A black hairy tongue can be startling to patients, but it is benign. Dr. Scott Froum explains the etiology of black hairy tongue and offers recommendations for treatment.
Black hairy tongue (appearance of a black tongue)—also known as lingua villosa nigra—is a black appearance on the top (dorsal surface) of the tongue and growth of the papillae on the tongue that make it appear as if hair is growing there. While it is named black hairy tongue, the tongue can also appear brown, yellow, green, or bluish . Black hairy tongue typically does not hurt, but bad breath (halitosis), altered taste (dysgeusia), dry mouth (xerostomia), and/or burning of the tongue can occur.
Causes of black hairy tongue
The exact cause of black hairy tongue is thought to be a growth of cells on the tongue that increase the size of tongue papillae, which then trap bacteria or yeast that produce chromatin and turn the tongue black.4 These extra cells can also accumulate bacteria from food, coffee, tea, and tobacco that can stain them and turn the tongue a darker color.
Studies have shown that black hairy tongue can occur in 1%–11% of the population. It occurs in males at three times the rate of females due to higher smoking rates and poor oral hygiene in males. The rate of this condition also increases in those older than 60.5
Factors that increase the risk of developing black hairy tongue
· Poor oral hygiene
· Smoking or chewing tobacco, alcohol, illicit drugs
· Certain medications: antibiotics (like tetracycline), psychiatric medications (especially ones that cause xerostomia), and chemotherapeutic agents
· Mouthrinses: chlorhexidine gluconate and other oxidizing mouthrinses
· Systemic illness: immunocompromised patients such as those with AIDS, advanced cancer, graft-versus-host disease, amyotrophic lateral sclerosis, chronic xerostomia, or who have received recent radiation therapy to the head or neck · COVID-19
Black hairy tongue should be differentiated from fake black tongue (pseudo–black hairy tongue), which can occur when the tongue becomes stained from coffee/tea, food coloring, or medications that contain bismuth subsalicylate (Pepto-Bismol)
Treatment for black hairy tongue
Aside from looking scary, black hairy tongue is benign. Treatment consists of mechanical debridement with a tongue scraper and a toothbrush, as well as removing the causative factors if possible.
As an adjunct to conventional debridement and to facilitate removal of the black color from the tongue, Dr. Froum advocates the application of StellaLife Vega Oral Care Gel to the tongue prior to tongue scraping (three times a day) and StellaLife Vega Oral Rinse (three times a day). In addition, taking StellaLife Probiotic Oral Lozenge (figure 2) twice a day for 10 days will foster an environment of good bacteria in the mouth to improve both the health and color of the tongue.
Until next time Stay Safe Stay Well
James A Vito, D.M.D.