Pathology · patient case question
What is the treatment?
Patient case: Hairy tongue
Scenario: 'I am here because I have something on my tongue' — a photograph of HAIRY TONGUE.
Show answer and explanation
Correct answer: D. Oral hygiene instruction, including tongue brushing or scraping
- A. Antifungals are not first-line. Candida is a secondary coloniser, and treating it does not address the underlying papillary hyperkeratosis.
- B. Surgical excision is unnecessary for a benign, reversible condition.
- C. Essential oil rinses may help freshen the mouth but do not remove the elongated papillae, which requires mechanical debridement.
- D. Correct. Management is mechanical DEBRIDEMENT and improved hygiene — brushing or scraping the tongue dorsum to remove the elongated keratinised papillae — together with eliminating predisposing factors: tobacco, excessive coffee or tea, poor oral hygiene, oxidising mouthrinses (chlorhexidine, hydrogen peroxide) and broad-spectrum antibiotics.
Note: The related item in this file describes 'a tongue between green and yellow' with the answer being HYPERKERATINISATION OF THE FILIFORM PAPILLAE — the same underlying process. The colour varies with the chromogenic bacteria and dietary staining present.