Black Tongue Discoloration: What Causes It?

It sounds like something out of a horror movie. No one wants to look in the mirror and see a black tongue staring back at them when they open their mouth. This particular condition is not uncommon and can cause a great deal of anxiety in those who experience it. What causes a black tongue discoloration and is it something to be concerned about?

Causes of Black Tongue Discoloration

A black tongue discoloration is most commonly caused by organisms such as yeast and bacteria growing on the surface of the tongue. These bacteria and yeast produce blood cell pigments called porphyrins which give rise to the black color characteristically seen. The overgrowth of bacteria can also cause cells of the tongue to be shed more slowly, causing the tongue to take on a hairy appearance, known as a black, hairy tongue.

What causes the bacteria and yeast to overgrow giving rise to the black tongue discoloration? A variety of factors are believed to contribute to this phenomenon including improper tooth and gum care; the use of tobacco products; drinking excessive amounts of tea or coffee; or use of antibiotics. Conditions that cause the immune system to function improperly can also play a role with black tongue discoloration being seen more often in those diagnosed with HIV. It’s also thought that the use of certain types of mouthwashes, particularly those containing hydrogen peroxide or witch hazel can cause black tongue discoloration.

Another Cause of Black Tongue Discoloration

Another cause of a black tongue is the use of medications containing bismuth such as Pepto-Bismol. Many people don’t realize when they take this medication for an upset stomach that they could end up with a black tongue. It appears that the bismuth found in Pepto-Bismol reacts with sulfur found in the mouth to form bismuth-sulfide, a compound with a distinctive black color. Fortunately, this effect is entirely reversible and will resolve within a few days after discontinuing the medication.

Treatment of Black Tongue Discoloration

When confronted with black tongue discoloration, it’s best to use a soft toothbrush to gently brush the discolored area several times a day. Cigarettes, tea, coffee, and mouthwash should be discontinued until the symptoms resolve. It’s important to rinse the mouth periodically throughout the day and drink additional water to keep mucous membranes moist. If the symptoms fail to resolve, antibiotic treatment may be needed. If this condition develops in the absence of smoking or use of tea coffee or Pepto-Bismol, a thorough medical exam should be schedule to rule out underlying health problems that could be affecting the immune system.