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A black hairy tongue (medical term: lingua villosa nigra) is a fairly common, temporary, painless, and harmless condition. But it can be unattractive, embarrassing, and even alarming. Please continue reading to find out what causes a black hairy tongue and how to get rid of it.

What is the black fuzzy stuff on my tongue?

The complex human epithelium of the tongue has hundreds of tiny projections on its dorsal surface called papillae, which contain taste buds. If these papillae grow longer than normal, they tend to trap dead skin cells, food, bacteria, and other substances like tobacco particles. The buildup of these materials in the filiform papillae gives the tongue a characteristic black, hairy appearance. It can also appear fuzzy or furry and be white, gray, yellow, green, or brown in color, depending on the food debris that is trapped.

A black hairy tongue syndrome is typically asymptomatic. However, it can be accompanied by other signs and symptoms such as a metallic taste in the mouth, halitosis (bad breath), and a tickling sensation or gagging sensation if there are severely elongated papillae. A rare symptom that indicates that a black hairy tongue is caused by a bacterial or yeast infection would be a burning feeling on the tongue.

What causes a black hairy tongue?

It’s not always possible to identify the exact cause of a black hairy tongue. Common contributing factors include:

• Poor oral hygiene

• Regular use of irritating substances, such as peroxide or oxidizing mouthwashes

• Xerostomia (dry mouth)

• Use of certain medications, such as antibiotics, that can alter the normal oral microbiome (change the usual bacteria and yeast in the mouth)

• Tobacco use

• Drinking excessive amounts of coffee, tea, or alcohol

• Eating mainly soft foods that prevent normal desquamation (natural rubbing off of dead skin cells from the dorsal tongue)

Is black hairy tongue an STD?

A black hairy tongue is not an STD (sexually transmitted disease). It is not an infection; this condition is not transmitted through kissing, touching, or sharing utensils or objects.

What deficiency causes black tongue? 

There is no known deficiency that causes a black hairy tongue. The two most common causes of black hairy tongue are poor oral hygiene and a soft diet.

Note: Vitamin B3 (niacin) was called the anti-black tongue factor in dogs. In humans, severe cases of vitamin B3 deficiency can cause a condition called pellagra. Symptoms include skin rashes on sun-exposed areas, a bright red tongue, and diarrhea or constipation. 

What medications can cause a black hairy tongue?

Some of the medications that can cause black discoloration and a hair-like appearance on the surface of the tongue include:

• Antibiotics such as penicillin, doxycycline, erythromycin, and neomycin.

• Older or first-generation antipsychotics such as clozapine, chlorpromazine, and olanzapine due to their xerostomic (mouth drying) effects as a result of their anticholinergic properties. Therefore, other anticholinergic medications, such as diphenhydramine (Benadryl), nortriptyline (Pamelor), etc., can cause dry mouth, thus increasing the risk of this oral problem. 

• There is a case report of black hairy tongue epithelium after erlotinib treatment in a patient with advanced lung cancer.

What is the treatment for a black hairy tongue?

A black hairy tongue (lingua villosa nigra) is a benign condition that usually does not require any treatment. However, depending on the cause, your doctor may prescribe medications. For example, if antibiotic use has caused oral candidiasis (a fungal infection of the mouth), your doctor may prescribe antifungal medications. 

Other treatment options for a black hairy tongue include using hydrogen peroxide and baking soda to dislodge the buildup of debris in the papillae. It is also recommended to increase water intake and consume more raw fruits and vegetables to improve and reduce the hairy projections on the tongue. In severe cases, if a black hairy tongue does not resolve with routine treatments, electrodesiccation or laser treatment may be necessary to trim the overgrown papillae.

Note: If you suspect a medication is one of the precipitating factors for the black hairy tongue, talk to your healthcare provider, especially if you experience dry mouth or expect the medication to cause dry mouth. Do not stop taking prescription medications without consulting your doctor.

Will practicing good oral hygiene get rid of a black hairy tongue? 

Yes, practicing good oral hygiene and eliminating predisposing factors can get rid of black hairy tongue, a harmless condition that can be alarming. Some of the things you can do for a black hairy tongue include:

• Use a flexible tongue scraper or soft toothbrush to gently remove dead skin cells and food debris from the surface of the tongue.

• Practice good oral hygiene and brush your teeth twice every day, preferably after meals.

• Floss daily to remove food particles from between your teeth.

• Visit your dentist every 6 months for professional cleanings and oral exams so that problems are picked up and treated early.

• Eat a healthy diet and stay well hydrated. Consume a variety of food textures (eating only soft foods can lead to defective shedding of the black hairy tongue epithelium).

• Avoid excessive tea, coffee, or alcohol intake.

When to see a doctor for black hairy tongue?

If your black hairy tongue does not go away with the home remedies outlined above, you should make an appointment to see your healthcare provider. They can make a proper clinical diagnosis based on the clinical appearance of your tongue. They will also rule out other causes, such as:

• Pseudo-black hairy tongue (black discoloration of the tongue due to certain foods or an oral medicine such as Pepto-Bismol)

• Oral hairy leukoplakia (a condition triggered by the Epstein-Barr virus or EBV)

• Fungal or viral infections of the mouth

If all other factors and causes are ruled out after obtaining a detailed history, it may be determined that black hairy tongue is due to normal variations in the color and appearance of your tongue.