Introduction:
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:
-
Dehydration is a condition characterized by a lack of enough water content in the body. Due to this, the saliva becomes thick, sticky, and less watery leading to dry mouth or xerostomia. The keratin on the papillae also sticks to the tongue rather than shedding.
-
Soft diet consumption does not allow the shedding of dead cells, as they do not rub over the surface of the tongue. People who are old, ill, or with appetite changes, usually consume a soft diet.
-
Tobacco use.
-
Medications like antibiotics, antacids, or cancer drugs taken for a long-term can initiate the growth of papillae on the tongue.
-
Poor oral hygiene results in the accumulation of food substances and bacteria over the tongue's surface, leading to thickening of the papillae.
-
Alcohol, when taken excessively.
-
Radiation therapy on the head and neck can cause dry mouth and thus predispose to the hairy tongue.
-
Mouthwash containing Chlorhexidine or Peroxidase on long-term use can predispose to the hairy tongue.
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:
-
Discoloration of the tongue's surface to black, brown, yellow, or white.
-
Burning sensation on the tongue.
-
Abnormal or metallic taste in the mouth.
-
Tickling sensation on the roof of the mouth.
-
Gagging sense due to overgrowth of the papillae.
-
Bad breath or halitosis.
-
Nausea.
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:
-
Swabs or scrapings are collected from the tongue's surface and stained with Gram or periodic acid-Schiff stains. It helps in detecting fungal infections of the tongue.
-
Latex agglutination-based card test is a laboratory procedure to detect candida organisms, if present.
-
Widefield optical fluorescence is a newer modality used in visualizing the enlarged filiform papillae and build-up of keratin. It is painless, accurate, non-invasive, and requires no staining.
-
Tongue biopsy is rarely done for the diagnosis of hairy tongue. The method involves surgical removal of a small piece of tissue from the tongue. It is stained to detect the presence of Epstein-Barr virus, which causes a different condition of the tongue called hairy leukoplakia.
What Is the Differential Diagnosis?
The diseases that are often misinterpreted with hairy tongues are as follows:
-
Oral hairy leukoplakia is characterized by a white folded and furry tongue appearance. It occurs in people with weakened immunity, especially those having an infection with Epstein-Barr virus or human immunodeficiency virus. It is diagnosed with the help of a biopsy.
-
Oral candidiasis is a fungal tongue infection caused by an overgrowth of candida albicans. Creamy white lesions are found on the tongue, inner cheeks, and other mouthparts. It causes a burning sensation, and the lesions are scrapable. People with a weak immune system and those on long-term use of steroids are commonly affected.
How to Get Rid of a Hairy Tongue?
-
Mechanical debridement of the enlarged papillae using a tongue scraper or toothbrush.
-
Avoiding long-term dehydrating mouthwash containing hydrogen and sodium peroxidase.
-
Maintaining good oral hygiene prevents the accumulation of food debris and bacteria on the tongue.
-
Treating the conditions that restrict the consumption of foods like temporomandibular jaw disorders, etc.
-
Quit smoking and alcohol drinking, as it triggers hairy tongue and other systemic disorders.
-
Discontinuing the use of drugs that are found to cause hairy tongue.
-
Avoid excessive intake of tea and other beverages.
-
Irritation of the tongue due to candidal infection is treated with topical antifungal agents like Candid mouth paint (1 % Clotrimazole), or tablets are suggested for two weeks.
-
Use of topical or oral Retinoids and Vitamin B complex is effective in treating hairy tongue.
-
Probiotic supplements are also suggested.
-
Surgical Management:
-
Electrodesiccation is a procedure of using electrical needles to generate heat and destroy the papillae that are resistant to other treatments.
-
Carbon Dioxide Lasers remove the enlarged filiform papillae, and faster recovery occurs with laser treatment.
How to Prevent a Hairy Tongue?
Certain lifestyle modifications that you should follow to prevent a hairy tongue are as follows:
-
Keep your body hydrated by drinking plenty of water and eating fresh fruits and vegetables.
-
Practice brushing twice a day or after every meal. Proper cleaning of teeth using an appropriate toothbrush and fluoridated toothpaste prevents the accumulation of food debris.
-
Clean your tongue while brushing using a tongue scraper.
-
A regular dental checkup every six months is recommended to get advice on oral hygiene and early interventions for oral disorders.
Conclusion:
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.