Hairy tongue is a clinical term referring to a condition of filiform papillary overgrowth on the dorsal surface of the tongue of variable color (Figure 1).
Filiform papilla’s is one type of lingual papillae which are small, nipple or hair–like structures on the upper surface of the tongue that give the tongue its characteristic rough texture.
Filiform papillae are the most numerous of the lingual papillae. Unlike the other kinds of papillae, filiform papillae do not contain taste buds. They cover most of the front two thirds of the tongue’s surface.
They appear as very small, conical or cylindrical surface projections (Figure 2).
Numerous initiating or predisposing factors for hairy tongue have been identified. Broad-spectrum antibiotics, such as penicillin, and systemic corticosteroids (cortisol) are often identified in the clinical history of patients with this condition. In addition, oxygenating mouth rinses containing hydrogen peroxide, sodium perborate, and carbamide peroxide have been cited as possible etiologic agents in this condition. Hairy tongue may also be seen in individuals who are intense smokers, in those who have undergone radiotherapy to the head and neck region for malignant disease, and in patients who have undergone hematopoietic stem cell transplantation. The basic problem is believed to be related to an alteration in microbial flora, with attendant proliferation of fungi and chromogenic bacteria (involve the production of color or pigments), along with papillary overgrowth.
- Clinical Features
The clinical alteration translates to asymptomatic hyperplasia (overgrowth) of the filiform papilla, with concomitant retardation of the normal rate of desquamation. The result is a thick, matted surface that serves to trap bacteria, fungi, cellular debris, and foreign material.
Hairy tongue is predominately a cosmetic problem because symptoms are generally minimal. However, when extensive elongation of the papilla occurs, a gagging or tickling sensation may be felt. The color may range from white to tan to deep brown or black, depending on diet, oral hygiene, oral medications, and the composition of the bacteria inhabiting the papillary surface.
Microscopic examination of a biopsy specimen confirms the presence of elongated filiform papilla over the dorsum of the tongue, with surface contamination by clusters of microorganisms and fungi.
Because the clinical features if this lesion usually quite characteristic, confirmation by biopsy is not necessary. Cytologic or culture studies are of little value.
- Treatment & Prognosis
Identification of a possible etiologic factor, such as antibiotics or oxygenating mouth rinses, is helpful. Discontinuing one of these agents should result in improvement with a few weeks. In other patients, brushing with a slurry of sodium bicarbonate (baking soda) in water of gentle once-daily scraping of the dorsum of the tongue may be beneficial. In individuals who have undergone radiotherapy with resultant xerostomia (dry mouth) and altered bacterial flora, management is more difficult. Brushing the tongue and maintaining fastidious oral hygiene should be of some benefit (application of a 1% solution of podophyllum resin with thorough rinsing has also been described as a useful treatment). It is important to emphasize to patients that this process is entirely benign and self-limiting, and that the tongue should return to normal after physical debridement and proper oral hygiene have been instituted.
- Etiology: Not well understood, believed to be related to alterations in oral flora.
- Initiating factors:-
- Use of Broad Spectrum antibiotics, systemic corticosteriods, hydrogen peroxide.
- Intense smoking
- Head and neck therapeutic radiation.
- Clinical Features:
- Represents overgrowth of filiform papilla and chromogenic bacteria.
- Dense hairlike mat formed by hyperplastic papilla on the dorsal tongue surface.
- Usually asymptomatic.
- May be cosmetically objectionable because of color (usually black).
- Identify and eliminate initiating factors identified and eliminated.
- Brush/scrape tongue with baking soda.
- Little significance other than cosmetic appearance.
Reference: Oral Pathology, Sixth Edition, By Regezi, Sciubba, & Jordan.
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Haider Maitham, DDS