Black Hairy Tongue (Lingua Villosa Nigra)
What is Black Hairy Tongue?

Black Hairy Tongue is the name given to the appearance of an abnormal coating of the tongue.

It is a benign disorder characterised by thickening of the
filiform papillæ (these are mushroom-shaped projections
covering most of the top surface of the tongue) of the tongue.  A brownish-black discoloration of the
papillæ occurs.
Why does it happen?

There is defective shedding of the cells in the central column of the filiform papillæ of the tongue resulting in the
formation of highly elongated, horn-like spines or "hairs" - the hallmark of this disease.  The cause for this is
unknown and often no definite cause can be identified.

Often there are no symptoms other than the cosmetic or anxiety over its cause.  Some patients complain of
gagging, nausea, alteration of taste or bad breath.

Contributing factors may include:

  • administration of topical or systemic antibiotics
  • soft diet
  • hypo-salivation
  • poor oral hygiene
  • smoking
  • alcohol
  • use of mouthwashes
  • iron compounds use of medications containing bismuth such as Pepto-Bismol antiseptic lozenges

How is it treated?

The condition may be very persistent and treatments include:

  • increasing hydration and salivation
  • discontinuing smoking
  • using a tongue scraper
  • brushing the tongue with a soft tooth brush followed by use of a dilute solution of hydrogen peroxide
  • scraping the tongue with a peach stone
  • eating pineapple
  • using sodium bicarbonate mouthwashes
  • topical retinoids or steroids
  • gentian violet, thymol, salicylic acid or vitamin B complex and
  • surgical excision of the papillæ.

Useful Websites:


Mayo Clinic

Medline Plus


New England Journal of Medicine


American Academy of Oral Medicine

DermNet NZ


Useful Articles:

Am Acad Oral & Maxillofacial Pathology.  Hairy / Coated Tongue Patient Information

Lancet 2011.  Lingua Villosa Nigra

Am J Med 2011.  Black Hairy Tongue

Am Assoc Family Phys 2011.  Tongue Lesion with Sensation of Fullness in the Mouth

CMAJ 2012.  Black Hairy Tongue in an Infant

CMAJ 2012.  Black hairy tongue: What is your call?

JAPI 2013.  Black Hairy Tongue (Lingua Villosa Nigra)

J Adv Int Med 2014.  Black Tongue

JAGS 2015.  Black Hairy Tongue treated with Oral Antibiotics - A Case Report

BSOM 2017.  Coated & Hairy Tongue

J Gen Intern Med 2017.  Clinical Practice.  Clinical Images.  Black Hairy Tongue

Acta Otorrinolaringol Esp 2017.  Images in Otorhinolaryngology.  Black Hairy Tongue (Lengua Vellosa Negra)

Laser 2017.  Treatment of Black Hairy Tongue

Eur J Int Med 2018.  Internal Medicine Flashcard.  Black Tongue

Dentist Case Rep 2019.  Case report.  Hairy Tongue, Geographic Tongue, Scrotal Tongue & Systemic Connections
- Clinical Images & An Overview