Black hairy tongue

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at January 24, 2016
StartDiseasesBlack hairy tongue

The name black hairy tongue sounds like something hideous that a person would never want to end up with. However it is a harmless condition and is somewhat common. It can cause bad breath and scare people away, but it is not contagious and is temporary in most cases.


Definition & Facts

Black hairy tongue occurs when bacteria or fungi is allowed to grow in the mouth, specifically on the tongue, that makes the tongue look black and hairy. The bacteria accumulate on small projections on the surface of the tongue called papillae. Under normal conditions these shed and go away. When they fail to shed, the papillae grow and lengthen, making them appear like hair on the tongue. Pigments from food or other bacteria get caught on the papillae. This causes them to appear black as they build-up. Some people report that their tongues turn brown, yellow and even green.

The frequency of the condition in children and young adults is around 8 percent. It can be as high as 57 percent in those addicted to drugs and incarcerated. There is around a 13 percent occurrence in the adult population. It has been reported more in men than women but both can suffer from the disorder. It seems that more adults and older people get this condition, probably because they have smoked for a longer period of time or been heavy coffee drinkers. It is seen more in those over the age of 40.

Symptoms & Complaints

The main symptom of the condition is the appearance of the tongue. Typically, people who are suffering from the condition do not feel any pain or discomfort. If the yeast, Candida is allowed to overgrow, it can cause a burning sensation on the tongue. There could also be some slight discomfort in the back of the roof of the mouth if it gets too extreme. Some people have reported having a metallic taste in their mouth.

When food is caught in the papillae, it can cause bad breath. In some cases, it can alter the taste buds causing food to taste funny. Some people report having a gagging sensation, when the bacterial build-up gets too heavy. Others report a tickling sensation in the throat when swallowing.


The causes of black hairy tongue can include lifestyle habits that allow the bacteria and yeast to grow in the mouth. As the bacteria and yeast grow they develop into hair-like clumps on the tongue. Some common causes of the condition include but are not limited to:

  • Smoking cigarettes or other forms of tobacco products.
  • Poor oral hygiene. Not brushing one’s teeth on a regular basis.
  • Drinking large amounts of coffee or tea.
  • Becoming severely dehydrated. The tongue gets very dry and allows the bacteria to grow on the surface.
  • Using medications like antibiotics. They disrupt the balance of bacteria in the mouth, allowing fungi or yeast to grow.
  • Taking other medications that cause the mouth to dry out.
  • Dry mouth. This is a condition that can be caused by taking certain medications or by simply not drinking enough water every day. Water is very helpful in flushing toxins out of the body, including the mouth.
  • Eating only soft foods. This does not allow rougher foods to scrap the dead skin cells off the surface of the tongue.
  • Having radiation treatments near the head or neck.
  • Taking over-the-counter medicines that contain bismuth such as Pepto-Bismol®.
  • Using intravenous drugs.
  • HIV-positive status.
  • Using mentholated mouthwash, or mouthwash that contains hydrogen peroxide. These dry out the mouth.

Diagnosis & Tests

Diagnosing black hairy tongue will include eliminating other possible conditions that can cause the tongue to appear dark. The doctor or dentist will look for inflammation in other areas of the mouth. They will ask questions about your oral hygiene habits as well as lifestyle habits, including consumption of coffee, smoking and the taking of medications. There are not any tests that are done, expect in severe cases. Biopsies are normally not done.

Treatment & Therapy

In most cases there is not medical treatment for black hairy tongue. Brushing the tongue along with the teeth twice a day will help get rid of the condition. Eliminating smoking, heavy coffee or tea consumption, and reducing the use of over-the-counter medications that contain bismuth will help alleviate the condition.

Practicing good oral hygiene will help get rid of the problem also. Brushing your teeth and tongue after each meal will help as well. It will prevent food from attaching to the papillae. Using a tongue scraper is also helpful. Applying an oral solution containing bleach on the scraper will help kill the bacteria. Flossing at the end of each day to remove food debris from between your teeth. If taking antibiotics, once the treatment stops, the bacterial imbalance should come back to normal.

Prevention & Prophylaxis

The most important thing preventative measure against black hairy tongue is good oral hygiene. Brushing the teeth and tongue two to three times a day is essential. Quitting smoking, reducing coffee consumption, drinking enough water each day to prevent dehydration are also crucial. Eating more rough foods so the dead skin cells are scraped off the tongue can help also prevent black hairy tongue. Visiting a dentist on a regular basis is a good practice. They can identify potential problems or warning signs, prompting a change in oral hygiene as a result,.

Black hairy tongue is not a serious condition, it simply may make a person less sociable because of the bad breath problems and the ugly appearance. Changing one’s lifestyle to one that is healthier, is the best defense against the condition. Preventing it from even occurring is the easiest way to deal with it. Good oral hygiene and avoiding unhealthy habits will prevent black hairy tongue from starting in the first place.