Black Hairy Tongue

In this article

What Causes Black Hairy Tongue?

What Are the Symptoms of Black Hairy Tongue?

How Is Black Hairy Tongue Treated?

The name black hairy tongue may sound scary, but the condition is harmless. Black hairy tongue
is caused by bacteria or fungi in the mouth, which make the tongue appear black and hairy. It's
easily remedied by good old-fashioned oral hygiene.

What Causes Black Hairy Tongue?

A black hairy tongue is caused by too much bacteria or yeast growth in the mouth. The bacteria
build up on tiny rounded projections called papillae. These lie along the surface of the tongue.
Instead of shedding as they normally do, the papillae start to grow and lengthen, creating hairlike projections. They can grow to 15 times their normal length.
Normally, the papillae are pinkish-white. But as they grow, pigments from food, drinks, and
possibly the bacteria or yeast themselves get caught in the papillae, dyeing the tongue a color.
Most often that color is black, hence the name. But the tongue can also turn brown, yellow,
green, or a variety of other colors.
Certain lifestyle habits and conditions can make people more likely to develop black hairy
tongue. They include:

poor oral hygiene

smoking tobacco

drinking a lot of coffee or tea

using antibiotics (which may disrupt the normal balance of bacteria in the mouth)

being dehydrated

taking medications that contain the chemical bismuth (such as Pepto-Bismol for upset
stomach)

not producing enough saliva

regularly using mouthwash that contains peroxide, witch hazel, or menthol

getting radiation therapy to the head and neck

Black hairy tongue is more common in men, people who use intravenous drugs, and those who
are HIV-positive.

What Are the Symptoms of Black Hairy Tongue?

Other than the appearance of the tongue, most people with black hairy tongue don't have any
symptoms or feel any discomfort. The exception is when there is too much growth of the yeast
Candida albicans, which can cause a burning sensation on the tongue. This burning sensation is
called glossopyrosis.
Some people complain of a tickling feeling in the back of the roof of the mouth, a metallic taste
in their mouth, or nausea. In more severe cases, the condition may lead to a gagging feeling.
Sometimes, food getting caught inside the extra-long papillae can cause bad breath.

How Is Black Hairy Tongue Treated?

Practicing good oral hygiene is the best way to treat black hairy tongue. Gently brush your teeth
twice a day with a soft toothbrush. Also, brush your tongue. You can use a tongue scraper to
make sure you're thoroughly cleaning the area. Drink plenty of water throughout the day to help
keep your mouth clean.
Other tips include:

If you smoke, quit.

Add more roughage to your diet. Soft foods won't clean off the tongue effectively.

Call your doctor or dentist if the problem doesn't get better on its own. Your doctor may
prescribe antibiotics or an antifungal drug to get rid of the bacteria or yeast. Topical medications,
such as tretinoin (Retin-A), are also sometimes prescribed. As a last resort, if the problem doesn't
improve, the papillae can be surgically clipped off with a laser or electrosurgery.
See What Black Hairy Tongue Looks Like, and Other Top Problems in Your Mouth
WebMD Medical Reference
View Article Sources
Reviewed by Steve Drescher, DDS on April 14, 2013
2013 WebMD, LLC. All rights reserved.

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Black hairy tongue

Black hairy tongue, or lingua villosa nigra, is a harmless condition caused by bacteria or fungi in
the mouth making the tongue look black and hairy.
Black hairy tongue can be treated with good oral hygiene.

What causes black hairy tongue?

A black hairy tongue is caused by too much bacteria or yeast growth in the mouth: the bacteria
build up on tiny rounded projections called papillae. These lie along the surface of the tongue.
Instead of shedding as they normally do, the papillae start to grow and lengthen, creating hairlike projections. They can grow to 15 times their normal length.
Normally, the papillae are pinkish-white. But as they grow, pigments from food, drinks, and
possibly the bacteria or yeast themselves get caught in the papillae, dyeing the tongue a colour.
Most often that colour is black, hence the name. But the tongue can also turn brown, yellow,
green or a variety of other colours.

Certain lifestyle habits and conditions can make people more likely to develop black hairy
tongue. They include:

Poor oral hygiene

Smoking tobacco

Drinking a lot of tea or coffee

Using antibiotics (which may disrupt the normal balance of bacteria in the mouth)

Being dehydrated

Taking medications that contain the chemical bismuth (used in some indigestion
medicines) - although this is often just staining and not accompanied by hairiness of the
tongue

Not producing enough saliva

Regularly using mouthwash that contains peroxide, witch hazel, or menthol

Having radiotherapy to the head and neck

Black hairy tongue is more common in men, people who use intravenous drugs, and those who
are HIV-positive.

