Black Hair Tongue

Black hairy tongue describes a change in the tongue that is characterized by a dark and furry tongue coating. Although it is cosmetically disturbing, it is harmless in most cases. The causes, symptoms, diagnosis and treatment options are explained below.

Black Hair Tongue

What is a black hairy tongue?

Black hairy tongue is found in around 3 percent of the population, particularly males. It manifests itself in the dark, fur-like coating on the middle to rear third of the tongue. This is caused by the elongation of the filamentous papillae on the tongue, which grow from about 1 mm to 1.8 cm, forming this fur-like covering. See beautyphoon for What is Bipolar Disorder.

These “hairs” are colored green, brown and even black by food and beverages and microorganisms. The coating on the tongue can be very extensive and extend into the so-called pharynx, where it causes a very unpleasant and annoying tickling sensation when speaking and swallowing, and sometimes also a gagging reflex. In many cases, the black hairy tongue disappears on its own after several weeks or months.


The thread papillae are often stained by pigment-forming bacteria and sometimes also by infections with Candida albicans. In the case of the latter, there is often also a strong burning sensation in the tongue. Another possibility is ingested food and stimulants (cigarettes, coffee, tea and alcohol) or medication, such as cortisone or antibiotics, which change the local environment in the oral cavity.

Various possible risk factors are known, but the exact cause has not yet been elucidated. Poor oral hygiene and insufficient tongue scraping of teeth, palate and food, such as when liquids are consumed and insufficient chewing of solid foods, also appear to be important.

The occurrence of black tongue coating is also often observed with a yeast infection, a vitamin deficiency (especially vitamin B) and excessive tobacco consumption. Chemotherapy or radiation treatment, AIDS and severe underweight are also possible reasons. Other possible triggers are irritating substances such as strong mouthwashes or rinses.

Symptoms, Ailments & Signs

The black hairy tongue shows up as a colored, hairy coating on the tongue. The discolouration can be grey, green, yellow, brown or even black. Symptoms may include itching, burning tongue, changes in taste, such as a metallic taste, bad breath, loss of appetite, and nausea.

When swallowing and speaking, it is possible that the “hairs” will make you tickle or vomit. In an extreme case, the tongue coating can lead to swallowing – up to speech disorders. Black hairy tongue can disappear on its own or persist for a long period of time.

Diagnosis & course of disease

The diagnosis should always be made during medical treatment. Here, the elongated papillae over 3 mm are the most important criterion. This is because the tongue can be colored even temporarily without elongation of the filamentous papillae. This can be, for example, when eating blueberries or other fruits.

But this can also be the case when drinking red wine, using mouthwash or taking bismuth salts. Diseases such as hairy leukoplakia, candida mycosis and the like can also produce a similar picture. Thorough questioning of the patient is therefore very important.


In most cases, this complaint does not lead to any special complications or serious complaints. The health of the patient is usually not negatively affected, so that the complaint does not always have to be treated. Most of those affected suffer from a discoloration of the tongue.

This discoloration can be accompanied by itching, which can also cause burning or pain in the tongue. The disease also has a negative effect on the sense of taste, so that changes can occur. Furthermore, those affected often suffer from bad breath, nausea or vomiting. The patient’s quality of life is significantly restricted and reduced.

If there is no treatment, the disease often leads to swallowing difficulties or speech disorders. As a rule, the disease can be treated relatively well with the help of medication. There are no particular complications. Surgical interventions are only necessary in rare cases. The life expectancy of the patient also remains unchanged by the disease.

When should you go to the doctor?

This condition should always be treated by a doctor whenever possible. It usually does not heal on its own, so treatment by a doctor is essential. Furthermore, the symptoms can worsen if the disease is not treated in time. First and foremost, the underlying disease that is responsible for this complaint must also be identified. A doctor should be consulted if the person concerned suffers from a burning sensation and itching on the tongue. This also leads to bad breath and permanent nausea, so that the person concerned also completely loses his appetite.

