Differential Diagnosis for Brown Tongue in an Elderly Person

• Single Most Likely Diagnosis
  • Black hairy tongue (BHT): This condition is characterized by an abnormal elongation of the papillae on the tongue, which can give it a brown or black appearance. It is often associated with poor oral hygiene, antibiotic use, and smoking. In elderly individuals, it may also be related to decreased saliva production, which can lead to an accumulation of bacteria and debris on the tongue.
• Other Likely Diagnoses
  • Oral candidiasis: This fungal infection can cause white patches on the tongue, but in some cases, it may also lead to a brownish discoloration. Elderly individuals with dentures, diabetes, or those taking antibiotics are more prone to developing oral candidiasis.
  • Lichen planus: This chronic inflammatory condition can affect the mucous membranes in the mouth, including the tongue, and may cause brown or white patches.
  • Tobacco use: Smoking or using smokeless tobacco products can cause staining on the tongue, leading to a brown appearance.
• Do Not Miss Diagnoses
  • Vitamin deficiencies (e.g., vitamin B12, iron, or folate deficiency): These deficiencies can cause changes in the appearance of the tongue, including a brownish discoloration. It is essential to rule out these deficiencies, as they can have significant health implications if left untreated.
  • Diabetes mellitus: Uncontrolled diabetes can lead to oral infections, including those that cause a brown tongue. It is crucial to consider diabetes as a potential underlying cause, especially in elderly individuals with other risk factors.
• Rare Diagnoses
  • Hairy leukoplakia: This rare condition is associated with Epstein-Barr virus infection and can cause white or brown patches on the tongue.
  • Melanin deposition: In some cases, an increase in melanin production can cause a brownish discoloration of the tongue. This is a rare condition and would require further investigation to determine the underlying cause.
  • Medication side effects: Certain medications, such as minocycline or bismuth subsalicylate, can cause tongue discoloration as a side effect. While rare, it is essential to consider the patient's medication history when evaluating a brown tongue.