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Pathology · single question

A patient is diagnosed with hairy tongue. What are the MOST appropriate instructions to give?

  1. Prescribe systemic antibiotics
  2. Perform surgical resection of the elongated papillae
  3. Discontinue predisposing factors (antibiotics, tobacco, peroxide rinses), improve oral hygiene, and gently brush the tongue dorsum
  4. Prescribe antifungal medication
Show answer and explanation

Correct answer: C. Discontinue predisposing factors (antibiotics, tobacco, peroxide rinses), improve oral hygiene, and gently brush the tongue dorsum

  • A. Systemic antibiotics may actually be a CAUSE of hairy tongue (by disrupting normal oral flora) — prescribing more antibiotics would worsen the condition.
  • B. Surgical resection of papillae is not indicated — the condition is reversible with elimination of causes.
  • C. CORRECT. Hairy tongue management is primarily CONSERVATIVE: (1) identify and eliminate predisposing factors (antibiotics, tobacco, excessive tea/coffee, chlorhexidine, peroxide rinses, xerostomia), (2) improve oral hygiene including GENTLE brushing of the tongue dorsum to debride the elongated papillae, (3) increase hydration. Most cases resolve with these measures alone.
  • D. Antifungal medication is only indicated if Candida is concurrently present. Hairy tongue itself is not caused by candidiasis — though candida may superinfect the lesion.

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