II. Epidemiology
- Prevalence: 0.5 to 11%
- More common in older patients
- More common in males (3 fold more common than in females)
III. Pathophysiology
- Hyperplasia of Filiform Papillae on anterior two thirds of dorsal Tongue (retention hyperkeratosis)
- Papillae may elongate to >1 cm (usually 1 mm)
- Response to poor Desquamation, excessive keratinization
- Results in trapping of debris and Bacteria
- Bacterial colonization may result in black appearance
IV. Risk Factors
- Tobacco Abuse
- Alcohol Use
- Inadequate Oral Hygiene
- Low fiber diet
- Hyposalivation
- Mouth breathing
- Oxidizing mouth wash use
- Overgrowth of oral fungus (Thrush)
- Aspergillus niger
- Candida albicans
- HIV Infection or other Immunosuppression
- Epstein Barr Virus has been identified on biopsy
- Radiation Therapy
- Medications
- See Medication Causes of Dry Mouth
- Recent Antibiotic therapy (e.g. Linezolid)
V. Symptoms
- Painless
- May cause gagging Sensation or altered Taste Sensation
- Halitosis may occur from food accumulation
VI. Signs
VII. Management
- Improves with Tongue brushing with soft brush
- Use a standard ToothBrush or scrape the Tongue
- May apply a 1.5% Hydrogen Peroxide
- Avoid predisposing factors above (including drug-induced causes of Xerostomia)
- Increase Dietary Fiber
- Tobacco Cessation