II. Epidemiology

  1. Prevalence: 0.5 to 11%
  2. More common in older patients
  3. More common in males (3 fold more common than in females)

III. Pathophysiology

  1. Hyperplasia of Filiform Papillae on anterior two thirds of dorsal Tongue (retention hyperkeratosis)
    1. Papillae may elongate to >1 cm (usually 1 mm)
  2. Response to poor Desquamation, excessive keratinization
  3. Bacterial colonization may result in black appearance

IV. Risk Factors

  1. Tobacco Abuse
  2. Alcohol Use
  3. Inadequate Oral Hygiene
  4. Low fiber diet
  5. Hyposalivation
  6. Mouth breathing
  7. Oxidizing mouth wash use
  8. Overgrowth of oral fungus (Thrush)
    1. Aspergillus niger
    2. Candida albicans
  9. HIV Infection or other Immunosuppression
  10. Epstein Barr Virus has been identified on biopsy
  11. May follow antibiotic therapy

V. Symptoms

  1. Painless
  2. May cause gagging Sensation or altered Taste Sensation
  3. Halitosis may occur from food accumulation

VI. Signs

  1. "Hair" of elongated papillae on anterior two thirds of Tongue dorsum
    1. Yellowish to brown or black coloration
    2. Velvety, or shaggy, asymptomatic keratoses
    3. Unable to wipe off Plaque
    4. Color altered by foods, Tobacco, coffee, tea
  2. Distribution
    1. Dorsal Tongue surface

VII. Management

  1. Improves with Tongue brushing with soft brush
    1. Use a standard ToothBrush or scrape the Tongue
    2. May apply a 1.5% Hydrogen Peroxide
  2. Avoid predisposing factors above
  3. Increase Dietary Fiber

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