Tongue

Black Hairy Tongue

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Black Hairy Tongue, Hairy Tongue, Furry Tongue, Black Tongue, Lingua Villosa Nigra

  • See Also
  1. Tongue Disorders
  2. Tongue Mass
  • Epidemiology
  1. Prevalence: 0.5 to 11%
  2. More common in older patients
  3. More common in males (3 fold more common than in females)
  • Pathophysiology
  1. Hyperplasia of Filiform Papillae on anterior two thirds of dorsal Tongue (retention hyperkeratosis)
    1. Papillae may elongate to >1 cm (usually 1 mm)
  2. Response to poor Desquamation, excessive keratinization
  3. Results in trapping of debris and Bacteria
    1. Bacterial colonization may result in black appearance
  • Risk Factors
  1. Tobacco Abuse
  2. Alcohol Use
  3. Inadequate Oral Hygiene
  4. Low fiber diet
  5. Hyposalivation
  6. Mouth breathing
  7. Oxidizing mouth wash use
  8. Overgrowth of oral fungus (Thrush)
    1. Aspergillus niger
    2. Candida albicans
  9. HIV Infection or other Immunosuppression
  10. Epstein Barr Virus has been identified on biopsy
  11. Radiation Therapy
  12. Medications
    1. See Medication Causes of Dry Mouth
    2. Recent Antibiotic therapy (e.g. Linezolid)
  • Symptoms
  1. Painless
  2. May cause gagging Sensation or altered Taste Sensation
  3. Halitosis may occur from food accumulation
  • Signs
  1. "Hair" of elongated papillae on anterior two thirds of Tongue dorsum
    1. Yellowish to brown or black coloration
    2. Velvety, or shaggy, asymptomatic keratoses
    3. Unable to wipe off Plaque
    4. Color altered by foods, Tobacco, coffee, tea
  2. Distribution
    1. Dorsal Tongue surface
  • Management
  1. Improves with Tongue brushing with soft brush
    1. Use a standard ToothBrush or scrape the Tongue
    2. May apply a 1.5% Hydrogen Peroxide
  2. Avoid predisposing factors above (including drug-induced causes of Xerostomia)
  3. Increase Dietary Fiber
  4. Tobacco Cessation
  • References
  1. McGrath (2008) CMAJ 178(9): 1137-8 [PubMed]
  2. Randall (2022) Am Fam Physician 105(4): 369-76 [PubMed]
  3. Straub (2024) Am Fam Physician 110(5): 467-75 [PubMed]