Suffering From a Hairy Tongue? Here’s What You Need to Know

Healthy tongue cells regenerate quickly. However, if older cells continue to remain and grow on top of one another, they produce a black, thick, fuzzy overgrowth known as a hairy tongue. Hairy tongue, also known as “furred tongue”, is frequent and affects up to 13% of adults.

Key takeaways:
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    A hairy tongue refers to an abnormal covering of the top (dorsal) surface of the tongue.
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    It occurs due to a defect in the normal shedding process of the filiform papilla and may cause the tongue to appear black, brown, or greenish.
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    Although a black hairy tongue may appear intimidating, it usually causes no health issues and is painless.
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    It can be prevented by maintaining good oral hygiene and reducing smoking and alcohol intake.
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    A regular dentist visit can help you identify the symptoms and risk factors associated with a hairy tongue.

It occurs across all ethnicities and is more frequent in men over 65. Mainly associated with viral infections, smoking, long-term antibiotic usage, and poor hygiene, this condition is generally transient and harmless.

What is a hairy tongue?

The tongue's upper surface is usually coated with conical projections known as filiform papillae. These papillae are typically 1 millimeter in length. These bumps serve two primary functions-provide taste (as they have taste buds) and grip foods.

Like most other cells, the cells on your tongue have a life cycle- they grow, fulfill their role, and then die. If the papilla does not shed timely, a rapid buildup of keratin and more papilla occurs on the tongue surface. With time, the length of these papillae gets pretty long (up to 18mm), giving the top of the tongue a “hair-like” look. In severe situations, food particles, germs, and yeast can collect in the hair-like mesh, giving different tints to the tongue (brown, white, green, and grey). Certain bacteria can produce colors (chromogenic) and give the hairy tongue a black dirty look, known as a “black hairy tongue”.

What causes a hairy tongue?

Among the many causes that can lead to a hairy tongue, the most common ones are:

  • Lack of good oral hygiene.
  • Chronic antibiotic use.
  • Radiation therapy to the head and neck area (in cancer patients).
  • Heavy smoking.
  • Alcohol intake.
  • Heavy coffee or tea drinking.
  • It can also occur in people who have no teeth. Their soft diet prevents the papillae from shedding normally.

Recent research reveals that a hairy tongue can arise as a post-COVID complication. This is because angiotensin-converting enzyme-2 (ACE2), the receptors on which the virus acts, is thickly present on the tongue surface.

Individuals with mild COVID-19 have thinner tongues with lighter hues, but patients with severe COVID can have thicker coats and tender and purple tongues. Microcirculation injury reduced arterial oxygen pressure, and enhanced platelet aggregation are the causes behind the COVID -related tongue color changes.

The study highlights that the most frequent risk factors for developing oral lesions in COVID-19 patients are poor oral hygiene, opportunistic infections (OIs), medicines, and hyper-inflammatory responses to infection. The experts recommended that all suspected cases of COVID-19 patients should undergo an intraoral examination to rule out the possibility of a COVID tongue.

What are the symptoms of a hairy tongue?

Besides the color changes, a hairy tongue is generally without any apparent discomfort. However, in some, it may accompany:

  • A burning or stinging sensation.
  • A gagging sensation due to rubbing of the elongated papilla with the palate.
  • Foul smell from the mouth due to bacteria, food, and yeast accumulation.
  • Altered, metallic taste.
  • A heavy, furry feeling in the mouth.

These symptoms can be due to other oral conditions and vary from person to person. Consulting an oral pathologist is the best choice to get a clear idea.

Risk factors associated with a hairy tongue

People with weak immunity or who suffer from a condition (physical or mental) that limits their ability to brush and floss are prone to developing a hairy tongue. You must keep yourself aware and updated on these risk factors to better manage the condition. Some antipsychotic drugs can reduce the amount of saliva in the mouth, lower the ability of saliva to self-cleanse and aggravate the condition.

Can I prevent a hairy tongue?

A hairy tongue is generally resolved by removing potential causes or contributing factors and maintaining basic dental hygiene:

  • Brush twice daily.
  • Use a tongue cleaner to scrape the tongue surface regularly.
  • Avoid mouthwashes that irritate your tongue.
  • Floss regularly.
  • Rinse your mouth thoroughly after meals.
See your dentist every six months. Professional dental cleanings and frequent oral examinations can help your dentist detect issues.

How to treat it?

Managing the risk factors and practicing good oral hygiene are the pillars of getting rid of a hairy tongue.

Brushing, flossing, and rinsing your mouth correctly can help prevent a hairy tongue.

If you are on medications (antibiotics), the hairy tongue can go away once you stop taking the drug. Consult your doctor to know if you can stop your medicine or opt for an alternative medication.

Cut back on alcohol and smoking to recover your oral health.

Avoid spicy foods.

In most situations, hairy tongue symptoms will resolve within one to two weeks. If these therapies do not work, your doctor might prescribe you antifungal drugs or specific antiseptic mouthwashes.

If the hairy tongue is resistant to the above treatments, surgical trimming of the filiform papilla is the last resort. Diode laser therapy is an emerging therapy for managing a hairy tongue due to its less invasive nature.

If you have a hairy tongue, consider using a tongue scraper or the back of a toothbrush to scrape away the cell layers. Remember, practicing proper oral hygiene is key to avoiding further buildup.

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