Do You Have a Hairy Tongue?
Yes, you read that question correctly! Tongue hair, and do you have it? And, yes, we know this question prompts many immediate and additional follow-up questions. So, open wide and let’s see if your tongue needs a “haircut.”
Do You Have a Hairy Tongue?
While the condition is called “hairy tongue,” what’s growing on your tongue isn’t actually hair. We all have tiny hair-like filaments on our tongues that help us grip food and keep the surface of our tongues clean. These are called filiform papillae, and they typically only stand up about one millimeter in height—so they are essentially unnoticeable. For various reasons, some of us form a keratin (what your hair and nails are made of) build-up on our filiform papillae. This build-up causes hairy tongue and can add 18 millimeters of length and two millimeters of width to the filiform papillae on your tongue—this is now noticeable.¹
As your filiform papillae become encrusted with keratin, they can appear dark in color (black or brown) and change color (white, pink, green, blue) depending on what you have been eating or drinking. According to the American Academy of Oral Medicine, this condition occurs in 13% of the population.² Also known as black hairy tongue, this abnormal coating on the tongue is typically temporary and usually harmless. But that doesn’t mean you should ignore it.
What Can Cause Hairy Tongue?
Like all cells, the cells on our tongue have a life cycle (they grow, play their role, die, and shed off). Our diet usually delivers enough abrasion to help scrap off the shedded filiform papillae, which prevents a build-up. However, an individual who eats a soft diet might not have enough stimulation to keep the tongue free of this type of build-up. Chronic dehydration and dry mouth; tobacco, alcohol, and drug use; radiation therapy to the head and neck; certain types of medications and heavy antibiotic use; and poor oral hygiene can cause this condition.
Aside from the appearance factor of hairy tongue, most people don’t experience other symptoms. When symptoms manifest, they can include a burning sensation on the tongue, bad breath (halitosis), a tickling sensation on the roof of your mouth when swallowing, or a strange taste. The burning sensation is usually caused by an accumulation of bacteria or yeast on the filiform papillae. Halitosis is caused by the food debris that gets stuck in the thick “hair” on your tongue.
As you can see from some of the common causes, hairy tongue is often the result of diet and lifestyle choices. And diet and lifestyle are also significant contributors to the health of your oral microbiome (and, in turn, your systemic health). Research has shown a strong correlation between oral microbiome disharmony and black hairy tongue.³
The Oral Microbiome and Hairy Tongue
Our oral microbiome is home to a diverse community of microbes (over 700 species) that play an integral role in our physiology and health. Like in our gut microbiome, the balance (abundance and diversity) of microbes is essential for maintaining oral and systemic health. When the finely tuned equilibrium of the oral microbiome is disrupted, disease-promoting microbes can flourish, leading to caries, gingivitis, periodontitis, and black hairy tongue.⁴
Studies have observed that a common thread among those experiencing black hairy tongue is often severe disharmony of the oral bacterial community. One study found that proteobacteria were the most abundant phylum (over 90%) found in participants with black hairy tongue. Your oral microbiome is comprised of 12 phyla of microbes, so for one specific phylum to dominate is indicative of a major imbalance.⁵
As mentioned previously, hairy tongue is typically not a serious condition. However, when bacteria or yeast overgrowth is the cause, it can turn severe and lead to systemic infections via the bloodstream.
How to Keep Your Tongue “Hair” Trim and Tidy?
To prevent and/or resolve black hairy tongue:
Be diligent about your oral hygiene (brushing, flossing, tongue scraping, professional checkups)
Eat a fibrous diet
Drink plenty of water
Eliminate bad habits (excessive drinking, using tobacco)
Bring your oral microbiome back into balance
1. L Radfar, & AAOM Web Writing Group. (2015, May 13). [Information on condition hairy tongue]. The American Academy of Oral Medicine. Retrieved December 1, 2022, from aaom.com
2. L Radfar, & AAOM Web Writing Group. (2015, May 13). [Information on condition hairy tongue]. The American Academy of Oral Medicine. Retrieved December 1, 2022, from aaom.com
3. Shangguan, Y., Ji, Z., Guo, W., Hu, W., Li, X., & Xu, K. (2022, September 14). [Case series on oral microbiome imbalance and hairy tongue]. Infection and drug resistance. Retrieved December 1, 2022, from PubMed Central.
4. Kilian, M., Chapple, I. L. C., Hannig, M., Marsh, P. D., Meuric, V., Pedersen, A. M. L., Tonetti, M. S., Wade, W. G., & Zaura, E. (2016, November 18). [Update on oral microbiome].Nature News. Retrieved December 1, 2022, from nature.com.