What does it mean when your tongue is black?

Having a black tongue can be alarming, but it is usually harmless and temporary. A black coating on the top surface of the tongue is often just a buildup of dead cells, bacteria, and food debris. This condition is called black hairy tongue. However, a black tongue can also indicate a more serious medical condition. Here’s an overview of the common causes and treatments for black tongue.

Table of Contents

What Causes a Black Tonged?

There are several possible causes for a black tongue:

Black hairy tongue – Dead cells, bacteria, food debris, tobacco, coffee, tea, and other substances can accumulate on the filiform papillae (small bumps on the tongue’s surface), causing them to elongate and turn black. This gives a black, furry appearance.
Medications – Certain medications like bismuth subsalicylate (Pepto Bismol), iron supplements, and antibiotics can cause black discoloration on the tongue.
Dry mouth – Reduced saliva flow allows more bacteria to grow, leading to a black coating.

Tobacco use – Chewing tobacco or smoking can stain the tongue black.
Fungal infection – A yeast infection called oral thrush can appear black.
Immune disorders – Weakened immunity makes the tongue more vulnerable to bacteria growth and discoloration.

Chemotherapy – Chemotherapy drugs can cause black fuzzy patches on the tongue.
Radiation therapy – Radiation to the neck and head can damage taste buds and cause a dark tongue.
Metabolic disorders – Anemia, diabetes, liver disease, copper deficiency, and other issues can be associated with black discoloration of the tongue.

Pigmentation – Rarely, some people are born with extra melanin (pigment) on their tongues that make the surface appear blackish.

Is a Black Tongue Dangerous?

In most cases, having a black tongue is harmless, but it can indicate an underlying health condition. Here are the possible concerns:

Oral cancer – Persistent black patches or spots on the tongue could potentially indicate oral cancer. This is particularly concerning if the patches are dark brown or blackish red.

Immune deficiency – Tongue discoloration is more common with reduced immunity, like from HIV/AIDS or chemotherapy.
Diabetes – A black tongue with a yeast infection (thrush) may signal uncontrolled diabetes.
Harmful bacteria – The bacteria that causes black hairy tongue can be harmful if it spreads.

Dehydration – A black tongue with dry mouth can mean you have insufficient fluids.
Medication effects – Certain medications linked to black tongue can have adverse side effects.
Digestive issues – Intestinal problems like ulcers can cause black stools that stain the tongue.

Additionally, a black tongue produces an unpleasant appearance and bad breath that can affect social and professional interactions.

When to See a Doctor

You should see a doctor or dentist if:

The black color spreads across your entire tongue.

You have dark spots, patches, or lesions on your tongue that are new or rapidly changing.
Your tongue remains black for more than 2 weeks after stopping medications that cause it.
You have other worrisome symptoms like chronic bad breath, unexplained weight loss, or difficulty chewing/swallowing.

Brushing, scraping, or rinsing doesn’t remove the dark coating.
The top and bottom sides of your tongue are both black.
You smoke or use tobacco and have a painless black hairy tongue.

A doctor can examine your mouth and tongue and determine if any testing is needed. Based on the cause, they may prescribe medication, recommend changing oral hygiene habits, or refer you to a specialist.

Diagnosing Black Tongue

To diagnose the cause of black tongue, a doctor will typically:

Ask about your symptoms, including how long you’ve had a black tongue, pain levels, and any associated symptoms.

Ask about your medical history, particularly any conditions or medications that could be related.
Perform an oral exam looking for signs of infection, thrush, or abnormal growths.
Check other areas in your mouth like gums, cheeks, roof of mouth.

Scrape off some of the dark coating for analysis under a microscope.
Order blood tests or a biopsy if oral cancer is suspected.
Refer you to an oral medicine doctor or other specialist if needed.

In some clear-cut cases, like black hairy tongue, a doctor can make the diagnosis just by examining the appearance of your tongue. But testing is often needed to pinpoint the exact cause.

Home Remedies and Lifestyle Changes

You may be able to treat minor cases of black tongue at home using these remedies:

Brush your tongue – Gently brushing the top surface of your tongue twice per day helps remove debris and dead cells that cause discoloration. Use soft bristles.

Scrape your tongue – Using a tongue scraper can remove bacteria buildup more effectively than brushing.
Use a mouthwash – Antiseptic mouthwashes help kill bacteria and prevent fungal infections that lead to black tongue.
Drink more water – Staying hydrated helps produce more saliva, which protects against dry mouth and fungal overgrowth.

Avoid irritants – Stop smoking or chewing tobacco if they are staining your tongue.
Improve oral hygiene – Brush and floss teeth thoroughly after each meal.
Eat yogurt – The probiotics in yogurt discourage the bacteria that causes black hairy tongue.

Stop medications – Check with your doctor before stopping any medications.

Practicing good oral hygiene is the best way to treat and prevent a black tongue in healthy individuals. But if home care doesn’t work, see your doctor.

