Welcome to Am I Dying, a column that hopes to save you from your late-night WebMD spiraling. You can email us your hypochondriac questions at firstname.lastname@example.org.
Okay, here’s the backstory: Last month, I had pneumonia, which was bad enough. My doctor put me on antibiotics for seven days. Great. I got better. Not long after, my dad had the AUDACITY to send me a link to a story about something called — horrifyingly — “black hairy tongue.” (This should go without saying, but the pictures are very upsetting!) What makes this relevant to ME is that the woman in the story got black hairy tongue by being on antibiotics. Is this my future now? WebMD says bad oral hygiene can also cause it, and I don’t floss as much as I should … it’s already happening, isn’t it?
Can I just say: aaaaaaaAAAAAAAAAHHHHHHHHHHHHHHH!!
How did I, a lover of everything that is most disgusting about human beings, make it this far into life without knowing about the aptly, succinctly named “black hairy tongue”? Why have I not spent my entire life thus far trying to avoid getting it? Were all the antibiotics worth it??? (Okay, yes.)
More alarming still: did you know that ALL of our tongues are hairy??? I received this terrible news from Dr. Ross Kerr, an oral medicine expert at the NYU College of Dentistry, who tells me that all human tongues are covered in what’s called “filiform papillae,” or tiny little hairs. Admittedly, in normal cases, they’re very, very short, and useful, too. “They’re typically less than a millimeter long, and they’re very important for conveying taste when you’re eating something nice, and they’re also important for mastication,” says Kerr.
Where things get … hairy … is when some external stimuli encourages the papillae to grow. Kerr compares it to a callus — if there’s a spot on your heel that keeps rubbing against your shoe, you’ll produce more tissue to cover it, in the form of a callus. The tongue does the same thing, and a number of things can cause this type of reaction. The most common, says Kerr, is not eating. “If you just left someone and fed them by a tube through their stomach, and they didn’t have the capacity to eat at all, their hairs would grow,” he says. Does this mean that eating food is essentially a haircut for your tongue? Yes, it does, Kerr says. (!!!!!!)
Other culprits responsible for tongue hair growth include smoking, poor oral hygiene, oxidizing mouthwashes, certain fungal infections, and, yes, certain antibiotics, says Kerr. Most of the antibiotics implicated belong to the tetracycline family (including minocycline and doxycycline), though it’s unclear why. “When we take antibiotics, that can sometimes change the ecology, and sometimes new bacteria are allowed to grow, and some of these bacteria can actually produce pigments, and they can produce dark pigments, and lead to this dark staining,” says Kerr. Antibiotics themselves are unlikely to stimulate papillae growth, says Kerr, but they can turn a hairy tongue black.
The good news in this horrifying situation is that, typically, the tongue should return to normal once the papillae growth cycle renews — a process that Kerr says typically takes between two weeks and a month, or as long as it takes for the existing hair to come off, and new hair to grow. (That is not quickly enough, I know.) If you were to come down with a case of BHT, says Kerr, you’d want to practice excellent oral hygiene: not just brushing one’s teeth, but brushing (and scraping) one’s tongue. This leads me to the most viscerally disgusting and amazing story I have ever heard in my life — what Kerr presents as the likely worst-case scenario.
“I had a patient who because of a swallowing disorder couldn’t swallow,” he says. “He essentially took all his food through a peg tube, and the top of his tongue was just like a mat of hair. It was very difficult for him to even brush his tongue, so I actually went in and shaved it. I took a scalpel and shaved the tongue — without cutting it, but just scraped it with a short blade, and I was able to remove a bunch of the hairs.” I know what I will be dreaming about tonight!
But again: this will probably not happen to you, especially if you’ve already finished your antibiotics. (Kerr says it’s theoretically possible for BHT to show up after a course of antibiotics, but he’s never seen it.) And if you eat regularly, and practice good oral hygiene, you’re unlikely to see any above-average tongue hair growth. But just in case, you may want to eat something nice and scrape-y for dinner.