"Hairy" tongue is a misnomer. Small protuberances on the tongue become thick and appear black as a result of poor oral hygiene.
This image displays back, brown, and gray papillae typical of hairy tongue.
This image displays back, brown, and gray papillae typical of hairy tongue.
This image displays hairy tongue, where the taste buds are longer than normal, giving a dark, hairy look to the back of the tongue.
This image displays hairy tongue, where the taste buds are longer than normal, giving a dark, hairy look to the back of the tongue.

Images of Hairy Tongue (3)

This image displays back, brown, and gray papillae typical of hairy tongue.
This image displays hairy tongue, where the taste buds are longer than normal, giving a dark, hairy look to the back of the tongue.

Hairy Tongue

Hairy tongue, also known as black tongue, is a benign condition of elongation and staining of the fingerlike projections (papillae) on the tongue surface. This condition may be caused by overgrowth of a bacteria or yeast that produces a colored substance (pigment). Anything that reduces the flow of saliva in the mouth, such as dehydration or illness, or if the person is not eating a normal diet, can lead to the condition, which typically develops over a few weeks. Medications that commonly cause hairy tongue include antibiotics, anti-psychotics, anti-depressants, and anti-cholinergic agents. Other causes include smoking, alcohol, the use of mouthwashes, and exposure to radiation therapy.

Who's At Risk?

Hairy tongue can occur at any age, but it is most common in people who are dehydrated, ill, or not eating a normal diet. People taking certain medications or with certain exposures may also be more susceptible.

Signs & Symptoms

Hairy tongue most commonly affects the front two thirds of the tongue surface (not underneath the tongue). The tongue may be yellow, orange, green, brown, or black, with a coated, rough, or “hairy” look. You may notice a stale taste or smell in the mouth and a more sensitive gag reflex, but it is painless.

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Self-Care Guidelines

  • Gently brush the tongue with a toothbrush twice daily. Then rinse the mouth with a dilute solution of hydrogen peroxide (1 part peroxide to 5 parts water), or apply the solution with a toothbrush. Rinse the mouth with plain water.
  • Maintain good oral hygiene with regular tooth brushing.
  • Minimize mouthwash use and avoid smoking or chewing tobacco.
  • Eat more foods with fiber (fruits and vegetables); sucking on pieces of fresh pineapple may also be helpful.
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Treatments

A scraping or biopsy might be recommended. Sometimes an antibiotic or antifungal medication will be prescribed.

Visit Urgency

If self-care measures are unsuccessful, seek medical advice.

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References

Bolognia, Jean L., ed. Dermatology, pp.1080-1081. New York: Mosby, 2003.

Freedberg, Irwin M., ed. Fitzpatrick’s Dermatology in General Medicine. 6th ed, pp.1079-1080. New York: McGraw-Hill, 2003.