(By Dr. Joseph D. Lim and Dr. Kenneth Lester Lim, BS-MMG, DDM, MSc-OI)
THE 69-year-old woman was not feverish.
Nor was she feeling nauseated; her sense of taste remained the same.
She was neither a smoker, which did not explain the brown “stain” on her tongue that had developed 10 days before.
Which was why she was brought to a clinic. Her medication for high blood pressure, hyperlipidemia, diabetes mellitus, osteoporosis, and mixed connective tissue disease remained the same, reports Kate Kneisel, a contributing writer to MedPage Today.
And no, she was not using herbal medicines, nor mouthwashes, tongue cleaners or scrapers, Ms. Kneisel writes.
However, the woman had surgery for tenosynovitis of the right index and middle finger. Tenosynovitis is the inflammation of the lining of the sheath that surrounds a tendon, the cord that joins muscle to bone.
Because of bacterial infection, she was given intravenous tobramycin and imipenem and oral clarithromycin antibiotics for six weeks. Then she received oral moxifloxacin and clarithromycin antibiotics.
Ten days later, the brown discoloration appeared on her tongue.
She was in good physical health, with no tooth decay, bad breath, nor were her gums bleeding. And her right finger had healed. In other words, she was healthy.
Doctors had a tentative diagnosis of a stained tongue due to foods, or black hairy tongue from antibiotics.
The woman was told to scrape her tongue while observing good oral hygiene.
The brown-tainted tongue persisted. On doctors’ advice, she opted to stop taking moxifloxacin and continued clarithromycin therapy. Her tongue returned to normal within two days of discontinuing moxifloxacin medication. A year later the brown discoloration did not return.
The discoloration was diagnosed as Black Hairy Tongue or BHT, Ms. Kneisel reports. Relatively rare, it is a superficial black and hairy carpet-like growth on the tongue first described in the 16th century as “hairs on the tongue that would regrow upon being removed.”
BHT is not fully understood. It seems to be caused by the accumulation on the tongue surface of cells producing large amounts of a protein called keratin. Cells that produce keratin are stronger than other cells, forming a barrier between the outside world and in the inside of the body.
The condition leads to superficial hair-like papillae which then can accumulate fungi, bacteria, and debris such as residues from food, tobacco, coffee and tea as well as organisms that gives the discoloration ranging from blackish-brown to yellow-green to unpigmented.
The presence of the characteristic long, thick filiform papillae is key to differentiating BHT from other reasons for tongue discoloration, and may be confirmed through the microscope.
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Dr. Joseph D. Lim, Ed. D., is the former Associate Dean of the College of Dentistry, University of the East; former Dean, College of Dentistry, National University; Past President and Honorary Fellow of the Asian Oral Implant Academy; Honorary Fellow of the Japan College of Oral Implantologists; Honorary Life Member of the Thai Association of Dental Implantology; and Founding Chairman of the Philippine College of Oral Implantologists. For questions on dental health, e-mail jdlim2008@gmail.com or text 0917-8591515.
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Dr. Kenneth Lester Lim, BS-MMG, DDM, MSc-OI, graduated Doctor of Dental Medicine, University of the Philippines, College of Dentistry, Manila, 2011; Bachelor of Science in Marketing Management, De la Salle University, Manila, 2002; and Master of Science (MSc.) in Oral Implantology, Goethe University, Frankfurt, Germany, 2019. He is an Associate Professor; Fellow, International Congress of Oral Implantologists; Member, American Academy of Implant Dentistry and Fellow, Philippine College of Oral Implantologists. For questions on dental health, e-mail limdentalcenter@gmail.com./PN
