Black Hairy Tongue – Treatment, Images, Antibiotics, Specialists

Key Facts

• Black hairy tongue is a benign condition characterized by a dark, furry appearance of the tongue.
• It is caused by the overgrowth and elongation of the filiform papillae on the tongue.
• Factors contributing to this condition include poor oral hygiene, smoking, excessive consumption of coffee or tea, and certain medications.
• The condition is reversible and usually resolves with improved oral hygiene practices, it does not cause any permanent damage to the tongue.
• Poor oral hygiene, tobacco use, excessive consumption of dark-colored beverages, and certain medications are common contributing factors.
• It is generally harmless but can cause bad breath and altered taste.

What is Black Hairy Tongue?

Black Hairy Tongue, medically known as lingua villosa, is an oral condition where the tongue appears black and hairy. Despite the name, the tongue does not actually grow hair. The hairy appearance is due to the elongation of the filiform papillae, which are tiny projections on the tongue’s surface. These elongated papillae can trap food particles, bacteria, and other substances, causing them to appear dark and hair-like.
In Black Hairy Tongue, the filiform papillae, which normally have a short length, grow significantly longer. This elongation can cause the tongue to trap bacteria and other debris more easily. Over time, this can result in a buildup that causes the tongue to look discolored and have a furry texture. It’s important to note that while the appearance may be alarming, this condition is usually harmless and reversible.

How Common is Black Hairy Tongue?

Black Hairy Tongue is relatively common and can affect individuals of any age or gender. However, it is more prevalent among individuals who smoke, consume excessive amounts of coffee or tea, have poor oral hygiene practices, or use medications that cause dry mouth. The prevalence of black hairy tongue varies among different populations. It has been observed that the condition is slightly more common in men and tends to increase in prevalence with age. It is estimated to affect around 13% of the general population.

What are the Symptoms of Black Hairy Tongue?

The primary symptom of Black Hairy Tongue is the distinct change in the tongue’s appearance. The tongue typically becomes discolored, taking on a black, brown, or even greenish hue, and appears to have a furry or hairy surface.
In addition to the changes in appearance, individuals with Black Hairy Tongue may experience:

• Altered Taste Sensation: A person may experience changes in taste or a metallic taste in the mouth.
• Halitosis: Bad breath is common due to the buildup of bacteria and debris on the tongue.
• Gagging or Tickling Sensation: The elongated papillae may cause a tickling or gagging sensation in the mouth, particularly if they touch the roof of the mouth or back of the throat.
• Oral Discomfort: Some individuals may feel discomfort or a foreign body sensation in the mouth.

What Causes Black Hairy Tongue?

Black Hairy Tongue is primarily caused by the overgrowth and elongation of filiform papillae on the surface of the tongue.
Various factors can contribute to this overgrowth, including:

• Poor Oral Hygiene: Not cleaning the tongue and teeth properly can lead to the accumulation of bacteria and food particles, which can contribute to the overgrowth of papillae.
• Tobacco Use: Smoking or chewing tobacco can cause irritation and discoloration of the tongue, contributing to the development of Black Hairy Tongue.
• Excessive Consumption of Dark-Colored Beverages: Drinking large amounts of coffee, tea, or other dark-colored beverages can cause staining and contribute to the condition.
• Dry Mouth: A lack of adequate saliva can lead to an environment where the cells on the tongue are not being naturally cleaned, leading to overgrowth of papillae.
• Medications: Certain medications, especially those that cause dry mouth or are used to treat mental health conditions, can contribute to the development of Black Hairy Tongue.
• Excessive Alcohol Use: Alcohol can contribute to a dry mouth and the irritation of the oral mucosa, which can lead to Black Hairy Tongue.
• Use of Mouthwashes Containing Peroxides or Astringents: These substances can promote the elongation of papillae.
• Soft Diet: Not eating enough abrasive foods may contribute to a lack of natural cleaning of the tongue’s surface.
• Overuse of Lozenges or Candies: Consistently having something in the mouth can change the environment and contribute to the condition.
• Mechanical Irritation: Using a breathing tube or other oral devices can sometimes irritate the tongue and contribute to the condition.

How is Black Hairy Tongue Diagnosed?

Black Hairy Tongue is primarily diagnosed through a clinical examination. A dentist or healthcare provider will review the patient’s medical history and perform a visual examination of the oral cavity. The characteristic appearance of elongated filiform papillae and the darkened, hairy-looking surface of the tongue usually make the diagnosis apparent.
The healthcare provider may also ask questions regarding lifestyle, medication use, and oral hygiene practices to determine contributing factors.
In rare cases, if there is uncertainty about the diagnosis or if there is concern about underlying conditions, a healthcare provider might take a biopsy of the tongue tissue for further analysis.

What is the Classification of Black Hairy Tongue?

Black hairy tongue is classified based on the severity and length of the filiform papillae. There isn’t a standard classification system, but it is generally considered:

• Mild when the length of the papillae is less than 3mm
• Moderate if between 3mm and 5mm
• Severe if greater than 5mm

How Do You Get Rid of Black Hairy Tongue?

