Black hairy tongue is an acquired benign condition characterized by the appearance of hypertrophied and elongated filamentous papillae on the dorsal surface of the tongue. Patients complain of dryness and a change in the appearance of the tongue. With significant hyperplasia of the filamentous papillae, there is a feeling of a foreign body in the throat. In the case of activation of yeast fungi, a burning sensation of the mucous membrane appears. Diagnosis is reduced to collecting complaints, compiling a medical history, conducting a clinical examination. Treatment is aimed at correcting the hygienic condition of the oral cavity. Keratolytics, liquid nitrogen are applied topically.
K14.3 Hypertrophy of the papillae of the tongue
Black hairy tongue is a disease of the tongue characterized by hyperkeratosis of the filamentous papillae and their staining in dark brown or black. Pathology occurs both in childhood and in adulthood, but in patients of the older age group, the disease is diagnosed much more often. Often, a villous tongue is detected in adolescents after taking antibacterial drugs. The main group of patients are heavy smokers who abuse alcohol. In most cases, with this disease, the activation of fungal flora is observed. Removal of overgrown papillae is carried out by cryodestruction or with the help of applications of keratolytic agents.
The etiology of the black hairy tongue has not been fully studied. A significant role in the development of the disease is assigned to infectious, trophic and physico-chemical factors.
- Infections. Black hairy tongue may occur after a viral or bacterial infection. At the same time, the body’s defenses decrease in patients, which contributes to the activation of pathogenic microflora. Bacterial microorganisms, accumulating on the tongue together with the cells of the keratinizing epithelium, become a stationary irritant. As a result, the process of keratinization is blocked, hyperplastic changes develop.
- Diseases of the gastrointestinal tract. The causes can be diseases of the digestive system. The shift of acid-base balance in patients with colitis and enterocolitis creates the necessary conditions for the development of pathogenic microbes.
- Hypovitaminosis. Riboflavin deficiency leads to disruption of metabolic processes, contributes to the appearance of trophic changes in the surface layer of the epithelium.
Predisposing factors in the development of a black hairy tongue are smoking, excessive consumption of coffee or strong black tea, an unsatisfactory level of hygiene, trigeminal neuralgia, general exhaustion of the body, penicillins and tetracyclines, alcoholism.
Histologically, with this pathology, a dense stratum corneum is visible on the enlarged filamentous papillae, which includes eleidin. Projections resembling a bird’s feather symmetrically depart from the keratinized rod. The keratinization process is blocked. Papilla staining occurs alimentally, as well as under the influence of bacterial pigments, chromogenic fungi.
With a black hairy tongue, pathologically altered filamentous papillae are located in the middle and posterior third of the dorsal surface of the tongue. In this case, the lesion area has the shape of a circle, oval or triangle. The length of hyperplastic papillae reaches 2-3 cm, diameter – 2 mm. At the base of the papillae are wider, denser on palpation, colored brown. Closer to the top, the filamentous papillae thin out, acquire a rich black hue. The direction of papillary growth with a black hairy tongue is from front to back. The anterior and lateral surfaces of the tongue are unchanged. Regional lymph nodes are not palpated. The general condition of patients with black hairy tongue is not disturbed.
The diagnosis is based on complaints, anamnesis of the disease, clinical examination:
- Intraoral examination. During a physical examination, a dentist identifies a section of pigmented hyperplastically altered filamentous papillae on the tongue. Papillae are less intensely colored at the base than at the periphery. When stroking the dorsal surface from the root to the tip of the tongue, the papillae are raised. In patients with a black hairy tongue, the hygienic condition of the oral cavity is unsatisfactory, as evidenced by the values of the Fedorov-Volodkina, Green-Vermillion hygiene indices over 3 points. Dental deposits, multiple carious defects are detected.
- Laboratory diagnostics. With bacterioscopy of a smear taken from the lesion site, along with the normal microflora of the oral cavity, mycelium and budding cells of yeast fungi are often detected.
Differentiate this disease with color changes in false black tongue and Addison’s disease, as well as with a hairy form of leukoplakia. A patient is examined by a dentist-therapist. To exclude concomitant background pathology, consultations of a gastroenterologist and a therapist are indicated.
If a black hairy tongue is detected, hygienic measures are necessary to reduce the level of bacterial contamination of the oral cavity. For the same purpose, with a black hairy tongue, professional cleaning is carried out. For oral baths in dentistry, antiseptic solutions based on chlorhexidine bigluconate, hydrogen peroxide are used. To remove keratinized cells and hyperplastically altered filamentous papillae, applications of resorcinol, salicylic alcohol – drugs with keratolytic effect are prescribed.
Also, the removal of overgrown papillae can be carried out by cryodestruction when exposed to a pathological focus of liquid nitrogen. For the purpose of general treatment of the villous tongue, antihistamines and multivitamin complexes are indicated. If signs of candidiasis are detected, antimycotic medications are additionally prescribed.
The prognosis for a black hairy tongue is favorable. Elimination of causal factors, complex treatment of the disease leads to the restoration of the surface of the tongue.
- Black hairy tongue syndrom – Grigoriy E Gurvits, Amy Tan link
- Oral Bacteria Dysbiosis in Patients with Linezolid-Induced Black Hairy Tongue: A Case Series – Yanwan Shangguan, Zhongkang Ji link
- Diode Laser Surgery as a Conservative Management of Hairy Tongue Lesion Resistance to Treatment. Samiei N, Ghane HK, Fekrazad R. link
- Black hairy tongue caused by metronidazole. Niiyama Y, Hase R. link