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Black hairy tongue
Black hairy tongue
Black hairy tongue
Black hairy tongue

Tongue problems
Definition:
Soreness, enlargement, or irregularities of the tongue.

Alternative Names:
Dark tongue

Considerations:
Tongue problems may include pain, hairy appearance, unusual color, unusual smoothness, swelling, ulcers, white lining, a split or groove in the tongue (fissure), cobblestone appearance, or positioning off to one side.

The tongue is mainly composed of muscles. It is covered with a mucous membrane. Small nodules of tissue (papillae) cover the upper surface of the tongue. Between the papillae are the taste buds, which provide the sense of taste. In addition to taste, the tongue functions in moving food to aid chewing and swallowing, and it is important in speech. Changes in appearance of the tongue may indicate a primary tongue disorder or may be a symptom of other disorders.

DIFFICULTY MOVING THE TONGUE properly is most often caused by damage to the hypoglossal nerve (cranial nerve XII). It may also be caused by ankyloglossia (tongue-tie), a disorder where the band of tissue that attaches the tongue to the floor of the mouth (frenulum) is too short. These disorders rarely cause difficulty but may result in speech difficulties and/or difficulty moving food during chewing and swallowing.

TASTE ABNORMALITIES can be caused by damage to the taste buds, neurologic abnormalities, side effects of medications, infections, and many other conditions. The tongue normally senses sweet, salty, sour, and bitter tastes. Other "tastes" are actually a function of the sense of smell.

ENLARGEMENT OF THE TONGUE occurs with Down's syndrome, cretinism, acromegaly, myxedema, amyloidosis, rhabdomyoma, and other disorders. The tongue may broaden in persons with no teeth who do not have dentures.

TEMPORARY SWELLING AND COLOR CHANGES occur with acute or chronic inflammation of the tongue (glossitis). Papillae are lost, causing the tongue to appear smooth. GEOGRAPHIC TONGUE (benign migratory glossitis) is a patchy form of glossitis where the location of inflammation and appearance changes may vary from day to day.

HAIRY TONGUE is a benign condition that involves enlargement and profusion of tongue papillae, causing the tongue to appear hairy or furry. Hairy tongue is not a harmful disorder, although it can appear worrisome. The disorder usually clears after antibiotics or other causes are resolved.

BLACK TONGUE occurs occasionally. The upper surface of the tongue turns black or brown in color, and in some cases the papillae elongate. This is an unsightly condition but not harmful.

PAIN IN THE TONGUE may occur with glossitis and geographic tongue. It may also occur in some post-menopausal women (for unknown causes) and with diabetic neuropathy. The tongue may be a site of oral cancer, mouth ulcers, and leukoplakia.
Common Causes:
  • Minor infections or irritations are the most common cause of tongue soreness.
  • A viral ulcer or "canker sore" commonly appears on the tongue (or anywhere in the mouth) for no apparent reason. While it is not medically proven some doctors believe that viral ulcers are linked to emotional stress, fatigue, or lowered resistance.
  • Injury (biting the tongue) can cause painful sores.
  • A hangover or an allergic reaction to food or medication can cause a swollen tongue.
  • Heavy smoking will irritate the tongue and make it painful.
  • A smooth and pale tongue surface suggest nutritional (Vitamin B-12) deficiencies.
  • A coated tongue may be caused by dehydration, oral sex, or antibiotic side effects (such as thrush).
  • An allergic reaction to food or medication can cause tongue swelling.
  • A "hairy" appearing tongue (hairy leukoplakia) is a complication of AIDS.
Possible causes of tongue pain: Possible causes of tongue tremor: Possible causes of white tongue: Possible causes of smooth tongue: Possible causes of red (ranging from pink to magenta) tongue: Possible causes of tongue swelling: Possible causes of a hairy tongue: Possible cause of tongue fissure (grooves in the tongue):
  • congenital defect (normally occurs in 10% of population)
Home Care:
Follow the health care provider's recommendations for treatment.

Good oral hygiene is recommended for hairy tongue and black tongue. Be sure to eat a well-balanced diet.

For tongue problems caused by canker sores, the viruses can't be cured by treatment and must heal on their own. Be patient.

For tongue problems caused by dentures, see your dentist about making adjustments.

For a swollen tongue caused by allergies, antihistamines can help. Avoid the offending food or drug.
Call your health care provider if:
  • the tongue problem is persistent.
What to expect at your health care provider's office:
The medical history will be obtained and a physical examination performed with particular attention to the tongue.

Medical history questions documenting the tongue problem in detail may include:
  • time pattern
    • When was it first noticed?
    • Have you had similar symptoms before?
  • quality
    • Exactly what type of problem is it?
    • Is there pain?
    • Is there swelling?
    • Is there difficulty swallowing?
    • Does it look like a hairy tongue?
    • Does it look like a black tongue?
    • Does it look like an open sore?
    • Is there a tremor?
    • Does it look like a white tongue?
    • Does it look like a smooth tongue?
    • Does it look like a red tongue?
    • Does it look like a fissure?
    • Are there grooves in the tongue?
  • location
    • Where is the problem located on the tongue (all over or just in one location)?
  • aggravating factors
    • What makes the problem worse?
      • Eating?
      • Drinking?
      • Swallowing?
      • Talking?
    • Do you have dentures?
    • Do you have any orthodontic devices?
  • relieving factors
    • What helps?
  • other
    • What other symptoms are also present?
    • Have you noticed changes in taste?
    • What medications are being taken?
    • Are any medical conditions being treated?
    • Has there been a recent injury, such as having the tongue bitten?
    • Do you smoke cigarettes, cigars, or a pipe?
    • Do you use alcohol excessively?
Diagnostic tests will be determined by other symptoms. Blood tests may be used to confirm specific disorders, particularly systemic causes of tongue disorders. Biopsy of tongue lesions may be required in some cases.

Intervention:
Treatment depends on the cause of the tongue problem.
  • Cranial Nerve (CN) XII paralysis is usually treated by treating the cause of the disorder if possible. Therapy may be needed to improve speech and swallowing ability.
  • Ankyloglossia (tongue-tie) may not require treatment unless speech or swallowing difficulties occur. Surgical division of the frenulum will release the tongue and relieve the problem.
  • Mouth ulcers, leukoplakia, oral cancer, and other lesions can be treated by surgical removal of the lesion and/or various medications (see the specific disorder).
  • Glossitis and geographic tongue are treated by treating the cause of irritation or inflammation.
  • Medications prescribed may include corticosteroids to reduce inflammation, and antibiotics or antifungal medications.
  • Other treatments may include treatment for anemia and other disorders, and removal of the source of irritation.
After seeing your health care provider:
You may want to add a diagnosis related to tongue problems to your personal medical record.
Review Date: 11/9/2001
Reviewed By: Ashutosh Kacker, M.D., Department of Otolaryngology, New York Presbyterian Hospital, New York, NY. Review provided by VeriMed Healthcare Network.
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