Black hairy tongue refers to a change in the tongue characterized by a dark and furry tongue coating. It is cosmetically bothersome but harmless in most cases. The causes, symptoms, diagnosis and treatment options are explained below.
What is black hair tongue?
Black hair tongue is found in about 3 percent of the population, especially in men. It is manifested in the dark, furry coating in the middle to back third of the tongue. This is caused by the elongation of the filamentous papillae on the tongue, which grow from about 1 mm to 1.8 cm and form this fur-like coating. These “hairs” are colored green, brown and even black by food, stimulants and microorganisms. The tongue coating can be very extensive and reach as far as the so-called pharynx, where it causes a very unpleasant and disturbing tickling sensation when speaking and swallowing, and sometimes also a gag reflex. In many cases, black hair tongue disappears on its own after several weeks or months.
Causes
The thread papillae are often stained by pigment-forming bacteria and, in some cases, by infections with Candida albicans. In the latter case, severe burning of the tongue often occurs in addition. Another possibility is ingested food and stimulants (cigarettes, coffee, tea and alcohol) or medications, for example cortisone or antibiotics, which alter the local environment in the oral cavity. Various possible risk factors are known, but the exact cause has not yet been elucidated. Also of importance seem to be poor oral hygiene as well as insufficient scraping of the tongue against teeth, palate and food, for example when liquid food is taken and too little solid food is chewed. The occurrence of black tongue coating is also frequently observed in yeast infection, vitamin deficiency (especially vitamin B) and excessive tobacco consumption. Other possible causes are chemotherapy or radiation treatment, AIDS and severe underweight. Other possible triggers include irritating substances such as strong mouthwashes or rinses.
Symptoms, complaints, and signs
Black hairy tongue is manifested by a discolored, hairy coating on the tongue. The discoloration can be gray, green, yellow, brown, or even black. Possible symptoms include itching, burning of the tongue, changes in taste, for example a metallic taste, bad breath, lack of appetite and nausea. When swallowing and speaking, it is possible that the “hairs” cause tickling or nausea. If extreme, the tongue coating can lead to swallowing and even speech disorders. Black hair tongue may disappear on its own or persist for a long period of time.
Diagnosis and course of the disease
The diagnosis should always be made in a medical treatment. Here, the elongated papillae over 3 mm form the most important criterion. The reason for this is that the tongue can also be temporarily colored without elongation of the filiform papillae. This can be, for example, when eating blueberries or other fruits. But this can also be the case when drinking red wine, using mouth rinses or taking bismuth salts. A similar picture can also cause diseases, for example, hair leukoplakia, candidamycosis and the like. Therefore, thorough questioning of the patient is very important.
Complications
In most cases, this complaint does not cause special compilcations or serious discomfort. Also, the health of the patient is usually not negatively affected, so that the complaint also does not need to be treated in every case. Most patients suffer from discoloration of the tongue. This discoloration may be accompanied by itching, so that there may also be a burning sensation or pain on the tongue. The disease also has a negative effect on the sense of taste, which can lead to changes. Furthermore, those affected often suffer from bad breath, nausea or vomiting. The patient’s quality of life is considerably restricted and reduced. If there is no treatment, the disease often leads to swallowing difficulties or speech disorders.As a rule, the disease can be treated relatively well with the help of medication. Particular complications do not occur. Only in rare cases are surgical interventions necessary. The patient’s life expectancy is also unaffected by the disease.
When should one go to the doctor?
If possible, this disease should always be treated by a doctor. In this case, it usually does not come to an independent cure, so that treatment by a doctor is indispensable. Furthermore, it can also lead to a worsening of the symptoms if the disease is not treated in time. First and foremost, the underlying disease responsible for this complaint must also be recognized. A doctor should be consulted if the affected person suffers from burning and itching of the tongue. There is also bad breath and permanent nausea, so that the affected person also completely loses his appetite. In many cases, discomfort when speaking or swallowing also indicate this disease. A doctor should be consulted especially if the patient suffers from a black colored tongue and the coloration does not disappear on its own. Usually, a dermatologist or a general practitioner can be consulted for this disease. However, further treatment depends on the exact symptoms and the underlying disease.
