History and exam
Key diagnostic factors
common
grooves and fissures on the dorsal tongue (fissured tongue)
Dorsal surface of the tongue is involved and the fissures and grooves may interconnect to portray a lobulated appearance. The grooves are asymptomatic.
hairy projections on the dorsal midline tongue (hairy tongue)
These projections can vary in color from yellow to brown-black depending on food and beverage consumption.
well-demarcated areas of erythema on the dorsal tongue (geographic tongue)
Well-demarcated areas of erythema on the dorsal tongue sometimes with a scalloped white margin. These areas often extend to the lateral tongue.
atrophic red central zone within patches (geographic tongue)
Within the areas of erythema on the dorsal tongue there is usually a loss of filiform papillae and therefore an atrophic appearance.
lesions that seem to migrate (geographic tongue)
The patients who are aware of the patches on the tongue usually note that the patches of erythema appear to migrate, affecting different areas of the tongue.
Other diagnostic factors
common
halitosis (hairy tongue and fissured tongue)
Some patients may complain about bad breath, which is related to bacterial colonization on the tips of the papillae in the case of hairy tongue. In fissured tongue, trapped food debris may also cause halitosis. It is likely that poor oral hygiene is a contributory factor.
bad taste in mouth (hairy tongue)
Some patients may complain about a bad taste, which is related to bacterial colonization on the tips of the papillae. This may be due to poor oral hygiene practices.
discoloration (hairy tongue and fissured tongue)
Tongue color can vary from yellow to brown-black. The color variation may depend on the exogenous staining from various foods and beverages.
burning sensation (geographic tongue)
Patients may experience a burning sensation, especially in response to hot and spicy foods.
oral mucosal pain (hairy tongue)
Fissured tongue is often asymptomatic; however, some patients report mild discomfort, particularly in response to contact with irritant substances such as toothpaste or spicy food. The typical description of the discomfort is that of a burning sensation and may be aggravated by the entrapment of food particles in the fissures.[25]
Risk factors
strong
coffee/tea consumption (hairy tongue)
Implicated in the increased retention of keratin on the tongue.[10]
poor oral hygiene (hairy tongue)
Lack of mechanical debridement (such as tooth brushing) leads to hypertrophy of the papillae, which clinically causes the appearance of the hairy projections on the dorsal midline tongue through hypertrophy and retention of keratin on the filiform papillae.
increasing age (hairy tongue and fissured tongue)
Black hairy tongue is known to increase in prevalence with age, particularly in male patients.[7]
Patients usually have fissured tongue from childhood, but the condition may become more prominent with increasing age.
hyposalivation (hairy tongue)
The presence of hyposalivation is a known predisposing factor to the development of black hairy tongue.[2]
weak
Melkersson-Rosenthal syndrome (fissured tongue)
Rare syndrome that should only be considered with the presence of fissured tongue in combination with granulomatous cheilitis and intermittent seventh (facial) nerve paralysis (Bell palsy).[18]
Down syndrome (fissured tongue)
orofacial granulomatosis (fissured tongue)
Fissured tongue is a relatively common finding in people with orofacial granulomatosis.[5] However, fissured tongue is usually a normal variant of tongue appearance.
oxidizing mouthwash use (hairy tongue)
Implicated in the increased retention of keratin on the tongue.
drug abuse (hairy tongue)
The incidence of hairy tongue was 57% in one study of people in prison who are addicted to drugs.[21]
Use of this content is subject to our disclaimer