Hairy tongue

Description

A 37-year-old housewife presented with yellow and black discolouration and hairy appearance of the tongue for several months (figure 1). She had smoked 20 pack-years, and had drunk alcohol over 20 years. She admitted chronic use of bismuth-containing oral preparations for her diarrhoea due to irritable bowel syndrome and denied the use of any other drugs. Hairy tongue is a benign hyperplasia of the filiform papillae of the tongue with the formation of highly elongated, cornfied spines or ‘hairs’. This is caused by defective desquamation of the cells in the central column of filiform papillae.¹ A number of aetiological factors have been reported including hyposalivation, poor oral hygiene, trigeminal neuralgia or drugs such as antibiotics, psychotropic agents, smoking and alcohol.^{2 3} Patients may manifest halitosis, stale taste or nausea as well as yellowish or black discolouration of the surface of the tongue. Treatments are hydration, discontinuing suspected agents or drugs, and/or mechanical debridement with a soft toothbrush with toothpaste or tongue scraper two or three times a day. Her symptom diminished after she was instructed to abstain from smoking, alcohol and bismuth-containing agents with improvement of oral hygiene. Her hairy tongue may be attributed to a long history of smoking, alcohol and bismuth-containing agents. Although the black hairy tongue is a benign condition, it is recommended to advise patients to improve their oral hygiene for their cosmetic benefit.

Figure 1.

Yellow and black discolouration and hairy appearance of the tongue.