A patient presents with an elevated, greenish-brown lesion in the middle of the dorsal tongue with elongated hair-like papillae, consistent with hairy tongue. Which treatment approach is most appropriate?

Hairy tongue (lingua villosa) appears as elongated, hair-like filiform papillae on the dorsal tongue. The color (green, brown, black) depends on chromogenic bacteria, yeast colonization, diet, tobacco, and coffee/tea. Treatment is primarily conservative: (1) Gentle mechanical debridement with a soft toothbrush or tongue scraper; (2) Improved oral hygiene; (3) Elimination of precipitating factors — discontinue antibiotics if possible, stop smoking, reduce coffee/tea. Antifungal therapy (nystatin) may be added if concurrent Candida is confirmed by culture, but it is not the primary treatment. Antiviral therapy is not indicated (hairy tongue is not viral). Systemic antibiotics would worsen the condition. The condition typically resolves spontaneously once predisposing factors are removed.