Black hairy tongue
| Black hairy tongue | |
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| A picture of black hairy tongue. | |
| Classification and external resources | |
| Specialty | gastroenterology |
| ICD-10 | K14.3 |
| ICD-9-CM | 529.3 |
| DiseasesDB | 31923 |
| eMedicine | derm/639 |
Black hairy tongue (BHT, also termed lingua villosa nigra) refers to a condition of the tongue where the filiform papillae elongate with black or brown discoloration, giving a black and hairy appearance. The appearance may be alarming, but it is a harmless condition. Predisposing factors include smoking, xerostomia (dry mouth), soft diet, poor oral hygiene and certain medications. Management is by improving oral hygiene, especially scraping or brushing the tongue.
Hairy tongue largely occurs in the central part of the dorsal tongue, just anterior (in front) of the circumvallate papillae, although sometimes the entire dorsal surface may be involved. Discoloration usually accompanies hairy tongue, and may be yellow, brown or black. Apart from the appearance, the condition is typically asymptomatic, but sometimes people may experience a gagging sensation or a bad taste. There may also be associated oral malodor (intra-oral halitosis).
The cause is uncertain, but it is thought to be caused by accumulation of epithelial squames and proliferation of chromogenic (color producing) micro-organisms. There may be an increase in keratin production or a decrease in normal desquamation (shedding of surface epithelial cells). Many people with BHT are heavy smokers. Other possible associated factors are poor oral hygiene, general debilitation,hyposalivation (decreased salivary flow rate), radiotherapy, overgrowth of fungal or bacterial organisms, and a soft diet. Occasionally, BHT may be caused by the use of antimicrobial medications e.g. tetracyclines, or oxidizing mouthwashes or antacids. A soft diet may be involved as normally food has an abrasive action on the tongue, which keeps the filiform papillae short. Pellagra, a condition caused by a vitamin deficiency, may cause a thick greyish fur to develop on the dorsal tongue, along with other oral signs.
Transient surface discoloration of the tongue and other soft tissues in the mouth can occur in the absence of hairy tongue. Causes include smoking (or betel chewing), some foods and beverages (e.g. coffee, tea or liquorice), and certain medications e.g. chlorhexidine, iron salts, or bismuth subsalicylate (Pepto-Bismol).
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