Case Study of the Week: Black Hairy Tongue

This might just be the most disgusting thing I have ever seen!  I learned about Black Hairy Tongue (Lingua Villosa) while on my CME conference a few weeks ago and decided to delve into the topic a bit further as this week's case study.  Although I have never seen or treated a severe case of black tongue thus far in my career, I will now be prepared when a patient presents with these appalling oral changes.

Case Presentation

A 46 year old female presents to your clinic complaining of dark discoloration to her tongue accompanied by halitosis and a tickling sensation in the oropharynx with swallowing.  She does not feel ill or have any other symptoms.  Her tongue is not painful.  This patient is a smoker and has a history of hypertension for which she takes lisinopril daily.  She denies any other medical history and her vital signs are stable. 

One physical exam you note that the patient's tongue is discolored and dark.  The tongue's papillae are significantly elongated.  Halitosis is noted.  Based on this patient's physical exam, you diagnose her with Black Hairy Tongue

Management and Outcome

Treatment of Black Hairy Tongue is conservative and is accomplished by proper oral hygiene.  Gently brushing the tongue twice daily with a soft toothbrush or using a tongue scraper should be effective.  Patient's should be encouraged to drink plenty of water to keep the mouth clean as well as encouraged to stop smoking.  Thrush can be a complication of this condition and should be treated if it develops.  Rarely, if Black Hairy Tongue does not resolve, the papillae can be surgically clipped or removed with laser therapy. 

Discussion

Black Hairy Tongue results when the tongue's papillae don't shed normally and grow longer, up to 15 times their normal length.  The elongated papillae trap debris, bacteria and food and drinks resulting in discoloration.  Smoking, antibiotic use (disrupting normal oral flora), poor oral hygiene, dehydration and radiation therapy can cause this condition.  Soft diets may also cause Black Hairy Tongue as soft foods won't mechanically remove papillae from the tongue.  Prevalence of this disease varies widely- as many as 57% of drug users and incarcerated individuals will experience hairy tongue.  

Although this disease is benign, it is cosmetically unappealing and can signal poor oral hygiene.  When you notice it in your patients, teach them how to treat it in order to help them improve their oral health. 

Comments

Unfortunately, I developed this condition but it is a white hairy tongue, def. not as severe as the picture shown and its mainly in the back of the tongue. Had it for about 2 years, every day i brush my tongue with a soft toothbrush and scrape my tongue however, no progress. I've done some research and a lot of people with the same condition are complaining that brushing your tongue and using a tongue scraper doesn't do anything. Maybe in the beginning stages but not when the dorsal of the tongue has long overgrown papillae. Any suggestions?

anonymous