Laboratory Studies
Culture of the tongue's dorsal surface may be taken if a superimposed oral candidiasis or other specific oral infection is suspected.
Cytologic smears stained with Gram stain or periodic acid-Schiff stain may reveal candidal organisms.
Potassium hydroxide preparations are useful for rapid diagnosis of oral candidiasis, as are latex agglutination-based card tests (eg, CandidaSure).
Procedures
As the finding of pigmentation in the oral cavity may represent systemic disease, normal physiologic pigmentation, medication-induced hyperpigmentation, or a localized neoplasm, a biopsy may be in order to help with diagnosis. [25] A simple biopsy and histologic examination may be helpful in distinguishing between similar-appearing conditions. In HIV patients, oral hairy leukoplakia may appear similarly to hairy tongue. A mucosal punch biopsy and appropriate immunostaining of the specimen for the presence of Epstein-Barr virus may differentiate the two conditions. However, mechanical debridement of suspected hairy tongue may be the most straightforward approach. [26]
Histologic Findings
Histopathologic findings in hairy tongue consist of elongated filiform papillae, with mild hyperkeratosis and occasional inflammatory cells. Finding accumulated debris intermingled among the papillae and candidal pseudohyphae is not unusual. No other specific microscopic findings are associated with this entity.
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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.