Getting rid of Black Hairy Tongue involves addressing the underlying causes and improving oral hygiene practices.
Here are the main ways to treat and manage Black Hairy Tongue:

Oral Hygiene

• Regular Cleaning: Brushing your teeth at least twice a day and including the tongue in your routine is essential. Using a tongue scraper can be particularly effective in removing debris and bacteria from the tongue.
• Avoiding Tobacco and Limiting Alcohol Consumption: Smoking or using tobacco products can exacerbate Black Hairy Tongue. Limiting alcohol intake is also beneficial as alcohol can dry out the mouth.
• Drinking Water: Staying hydrated helps to ensure that your mouth doesn’t get too dry. Drinking water throughout the day can help to clean the mouth and tongue naturally.
• Eating a Balanced Diet: Including more fibrous foods in your diet can help to naturally clean your tongue when you chew.

Medications

• Antibiotics: In some cases, especially if there is a secondary infection, antibiotics may be prescribed.
• Medicated Mouthwash: A healthcare provider may recommend using a medicated mouthwash that doesn’t contain peroxides or astringents, as these can worsen the condition.

Surgery

• Papillae Trimming: In very severe cases, a dental professional might recommend a procedure to trim the elongated papillae. This procedure is rarely needed and is considered as a last resort.

How Long Does it Take for Black Hairy Tongue to Go Away?

The duration it takes for Black Hairy Tongue to resolve can vary depending on the severity of the condition and the effectiveness of the treatment approach. With improved oral hygiene and lifestyle modifications, most people see improvement within a few weeks. However, in more severe cases, or if the cause is due to a medication or underlying health condition, it might take longer.

How Can I Reduce My Risk for Black Hairy Tongue?

To reduce your risk for developing Black Hairy Tongue, consider the following practices:

• Maintain Good Oral Hygiene: Regularly brush and floss your teeth, and clean your tongue with a toothbrush or tongue scraper.
• Stay Hydrated: Drink water throughout the day to help keep your mouth moist and reduce the risk of oral bacteria overgrowth.
• Avoid Tobacco Products: Refrain from smoking or using tobacco products which can contribute to the condition.
• Limit Intake of Dark-Colored Beverages: Beverages like coffee and tea can stain the tongue, so it’s a good idea to limit intake.
• Eat a Balanced Diet: Including a range of fibrous foods can help to naturally clean the tongue.
• Be Cautious with Mouthwash: If using mouthwash, choose one that does not contain peroxides or astringents.

By adopting these practices and being mindful of oral hygiene, you can significantly reduce your risk of developing Black Hairy Tongue.

What is the Long-Term Outlook for Someone Who Had Black Hairy Tongue?

The long-term outlook for someone who has had black hairy tongue is generally good, particularly if they adhere to improved oral hygiene practices and address the underlying causes. Since black hairy tongue is often a result of lifestyle choices or poor oral hygiene, making appropriate changes can lead to the resolution of the condition. However, it’s important to maintain these practices to prevent recurrence.
For individuals whose condition might have been triggered by medications or an underlying health issue, management of those specific factors is vital in ensuring a good long-term outlook.

When Should I See My Healthcare Provider?

It’s advisable to see a healthcare provider or dentist in the following scenarios:

• Persistence of Symptoms: If you’ve improved your oral hygiene and the condition doesn’t improve or worsens over a few weeks, it’s important to consult a healthcare provider.
• Pain or Discomfort: If you experience pain, difficulty swallowing, or significant discomfort associated with black hairy tongue.
• Concern About Appearance: If you are concerned about the appearance of your tongue, especially if it’s affecting your self-esteem or mental well-being.
• Possible Underlying Conditions: If you suspect that an underlying health condition or medication is contributing to black hairy tongue.

What are the Complications of Black Hairy Tongue?

Though generally harmless, black hairy tongue can cause bad breath and altered taste. In severe cases, it might cause a gagging sensation or contribute to periodontal disease.

What is the Clinical Presentation of Black Hairy Tongue?

Clinically, patients with black hairy tongue present with elongated filiform papillae that are discolored. The discoloration can range from brown to black. The posterior part of the tongue is commonly affected, while the tip and edges usually remain unaffected.

What is the Anatomy and Pathophysiology of Black Hairy Tongue?

The tongue is covered by small projections called papillae. Filiform papillae are responsible for the texture of the tongue’s surface. In black hairy tongue, these filiform papillae become elongated and don’t shed as they normally do. This causes them to trap food, bacteria, and other substances which lead to discoloration.

What is The ICD-10 Code for Black Hairy Tongue?

ICD 10 code for black hairy tongue is K14.3: Hypertrophy of tongue papillae.
This code applies to the following descriptions of conditions:

• Black hairy tongue
• Coated tongue
• Hypertrophy of foliate papillae
• Lingua villosa nigra

What Does a Black Tongue Indicate?

A black tongue typically indicates the overgrowth and staining of the filiform papillae. It can be a sign of poor oral hygiene, lifestyle habits like smoking, or a side effect of medications.

Bottom Line

Black hairy tongue is a condition that, while unsettling in appearance, is generally harmless and often reversible with proper oral hygiene and lifestyle changes. The long-term outlook is favorable if individuals maintain good oral health practices and address any underlying causes. It’s important to consult a healthcare provider if the condition persists, worsens, or is accompanied by pain or discomfort. If you are concerned about changes in your tongue’s appearance, consult your healthcare provider for personalized advice and management.

This article is complete and was published on June 14, 2023, and last updated on August 25, 2023.