Why do I have a black tongue?

Why is My Tongue Black?

A black tongue is a common but alarming phenomenon. The unpleasing look often leads to insecurities and psychosocial problems. The tongue's surface color may appear on a range from natural pink to black. This appearance is most common in older men.

The tongue will also take on a dark and furry appearance. This change is due to the buildup of skin cells on the tongue’s surface and the accumulation of excess keratin. A typical papilla is 1mm in length, but it can grow as long as 18mm. Food debris and other materials accumulate on these cells, leading to a discolored look.

Fortunately, many of the causes of a black tongue are temporary and reversible.

Black Hairy Tongue

Black hairy tongue is the most common diagnosis accompanying a black tongue.

Symptoms

Black Hairy tongue does not typically cause discomfort. If it is accompanied by a yeast infection, there is a possibility of experiencing burning mouth syndrome. Some patients report a metallic taste in the mouth or even nausea. Bad breath may also be present.

Additional Contributing Factors

- Poor oral hygiene

- Pellagra (Vitamin B3 deficiency)

- Smoking tobacco

- Betel chewing

- Certain medications (such as those containing bismuth found in Pepto Bismol, iron, chlorhexidine, and other metals)

- Dehydration

- Low saliva production (it may be medication or radiation related)

- Drinking a lot of coffee and tea

- Utilizing mouthwashes with peroxide, witch hazel and menthol

- Antibiotic usage (case reports related to minocycline, Linezolid, Metronidazole, Piperacillin-tazobactam, erythromycin, doxycycline)

Treatment

Appropriate treatment involves keying in on the primary cause of the discoloration.

- Increasing daily brushing

- Tongue scraper

- Warm saltwater rinses

- Sodium bicarbonate rinses

- Dry mouth rinses (if the underlying cause

- Antifungal medications are utilized in yeast-associated cases

Avoid mouthwashes with oxidizing agents (peroxides in whitening mouthwashes are oxidizing agents as are chlorine dioxide in breath-freshening