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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
- 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.
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.
Last reviewed at:
22 Mar 2022 - 4 min read
Query: Hi doctor,Part of my tongue seems to have lost some papillae. I have attached some pictures. Is this something to worry about? I take Nexium 40 mg daily. Kindly give your opinion. Read Full »
Query: Hello doctor, I am a 28 year old male who discovered this lesion on my tongue by accident while brushing my teeth. It does not come off easily with the toothbrush. Actually, it does not, unless I apply significant force to remove it. It has been a month since I first discovered it and no other symp... Read Full »
Article Overview: Epstein-Barr virus infection of the tongue with a corrugated or folded appearance is known as oral hairy leukoplakia. Read the article to know more. Read Article
What Is Oral Hairy Leukoplakia? A condition that gets triggered by the Epstein-Barr virus (EBV) is called oral hairy leukoplakia (OHL). The term oral hairy leukoplakia was given because of the rough and corrugated surface of the epithelium. White patches could be visible on the corrugated tongue, a... Read Article
Most Popular Articles
Do you have a question on Hairy Tongue or ?Ask a Doctor Online