What Is Black Tongue?

Black tongue (or black hairy tongue) is usually caused by too much bacteria or yeast growth in the mouth. It is a harmless (benign) condition. Even though the name sounds scary, the situation is not typically a cause for concern.

Black tongue can happen for several reasons, including poor dental hygiene. The treatment for the disease is usually simple.

Here's what you need to know about what causes black tongue, what to do if you have the condition, and when you should see your healthcare provider.

What Causes a Black Tongue? 

Black tongue is more common in older people but can happen at any age. The condition might be more common in men than women.

However, the situation is more strongly linked to an individual's smoking status and oral hygiene habits.

Black tongue is often related to poor dental hygiene, but there are also other risk factors including:

• Drinking a lot of coffee or tea
• Tobacco use
• Excessive alcohol consumption
• Certain medications
• Some mouthwashes
• Dehydration
• Intravenous drug use
• Cancer
• Trigeminal neuralgia
• Compromised immune system
• Radiation therapy
• Dry mouth

Certain medications are associated with black tongue. One common medication related to discoloration is Pepto-Bismol (bismuth subsalicylate), which can temporarily turn your tongue. When you stop taking it, your tongue should return to its normal appearance.

Other medications that cause the condition include:

• E.E.S. Granules (erythromycin)
• Monodox (doxycycline)
• Penicillin
• Panmycin (tetracycline)
• Prevacid (lansoprazole)
• Mycifradin (neomycin)
• ZyPREXA (olanzapine)
• Tarceva (erlotinib)
• Zyvox (linezolid)

Symptoms

Although the name for the condition implies that the tongue turns black, the discoloration can also be brown, white, or yellow. The discoloration is typically focused on the center of the tongue.

Some people do not experience other symptoms. When other symptoms do occur, they can include:

• Bad breath
• Change in the way food tastes
• Gagging sensation
• Tickling sensation
• Nausea

If your black tongue is caused by an overgrowth of the fungus Candida albicans, you may experience a burning sensation on your tongue.

Diagnosis

Dentists can usually diagnose black tongue by looking at your mouth.

Black spots on the tongue can be a sign of cancer. However, tongue cancer is more likely to appear as a lesion or scab that does not heal.

If there’s any doubt about the diagnosis, your healthcare provider may want to do more tests, such as a biopsy to rule out cancer.

Other tests that might be needed include:

• Bacterial culture swabs
• Fungal scrapings

Treatment 

You can prevent black tongue by maintaining good oral hygiene.

Scraping or brushing the tongue can prevent food and bacteria from getting stuck on the tongue’s surface. Avoid substances or medications known to cause a black language when possible. For example, if you've been using Pepto-Bismol, your healthcare provider might suggest a different medication to help with diarrhea, heartburn, or stomach upset.

Likewise, if the tongue discoloration is related to something you frequently eat or drink, dietary changes—like cutting out or limiting your intake of alcohol, coffee, or tea—can help. Eating foods with a rough texture such as celery or raw carrots may also help reduce the discoloration.

If you see your dentist about the black tongue, they might suggest you stop using mouthwashes containing peroxide. Switching formulas may help prevent a recurrence of black tongue. 

Sometimes, avoiding these things or making changes might not help the black tongue go away. If so, your healthcare provider may prescribe an antifungal medication.

There has been some limited research on using Retin-A (tretinoin) to treat your black tongue, but the treatment includes side effects that may be unpleasant. More research is needed on the effectiveness of this medication.

In rare cases, laser surgery is required to treat the condition.

Summary

Black, hairy tongue is usually a harmless condition. It may be caused by poor oral hygiene, overgrowth of fungus on the tongue, or medications. It may not cause any other symptoms, or you may have burning of the tongue, bad breath, and a tingling sensation on the tongue.

You can usually treat black tongue at home by scraping the tongue daily and avoiding any medications or mouthwashes that may be contributing to the problem.

See your healthcare provider if you have any discoloration on the tongue.