Medical Treatments

If improving your oral hygiene routine doesn’t get rid of a black tongue, your doctor may prescribe:

Antifungal medication – Antifungal rinses, lozenges, or tablets can clear up fungal infections causing a black coating.
Antibiotics – If bacteria overgrowth is the culprit, antibiotics may be used short term.
Steroid mouthwash – Medicated mouthwash with corticosteroids reduces inflammation and white cell buildup on the tongue.

Iron or vitamin supplements – These can treat nutritional deficiencies leading to black tongue.
Saliva substitutes – Products like gels and rinses add moisture to combat dry mouth.
Tongue scraping – A dentist or hygienist can professionally scrape your tongue to instantly remove discoloration.

Tongue debridement – For severe black hairy tongue, a dentist may use tools to remove elongated papillae and discoloration.
Medication adjustment – Switching medications known to cause black tongue may resolve the problem.

See your doctor promptly if over-the-counter care fails so they can prescribe appropriate treatment based on the cause.

Prevention

You can take proactive steps to prevent black tongue:

Brush your tongue gently when you brush your teeth, twice a day.
Use antiseptic mouthwash daily.

Drink plenty of water and limit caffeine/alcohol to avoid dry mouth.
Avoid smoking or chewing tobacco.
Treat gastric reflux, vitamin deficiencies, and other medical conditions.

Practice good oral hygiene with regular flossing and professional cleanings.
Get prompt treatment for colds, flu, and sinus infections.
See your dentist about custom-fitted mouthguards if you grind your teeth.

With diligent oral hygiene and attention to overall health, you can lower your chances of developing an unsightly black tongue.

Outlook for Black Tongue

The prognosis for black tongue depends on the underlying cause:

Black hairy tongue usually responds well to tongue scraping and improving oral hygiene. But the dark coating may come back if you don’t keep up with brushing, scraping, and mouth rinsing.

Fungal infections should clear with antifungal treatment, but may recur if oral health isn’t maintained.
Pigmentation from excess melanin is permanent, but harmless.
Blackening caused by medications should resolve if you stop the medications. Discuss options with your doctor.

If an immune disorder or cancer is responsible, prognosis depends on successfully treating those conditions.

While annoying and embarrassing, simple cases of black tongue are temporary and pose no lasting harm. Practicing excellent oral hygiene can usually resolve the issue.

But if the cause is an underlying systemic disease, seeking prompt treatment improves your prognosis and overall health.

When to Seek Emergency Care

Most cases of black tongue don’t constitute an emergency. However, you should seek urgent medical care if you experience:

Difficulty breathing or swallowing
Bleeding from the mouth or tongue

Sudden inability to move the tongue
Swelling of tongue that obstructs breathing
Numbness in the tongue or mouth

Severe pain in the tongue or mouth
Drooping tongue
Uncontrolled tongue movements

High fever and fatigue alongside tongue symptoms

Emergency care is crucial if your tongue symptoms prevent breathing or eating. Some conditions like infections, injuries, or strokes can rapidly endanger your health. Don’t hesitate to call emergency services or go to ER if you have severe tongue issues.

Key Points

Common causes of black tongue include buildup of bacteria and dead cells, yeast infections, dry mouth, tobacco use, medications, and weak immunity.

See a doctor if the black color doesn’t go away with brushing, scraping, and mouthwash, or if you have dark patches or spots.
Doctors diagnose the cause by examining your tongue, scraping off a sample, and ordering tests as needed.
Treatments range from improving oral hygiene to taking prescription antifungal or antibiotic medication.

Avoid irritants, treat conditions causing dry mouth, and practice good oral care to prevent black tongue.
Most cases are harmless but a persistent black tongue could indicate a health condition needing prompt medical care.

Cause	Appearance	Treatment
Black hairy tongue	Hair-like papillae on tongue surface appear dark or black	Brush tongue, use scraper, improve oral hygiene
Tobacco use	Stains entire top surface of tongue black or brown	Quit smoking or chewing tobacco
Medications	Black discoloration confined to top of tongue	Change medications if possible
Fungal infection	White or yellow coat with dark patches underneath	Antifungal mouthwash, lozenges, or medication
Dry mouth	Black, furry coating from bacteria overgrowth	Sip water, avoid caffeine, use saliva substitutes
Pigmentation	Tongue entirely black but smooth surface	No treatment needed

This table summarizes the common causes of black tongue, how each one typically appears, and the recommended treatments.

Conclusion

Discoloration of the tongue ranging from black to yellow to brown is usually harmless but can look unpleasant and signal an underlying health issue. Causes include oral hygiene problems, medications, tobacco use, low immunity, and fungal infections.

See a dentist or doctor if gentle scraping, brushing, and rinsing doesn’t remove the black coating on your tongue within two weeks. Persistent black patches or spots also warrant medical evaluation to rule out oral cancer.

With the right treatment for the underlying cause and diligent oral hygiene care, black tongue can be cleared up or at least managed. Practicing good oral health habits provides the best prevention.