What are the symptoms of hairy tongue?

Other than the appearance of the tongue, most people with black hairy tongue don't have any
symptoms or feel any discomfort. The exception is when there is too much growth of the yeast
Candida albicans, which can cause a burning sensation on the tongue. This burning sensation is
called glossopyrosis.
Some people complain of a tickling feeling in the back of the roof of the mouth, a nasty metallic
taste in their mouth, or nausea. In more severe cases, the condition may lead to a gagging feeling.
Sometimes, food getting caught inside the extra-long papillae can cause bad breath.

How can I get rid of black hairy tongue?

In some cases the condition will resolve on its own, but practising good oral hygiene is the best
way to treat black hairy tongue. Gently brush your teeth twice a day with a soft toothbrush. Also,
brush your tongue. You can use a tongue scraper to make sure you're thoroughly cleaning the
area. Drink plenty of water throughout the day to help keep your mouth clean.
Other tips include:

Stop smoking.

Add more roughage to your diet. Soft foods won't clean off the tongue effectively.

See your doctor or dentist if the problem doesn't get better on its own. Your doctor may prescribe
antibiotics or an antifungal medication to get rid of the bacteria or yeast. As a last resort, if the
problem doesn't improve, the papillae can be surgically clipped off with a laser or electrosurgery.
Medically Reviewed by Dr Rob Hicks on September 12, 2014
2014 WebMD, LLC. All rights reserved.

Hairy Tongue
The term hairy tongue is used to describe an abnormal coating on the top (dorsal) surface of the
tongue. It is a relatively common, temporary, and harmless condition that occurs in as much as
13% of the population.
Hairy tongue can occur at any age but is more frequent in older age. It is found more commonly
in males than females and equally among races. In hairy tongue there is defective shedding of
the tongues covering tissue. Normally the tongue is covered with conical shaped projections
referred to as filiform papillae. Usually these papillae are approximately 1 millimeter in length.

Hairy tongue occurs due to lack of stimulation / abrasion

to the top of the tongue. The result is a buildup of a protein known as keratin (the same protein
that makes up the hair on your head). In severe cases, the length of these papillae can become
quite long, giving a hair-like appearance to the top of the tongue (see Below and Right). Also,
when the papillae dont properly shed, food, bacteria, and sometimes yeast can accumulate in the
hair-like mesh. These accumulations result in various colors to the surface of the tongue. Hairy
tongue may appear brown, white, green, or pink, depending upon the specific cause and other
factors, such as mouthwashes or even candy. Certain types of bacteria and yeast can even give
the tongue a black appearance, referred to as black hairy tongue.

QUESTIONS AND ANSWERS ABOUT HAIRY TONGUE

Q: What causes hairy tongue?

A: It can occur from poor oral hygiene (mouth cleaning), the use of medications, chronic or
extensive use of antibiotics, radiation treatment to the head and neck area, excessive coffee or
tea drinking, or tobacco use. It may also develop in persons with no teeth because their soft food
diet does not aid in the normal shedding of the papillae.
Q: Does hairy tongue hurt?
A: There are usually no symptoms but occasionally there is a burning sensation on the tongue
associated with the bacteria or yeast accumulations. Individuals with hairy tongue may also
complain of gagging or a tickling sensation in the soft palate (roof) of the mouth during
swallowing. Halitosis (bad breath) or abnormal taste may be present due to the taste buds
(papillae) holding onto debris in the mouth.
Q: How is the diagnosis of hairy tongue made?
A: In most instances, dentists or health care providers can make the diagnosis based on
clinical appearance. Biopsy of hairy tongue is not necessary.
Q: How do I get rid of hairy tongue?
A: In most instances good oral hygiene with a toothbrush or tongue scraper will result in
elimination of the build up. Individuals with a persistent coating on the tongue should consult
their dentist or other trained oral health professional. Hairy tongue that does not resolve with

such simple measures may be treated with medical or surgical treatments by qualified
individuals.
Q: How can I prevent hairy tongue?
A: Most individuals can prevent hairy tongue by practicing good oral hygiene. Brushing the top
of the tongue with a tooth brush should be part of regular daily oral hygiene activities. Many
individuals are sensitive and have a tendency to gag when accomplishing this procedure. Using
a small brush and gradually going backwards tends to lessen this problem. A number of tongue
cleaning devices (tongue scrapers) are available. If you continue to have a problem cleaning
your tongue, consult your dentist or an individual with experience in this area.
Q: Will hairy tongue come back?
A: The key to successful long-term elimination is excellent oral hygiene. Patients who have had
hairy tongue are at greater risk for recurrence.
Prepared by L Radfar and the AAOM Web Writing Group
Prepared 8 January 2008