Thursday, October 6, 2016

Black Hairy Tongue

A 60-year-old man who smokes presents to the physician’s office smelling of alcohol. He complains of a black discoloration of his tongue and a gagging sensation on occasion. He admits to smoking
1 to 2 packs per day along with drinking at least 6 to 8 beers per day. The patient brushes his teeth infrequently and has not seen a dentist for a long time.
On physical exam, his teeth are stained and his tongue shows elongated papillae with brown discoloration . See picture below:

Diagnoses include black hairy tongue (BHT), poor oral hygiene, and tobacco and alcohol addiction.

Case Discussion:

Black Hairy Tongue: 

Black hairy tongue (BHT) is a benign disorder of the tongue characterized by abnormally hypertrophied and elongated filiform papillae on the surface of the tongue. In addition, there is defective desquamation of the papillae on the dorsal tongue resulting in a hair-like appearance
Also known as : Hyperkeratosis of the tongue and lingua villosa nigra.

Risk factors include:

• Tobacco (smoking and chewing).
• Alcoholism and drug abuse (especially drugs that are smoked).
• Poor oral hygiene.
• Medications (especially antibiotics and those causing dry mouth).
• Oxidizing mouthwashes (containing peroxide).
• Cancer, especially with radiation therapy.
• Drinking black tea or coffee.

Clinical Features: Patients may be asymptomatic. However, the accumulation of debris in the elongated papillae may cause taste alterations, nausea, gagging, halitosis, and pain or burning of the tongue. The lesion is restricted to the dorsum of the tongue, anterior to the circumvallate papillae, rarely involving the tip or sides of the tongue.

Diagnosis: The diagnosis is made by visual inspection and clinical history of smoking and poor oral hygiene.
 Consider performing a KOH preparation to rule out associated candidiasis.

Differential Diagnosis: Black tongue can occur with:
• Ingestion of bismuth subsalicylate or minocycline. Although the tongue has a black coating, the papillae are not elongated. Without the hypertrophy of papillae this is not a Black Hairy Tongue.
• Hairy leukoplakia—Appears as faint white vertical keratotic streaks typically on the lateral side of the tongue .
Do not confuse BHT with oral hairy leukoplakia, an Epstein- Barr virus–related condition typically affecting the lateral tongue bilaterally in immunocompromised patients, especially those with HIV infection.
• Oral candidiasis—White plaques typically found on the buccal mucosa, tongue, and palate when removed has an erythematous base. The white color should make this easy to distinguish from BHT

Management: 
1. Avoidance of predisposing risk factors (e.g., tobacco, alcohol, and antibiotics).
2.  Stop the offending medication in drug-induced BHT whenever possible.
3.  Regular tongue brushing using a soft toothbrush or tongue scraper.
4, If candidiasis is present, an oral antifungal is indicated. If there is no liver disease, the preferred regimen for oral candidiasis is fluconazole 100 mg daily for 14 days. An alternative is clotrimazole troches 5 times a day for 14 days. Nystatin is less effective.
5, Patients with poor oral hygiene should be referred to a dentist.

2 comments:

  1. Hello, my name is Betty. i was diagnosed of HIV virus 4 years back. Before then, i was dating this Derrick guy. we had something great going on. Our love life only lasted for 8 months. the sixth and seven month of our relationship, i began feeling very weak every now and then. But i never suspected anything until I kept on experiencing different symptoms like having sore throats, constant headache, body weakness e.t.c. I decided to go for a medical check up. I was tested HIV positive. when the doctor broke the news to me, it was as if my whole world had crumbled. it dawned on me then that Derrick has been lying to me. i was very mad to an extent i almost committed suicide. But there was nothing i could do, other than weep and weep. ever since then, i have been spending heavily on medications, going from one medical clinic or the other so I can look healthy. Though since i was a kid, i love herbs a lot. i take herbal tea with grandma while growing so i am quite familiar with herbs. early last year, i was on the internet and on a particular health blog, to check for herbal medication as alternative. I saw many comments and read many testimonies. Until i came across a particular testimony on how Dr.ugo cured a patient from herpes simplex virus using pure natural herbs. i reached out to the doctor because I also was thinking Herpes had no cure. I told him about my HIV status.He encouraged me not to panic that he will help me get my deliverance. he prepared some herbs and sent them to me. The herbs were in four 70ml bottles and I took them morning and night. i used as he directed, and in less than three weeks, i started having appetite to eat plenty of food and i gained back my strength. the fourth week,I consumed all the herbal meds. He encouraged me to go for a test which i did. This time, the result was negative. I quickly contacted the doctor and informed him of the news. I immediately asked him to prepare for Derrick too. He did and sent it. Today, me and Derrick are HIV free. All thanks goes to God Almighty for healing us through Dr.Ugo. if you are having any kind of sickness at all, Dr.Ugo is the right person to talk to and i assure you, you will be glad you did. His email: ugoherbalhome@gmail.com you can also write him on WhatsApp +2348104990619.

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  2. Nice blog
    Have been totally convinced that HIV,and many others dangerous diseases can be best cured using the Herbal Medicine. Dr.Akpu the great and powerful herbalist cured me with his Herbal remedy. I'm Linda,15 years from Texas. I was born with HIV. I lost parents at my teenager age when I was 4th. I had to grew up with my mum only Sister, whom I loved so much. She was so worried about my life as my condition was her mature problem in life. I had taken lots of antiviral treatment to get ride of the virus not believing what there said HIV has no cure. I was on the internet when i came across blogs of testimony about a lady who where cured of a 7 years diagnose of Herpes by this powerful Herbalist, Dr.Akpu.I wrote down his mail @ Dr.akpupowerherbscenter@gmail.com
    I told my Aunt,luckily it was the same Dr,we where referred to few months back by my pastor in church whom members have being testifying about of his cure We did contacted him and explained my problem to him.He prepared the medicine and sent to me with details of how to use and apply. After a while, I began to feel more strong than never before, I felt so lucky and happy when my Doctor congratulated me that he could found no HIV virus again in me. I knew I was free cos my body was so strong. His herbal medicine should have saved my parents life, i said!
    Thanks so much for reading my article, you should share your testimony if you have cure as well
    Dr.akpupowerherbscenter@gmail.com
    Is the solution

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