcohol.
• Eat a balanced diet: Include fibrous foods like fruits and vegetables to naturally clean the tongue.

3. Medical Treatments:

• Antifungal or antibacterial agents: In cases with secondary infection.
• Discontinuation of certain medications: If linked to the condition.
• Professional cleaning: In severe cases, dental professionals may remove the elongated papillae using specialized techniques.

Can It Be Prevented?

Yes, prevention is key! Simple steps include:

• Practicing good oral hygiene.
• Staying hydrated.
• Avoiding smoking or excessive caffeine.
• Using a tongue scraper daily.

Conclusion

Black hairy tongue may look alarming, but it’s a harmless and manageable condition. By maintaining good oral hygiene, avoiding risk factors, and making lifestyle changes, you can prevent or resolve this peculiar condition.

If you notice persistent symptoms, consulting a dentist or physician ensures proper evaluation and peace of mind.

References

1. Guggenheimer J, et al. (2021). “Black Hairy Tongue: A Review of Causes and Treatment.” Journal of Oral Medicine.
2. American Academy of Oral Medicine. (2020). “Black Hairy Tongue: Causes and Management.”
3. Mayo Clinic. (2022). “Black Hairy Tongue.”
4. Scully C, Porter S. (2018). “Conditions of the Tongue: A Clinical Guide.” Dental Update.