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July 2003
By Youn W. Park, MD, and William Ritchey,
DO
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CASE:
A 67-year-old female smoker complains that the central area
of her tongue has turned black. She denies any ulceration,
bleeding or pain associated with this change.
WHAT IS YOUR DIAGNOSIS?
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Black (or brown) hairy tongue, so called for the appearance
of hair growth on the tongue, is characterized by elongated
hypertrophic filiform papillae with an accumulation of bacteria,
fungi, and foreign debris. The resulting discoloration may vary
from tan to black, depending on the contents of the coating.
Although usually asymptomatic, it may be associated with a gagging
sensation or halitosis. The development of this condition is
often related to smoking, poor oral hygiene, antibiotics, systemic
steroids, or local radiation treatment. It is harmless and may
disappear spontaneously. Proper oral hygiene, including frequent
brushing of the tongue, should be part of the treatment. White
hairy tongue is caused by an accumulation of keratin on the
surface and usually is the result of reduced salivary flow.
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Dr. Park is a clinical professor of otolaryngology
at Northeastern Ohio Universities College of Medicine and
section head of otolaryngology at Barberton Citizens Hospital
in Barberton, Ohio. Dr. Ritchey is an attending physician
in the department of family practice at Akron General Medical
Center in Akron, Ohio.
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