Initially, what looks like a white lesion turns black with the accumulation of exogenous pigments contained in substances such as coffee and tobacco combustion products that are not removed by proper oral hygiene.

On the surface of the black hairy tongue the characteristic hyperkeratosis of filiform papillae is observed. In addition to the typical dark colors, yellow and green patches have also been found.

What is hairy tongue

Hairy tongue is a pathology that can be related to several causes. The color depends on both the underlying condition and the presence of additional factors such as the type of food consumed.

Hairy tongue is caused by irritation of the surface of the tongue, resulting in elongation of the papillae normally present on its surface. In this context, the filiform papillae are abnormally hypertrophied and elongated on the surface of the tongue, so they tend to trap food residues and microorganisms, which proliferate excessively.

There are different conditions that may predispose to the development of black hairy tongue. Some of these may include:

• Poor oral hygiene.
• Ingestion of certain foods (licorice candy or coffee).
• Smoking or chewing tobacco.
• Excessive use of mouthwashes containing oxidizing agents (hydrogen peroxide, or astringent substances).
• Reaction to certain drugs (antibiotics and antidiarrheals containing bismuth subsalicylate).
• Chemo- or radiotherapy for the treatment of head and neck cancer.
• Poorly controlled diabetes.

All cases of black tongue are characterized by hypertrophy and elongation of the filiform papillae, in addition to normal desquamation. Normally, filiform papillae have an average length of one millimeter. However, in the presence of a black tongue, they can reach up to fifteen millimeters.

Symptoms of hairy tongue

Hairy tongue rarely has specific symptoms, although if Candida albicans overgrowth occurs it can cause glossitis . Signs and symptoms of glossitis may include:

• Swollen tongue.
• Tongue pain.
• Swollen tongue.
• White spots on the tongue.
• Tongue like a map, with cuts.
• Red spots on the tongue.
• Strawberry tongue.

Causes of white tongue

As described above, in the presence of a hairy tongue, the tongue can take on different colors. One of the common colors is white tongue, which can have several causes, most of which are completely harmless. In fact, it is normal to wake up with a slightly white tongue in the morning, indicating a buildup of toxins caused by digestion.

Other causes of this white tongue may be:

• Poor oral hygiene.
• Abuse of alcoholic beverages.
• Low fiber diet.
• Tongue irritation.
• Oral candidiasis.
• Prolonged use of antibiotics.

Treatment of hairy tongue

This pathology does not require any medical treatment, however, certain measures can be taken to control it:

• Eliminate alcoholic beverages.
• Use specific toothbrushes.
• Clean the oral cavity constantly and attentively.
• Drink plenty of water.
• Adequate nutrition.

Measures should be defined after an evaluation of the main cause. If the cause is not clear or other symptoms appear, it is best to consult a physician to confirm the diagnosis.

Whether it is dry mouth or a simple accumulation of bacteria, the solutions are to eliminate the factors that can aggravate it, such as foods rich in dyes and alcoholic beverages. In the case of smokers, they should devote more time to taking care of their own well-being and the hygiene of their teeth and gums. High coffee consumption can also be a risk factor.

Gently brushing the back of the tongue with a special brush and daily use of a tongue cleaner is essential to alleviate the amount of bacteria on the surface and improve the bacterial flora of the mouth, this will help fight bad breath and mouth taste. Its bristles and blades remove the layer of dental biofilm and food debris deposited on the taste buds, which are the cause of bad odor and dark discoloration.

The constant use of toothpaste and mouthwash or, under dental advice, bicarbonate and antifungals, can also be a remedy to treat black hairy tongue, as well as drinking plenty of water and improving the diet with supplements rich in zinc, vitamin A, C and E.

Prevention of hairy tongue

First, identify the trigger for black hairy tongue. If antibiotic therapy is being followed, it is logical to assume that the problem will disappear a few days after the end of treatment.

It is equally important to check the composition of the mouthwash used and, if necessary, use another one with a different formulation. In any case, it is essential to be strict with daily oral hygiene:

• Brush the tongue: use a soft-bristled toothbrush or tongue scraper.
• Brush teeth after every meal: use fluoride toothpaste at least twice a day.
• Flossing: helps remove plaque and food debris between the teeth.
• Visit the dentist at least twice a year.