Patient Story
A 60-year-old man who smokes presents to the physician’s office smelling of alcohol. He complains of a black discoloration of his tongue and a gagging sensation on occasion. He admits to smoking 1 to 2 packs per day along with drinking at least 6 to 8 beers per day. The patient brushes his teeth infrequently and has not seen a dentist for a long time. On physical exam, his teeth are stained and his tongue shows elongated papillae with brown discoloration (Figure 37-1). Diagnoses include black hairy tongue (BHT), poor oral hygiene, and tobacco and alcohol addiction.
Introduction
Epidemiology
Etiology and Pathophysiology
- BHT (Figure 37-1) is a disorder characterized by elongation and hypertrophy of filiform papillae and defective desquamation of the papillae.2,6
- These papillae, which are normally about 1 mm in length, may become as long as 12 mm.
- The elongated filiform papillae can then collect debris, bacteria, fungus, or other foreign materials.1
- In an extensive literature review of reported cases of drug-induced BHT, 82% of the cases were caused by antibiotics (Figure 37-2).1
- Dry mouth (xerostomia) from medications, tobacco, and radiation therapy can lead to BHT.1