Journal of Case Reports in Medical Science

Aims: Black hairy tongue is a benign acquired disorder characterised by elongation, defective desquamation, and discolouration of the filiform papillae on the dorsal surface of the tongue. Although it is commonly associated with poor oral hygiene, tobacco use, staining beverages, xerostomia, and selected medications, it may also occur without these factors. This case report presents an elderly patient with black hairy tongue and highlights the value of clinical recognition and conservative management.

Case Presentation: A 72-year-old male patient presented with persistent dark discolouration of the tongue for the previous 2–3 years. He had no pain, burning sensation, altered taste, or halitosis, and his main concern was the aesthetic appearance. His medical and drug history was non-contributory, and he reported no tobacco use, alcohol consumption, or deleterious oral habits. He had used complete dentures for 7 years. Intraoral examination showed diffuse blackish-brown discolouration over the posterior two-thirds of the dorsal tongue, with a hairy, carpet-like appearance and elongated filiform papillae. The lateral borders and tip of the tongue were relatively normal. The diagnosis of black hairy tongue was made clinically, and no additional laboratory investigations were performed.

Management and Outcome: The patient was managed conservatively with gentle brushing of the dorsal tongue, use of a tongue cleaner, reinforcement of oral hygiene, once-daily antiseptic mouthwash, adequate hydration, denture cleaning, night-time denture removal, and reassurance. Follow-up showed a marked reduction in pigmentation and improvement in tongue texture, with gradual resolution of the hairy appearance.

Conclusion: Black hairy tongue is a benign and reversible condition. Careful clinical assessment, patient education, oral and denture hygiene, and mechanical debridement can support favourable outcomes while avoiding unnecessary interventions.