Black hairy tongue

The exact cause of black hairy tongue is unknown; however, it is thought to be related to ineffective shedding of the outermost portion of the central top area of the tongue. This leads to accumulation of layers of tissue and a protein called keratin. The accumulations take on a hair-like appearance and can reach a length of 12-18 mm. While black hairy tongue can occur at any point, certain lifestyle factors can increase the risk such as use of tobacco and alcohol, dehydration, and poor oral hygiene. Low saliva production, trigeminal neuralgia and cranial radiation therapy have additionally been found to increase the risk for black hairy tongue to develop.

Black hairy tongue is a relatively common condition in which the the central top portion of the tongue presents with an abnormal coloring and coating. Although the abnormal coating is typically black in color, brown, yellow, and green discoloration have been described. Individuals with black hairy tongue usually do not have symptoms, although occasionally there may be a burning, gagging, or tickling sensation. Halitosis (bad breath) or abnormal taste may additionally be present. Black hairy tongue can occur at any age, but the incidence increases with age. Black hairy tongue occurs due to a lack of stimulation on the top of the tongue resulting in a buildup of a protein known as keratin. This buildup can become quite long, giving it a hair-like appearance. Though black hairy tongue can present at any point, certain factors increase one's risk, such as poor oral hygiene, use of medications (particularly antibiotics), tobacco use, therapeutic radiation, and certain illnesses. Treatment varies depending on complexity; however, many cases can easily be resolved with brushing the tongue with a toothbrush or using a tongue scraper.

Although black hairy tongue normally resolves on its own, patients are encouraged to avoid the factors that have been shown to bring about hairy tongue. Treatment usually involves gentle cleaning of the tongue with a soft toothbrush. Medication is rarely prescribed for hairy tongue; however, in severe cases, antifungals, retinoids or mouthwashes may be used. If treatment fails, the affected portion of the tongue called the papillae (finger-like projections) may be clipped or removed using techniques such as carbon dioxide laser burning or electrodesiccation (a procedure in which an electrical current is used to seal of the affected area).

The American Academy of Oral Medicine, the membership organization for clinicians providing oral and dental health, provides information about Black hairy tongue