Black hairy tongue refers to a dark color to a tongue with an irregular dorsal surface.


Synonym: lingua villosa nigra


Risk factors:

(1) poor oral hygiene

(2) heavy smoking

(3) antibiotic use (which alters normal oral flora)

(4) chronic use of Pepto-Bismol (bismuth turns other things black)


Clinical features:

(1) hyperplasia of the filiform papillae, resulting in a "hairy" appearance to the dorsal tongue

(2) proliferation of bacteria and accumulation of pigmented metabolites (porphyrins, other) among the papillae, imparting a dark (black, brown) appearance

(3) variable presence of halitosis

(4) variable presence of abnormal taste


Management involves:

(1) improving oral hygiene, which includes brushing and cleaning the tongue.

(2) stopping use of tobacco products

(3) discontinuation of antibiotic and Pepto-Bismol therapy


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