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Dorsal pigmentation of tongue

Published:August 12, 2022DOI:https://doi.org/10.1016/j.ejim.2022.08.006

      Keywords

      1. Case description

      A 56-year-old male patient with diabetes presented with black discolouration of the tongue 7 days after extraction of two mandibular molars (Fig. 1). Prophylactic oral amoxicillin 750 mg was started a day before the extraction and was continued for 4 days after extraction. Post-extraction, because of severe pain in the socket, he did not eat properly or maintain good oral hygiene. We collected a sample from the tongue lesion and performed a cytological analysis. Fragments of filiform papillae with markedly enhanced keratinisation were observed on microscopic examination of the scraped specimen. Microbes detected were primarily gram-positive cocci, and no fungi were detected.
      Fig. 1
      Fig. 1Color photograph showing a centrally located, black lesion on the dorsal surface of the tongue, in front of the circumvallate papillae. This patient with diabetes had undergone dental extractions 1 week prior to this clinical finding.

      2. Discussion

      A diagnosis of black hairy tongue was made based on clinical findings. The patient was instructed to gargle with benzethonium chloride and to maintain orodental and lingual hygiene using toothbrush and a tongue brush respectively. He recovered in approximately 3 weeks.
      Black hairy tongue is a condition in which filiform papillae elongate due to hyperplasia and develop black discolouration [
      • Gurvits G.E.
      • Tan A.
      Black hairy tongue syndrome.
      ]. The mechanism underlying this elongation is unknown but is thought to involve microbial substitution due to long-term antibiotic and/or adrenocorticosteroid use [
      • Gurvits G.E.
      • Tan A.
      Black hairy tongue syndrome.
      ]. Excessive smoking, irritant foods, immunocompromised states, and radiation therapy to the head and neck have also been reported to be the risk factors [
      • Ren J.
      • Zheng Y.
      • Du H.
      • Wang S.
      • Liu L.
      • Duan W.
      • et al.
      Antibiotic-induced black hairy tongue: two case reports and a review of the literature.
      ]. Furthermore, Candida is often detected in the saliva and on the tongue of patients with this disease, suggesting a link between the two [
      • Ren J.
      • Zheng Y.
      • Du H.
      • Wang S.
      • Liu L.
      • Duan W.
      • et al.
      Antibiotic-induced black hairy tongue: two case reports and a review of the literature.
      ]. There are no objective diagnostic criteria for this disease, and diagnosis relies on visual identification [
      • Ren J.
      • Zheng Y.
      • Du H.
      • Wang S.
      • Liu L.
      • Duan W.
      • et al.
      Antibiotic-induced black hairy tongue: two case reports and a review of the literature.
      ]. Differential diagnosis includes oral candidiasis, melanin pigmentation, melanocytic nevus, melanoma, and extrinsic pigmentation []. Treatment methods include removal of possible causative factors and improvement of oral hygiene. Antifungal drugs are often administered if Candida is present. In the present case, the use of antibiotics, immunocompromised state (due to diabetes), and poor oral hygiene were considered to be the triggers for this disease.

      Declaration of Competing Interest

      There are no competing interests.

      Funding information

      This report received no specific funding.

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