Hairy tongue is a common, benign clinical condition that represents accumulation of varying amounts of keratin on the dorsum of the tongue. Normally, the rate of keratin production on the dorsal tongue equals the rate at which keratin is naturally debrided during chewing and swallowing. If a patient has reduced food intake or a primarily soft or liquid diet, then the keratin simply accumulates. It is not a sign of any underlying systemic disease in an otherwise healthy and non-debilitated patient, as was historically believed. Factors that may be associated with increased production of keratin include smoking, poor oral hygiene, use of oxidizing mouthwashes, and hot beverages.
The elongated papillae are usually yellow to brown–black, although a wide range of colors may occur due to differential exogenous staining from food, tobacco, or chromogenic bacteria. Overgrowth of the latter may occur in the setting of systemic antibiotic therapy. Some patients complain of bad breath, bad taste, or a gagging sensation when the tongue contacts the palate.
Hairy tongue is a benign condition requiring no treatment. Some patients desire treatment due to the unaesthetic nature of the process, or because of altered taste, bad breath, or gagging sensation. In such cases, patients should be encouraged to scrape the tongue with a tongue scraper or brush it while tooth brushing.
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