Treatment and therapy
The treatment of a black hair tongue can be done without medication as well as with medication: First, regular cleaning of the tongue coating using a soft toothbrush or tongue cleaner is recommended. Good oral hygiene is the optimal way to remove impurities and prevent their reappearance. Strong mouthwashes must be discontinued, as they can trigger and promote the symptoms. If possible, the risk factors should be eliminated. For example, discoloration can be eliminated after discontinuing or reducing triggering medications. If dry mouth is present, it is important to ensure adequate hydration. If the symptoms cannot be alleviated, medication is another option. Keratolytics such as salicylic acid, trichloroacetic acid or urea in an appropriate dilution can be applied locally. These agents should, of course, be prescribed by a physician. External or internal antifungal agents are used only when fungal colonization with Candida albicans has been detected. In severe cases, the pharmaceutical agent isotretinoin may be considered for treatment. However, precautions must be observed here, as numerous side effects are possible. The therapy basically depends on how severe the black hair tongue is. In milder cases, a change in diet and avoidance of noxious substances, such as smoking, usually leads to a reduction in symptoms and discomfort. In pronounced cases, on the other hand, surgical ablation under local anesthesia may be necessary.
Prevention
The optimal prevention of black hair tongue lies in good oral hygiene, a healthy diet and a diet rich in fiber. A soft toothbrush or a special tongue cleaner can significantly help the abrasion of the dark coating on the tongue. It is also helpful to chew food thoroughly. A coating, which remains on the tongue from food residues, germs and cells, must be removed by an appropriate abrasion. Therefore, fruit, raw vegetables and solid bread should be chewed thoroughly. In this way, the tongue is rubbed as intensively as possible. In addition, smoking should also be avoided. Potentially triggering factors should be avoided. Therefore, it is primarily important to find the causes of black hair tongue.
Aftercare
Black hairy tongue often disappears on its own after a few weeks or months. In severe cases, symptomatic therapy with vitamin C tablets or tongue scrapers is possible. After the condition has receded or been cured, follow-up care by the physician is necessary. Follow-up care is provided by the ear, nose and throat specialist, the dentist or the family doctor. The physician performs a physical examination and then discusses any symptoms or side effects of the prescribed medication with the patient. During the physical examination, the oral cavity and especially the tongue are examined. For this purpose, the doctor uses a tongue scraper.If necessary, a swab must be taken again. Black hairy tongue can be accompanied by accompanying symptoms such as inflammation in the oral cavity, which must be clarified. If no abnormalities are detected, the therapy can be terminated. As a rule, a single follow-up examination is sufficient. If complications occur, the therapy must be resumed. The patient should consult the doctor at regular intervals until the condition has been cured. Since black hair tongue can sometimes also be a psychological burden, a follow-up consultation with a therapist may be advisable. The exact measures of aftercare are based on the symptom picture.
What you can do yourself
A black hair tongue can be treated with as well as without medication. The decisive factor here is the symptomatology present. A very good oral hygiene is the be-all and end-all for a black hair tongue. Regular cleaning with a soft toothbrush or a tongue cleaner can lead to success in some cases. The focus here is on removing existing impurities and preventing them from reappearing. However, strong mouth rinses should be avoided. Under certain circumstances, they can lead to further problems. Risk factors should also be eliminated as far as possible. Nicotine consumption should be mentioned in the first place. Often, various changes in diet and habits help to alleviate or reduce the disease in mild cases. Medications of various kinds can also be the cause of this disease. The attending physician should carefully check the existing medication and, if necessary, determine any incompatibilities. If these measures fail to alleviate the symptoms, drug treatment is also possible. The drugs of choice here are keratolytics such as salicylic acid, trichloroacetic acid or urea. They are applied locally in the appropriate dilution as prescribed by a physician. Antimycotics are used only after the cause of black hair tongue is known for certain. Since side effects may occur here, their use should be carefully weighed.
