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Hairy Tongue - Causes, Symptoms, Diagnosis and Prevention

Published on Mar 19, 2022 and last reviewed on Mar 22, 2022   -  4 min read


A hairy tongue is an abnormal and temporary coating on the dorsal surface of the tongue. Read below to know the causes, symptoms, prevention, and management.



A hairy tongue is a benign (not cancerous) and non-infectious condition characterized by the enlarged and coated surface of the tongue. The coating mostly looks white, brown, or black. It is found to affect 13 % of the population and mostly older adults. Men are more affected than women. It is also referred to as black hairy tongue and lingua villosa nigra.

What Is a Hairy Tongue?

Typically, the front surface of the tongue is covered by tiny projections (filiform papillae), which gives a rough texture to the tongue and aids in chewing the food. The papillae consist of a protein called keratin. When there is an excess build-up of keratin, the surface (dorsum) of the tongue looks thickened and enlarged. Thus, giving a hairy appearance to the tongue.

What Causes a Hairy Tongue?

The components responsible for causing a hairy tongue are listed below:

What Are the Symptoms of a Hairy Tongue?

The hairy tongue does not cause any pain. Its appearance looks gross and discolored due to the accumulation of food, bacteria, and other colored substances. The features possessed by the hairy tongue are given below:

How to Diagnose a Hairy Tongue?

The hairy tongue is mainly diagnosed by its appearance. However, the following tests are performed for a definitive diagnosis:

What Is the Differential Diagnosis?

The diseases that are often misinterpreted with hairy tongues are as follows:

How to Get Rid of a Hairy Tongue?

How to Prevent a Hairy Tongue?

Certain lifestyle modifications that you should follow to prevent a hairy tongue are as follows:


A hairy tongue resolves soon with appropriate treatment but may recur. Therefore, education of the patient about oral hygiene maintenance, harmful effects of tobacco and alcohol, and a regular dental checkup is essential in eradicating such kinds of oral conditions.

Frequently Asked Questions


What Is a Black Hairy Tongue?

The dorsal surface of the tongue is covered by circumvallate, filiform, and fungiform papillae. The overgrowth of keratin in the filiform papillae gives the tongue a hairy and enlarged appearance. It is usually black, brown, or white due to bacterial accumulation, tobacco use, etc.


What Can Be Done to Get Rid of a Hairy Tongue?

The following steps are done to get rid of the hairy tongue:

- Use of tongue scraper or toothbrush to debride the enlarged papillae.

- Good oral hygiene.

- Avoiding excess consumption of tea, alcohol, and other beverages.

- Quit smoking.

- Avoid mouthwash containing peroxidase.

- Avoid medications that trigger the hairy tongue.

- Use of vitamin supplements and probiotics.


What Are the Characteristics of a Black Hairy Tongue?

The black hairy tongue looks enlarged, gross, and discolored due to bacterial build-up on the papillae. The hairy tongue may be in white, brown, or varying colors. It does not cause any pain but produces a burning sensation, bad breath, metallic taste, and gagging sensation.


How Does One Acquire a Black Hairy Tongue?

A hairy tongue is caused by:

- Improper maintenance of oral health.

- Use of tobacco.

- Eating a soft diet prevents the removal of dead cells from the tongue.

- Dehydration reduces salivation and sticks to enlarged papillae, thus preventing its shedding.

- Long-term use of peroxidase containing mouthwash.

- Excessive alcohol consumption.

- Certain drugs like antibiotics, antacids, etc.

- Radiation exposure.


Will a Hairy Tongue Last Long?

The hairy tongue is painless and usually resolves within a few weeks. It is treated with probiotics, vitamin B supplements and by avoiding peroxidase mouthwash, triggering factors, and debriding with a tongue scraper. Consult your dentist for further diagnosis and management if the hairy tongue does not resolve even after mechanical debridement.


Can Teeth Whitening Be Done if I Have a Hairy Tongue?

Teeth whitening procedure consists of various steps and techniques. First, the dentist will check the oral cavity for any other single tooth stain, broken restoration, and other oral lesions as they are contraindications of whitening procedures. Next, peroxidase-containing gels are used for about 8 to 12 minutes in the whitening procedure to remove extrinsic stains on the teeth. If you have a hairy tongue, then peroxidase can worsen it, so it is better to avoid such treatments before treating a hairy tongue.


Do Antibiotics Cause a Black Hairy Tongue?

Black hairy tongue is the enlargement of filiform papillae of the tongue, which is discolored by various reasons like poor oral hygiene, tobacco use, specific medications, etc. Antibiotics are one of the main causative factors of a hairy tongue. It includes Sulbactam, Ampicillin, Levofloxacin, etc., that are used to treat many bacterial infections.


How Is a Hairy Tongue Treated?

A hairy tongue resolves on its own if the triggering factors like tobacco, alcohol, excessive tea, other beverages, medications like antibiotics, and antacids are eliminated. It is treated by mechanically removing the enlarged papillae using a toothbrush or tongue scraper. The use of Vitamin B complex and Retinoids is beneficial. Surgical management is considered the last option if the hairy tongue does not heal through medications. It includes electrodessication and laser removal.


Should I Be Concerned About a Hairy Tongue?

A hair tongue is a benign and harmless condition and occurs in 13 % of the population. Men and older age groups are more commonly affected by a hairy tongue. It resolves independently or can be treated with supplements and antifungal medications. However, it requires proper diagnosis if it does not resolve within a few weeks.


Which Papillae Is Involved With a Black Hairy Tongue?

The dorsal surface of the tongue is covered by small projections known as papillae, which give a rough texture. It includes circumvallate, fungiform, filiform, and foliate papillae. The filiform papillae are larger and elongated and contain keratin. The overgrowth of keratin in filiform papillae causes a hairy tongue.


What Is the Difference Between a Hairy Tongue and Thrush?

- Oral thrush or candidiasis is a fungal infection that produces raised lesions on the tongue, cheeks, etc. It is more common in babies and affects individuals with compromised immunity. The lesions are white, painful, and give a cottony feeling in the mouth. It is treated with oral and topical antifungal medications.

- A hairy tongue is uncommon in babies. The tongue looks hairy and enlarged. It is harmless and resolves on its own or with mechanical debridement.


Does Hydrogen Peroxide Treat the Hairy Tongue?

Mouthwashes containing oxidizing agents like peroxidase increase the risk or worsen the hairy tongue. Therefore, the treatment of a hairy tongue focuses on avoiding the excessive use of hydrogen peroxidase-containing mouthwash.

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Last reviewed at:
22 Mar 2022  -  4 min read




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