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Hairy Tongue
Aka: Hairy Tongue, Black Hairy Tongue, Furry Tongue, Black Tongue
- Epidemiology
- Prevalence: 0.5 to 11%
- More common in older patients
- More common in males (3 fold more common than in females)
- 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
- Bacterial colonization may result in black appearance
- 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
- May follow antibiotic therapy
- Symptoms
- Painless
- May cause gagging Sensation or altered Taste Sensation
- Halitosis may occur from food accumulation
- Signs
- "Hair" of elongated papillae on anterior two thirds of Tongue dorsum
- Yellowish to brown or black coloration
- Velvety, or shaggy, asymptomatic keratoses
- Unable to wipe off Plaque
- Color altered by foods, Tobacco, coffee, tea
- Distribution
- Dorsal Tongue surface
- 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
- Increase Dietary Fiber
- References
- McGrath (2008) CMAJ 178(9): 1137-8 [PubMed]
- Randall (2022) Am Fam Physician 105(4): 369-76 [PubMed]