If you notice your tongue is black and hairy, you might get freaked out (and rightfully so). A color and texture so off-putting—and completely different from the normal pink color and flat texture of a healthy tongue—would be alarming to anyone.
The good news is that it doesn't usually mean anything too serious. But it does require immediate care, and it is certainly a sign that you need to make serious changes to your daily habits or diet.
In this article, we'll explain what black tongue is, its possible causes, and how to treat it effectively.
What Does A Black Tongue Mean, Exactly?
Those who find themselves with a black tongue often think the worst—that it's a sign of cancer or another life-threatening condition. The truth is that this discoloration can be caused by a number of benign factors, and it is rarely something serious.
In medical terms, the condition is known as "black hairy tongue" (BHT), and it occurs when bacteria, fungi, and dead skin cells accumulate on the tongue's papillae—tiny protrusions on the tongue that give it its characteristic texture.
This buildup then causes the tongue to turn black or brown in color and might cause it to become hairy-looking. Those with BHT may also experience a bad taste in their mouth or halitosis (i.e., bad breath), as well as a feeling of tingling or numbness on the tongue.
Is Black Tongue Dangerous?
Although spots on your tongue are unnatural, black tongue itself is usually not dangerous. It is not cancerous, nor does it indicate any other serious medical issue. But that doesn't mean you should ignore the condition or not seek help.
In some rare cases, the bacteria on the tongue can cause an infection, which can make your tongue sore or swollen and might lead to bad breath or a bitter taste in your mouth.
Since black hairy tongue is also a direct result of poor oral hygiene, there might be other affected areas (e.g., your gums or teeth) that you should address to protect your mouth from other potential infections.
Black Tongue Symptoms
The symptoms of black hairy tongue vary, but the most common one is obviously its discoloration. Depending on the cause and severity, it can range from dark brown to a deep black color.
Beyond the color, there are a few other signs of BHT that you should look out for:
- Unpleasant taste in the mouth. When you have black tongue, you might notice a bitter taste in your mouth. This is caused by bacteria and other organisms that accumulate on the papillae of your tongue.
- A burning or itching sensation. BHT can cause your tongue to feel weird, similar to a "pins and needles" sensation. This can make eating or drinking uncomfortable.
- A feeling of dryness or discomfort in the mouth. The accumulation of bacteria on your tongue may cause a dry, stiff feeling that can be uncomfortable.
- Halitosis (bad breath). BHT can cause bad breath due to the bacteria on your tongue and as a result of an overgrowth of yeast in your mouth.
- Other discoloration. Some patients find parts of their tongue to be yellow or gray in color. This is a sign that bacteria and other organisms are still active on the tongue.
Causes Of Black Tongue
To get to the bottom of your condition or prevent it from happening, it's important to understand what might have caused it in the first place. Here are a few possible causes:
Poor Oral Hygiene
The most common cause of black hairy tongue is poor oral hygiene—namely, not brushing and flossing regularly and/or not using a tongue scraper. If you consistently skip your oral hygiene routine, bacteria, fungi, and dead skin cells will build up on your tongue.
Black tongue isn't usually the first, second, or third sign of poor oral hygiene. It takes time for the bacteria and other organisms to accumulate enough to discolor your tongue.
Most people notice yellow teeth, bad breath, tooth sensitivity, and other signs of poor oral hygiene long before their tongue turns black.
Liquid Diet
Eating solid food helps remove bacteria from your tongue. When you bite into, chew, and swallow your food, some of the bacteria gets scraped off. But when you go on a liquid-only diet (e.g., smoothies, shakes, or juice cleanses) for an extended period of time, you might notice a black discoloration on your tongue within days.
This is because drinking liquids is not as effective at removing bacteria from the tongue as eating solid food. Since they don't have the same mechanical action on your tongue, they won't be able to clean your tongue as effectively.
