Black ‘Hairy’ Tongue

Joseph R Anticaglia MD
Medical Advisory Board

Many people regard the appearance of the tongue as an indicator of their general health. Imagine waking up in the morning, looking in the mirror and seeing your tongue resembling the photo below?

Wikipedia Black Hairy Tongue

Thoughts race through your mind: What is it? How did I get it? Why is it getting worse? Is it cancer? Why have I waited so long before visiting the doctor? How can I get rid of it?

Those thoughts and questions bothered Hank, a 52 year old electrician and two pack of cigarettes a day smoker. He wanted answers to this problem from his doctor.

Surprisingly his doctor said, “It’s nothing serious. You have an extreme case of black hairy tongue (BHT).

“What in the world is that?

The doctor continued, “This problem results from the build-up of dead cells on the surface of the tongue. On the surface of the tongue are tiny bumps called filiform papillae. These finger-like projections periodically slough off. However, when they don’t fall off, they can grow to 10-15 times their normal size. These elongated papillae can become darkly stained by bacteria, yeast, tobacco or food giving the tongue a brown or black furry, hairy appearance

“Regularly using certain mouth washes or products containing bismuth (Pepto-Bismol) can cause BHT. Also, excessive intake of alcohol, coffee or black tea, certain antibiotics can cause this condition.

“The prevalence of BHT is quite variable. People have had symptoms of a metallic taste in their mouth and others have noticed bad breath. If there’s an overgrowth of yeast, patients have complained of a burning sensation of the tongue called glossopyrosis. The tongue may look menacing but the problem is usually harmless, temporary and painless.”

Wikipedia Normal tongue

The treatment entails good oral hygiene. Floss and brush the teeth and gently brush the tongue to remove dead cells from the tongue. Quit smoking and drink enough water so you do not become dehydrated. Again, the tongue looks awful but the condition is not dangerous and does not require medication.


  1. Grigoriy E Gurvits and Amy Tan; Black hairy tongue syndrome; World J Gastroenterol. Aug 21, 2014
  2. Sarti GM, et al; Black Hairy Tongue; Am Fam Physician, 1990
  3. Thompson, Dennis; Drug Induced Black Hairy Tongue; Am College of Clin Pharm, Jan 6, 2012
  4. Govindan Balaji et al; Linezolid induced black hairy tongue; Indian J Pharmacol. Nov-Dec 2014

This article is intended solely as a learning experience. Please consult your physician for diagnostic and treatment options.