BLACK HAIRY TONGUE

Black hairy tongue (BHT) is a benign discoloration of the dorsal surface of the tongue. Excessively long filiform papillae are black in color due to accumulation of keratin and chromogenic microorganisms.

• The condition usually occurs in older individuals but infants as young as 2 months of age may be affected.
• Common contributing factors include poor oral hygiene, regular use of oxidizing mouthwashes, dry mouth, antibiotic use, tobacco, coffee, tea, alcohol, and eating mainly soft foods.
• Some oral antibiotics can precipitate a black, hairy tongue by altering the microflora of the oral mucosa. Reported offenders include the tetracyclines (like doxycycline and minocycline), erythromycin, penicillins, linezolid, and amoxicillin-clavulanate.
• Taking bismuth subsalicylate (Pepto-Bismol) can induce it as well.

BHT occurs because of a buildup of keratin cells, which are the proteins that also make up human hair. This buildup can give the tongue a rough, hairy texture. This rough surface also provides an excellent area for bacteria and fungi to multiply, which could also cause a green tongue.

Clinical

The dorsal surface of the tongue is blackened. The filiform papillae are long and dark in color.

Treatment

To both treat and prevent black hairy tongue, the patient should maintain good oral hygiene (i.e. brush and floss regularly), avoid smoking, limit alcohol consumption, and ensure a balanced diet that includes roughage.

If an oral antibiotic precipitated the condition, the condition may remit once the antibiotic is stopped.

Using a flexible tongue scraper or soft toothbrush to gently remove dead skin cells and food debris from the surface of the tongue may help.

For infants, no treatment is recommended as it usually remits spontaneously within a month or two.

RegionalDerm

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