Black Hairy Tongue

What is Black Hairy Tongue?

Black hairy tongue is a condition wherein the papillae on the tongue surface lengthen. The papillae may grow longer up to 15 mm in length and rub away with food, causing it to become disfigured and look furry. Black hairy tongue disease is also called lingua villosa nigra. The black color is associated with staining of the papillae with food, tobacco or tar. Black hairy tongue syndrome is usually yellowish-black in color. In the appearance of hairy papillae, it is due to the defective desquamation of the projections.

The appearance of black hairy tongue syndrome is usually mild and harmless. However, people become alarmed because of a peculiar color and appearance of the tongue. This condition is associated with the development of thrush or fungus in the oral cavity; however, some conditions are also not linked to fungal and bacterial infection.

Collectively, hairy tongue may be white, yellow, brown, or black in color depending on the cause that resulted in discoloration. Black hairy tongue is more common in men than in women because of more chronic vices such as smoking and the like. It may affect all age groups, but it is more predominant in adults because of more chronic exposure to causative factors.

 

Hair-like projections on the surface or dorsal part of the tongue

Image 1 Source: webmd.com

Black Hairy Tongue Symptoms

Symptoms of Black Hairy Tongue often include:

• Hair-like projections on the surface or dorsal part of the tongue
• Black discoloration on the tongue, but sometimes may be white, yellow or brown depending on the food that causes discoloration.
• Slight alterations on the taste as a result of food debris that piles up and presence of long papillae
• Halitosis because of accumulation of food particles on the elongated papillae
• Burning sensation on the tongue or glossopyrosis
• Tickling sensation on the oral cavity especially on the soft palate
• Gagging sensation

Black Hairy Tongue Causes

The appearance of hairy tongue is not a disease, nor frequently caused by a disease. It is usually caused by external factors, which include:

• Poor oral hygiene – Failure to brush the teeth and the tongue leads to accumulation of food debris and microorganism that thrive in the mouth. Fungal infection may occur and may leave swollen papillae that cause food particles to get in the tongue.
• Frequent use of mouthwashes – Mouthwashes that contain hydrogen peroxide, menthol and witch hazel decrease the normal flora in the mouth, which results in opportunistic infections and reduction in the integrity of the tongue.
• Antibiotic Treatment – The use of penicillin such as amoxicillin and other broad spectrum antibiotics causes the affectation of the oral cavity, which also destroys the normal bacterial flora in the mouth. As a result, opportunistic infections such as thrush or oral candidiasis may occur.
• Pepto-Bismol – Taking chewable tablets of Pepto-Bismol may result in black hairy tongue after 24 hours.
• Head and Neck Radiation – Exposure of the tongue to radiation causes the changes in the papillae resulting in hypertrophy and abnormal desquamation.
• Mouth breathing – Frequent mouth breathing as a result of impaired respirations may also lead to black hairy tongue because of lack of moisture in the oral cavity. The tongue and lips often become dry and cause damages on the lining.
• Tobacco use – The presence of tar in tobacco or cigarettes causes chronic irritation of the papillae, causing it to undergo hypertrophy. In addition, the tar can also discolor the tongue to a yellowish-black hue.
• Chronic Coffee and Tea drinking – Coffee and tea may discolor the tongue over time. This is seen in elderly clients who have regularly consumed coffee or tea over their lifetime.
• Soft Diet – The intake of soft diet lacks roughage and other food textures. These are essential in naturally debriding the tongue during chewing. In this regard, food debris and microorganisms may pile up on the surface of the tongue causing a thick surface with discoloration.
• Drug abuse – Using prohibited drugs also affect the integrity of the tongue leading to hypertrophy and discoloration.
• HIV infection – HIV may also lead to black hairy tongue because of increased risk for opportunistic infections such as candidiasis.

Black Hairy Tongue Diagnosis

Diagnostic tests employed for the condition include those that check for the presence of fungal infection. Diagnostic tests for black hairy tongue include:

• Culture – Culture is done on the samples on the surface of the tongue to determine presence of fungal infection such as candidiasis or presence of other infections in the mouth.
• Smears – Smears of the cells on the tongue may indicate presence of Candida albicans, the causative microorganism for candidiasis.
• Histologic examinations –Histologic tests may indicate the presence of elongated filiform papillae. Occasional inflammatory cells and mild hyperkeratosis may also be observed.

In patients with HIV, black hairy tongue should be differentiated from the presence of a more serious condition called hairy leukoplakia. Leukoplakia is a complication of HIV as a result of Epstein-Barr virus. Mucosal punch biopsy may be significant in determining hairy leukoplakia in HIV patients.

Black Hairy Tongue Treatment

Treatment for black hairy tongue syndrome is focused on the eradication of the causative factor and enhancing the appearance of the tongue. This condition is mild and may resolve on its own. Management can be instituted to hasten the resolution of the condition. Treatments include:

Brushing

Brushing the tongue twice a day or using tongue scraper helps in removing debris on the tongue and thereby reducing the discoloration. This measure also prevents the growth of fungus and bacteria that may cause infection. Mild cases of hairy tongue may be resolved using this management.

Diet modification

Patients who constantly consume soft diet may add additional roughage on the diet to mechanically debride the food particles that accumulated on the elongated papillae.

Antifungal medications

For patients with fungal infections along with the hairy tongue, antifungal medications are usually given. It may be given through mouth or by the use of topical anti-fungal agents.

Surgery

Removal of the hairy projections may be done using laser, electrodessication or surgical knife and scissors. This treatment is employed when other measures deemed ineffective.

Black Hairy Tongue Side-effects or Complications

Black hairy tongue may result in mild complications such as permanent altering of taste sensations or the presence of metallic taste. Black hairy tongue also reduces the aesthetic appearance of the tongue.

Black Hairy Tongue Pictures

Image 2 – Yellow or brown discoloration

Image Source: aocd-grandrounds.org