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Finding a black spot on your tongue can be alarming. Our tongues are usually pink and relatively uniform in color, so any noticeable change can trigger concerns. While a black spot on the tongue is not always a cause for panic, it is important to understand the potential causes, when to seek medical advice, and what steps to take to address it.
In this article, we’ll explore the possible reasons for black spots on the tongue, what symptoms to look out for, and how to proceed if you discover one.
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Common Causes of Black Spots on the Tongue
Hyperpigmentation: Hyperpigmentation occurs when there is an overproduction of melanin, the pigment responsible for skin and hair color. On the tongue, this can manifest as dark or black spots. Hyperpigmentation is generally harmless and often related to genetics or harmless skin conditions like oral melanotic macules.
Tongue Trauma or Injury: Biting your tongue, irritation from hot foods, or a sharp object can cause bruising or trauma. This can sometimes result in a black or dark spot as blood vessels break, similar to a bruise on the skin.
Lingua Villosa Nigra (Black Hairy Tongue): This condition occurs when the tiny bumps on the tongue, known as papillae, become elongated and stained. The dark appearance is due to trapped bacteria, food, or tobacco use. Despite its unsettling name, black hairy tongue is usually benign and can be resolved with good oral hygiene.
Oral Melanoacanthoma: This is a rare, benign condition that appears as a dark, rapidly growing lesion on the oral mucosa, including the tongue. It is more common among people of African descent and usually resolves on its own after a biopsy confirms it is not malignant.
Medications and Medical Treatments: Certain medications, such as antibiotics or medications for high blood pressure, and treatments like chemotherapy, can lead to changes in the pigmentation of the tongue. The condition, known as drug-induced pigmentation, can appear as black or dark spots.
Smoking and Tobacco Use: Tobacco products can stain the tongue and lead to black spots. This is often seen in individuals who chew tobacco or smoke regularly, causing discoloration of the tongue’s surface.
Fungal Infections: While less common, some fungal infections like Candida can cause dark patches on the tongue, especially in immunocompromised individuals.
Oral Cancer: Though rare, a black spot on the tongue can be an early sign of oral cancer, particularly if it is irregular in shape, grows over time, or is accompanied by other symptoms such as pain, difficulty swallowing, or a persistent sore.
When to See a Doctor
While many causes of black spots on the tongue are benign, certain characteristics should prompt a visit to a healthcare provider:
Persistent Changes: If the black spot does not disappear after a few days or weeks, especially if it’s getting larger.
Irregular Borders or Color: If the spot has an irregular shape, uneven color, or is asymmetrical.
Accompanied Symptoms: Symptoms such as pain, bleeding, swelling, numbness, a burning sensation, or difficulty swallowing.
Rapid Growth: If the spot or lesion is growing quickly, it warrants a prompt medical evaluation.
Additional Oral Lesions: If you notice multiple spots or lesions appearing in different areas of the mouth.
Health History: Individuals with a history of oral cancer, tobacco use, or significant alcohol consumption should be more vigilant and consult a healthcare provider.
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