How do you get rid of black hairy tongue?

The top of the tongue is covered in filiform papillae, threadlike projections that normally wear down and shed as you eat and talk. In black hairy tongue they stop shedding and lengthen; Cleveland Clinic notes they can reach 18 mm (about three-quarters of an inch). The long threads catch pigment from food, drink and tobacco, plus bacteria and yeast, creating a matted, furry look in the middle and back of the tongue.

Despite the name, it can be brown, green, yellow or white as well as black, depending on what is caught in the threads. It is not hair, not an infection on its own, and not dangerous. It is more common in men over 65 but can happen to anyone.

The core problem is too little friction on the tongue surface plus something that encourages buildup or staining. Cleveland Clinic and a PMC review of oral pigmentation list:

• Not cleaning the tongue, and a soft diet that does not naturally scrub it
• Tobacco smoking or chewing
• Large amounts of coffee or black tea
• Dry mouth, from medicines, mouth breathing or illness
• Mouthwashes containing peroxide or other oxidizing agents
• Recent antibiotics, which shift the balance of bacteria and yeast; published case reports include amoxicillin-clavulanate among several others
• Some antidepressants
• Heavy alcohol use
• Chemotherapy, radiation and conditions that weaken the immune system

A related look, sometimes called pseudo-black hairy tongue, comes from bismuth subsalicylate (Pepto-Bismol) staining normal papillae black. It clears within days of stopping the medicine.

1. Clean the tongue every day. Brush and floss your teeth, then scrape the tongue from back to front several times with light pressure, rinsing between strokes. This is the first-line step recommended by Cleveland Clinic. Our guide on using a tongue scraper for hairy tongue covers technique in detail.
2. Remove the trigger. Cut back on coffee, tea and alcohol, stop tobacco, and switch away from peroxide mouthwash.
3. Eat some firm, fibrous food. Raw vegetables and crunchy fruit help the papillae shed naturally.
4. Fix dry mouth. Sip water through the day, and ask your doctor if a medicine is drying your mouth.
5. Do not stop a prescribed medicine you suspect without talking to the prescriber first.

Expect gradual change: the color fades first as stain is removed, then the furry texture shortens over the following days.

Diagnosis is usually made by looking, and tests are rarely needed. If daily cleaning and trigger removal do not work, a dentist or doctor may prescribe an antifungal or antibacterial treatment if overgrowth is found, or a topical retinoid or other keratolytic agent to soften the excess keratin. In rare stubborn cases, the long papillae can be trimmed surgically or with a laser. If a medicine is the cause, your prescriber may be able to switch it.

Once it has cleared, a daily tongue clean as part of brushing is usually enough to keep it away. Keep up regular dental check-ups, stay hydrated, and keep coffee, tea and tobacco in check.