Black Hairy Tongue: What Causes It and How to Treat It

Medically Reviewed By Meredith Goodwin, MD, FAAFP
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Black hairy tongue is a harmless, temporary condition that causes the tongue to look hairy with a black or dark brown coating. The discoloration often starts toward the back of the tongue and moves forward. Also called lingua villosa nigra, black hairy tongue may look worrying but is not serious. It is also unrelated to a symptom of niacin deficiency called “black tongue.”

Black hairy tongue is more common in adults than children, and appears more often in men than women. People with cancer, people who smoke, and people who drink black tea may also be at a greater risk of developing black hairy tongue.

Read on to learn more about the causes, symptoms, treatments, and prevention of black hairy tongue.

Sex and gender exist on a spectrum. This article uses the terms “men” and “women” to refer to sex that was assigned at birth.

What are the causes of black hairy tongue?

A woman brushing her teeth
Studio Firma/Stocksy United

Black hairy tongue can result from many factors. Sometimes, the papillae on the tongue do not shed at their typical rate.

Our tongues have several parts that allow us to taste. Papillae, which are thin hair-like structures about one millimeter long, cover the tongue. Papillae contain taste buds and usually shed from our tongues at a regular pace.

When papillae do not shed regularly, a protein called keratin builds up. Bacteria, yeast, or even food particles can collect on the long papillae and create what looks like a black coating.

There are several other factors that can lead to black hairy tongue, such as:

  • taking antibiotics, which can change the bacteria in your mouth and body
  • taking medicines that contain bismuth subsalicylate, like Pepto-Bismol
  • having dry mouth
  • smoking
  • chewing tobacco
  • drinking too much alcohol, coffee, or tea
  • using certain mouthwashes
  • experiencing trigeminal neuralgia, a condition that causes facial pain
  • lacking brushing or routine care for the mouth and teeth

What can black hairy tongue look like?

Black hairy tongue
Black hairy tongue can result from a buildup of dead skin cells and bacteria. It may also have different colorations, including brown, green, or yellow. Photo by Mohammad2018, 2019.

As the name suggests, black hairy tongue looks like small, longer hairs grouped together toward the back of the tongue and coated with a discolored substance.

Depending on the cause of the buildup on the papillae, your tongue may look black or brown. It can also look green, white, or pink but will retain its “hairy” appearance.

What other symptoms might occur with black hairy tongue?

Some people also experience other symptoms with black hairy tongue. These symptoms may include:

  • bad breath or taste in the mouth
  • sensation of tickling or burning on the tongue
  • dysgeusia, or a distortion of your sense of taste
  • nausea or gagging

How do doctors diagnose black hairy tongue?

A doctor or dentist can diagnose black hairy tongue after performing a physical examination and asking about your current medications and mouth care routine. If there is no obvious cause — like medications, medical conditions, or behaviors — your doctor might order more testing.

In some cases, cultures can help doctors determine if there are any bacterial or fungal infections present. If the condition does not respond to gentle brushing, a tongue biopsy may be necessary.

What are the treatments for black hairy tongue?

The treatment of black hairy tongue will depend on the cause. Once the cause is known, treatment often includes avoiding the factors that led to it. This may include stopping a specific medication, quitting smoking, or improving dental habits.

Doctors and dentists also typically recommend gently brushing the tongue a few times daily with a toothbrush or tongue scraper to remove the coating and encourage the papillae to shed.

What is the outlook for people with black hairy tongue?

After starting treatment, black hairy tongue often clears up within 1 or 2 days to possibly a few weeks. If an underlying condition contributes to black hairy tongue, managing that condition will be necessary in order to prevent a recurrence.

What are the risk factors for black hairy tongue?

Men and older adults may be at a greater risk of developing black hairy tongue. Around 40% of people who develop the condition are more than 60 years old. Other risk factors may include:

  • taking antibiotics or certain other medications
  • smoking or using tobacco
  • undergoing radiation therapy on the head or neck
  • lacking teeth
  • having difficulty maintaining dental hygiene habits
  • living with HIV

In addition, a soft or liquid diet may allow papillae on the tongue to continue to grow. Also, people who have had black hairy tongue are more likely to experience it again.

Can you prevent black hairy tongue?

To prevent black hairy tongue, experts recommend practicing daily oral hygiene by regularly brushing and flossing, and brushing your tongue with a toothbrush or tongue scraper.

Your doctor can tell you what else may be causing your black hairy tongue and recommend behavior modification, like smoking cessation programs, to help you.

Frequently asked questions

Here are a few other commonly asked questions about black hairy tongue.

Is black hairy tongue a fungus?

In some cases, black hairy tongue can result from a fungal infection. Your doctor may prescribe antifungal medications and recommend diligent oral hygiene to help clear up the condition.

Is black hairy tongue serious?

Black hairy tongue is generally not serious. Many times, gentle brushing and practicing oral hygiene habits are the only necessary treatment measures.

Summary

Black hairy tongue is not a serious condition and is easy to diagnose and treat. It generally looks like a furry black or brown patch on the top of the tongue.

Black hairy tongue can have many causes, so treatment may vary. Brushing the teeth and tongue regularly is important for treating and preventing black hairy tongue. The condition usually recedes within a few days or weeks after starting treatment.

Talk with your doctor if you experience symptoms consistent with black hairy tongue.

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Medical Reviewer: Meredith Goodwin, MD, FAAFP
Last Review Date: 2022 Jun 23
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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  2. Hairy tongue. (2015). https://www.aaom.com/hairy-tongue
  3. Owczarek-Drabińska, J. E., et al. (2020). A case of lingua villosa nigra (black hairy tongue) in a 3-month-old infant. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7774497/
  4. Redzic, S., et al. (2021). Niacin deficiency. https://www.ncbi.nlm.nih.gov/books/NBK557728