In many cases, problems with speaking or swallowing also indicate this disease. A doctor should be consulted in particular if the patient suffers from a blackened tongue and the coloration does not go away on its own. In the case of this disease, a dermatologist or a general practitioner can usually be consulted. However, further treatment depends on the exact symptoms and the underlying disease.

Treatment & Therapy

A black hairy tongue can be treated both without medication and with medication: First of all, regular cleaning of the tongue coating with a soft toothbrush or tongue cleaner is recommended. Good oral hygiene is the best way to eliminate contamination and prevent it from recurring. Strong mouthwashes must be discontinued because they can trigger and promote the symptoms.

If possible, the risk factors should be eliminated. The discoloration can be eliminated, for example, after stopping or reducing triggering medication. If you have a dry mouth, make sure you drink enough fluids.

If the symptoms cannot be relieved, medication is another option. Keratolytics such as salicylic acid, trichloroacetic acid or urea can be applied locally in an appropriate dilution. These remedies should of course be prescribed by a doctor. External or internal antimycotics are only used if a fungal colonization with Candida albicans has been detected. In severe cases, the pharmaceutical agent isotretinoin may be considered for treatment.

However, the precautionary measures must be observed here, as numerous side effects are possible. The therapy basically depends on how pronounced the black hairy tongue is. In milder cases, changing the diet and avoiding noxae, such as smoking, usually leads to a reduction in the symptoms and complaints. In severe cases, however, surgical removal under local anesthesia may be necessary.


The best way to prevent black hairy tongue is good oral hygiene, a healthy diet rich in fiber. A soft toothbrush or a special tongue cleaner can significantly support the abrasion of the dark coating on the tongue. It also helps to chew food thoroughly. A coating that remains on the tongue from food residues, germs and cells must be removed by appropriate abrasion.

Therefore, fruit, raw vegetables and solid bread should be chewed thoroughly. In this way, the tongue is rubbed as intensively as possible. Smoking should also be avoided. Potential triggering factors should be avoided. Therefore, it is primarily important to find the causes of black hairy tongue.


The black hairy tongue often disappears on its own after a few weeks or months. In severe cases, symptomatic therapy with vitamin C tablets or tongue scrapers is possible. After the condition has subsided or has been cured, follow-up care by the doctor is necessary. Follow-up care is provided by the ear, nose and throat specialist, the dentist or the general practitioner.

The doctor performs a physical examination and then discusses with the patient any symptoms or side effects of the prescribed medication. During the physical examination, the oral cavity and especially the tongue are examined. For this, the doctor uses a tongue scraper. If necessary, a smear must be taken again. The black hairy tongue can be accompanied by side effects such as inflammation in the mouth, which must be clarified.

If no abnormalities are found, the therapy can be stopped. A one-time follow-up examination is usually sufficient. If complications occur, therapy must be resumed. The patient should consult the doctor at regular intervals until the condition has been cured. Since the black hairy tongue can sometimes also represent a psychological burden, a follow-up discussion with a therapist may make sense. The exact aftercare measures are based on the symptoms.

You can do that yourself

A black hairy tongue can be treated with or without medication. The present symptoms are decisive for this. Very good oral hygiene is the be-all and end-all with a black hairy tongue. Regular cleaning with a soft toothbrush or a tongue cleaner can lead to success in some cases. The focus here is on removing existing contamination and preventing it from recurring. However, strong mouthwashes should be avoided. Under certain circumstances, they can lead to further problems.

Risk factors should also be eliminated as far as possible. The first thing to mention here is nicotine consumption. Various changes in diet and habits often help to alleviate or reduce the disease in mild cases. Various types of medication can also be the cause of this disease. The attending physician should carefully check the existing medication and, if necessary, determine intolerances.

If these measures do not alleviate the symptoms, medication can also be used. The drugs of choice here are keratolytics such as salicylic acid, trichloroacetic acid or ureas. They are applied locally in the appropriate dilution as prescribed by a doctor. Antimycotics are only used after reliable knowledge about the cause of the black hairy tongue is used. Since side effects can occur here under certain circumstances, the use must be carefully considered.