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You are seeing a 2-month-old infant brought in by parents because they notice the center and mid-back of the tongue is black in color. The baby is part-breastfed and part-formula fed, with a standard cow’s milk based formula. Nothing else has been given orally to the child. The remainder of the exam is normal. There are no findings in the buccal mucosa and there is no exanthem.
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May 14, 2024 at 8:24 pm
D) Reassurance
Lingua nigra ex vellosa (black hairy tongue) is an uncommon but benign finding in infants. It is more often seen in adults (associated with smoking, poor oral hygiene, use of bismuth preparations) and hospitalized patients with gastrostomy tubes. The filiform papillae (located on the entire dorsal surface of the tongue) become blackened; this is thought to be due to proliferation of chromogenic bacteria in the area. Sometimes the papillae elongate, making the tongue appear hairy. Candida can often be cultured but whether this represents a thrush-like infection requiring treatment is unclear; oral nystatin can be given. The mainstay of therapy is reassurance regarding its benign self-limited nature, and having the parent gently brush the tongue with a soft toothbrush dipped in warm water a few times per day.