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Hairy Tongue (Black Hairy Tongue)

  • Etiology: elongation of keratin on filiform tongue papillae from inadequate oral hygiene, dry mouth, or microbial overgrowth (Fig. 4-1). Also associated with smoking, antibiotic therapy, extended hospital stays, and poor general health status

  • Clinical findings: white, black, or brown hair-like projections on dorsal tongue, more concentrated toward posterior and often associated with halitosis. There may be a burning sensation from secondary candidiasis

  • Treatment: scrape off daily with floss or a tongue scraper; eliminate smoking; improve oral hygiene; treat burning symptoms with antifungals


Black hairy tongue. (Used with permission from Dr Nadarajah Vigneswaran.)

Hairy Leukoplakia

  • Etiology: HIV in AIDS (Fig. 4-2)

  • Clinical findings: vertical or randomly oriented, asymptomatic white keratotic thickening of the lateral border of the tongue, usually unilateral. No other evidence of biting trauma and no ulceration

  • Treatment: treat the HIV infection; this lesion will disappear with systemic treatment of the AIDS


Hairy leukoplakia. (Used with permission from Dr. Bela Toth.)

Fissured Tongue (Scrotal Tongue; Lingua Plicata; Hamburger Tongue)

  • Etiology: developmental anomalies; becomes more pronounced over decades (Fig. 4-3)

  • Associated frequently with: Melkersson-Rosenthal syndrome; Down syndrome; benign migratory glossitis (geographic tongue)

  • Clinical findings: irregular, often deep fissures of the tongue dorsum, often with a fissure down the midline; may be symptomatic (burning sensation, pain with spicy foods) if associated with secondary candidiasis

  • Treatment: maintain good oral hygiene; antifungals if symptomatic

Bifid Tongue (in Oral-Facial-Digital Syndrome Type I)

  • Etiology: x-linked dominant inherited trait with multiple malformations of the face, oral cavity, and digits

  • Clinical appearance (oral): multiple deep clefts along border of tongue give the illusion of border lobules, sometimes with a deep central fissure; hamartomas or lipomas of the ventral tongue; cleft of the hard or soft palate; accessory gingival frenula, hypodontia

  • Treatment: surgical correction of clefts, as needed

Ankyloglossia (Tongue Tie)

  • Etiology: developmental defect fusing ventral tongue to oral floor (Fig. 4-4)

  • Clinical findings: attachment of the ventral tongue to the floor of the mouth, even to the gingivae of the lower incisors; limits tongue movement but seldom interferes with speech

  • Treatment: usually none is needed, but attachment can be surgically corrected if there is a speech defect or anterior mandibular gingiva becomes inflamed or deteriorated

Lingual Varicosities


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