Medication Side Effects
Studies have shown multiple medications as potential causes for black tongue. There are several antibiotics and antifungal medications that can cause discoloration, including:
- Erythromycin
- Minocycline
- Doxycycline
- Fluconazole
- Itraconazole
- Penicillin
Antipsychotic and chemo drugs have also been linked to black tongue discoloration, although they typically cause xerostomia (dry mouth) more than BHT.
Low Saliva Production
When saliva production is low, normal bacteria on the tongue can't be washed away, which leads to a bacterial overgrowth. This is especially true for people with dry mouth as saliva helps keep the oral cavity clean.
Diabetes can impact your oral health in various ways, one of which is dry mouth. Not only does diabetes cause low saliva production, but it can also make you more prone to infection. Both of these put you at risk for developing black tongue discoloration.
Other conditions like Sjogren's syndrome, HIV/AIDS, and anemia can cause dry mouth as well.
Beyond these medical causes, dry mouth is often caused by dehydration, lifestyle habits, and certain medications.
What Increases The Risk Of Black Hairy Tongue?
Aside from the things that directly cause BHT, there are other factors that can increase the risk. Poor oral hygiene habits make it easier for bacteria, fungi, and dead skin cells to accumulate on the tongue.
Here are some of the most common lifestyle habits that can increase the risk of black tongue:
Drinking Lots Of Coffee And Tea
If you’re a big fan of coffee or tea, you might want to consider cutting back. Coffee and tea contain tannins (i.e., pigmented molecules), which can discolor the tongue over time.
Drinking too much of these beverages can also lead to dehydration and dry mouth, both of which can contribute to black tongue discoloration.
Of course, most of the world drinks coffee and tea and does not experience BHT, so the risk is relatively low. But if you are already at risk for BHT due to other factors, it may be a good idea to cut back on these beverages.
Tobacco Use
It's no secret that smoking cigarettes, chewing smokeless tobacco and using various other forms of tobacco can have a devastating effect on one's oral health.
These products put individuals at an increased risk for developing cancer, gum disease and cavities. Among those aged 20 to 64 who currently smoke cigarettes, more than 40% suffer from undiagnosed tooth decay.
Excessive smoking can also cause black hairy tongue, as the carcinogenic chemicals in cigarettes can lead to discoloration. Smokers may also be more likely to develop bacterial overgrowth or fungi on their tongues due to poor oral hygiene habits and low saliva production.
In addition, smokeless tobacco users are at an increased risk for developing BHT because the small particles of tobacco can get lodged in the tongue’s papillae, creating an ideal environment for bacteria and fungi to grow.
Heavy Alcohol Use
Alcohol is a well-known culprit for many oral health issues, including black tongue.
Heavy alcohol consumption can lead to dehydration, dry mouth, and poor oral hygiene habits—all of which increase the risk for BHT.
Alcohol can also cause irritation and inflammation in the mouth, making it more susceptible to bacterial overgrowth.
That said, the likelihood of alcoholic beverages causing black tongue depends on the frequency with which you do so. Research shows that daily excessive drinking is generally associated with black tongue discoloration, rather than occasional or binge drinking.
Certain Medications
As previously mentioned, certain medications can cause dry mouth, which in turn increases the risk for BHT.
These include drugs used to treat allergies, pain, high blood pressure, depression, and anxiety. Antihistamines and decongestants are especially known for causing dry mouth.
If you’re taking any of these types of medication, talk to your doctor to see if they can help you manage the side effects. Sometimes, switching to a different medication or adding saliva-stimulating products (such as sugarless gum) can help reduce dry mouth.
Another thing to consider is that certain medications may cause a darkening of the tongue itself, rather than just discoloration. Vitamin deficiencies resulting from some medications can cause purple tongue discoloration, for example.
Radiation Therapy
Radiation therapy used in cancer treatment is well-known for its taste-altering side effects. However, it can also increase the risk for black tongue due to its effect on saliva production and immune system function.
Particularly when treating cancers in the head, face, and neck region, oral health can rapidly deteriorate due to radiation therapy.
