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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.