Black spots on tongue vary from small black specks to black patches. Also, the darkness of the spots varies from person to person. Some spots disappear on their own while some spots reoccur from time to time while others remain permanently.

The period for which they stay is also a symptom and helps the doctor narrow down to a particular cause.

There could be various causes of black spots on the tongue such as hyperpigmentation, oral cancer, piercing, injury, smoking, alcohol, reaction to medicine, etc.

Let us understand how to deal with different kind of black spots on tongue.

Causes and symptoms of black spots on tongue

Hyperpigmentation

Melanocytes contain melanin and are responsible for the color or pigment of tongue and skin. Excessive release of melanin causes hyperpigmentation and tongue appear black.

Other causes of hyperpigmentation can be certain medications, the age of the person, low production of hormones by the adrenaline glands. Most of the times the spots are not harmful. (2)

Oral cancer

Tobacco chewers, smokers and people who eat betel leaves have a risk of oral cancer. Tongue cancer causes thick patches on the tongue and non-healing ulcers.

Patients undergoing chemotherapy for oral cancer may have black spots on the tongue. These spots disappear once the treatment is over.

Hairy tongue

Hairy tongue is a medical condition where the tongue appears to have black furry patches of hair. Usually, the back and mid-region of the tongue are affected. Papillae on the tongue trap dead cells which get discolored and turn black.

Usually, people with hairy tongue have a history of poor oral hygiene regime. People with hairy tongue often complain of bad breath and metallic taste. Yeast or bacterial infection is the cause at times. However, this is a self-limiting disease. (1)

Injury to tongue

Piercing on the tongue may cause injury to the adjacent area and lead to black discoloration. When the area heals, the color goes back to normal.

A person with a tongue piercing must take proper care of oral hygiene especially during the healing period. If you do not take proper care then it can cause infection.

Reaction to medicine

Antidepressants, asthma medicines, and certain antibiotics contain bismuth salicylate. Bismuth is responsible for black spots on the tongue. So, if you are taking such medications then you can have black spots on your tongue.

Also, allergic reactions to some medication can cause black spots.

Alcohol and smoking

Smokers and alcohol abusers might have black spots on the tip of the tongue, side of the tongue and under the tongue. Also, smoking causes hyperpigmentation.

The presence of long black papillae among smokers might give their tongue a dark and hairy appearance. (4)

Oral fibroma

Oral fibroma is a smooth, round lump attached to the oral cavity tissue by a stalk at its base. Fibromas irritate teeth, piercings, and dental appliances. They are removed surgically but often recur.

Pregnancy

Many hormonal changes take place during pregnancy, and due to that, black spots may appear on the tongue. Oral contraceptives also cause hormonal changes leading to black spots on the tongue.

Laugier-Hunziker syndrome

A rare, benign and idiopathic condition which present clinically as pigmented macules on the lips, tongue and oral mucosa. The lesions are brown, bluish-black or black. Usually, women are affected more than men.

This condition doesn’t require any treatment. If a person wants, then he may undergo laser surgery for depigmentation. (3)

Treatment of black spots on tongue

Maintain oral hygiene

  • Brush twice a day and use a tongue cleaner along with flossing daily to maintain oral hygiene.
  • Maintaining oral hygiene is the best way to avoid majority infection, dark spots, etc.

Lifestyle changes

  • Stop alcohol abuse and smoking or chewing tobacco to avoid dark spots on the tongue.
  • Also, if you drink excess tea or coffee then rinse your mouth with water after drinking those beverages.
  • Drink enough water to wash out the debris of food present in the mouth.

Surgery

  • In the case of oral fibroma or oral cancer, you will require to undergo surgery. Tongue cancer may include chemotherapy and radiotherapy.

It goes without mention that you should visit your dentist every six months for regular check-ups. Follow the advice given by your dentist.

When should you visit the doctor?

Certain conditions when you should seek professional help for sure include –

  • Altered sense of taste.
  • Discolored patches present on the tongue, insides of the cheeks and roof of the mouth for a long period, but no pain or discomfort.
  • Persistent pain.
  • Difficulty in chewing of food which you may feel is due to the black spots on the tongue.

To be on the safe side, you should visit a dentist if the spots stay for more than five to seven days.

Over to you

Usually, spots on the tongue are harmless, irrespective of the color or nature. But, still, it is better to get an expert evaluation done for appropriate treatment modalities.

Take care of your oral hygiene and visit your dentist every six months. During routine check-ups, if there is any change in the structure of tongue or color, then they will be spotted early on. Treatment during the initial stages is always better than later.

Various causes of black spots on the tongue such as hyperpigmentation, oral cancer, piercing, injury, smoking, alcohol, reaction to medicine