History
Because hairy tongue is usually asymptomatic, the history is often irrelevant.
In most cases, lesions are noted as part of an intraoral examination, although patients may complain of a tickling or gagging sensation. Most patients with hairy tongue have a positive history of coffee or tea drinking, often in addition to tobacco use.
Although hairy tongue has been reported with increasing prevalence in persons who are HIV positive and in persons who are HIV negative and use intravenous drugs, it is not considered to be of any diagnostic or predictive value and probably represents a manifestation of social habits (eg, using tobacco, drinking coffee or tea).
Patients occasionally notice the condition of the tongue during tooth brushing and present to the office with concerns regarding potential malignancy.
See the images below.
Brown hairy tongue in a middle-aged man who smokes cigarettes. The condition is limited to the posterior two thirds of the dorsal surface of the tongue.
Close-up view of brown hairy tongue in a middle-aged man who smokes cigarettes. The condition is limited to the posterior two thirds of the dorsal surface of the tongue.
Physical Examination
Hairy tongue clinically appears as an elongation of the filiform papillae on the dorsal surface of the tongue.
Papillae, which are normally minimally keratinized and appear pinkish white, often retain pigments from food, beverages, and candies, resulting in the varying colors associated with the condition (eg, black, brown, white, green, pink). The tongue has a thick coating in the middle, with a greater accentuation toward the back.
Bacterial and fungal overgrowth, such as chromogenic bacteria or Candida species, [22] play a role in the color of the tongue.
In extreme cases of hairy tongue, a blast of compressed air results in the papillae "waving in the breeze."
Complications
Complications associated with hairy tongue are rare but can include glossodynia, taste aberration, halitosis, gagging, and nausea. Fungal superinfection can be appropriately managed with antifungal medications. Candidal overgrowth often results in an uncomfortable glossopyrosis (burning tongue).
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Brown hairy tongue in a middle-aged woman who drinks coffee. Note how the condition is limited to the mid-dorsal part of the tongue, becoming more prominent toward the posterior part.
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Brown hairy tongue in a middle-aged man who smokes cigarettes. The condition is limited to the posterior two thirds of the dorsal surface of the tongue.
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Close-up view of brown hairy tongue in a middle-aged man who smokes cigarettes. The condition is limited to the posterior two thirds of the dorsal surface of the tongue.
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This patient is a middle-aged woman who drank coffee and smoked cigarettes for many years. Her chief complaint was a tickling sensation in the oral pharynx during swallowing. The slight greenish cast to her tongue was due to the use of a mouthwash immediately prior to her appointment.
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This male geriatric patient had smoked a pipe for many years. He was unaware of the presence of his hairy tongue until it was brought to his attention during a routine dental examination.
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Male geriatric patient had smoked a pipe for many years. He was unaware of the presence of his hairy tongue until it was brought to his attention during a routine dental examination. Photo 1 month following his initial examination. While he has not decreased his pipe smoking, he has gently brushed the dorsal surface of his tongue when he brushes his teeth during the intervening 4 weeks. The hairy tongue has completely resolved.
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Middle-aged woman with a hairy tongue that is brown.