In rare cases, this can result in hyperpigmentation of the tongue, leading to a different type of black tongue discoloration.
Dry Mouth
Having a dry mouth can increase the risk for BHT, as saliva is an important part of keeping the tongue healthy and clean.
Dehydration, certain medications, and high stress levels are all common causes of dry mouth.
Most of these issues can be managed with lifestyle changes or medication, but if you’re having trouble keeping your mouth moist, it may be a good idea to see your doctor.
Some Types Of Mouthwash
Using a regular mouthwash can help keep your mouth clean, but some types of mouthwash can increase the risk for BHT due to their high alcohol content.
For example, some mouthwashes contain up to 25% alcohol, which can lead to dehydration and dry mouth. Alcohol-free mouthwash is usually a better option for those with BHT or side effects that can lead to BHT.
It’s also important to note that some types of mouthwash contain antibacterial agents, which can have the opposite effect by overstimulating oral bacteria.
How Do You Get Rid Of A Black Hairy Tongue?
Black tongue is typically a temporary condition, but getting rid of it (and preventing it in the future) can take some effort.
Oral Hygiene
When it comes to prevention and reversal, oral hygiene is key. Not only will it help you reverse black tongue, but it will also reduce the risks of developing dry mouth and other oral health issues that cause black hairy tongue.
Brush twice daily with a soft-bristled toothbrush and fluoridated toothpaste, and floss regularly. It’s also important to limit sugary snacks and drinks, as these can feed bacteria that cause BHT.
If you are a smoker, quitting or reducing your smoking habits is also critical to improving your dental health.
Saliva Stimulating Products
Over-the-counter saliva stimulants can also be helpful in reducing dry mouth and getting rid of BHT. These include sugarless gum, lozenges, sprays, and other products that are specifically designed to increase saliva production.
To stimulate your saliva, you may also find it helpful to suck on a lemon wedge or drink cold, unsweetened tea.
Dietary Changes
Making dietary changes is another way to prevent BHT. Eating a diet rich in vitamins and minerals can help keep your tongue healthy and reduce discoloration.
In addition, avoid processed foods, which are often high in sugar or sodium that can feed bacteria on the tongue.
Medications
If you have a black hairy tongue and your oral hygiene habits have not been able to get rid of it, you may need to take further steps in order to remove it.
Antibiotics, antifungal medications, mouthwash or retinoids (drugs related to vitamin A) can all be used to treat the condition.
It is important to ensure that these treatments are taken properly and for an adequate amount of time, as this will increase the chances of eliminating black hairy tongue.
Surgery
In severe cases where no regular treatment seems to solve the problem, a minor surgery may be necessary. This can involve removing the discolored tissue from your tongue, as well as some healthy tissue for testing.
Laser surgery is also an available treatment for BHT, as it can quickly and effectively remove the discolored tissue without damaging the healthy parts of the tongue.
What Causes Pseudo-Black Hairy Tongue?
If your tongue isn't completely black and looks more like a dark shade of pink, you may have pseudo-black hairy tongue.
This condition is caused by the same factors as black hair tongue and can also be prevented and treated with many of the same methods. However, it's important to note that there are several other causes of discoloration on the tongue that require different treatments.
Black Tongue Diagnosis
In most cases, black tongue can be diagnosed by a visual inspection of the tongue. Your doctor may also take a swab sample to test for bacteria or fungi that can cause the discoloration.
Generally, your dentist will know almost right away that you have BHT, as its visible symptoms are dead giveaways.
Black Tongue Home Remedies
In addition to the treatments detailed above, there are plenty of home remedies available that can help you treat black tongue. And most of them are probably in your home or readily accessible.
Brush Your Tongue.
Most people skip over or forget about their tongue when they brush their teeth. But it’s actually just as important to scrub your tongue when brushing to remove the bacteria, fungi and dead skin that cause black tongue.
Since your tongue is such a wide surface, it can house a lot of bacteria. And there are plenty of other issues that can arise from poor tongue hygiene, including thrush (white tongue) and other problems.
