Hairy tongue

This visual ‘atlas’ will help you to identify and describe non-malignant, potentially malignant and malignant oral lesions.

A diverse range of mucosal lesions can occur in the oral cavity. The history and clinical presentation of the non-malignant conditions listed below will help you differentiate them from potentially malignant or cancerous lesions. However, occasionally this can be difficult. If a lesion is suspicious, refer your patient for biopsy and definitive diagnosis.

The stage when oral cancer is diagnosed is important, as it indicates prognosis. Stage I and II oral cancer corresponds directly to size, with no evidence of metastases. Stage III and IV oral cancer has spread to the lymph nodes or distant organs. Detection of oral cancer at an early stage can save your patient’s life.

Benign increase in the length of the filiform papillae (responsible for giving the tongue its texture and the sensation of touch) on the posterior dorsal aspect of the tongue, resulting in hair-like projection and a coated appearance. This is caused by an increased accumulation of keratin and/or diminished normal desquamation. It may be a result of a change in diet to insufficient coarse foods, often seen in hospitalised very ill patients, or related to salivary hypofunction caused by either systemic medications, Sjogren’s Syndrome or radiotherapy.

The colour of hairy tongue can vary substantially from deep black to white, and is dependent on both the resident bacteria and food debris.

On the posterior aspect of the dorsal surface of the tongue are quite extensive elongated filliform papillae, some of which are very darkly pigmented. These become more pronounced posteriorly. This patient had no symptoms.

Last updated: March 2021