Hairy tongue is the common name given to a condition that causes your tongue to look “hairy.” Though the name and the appearance may make you think hair is growing on your tongue, this condition has nothing to do with actual hair growth.
Hairy tongue results when the filiform papillae (FP) on your tongue do not shed as they should. FP are cone-shaped projections on the surface of your tongue. They’re usually about 1 millimeter (mm) long. Like skin cells, the cells on your tongue have a life cycle that allows them to grow, serve their purpose, and then fall off.
For people with hairy tongue, the FP grow longer instead of falling off. They may become as long as 18 mm. As they grow, the FP begin collecting debris like bacteria and food. The foods you eat and the products you put in your mouth can also discolor the FP.
As this happens, the elongated FP begin to look like hair. This is where the condition draws its name. Hairy tongue is often temporary and usually quite harmless.
Hairy tongue is also relatively common. About 13 percent of the population will experience one form of hairy tongue at least once in their lifetimes.
Hairy tongue is more common in older people, though it can develop at any age. It’s also more common in men.
More than one type of hairy tongue exists, and each has several identifying characteristics. They all also happen to have different causes. Understanding which type you have and what causes it can help you learn to treat it.
It’s not clear what causes hairy tongue, but certain factors can increase your risk for developing the condition. For example, a lack of stimulation on the top of the tongue can prevent proper shedding. A person who eats a soft-food diet may not have enough stimulation in their diet to cause enough abrasion.
Other causes may also increase the chances of developing hairy tongue. These include:
- use of certain medications, especially antibiotics and proton-pump inhibitors (used to treat acid reflux)
- poor oral hygiene (not brushing your teeth regularly or well enough)
- radiation therapy, especially to the head and neck
- excessive use of alcohol
- use of cocaine
- dry mouth (xerostomia)
- excessive coffee or tea consumption
- smoking, chewing, or dipping tobacco
Black and hairy tongue
Black hairy tongue shares many of the same causes with all hairy tongues, but specific factors give this condition the telltale “black” look.
As the irregular FP on the tongue’s surface build up, the cells can become discolored by the foods and beverages you consume, as well as products you use. These include:
- tobacco (smoking, dipping, or chewing)
- coffee or black tea
- mouthwashes that contain whitening or oxidizing ingredients, such as peroxide
- mouthwashes that contain astringent ingredients, including menthol and witch hazel
In addition, substances like bacteria and yeast can discolor the FP. As the FP grow longer, these substances can get caught in the hair-like structures, which can lead to greater discoloration.
White and hairy tongue
White hairy tongues may be the result of hairy leukoplakia. This condition causes small, white patches with hair-like texture. These patches can grow to cover the entire tongue.
Unlike black hairy tongue, hairy leukoplakia has very specific causes. This condition is caused by two main conditions:
Epstein-Barr virus (EBV): This virus is very common. It can cause infectious mononucleosis, which is also called mono, among other illnesses. Most people will have at least one encounter with EBV in their lifetimes. Once you encounter the virus, it remains in your body. The virus can be reactivated if you have a weak immune system. When it’s active, it can cause many symptoms and conditions, including hairy leukoplakia.
HIV/AIDS: People with HIV or AIDS are more likely to develop a hairy, white tongue. In some people, the hairy tongue may be the first sign of an HIV infection. Most treatments for HIV and AIDS keep hairy leukoplakia away, but if the condition returns, it could be an early indication your medicines aren’t working properly.
Hairy tongues can take on other hues, including brown, gray, pink, and green. In almost all cases, however, the causes are the same as black hairy tongue.
The color is the result of foods or drinks you’re consuming or products you’re using. For example, candies and mouthwashes can color the FP.
A hairy tongue is almost always painless and rarely causes any other symptoms. Still, some symptoms or complications of hairy tongue can occur at the same time as the elongated FP.
These additional symptoms include:
- Burning on the tongue: The bacteria or yeast growth may cause a burning or stinging sensation.
- Gagging or tickling sensation: The extra-long FP may tickle the roof of your mouth or the back of your throat, especially as you swallow. If you’re extra sensitive to this sensation, you may experience gagging.
- Bad breath: The bacteria or yeast growth occurring in the FP can cause a smell. Rinsing with mouthwash to remove the smell may make the issue worse.
- Abnormal taste: The bacteria or yeast growth occurring on your tongue may alter the way food tastes. The extra-long FP can even cover up taste buds and prevent you from properly tasting what you eat or drink.
Hairy tongue is often only temporary, and usually it isn’t a sign of a more serious problem. However, some of the main causes of hairy tongue are the result of lifelong habits, such as smoking, so it may be necessary for you to actively try to treat the condition.
The most common strategies for treating hairy tongue include the following:
- Have good oral hygiene: Properly brushing, flossing, and rinsing your mouth can prevent hairy tongue.
- Scrape your tongue: You can purchase specialized tongue scrapers to help you clean your tongue and remove dead FP.
- Discontinue the responsible medications: In some cases, once you stop using a medication, the hairy tongue will disappear. Ask your doctor if it’s okay to stop using the medicine you suspect might be causing hairy tongue. You may also be able to find an alternative medicine with your doctor’s help.
- Stop bad habits: Smoking, excessive alcohol use, and some drugs can lead to hairy tongue. Cut back or stop altogether to restore a healthy mouth.
- Consider what you’re eating and drinking: Dark-colored liquids and foods can dye the FP on your tongue. These include black tea and coffee. Opt for more clear liquids like water.
If these treatments aren’t successful, you can talk with your doctor about more aggressive treatments. These include:
- prescription antifungal medicines
- over-the-counter (OTC) antiseptic mouthwash, such as Listerine or Orajel
- surgical treatment to trim the FP
You don’t need to see a doctor for hairy tongue unless the treatments you try at home, such as practicing good oral hygiene, aren’t successful. If that’s the case, make an appointment with your doctor or dentist to talk about your options.
Your doctor or dentist will verify a hairy tongue diagnosis by examining your mouth and taking your medical history. In rare cases, they may want to evaluate skin from your tongue. If they decide that’s necessary, your doctor may take a biopsy or scraping from your tongue.
The two of you can discuss treatment options and strategize how to eliminate hairy tongue if your first treatments aren’t successful.
The best way to prevent hairy tongue is to practice good oral hygiene. Keep these tips in mind:
- Brush at least twice a day. Brush your teeth after you wake up and before you go to bed. If you can, brush after each meal, too.
- Brush the top of your tongue. Don’t just focus on your teeth. Brush your tongue, too. If brushing the back of your tongue makes you gag, slowly work to move further and further back until you’re comfortable.
- Floss well. The spaces between your teeth can hide bacteria and food that can lead to greater problems both for your gums and teeth, as well as your tongue.
- Rinse with an antiseptic mouthwash. These OTC products help kill bacteria and reduce the risk of buildup on your tongue.
- Take care of your teeth. Coffee, black tea, and soda are highly abrasive liquids. They’re bad for your teeth, but they can affect your tongue, too. Try to drink fewer of those liquids and more clear ones, like water or green tea.