Use A Tongue Scraper.
A tongue scraper is a tool that is used to help remove bacteria, fungi, and dead skin cells from the surface of the tongue. It's often made of metal or plastic and works by gently scraping the top layer of cells off the tongue.
This helps to reduce bad breath, as well as providing other health benefits such as improving the taste of food. For those who want to protect themselves against BHT, however, the biggest benefit is that it prevents dead cells and bacteria from accumulating on the tongue's surface.
Brush After Eating.
Beyond your typical twice-per-day routine, going a step further and brushing your tongue after each meal can be beneficial. The combination of eating, drinking and talking can all contribute to the accumulation of bacteria on your tongue, which is why it’s important to brush or scrape as soon as possible after meals.
Stop Using Tobacco Products.
As we mentioned earlier, tobacco and nicotine products are terrible for your mouth—including your tongue. Not only do they discolor the tongue, but using them can also lead to an increased risk of developing oral cancer, tongue ulcers, and other unwanted problems. So if you’re trying to get rid of BHT and other problems in your mouth, kicking the habit is a great first step.
Floss Before Bed.
While you sleep, your mouth is prone to collecting bacteria and other debris on its surfaces. The food particles between your teeth will then have several hours to settle in, replicate, and cause damage. Flossing every night will help to remove these particles before you go to bed, leaving your mouth healthier overall.
Schedule A Cleaning.
Regular dental cleanings are essential for anyone who wants to maintain good oral hygiene. During a cleaning, your dentist will use special tools to remove plaque and tartar buildup on the teeth that can cause discoloration and other problems in the mouth.
It’s also important to keep up with regular checkups at your dentist's office so they can monitor for any changes or new developments in your mouth. This is especially important if you’re trying to treat or prevent oral health problems like black hairy tongue.
Drink Plenty Of Water.
Staying hydrated is critical for oral health, as it helps to flush out bacteria and other debris in the mouth. It’s also important to make sure that you are drinking water throughout the day, not just when you feel thirsty.
If you aren't drinking enough water, the acidity levels in your mouth will increase, which can lead to a number of problems including tooth decay, gum disease, and even black hairy tongue.
Summary
Black hairy tongue (BHT) is an oral health condition that can be caused by a variety of factors. Though it may be alarming (and unattractive), it isn't necessarily the worst thing that could happen to you.
BHT generally goes away on its own, but there are a few steps you can take to prevent it from occurring in the first place. These include brushing your tongue regularly, using a tongue scraper, brushing after eating, and stopping tobacco use.
Above all, taking preventive measures is your best bet when it comes to managing black hairy tongue. As long as you're brushing your teeth twice daily, meeting with your dentist every six months, and talking otherwise sufficient care of your teeth, there's a good chance BHT will never be an issue for you.
Want to learn more? Here are the questions our customers ask us the most.
How Common Is Black Hairy Tongue?
Black hairy tongue is a relatively common condition due to its ability to occur even with proper oral hygiene. It is a potential side effect of some common medications like penicillin, further contributing to its ubiquity. Globally, its prevalence varies wildly based on general access to proper dental care and hygiene.
What Does A Black Tongue Indicate?
Although a black tongue is harmless, it can indicate a few different things:
- Poor oral hygiene
- A medication side effect
- Underlying medical conditions such as asthma or diabetes
It is important to contact your doctor if you experience any kind of discoloration on your tongue or any other sudden changes in your mouth's health.
How Is Black Hairy Tongue Diagnosed?
Generally, a dental professional will know immediately if there is black hairy tongue present. To confirm the diagnosis, they may use a microscope to inspect the tongue and assess its condition. They may swab the infected areas for further testing and exploration of potential underlying causes, but this is usually not necessary.
How Can I Reduce My Risk Of A Black Hairy Tongue?
The following steps can help reduce the risk of developing a black hairy tongue:
- Practice good oral hygiene habits, including brushing teeth and tongue twice daily and flossing regularly.
