What are the other Names for this Condition? (Also known as/Synonyms)

• Black Hairy Tongue
• Hypertrophy of Tongue Papillae
• Lingua Villosa Nigra

What is Hairy Tongue? (Definition/Background Information)

• Hairy Tongue is an oral cavity condition of the tongue that is marked by the abnormal enlargement and dark staining of tiny natural protuberances, called papillae, on the upper tongue surface. The papillae are the tiny structures that give the tongue its characteristic rough texture
• There are several reasons for Hairy Tongue, which include poor oral hygiene, smoking and alcohol, medication use, dehydration, and dry mouth. Most of the cases are noted in middle-aged and older adults. Hairy Tongue is typically asymptomatic and self-limiting in many, although its appearance can be very unpleasant

Who gets Hairy Tongue? (Age and Sex Distribution)

• Hairy Tongue is generally observed in adults over 40 years of age. It is uncommon below this age, and is very rare in infants and young children
• Both males and females are affected
• Worldwide, there is no racial or ethnic preference observed

What are the Risk Factors for Hairy Tongue? (Predisposing Factors)

The risk factors for Hairy Tongue may include:

• Poor oral hygiene
• Beverages such as coffee
• Dehydration
• Drinking alcohol
• Dry mouth (Hyposalivation)
• History of smoking or chewing tobacco
• Radiation therapy for cancer
• Substance abuse such as cocaine use
• Use of certain mouthwash containing chlorhexidine or peroxidase 
• Use of medications including (certain):
  • Antibiotics
  • Antipsychotics
  • Antidepressants
  • Anticholinergic agents

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Hairy Tongue? (Etiology)

The primary change from normal in Hairy Tongue is the elongation of the hair-like projections on the tongue known as filiform papillae. As they increase in length and thickness, food elements and other debris accumulates.

• An accumulation of such debris results in overgrowth of bacteria and fungus on the tongue, which release certain compounds, called porphyrins, that stain the papillae resulting in a black or otherwise discolored tongue
• The thickening is thought to be from a decrease in the sloughing of the protein keratin from the surface, caused by decreased abrasion from foods and tooth brushing
• There are a variety of factors that predispose an individual to this oral condition include poor oral hygiene, dryness of mouth, dehydration, medication use, smoking and alcoholism, or an illness

What are the Signs and Symptoms of Hairy Tongue?

The signs and symptoms of Hairy Tongue may include:

• The front two-thirds of the tongue presents dark/black discoloration on the top surface
• In some individuals, the color of the discolored portion may be yellow, brown, orange, or dark green
• The tip of the tongue, sides, and bottom of the tongue do not show any discoloration
• The tongue presents a thick, corrugated, and hairy appearance
• Smelly mouth and bad breath
• Taste difference may be perceived by the affected individual
• Rarely, some individuals may notice burning and pricking sensation

However, generally Hairy Tongue is an asymptomatic condition that does not present any pain or discomfort.

How is Hairy Tongue Diagnosed?

A diagnosis of Hairy Tongue may involve the following exams and procedures:

• Physical examination of the individual and medical history evaluation
• Oral cavity examination: A visual exam of the tongue may be sufficient to establish a diagnosis. However, it is important to identify the predisposing factors
• Culture studies for bacteria and fungus
• Tissue biopsy: A tongue tissue biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Hairy Tongue?

The possible complications due to Hairy Tongue include:

• Unpleasant appearance of the tongue
• Superimposed bacterial and fungal skin infections
• Recurrence of the condition if the contributory factors are uncontrolled
• Treatment complications

How is Hairy Tongue Treated?

There is no specific treatment for this oral condition; it is self-limited in many cases. The healthcare provider may recommend the following treatment measures for Hairy Tongue:

• Maintain good oral hygiene
• Using a tongue scraper to clean or debride the tongue
• Using soft toothbrush to scrape the tongue
• Use of antiseptic mouthwash (hydrogen peroxide solution)
• Topical oral retinoids, if needed
• Antibiotic or antifungal therapy for secondary infections
• Occasionally, the papillae may be trimmed using CO2 laser therapy or electrodessication

It is also important to consider the following:

• Undertaking treatment of an underlying/coexisting condition if any
• Avoiding the triggering factors, where possible, such as discontinuing the offending medication
• Avoiding alcohol and stop smoking or chewing of tobacco

Regular follow up visits with the healthcare provider is important and recommended.

How can Hairy Tongue be Prevented?

Hairy Tongue may be prevented by considering the following steps:

• It is important to follow good oral hygiene practices such as brushing one’s teeth regularly, using oral rinses, etc.
• Taking more foods that are rich in natural fibers such as fruits and vegetables
• Consuming alcohol in moderation
• Completely avoiding smoking and illegal substances
• When possible, the offending medication may be discontinued and/or alternatives prescribed
• Undertaking early diagnosis and treatment of any medical illness
• Taking plenty of fluids to prevent dehydration and for dry mouth

What is the Prognosis of Hairy Tongue? (Outcomes/Resolutions)

The prognosis of Hairy Tongue is generally excellent on controlling the predisposing factors and taking appropriate treatment, if necessary. In most individuals, the condition is known to resolve by its own.

Additional and Relevant Useful Information for Hairy Tongue:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/healthy-living/dental-health/