Black hairy tongue is a condition which sounds alarming and gross, but is actually quite harmless and often goes unnoticed. It refers to the top of the tongue, towards the back usually, becoming darkened with a coating which actaully can be yellowish, brownish, or black.
The “hairy” appearance is due to the minute protuberances on the tongue surface called papillae becoming somewhat elongated. This seems to happen because the surface cells are not being periodically shed as they normally would. The elongated papillae trap food debris and inevitably bacteria collect and proliferate in this plaque, often along with certain types of fungi such as yeasts.
The tongue should be a “pleasantly” pinkish color, but can become dark due to various pigments from food and drinks which get caught up on the top surface, especially if there is an overgrowth of certain bacteria or fungi in the mouth. The papillae are concerned with our sensation of taste and are normally barely noticeable on the surface, because their color is the same as the rest of the tongue.
They can, however turn yellow, green, brown, or black depending on the types of food and drink consumed and the organisms which get involved in over-proliferation forming a coating or plaque on the tongue surface.
Often the condition goes quite unnoticed and this is in fact why it can occur in the first place, since many of us don’t bother to clean or check our tongue when we clean our teeth. It can sometimes be noticed by chance, or by examining the tongue as a result of a metallic taste in the mouth or because of a bad breath problem. Sometimes there may be a tickling sensation at the back of the mouth or a tendency to gag easily.
A common fungus involved is Candida which likes warm, moist parts of the body in order to grow, and if it really takes hold it can cause irritation of the skin, the tongue or the lining of the mouth causing redness and a burning sensation.
Black Tongue Causes
- The most common cause is basically lack of adequate oral hygiene where plaque collects on the teeth surfaces and can also accumulate on the back of the tongue, where it remains often relatively undisturbed.
- Smoking is an important contributory factor in the condition since it encourages tongue discoloration and depletes supplies of saliva in the mouth, so allowing more bacteria to proliferate.
- Drinking insufficient fluid can lead to dehydration which similarly encourages bacteria in the mouth to multiply.
- Drinking lots of tea or coffee seems to encourage discoloration of the accumulating plaque.
- Antibiotic therapy, especially if prolonged, can upset the normal balance of various micro-organisms in the mouth, allowing less desirable ones to proliferate.
- Taking certain medicines such as those containing bismuth, overdoing it with certain mouthwashes, or being unable to produce sufficient amounts of saliva as in Sjogren’s syndrome can also predispose to developing a hairy black tongue.
- Radiation therapy in the head and neck region for cancer treatment or a poor immune system are possible contributory factors.
By far the most common causes, though, are regular smoking and inadequate oral hygiene.
Treatment and Prevention
Simply improving your oral hygiene is usually sufficient to get rid of a hairy tongue. It is essential to carefully remove all the sticky plaque from all surfaces of all the teeth by thorough tooth-brushing and dental flossing, followed by brushing or scraping the back of the tongue to remove the superficial film. The normal toothbrush would suffice for this or you can buy a special tongue scraper.
You should also drink plenty of water throughout the day to keep hydrated and help keep your mouth clean and discourage plaque formation. It is important for anyone who smokes to quit, because the tars in tobacco smoke are incredibly sticky and likely to encourage plaque formation on teeth and soft tissues. In addition regular smoking upsets the normal mouth “flora” of various harmless bacteria and allows more harmful ones to take hold.
Ask your doctor or dentist for advice if your mouth feels overly dry for long periods.
A diet which minimizes soft foods and contains more fresh fruit and raw vegetables is a good idea to also help keep dental plaque at bay.
A hairy tongue should usually be back to normal within a few weeks with careful daily oral hygiene measures including mechanical brushing or scraping, but if the condition doesn’t resolve it’s best to see your dentist. Sometimes a prescription of topical medications or oral antifungal drugs may be necessary, and in extreme cases the papillae can be treated with laser or electrosurgical procedures.
Anyone who suffers from black hairy tongue should eradicate any existing predisposing factors as described and be sure to gently but firmly clean the top of the tongue – reaching as far back as possible, on a daily basis. This does not harm the tongue but simply removes the unpleasant coating and allows the surface to get back to normal again.