- Use a tongue scraper to clean your tongue thoroughly.
- Drink plenty of water throughout the day to keep your mouth hydrated.
- Avoid smoking, drinking alcohol excessively, and eating foods that irritate the tongue or weaken its defenses against bacteria.
- Consult a doctor if you notice any early signs of black hairy tongue, such as discolored patches on the top surface of your tongue.
When Should I See My Healthcare Provider About A Black Hairy Tongue?
Black hairy tongue (BHT) will usually go away on its own. And despite its appearance, it isn't something to worry about in most cases. But if the BHT doesn’t seem to be going away, or if it is accompanied by other symptoms such as bad breath, soreness, or a metallic taste in the mouth, you might want to meet with a dental or healthcare professional to get to the bottom of the issue.
Similarly, if you have other problems occurring simultaneously, such as herpes on your tongue or ulcers forming around the area, you should seek medical advice quickly.
Why Did My Tongue Turn Black Overnight?
If you don't have a history of anything that could cause black hairy tongue, there is a chance your condition showed up overnight as the result of a medication or an underlying medical condition. If this is the case, pay close attention to your other symptoms and make sure to contact your doctor if anything else changes.
Why Do I Have Black Spots On My Tongue?
There are two main reasons you would have black spots on your tongue: black hairy tongue or hyperpigmentation.
The former is common and harmless, while the latter is usually due to an underlying medical condition or medical treatment (such as radiation therapy). In either case, they will usually go away on their own.
What Deficiency Causes Black Tongue?
B vitamin deficiencies can cause tongue discoloration. Black tongue, specifically, can be caused by Niacin (vitamin B5) deficiency. Niacin is typically found in lean meat, poultry, fish, and liver. If you're concerned about your levels of this vitamin, you can also find supplements in most health food stores and pharmacies.
How Can I Get Rid Of Black Tongue Fast?
There aren't many ways to accelerate the healing of black tongue. The best thing you can do is practice good oral hygiene and cut out the bad habits that may have gotten you there, such as smoking and excessive drinking.
Additionally, you can use a tongue scraper or brush to help dislodge any discolored cells and reduce the appearance of black tongue.
Which Drug Causes Black Tongue?
Several drugs cause black tongue, including:
- Penicillin and other antibiotics
- Minocycline
- Doxycycline
- Tetracycline
- Cortiosteroids
- Psychotropics
- Tobacco and nicotine products
Is It Normal To Have A Black Tongue?
Since black tongue is caused by a number of factors, it can be considered normal in certain cases. However, if the discoloration persists and you don't have any underlying conditions or habits that could cause it, it might be the result of a medication or an underlying medical condition. If this is the case, it's best to contact a doctor for further testing and treatment.
Is A Black Tongue Serious?
A black tongue isn't usually serious—it's mostly just an aesthetic issue. However, if you experience other symptoms alongside the discoloration such as bad breath or a metallic taste in the mouth, it may be unpleasant to deal with.
Still, it isn't much to worry about in terms of your long-term health unless you know for sure that an underlying medical condition or poor oral hygiene causes the discoloration.
Does Stress Cause Black Tongue?
Stress and oral health go hand in hand. Although stress cannot directly cause a black tongue, it can increase your risk of developing one. This is because stress weakens the immune system and can lead to poor hygiene, which can contribute to black tongue development.
How Long Can Black Tongue Last?
As long as you care for your tongue properly, a black tongue can go away in one to two weeks. However, if you have an underlying medical condition or are taking certain medications, it may take longer for the discoloration to fade. Your healing time depends on several factors, including the severity of your condition and your oral health and lifestyle choices.
Can Diabetes Cause Black Tongue?
Diabetes can cause a type of black discoloration called melanoplakia. This form of hyperpigmentation appears as a velvety black patch on the tongue and is caused by an accumulation of skin cells. This is different from black hairy tongue and usually requires medical treatment to manage.
