What is the treatment for a black tongue?

Treatment for Black Tongue

The primary treatment for black tongue involves gentle tongue brushing or scraping and elimination of predisposing factors, which usually leads to resolution of the condition. 1

Causes and Clinical Presentation

Black hairy tongue (BHT) is a benign condition characterized by:

• Elongated filiform lingual papillae with a carpet-like appearance on the dorsum of the tongue 1
• Prevalence ranging from 0.6% to 11.3% geographically 1
• Common predisposing factors including:
  • Medications (particularly antibiotics) 2
  • Poor oral hygiene 1
  • Smoking 1
  • Excessive coffee/black tea consumption 1
  • Xerostomia (dry mouth) 1

Treatment Algorithm

First-line Management:

1. Identify and discontinue the offending agent

   • If medication-induced (such as antibiotics or bismuth subsalicylate), discontinue if possible 2, 3
   • Bismuth subsalicylate can cause temporary darkening of the tongue 3

2. Improve oral hygiene

   • Gentle tongue brushing or scraping to promote desquamation 1
   • Regular oral hygiene maintenance 1

3. Modify chronic predisposing factors

   • Reduce or eliminate smoking 1
   • Decrease excessive coffee/black tea consumption 1
   • Address xerostomia if present 1

For Persistent Cases:

• Antifungal therapy may be considered if fungal overgrowth is suspected, such as fluconazole 4
• Traditional Chinese Medicine has shown efficacy in some cases, particularly when black tongue is associated with gastrointestinal symptoms 5

Special Considerations

In Pediatric Patients:

• BHT is extremely rare in newborns and infants 6
• Careful evaluation is needed to avoid unnecessary treatments 6
• Gentle tongue cleaning is typically sufficient 6

Associated Symptoms:

• While often asymptomatic, BHT may cause:
  • Aesthetic concerns 1
  • Halitosis (bad breath) 1
  • Dysgeusia (altered taste) 1
  • Burning mouth sensation 1
  • Gagging or nausea 1

Prognosis

• Excellent prognosis with appropriate management 1
• Typically self-limiting and resolves within 1-2 weeks after elimination of causative factors 2
• In rare cases, may be associated with underlying systemic conditions that require further evaluation 4

Common Pitfalls to Avoid

• Misdiagnosis as thrush (oral candidiasis) leading to unnecessary antifungal treatment 6
• Failure to identify and address the underlying cause, leading to recurrence 1
• Aggressive tongue scraping, which can cause trauma and worsen symptoms 1
• Overlooking potential systemic conditions in persistent cases that don't respond to standard treatment 4