Black Spots on the Tongue

What are Black Spots on the Tongue?

Single spot or may be a cluster small dots may appear on the surface of the tongue. They may:

  • Appear on a particular part of the tongue such as the side, tip, etc.
  • Cover the entire surface of the tongue
  • Spread to the cheeks, lips and the rest of the mouth

The degree in which they manifest themselves is often dependant on the underlying cause associated with their appearance. The spots may be flat patches or slightly raised bumps. Some of the spots might disappear on their own within a few days while others may remain permanently or reoccur from time to time. The period for which they persist also signals towards the probable causes of its occurrence.

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Black Tongue Causes

  • Hyperpigmentation: It refers to a condition in which there is excessive release of the pigment. Cells that contain melanin are known as melanocytes are responsible for the color of the tongue and skin. Their presence in larg numbers also causes the appearance of black spots. Other causes may include intake of certain kinds of medication, low production of hormones by the adrenaline glands and the age of the individual. Most often, the spots are harmless.
  • Oral Cancer: People who are in the habit of chewing tobacco or old beetle may be at the risk of oral cancer. Sometime the cancer cells may affect the tongue, gums and others parts of the mouth. Even those who experience frequent cuts or lesions on the tongue may be affected by cancer. It includes thickening of the patch and formation of ulcers on the tongue. In severe cases, it may also cause pain. Black spots are also observed in patients undergoing chemotherapy and they disappear once the chemotherapy treatment is stopped.
  • Hairy Black Tongue: It usually affects the back and mid region of the tongue. The tongue may appear to have black furry patches of hair. This happens because papillae on the tongue trap dead cells. These cells get discolored and turn black. Along with it, people may also experience bad breathe and a metallic taste in their mouth. Such a condition may occur due to lack of oral hygiene or infection by bacteria or yeast.
  • Alcohol Consumption and Smoking: Smoking as well as alcohol consumption may cause the appearance of black spots on the tip, side and under the tongue. People who smoke are more prone to oral cancer. Moreover, it also causes hyperpigmentation. The presence of black long papillae is found mostly among smokers. This gives the tongue a dark and hairy appearance.
  • Reaction to medications: People may be allergic to certain medications that could cause dark spots or bumps on the tongue. Medications such as anti depressants, asthma drugs, some kinds of antibiotics and medicines that contain bismuth salicylate commonly cause the appearance of black spots on the tongue.  Allergic reactions may cause staining of the tongue. Image Source:
  • Oral Mucocele: When the salivary glands in the mouth get damaged or blocked, a cyst like lump forms in the mouth. These bumps may be found under the tongue and they are usually deep blue or almost black in color. They are known as oral mucocele. They commonly appear at the side, on the surface or below the tongue. Lip biting and trauma can cause such a condition. These bumps are harmless and go away on their own.
  • Oral Fibroma: It is a smooth, round lump attached to the oral cavity tissue by the stalk at its base. They are similar to freckles and moles and may irritate the teeth, dental appliance and piercings. Often these may reoccur even if they are surgically removed from the mouth.
  • Tongue piercing: When a piercing is made on the tongue, it takes some time to heal. After it has healed the color goes back to normal. However, special care must be taken to maintain oral hygiene while the piercing is still healing. If proper care is not taken, it can lead to bacterial infections or other infestations.
  • Blood Blisters: People may bite their tongue or cheek accidentally due to ill fitting dentures or due to stress. Whatever is the reason, it can cause the formation of blisters filled with blood. These are harmless and disappear when the injury heals.
  • Freckles and Staining from Fillings: Harmless spots with darker pigments are found on tongue as well as the skin. They occur due to uneven discoloration in various parts of the mouth. Dark spots on the tongue may occur due to staining from fillings. It is also called amalgam fillings or amalgam tattoos.
  • STD and HIV: Blemishes on the tongue and warts on the genitals are caused due to sexually transmitted diseases. Although, in such cases, the spots are more often white than black. The spots on the tongue are usually accompanied by other symptoms that help to conclude HIV or STDs as the probable causes.
  • Anemia: Anemia is a condition of a low level of red blood cells in the body. The tongue often helps to diagnose a condition of anemia. Although a pale tongue is the most common sign of anemia, the presence of clustered or scattered dark spots on the tongue can also imply that a person is anemic.
  • Pregnancy: There are many hormonal changes in the body during pregnancy and as a result black spots may appear on the tongue. Also, the intake of contraceptives causes hormonal changes leading to black spots on the tongue.
  • Babies – Dark spots may also appear on the tongue of babies due to allergic reactions or oral thrush. In such cases, the spots may be either black or white. The tongue may have a dark and hairy appearance due to antibiotic therapies applied on the baby. Debris may also build up in case of breastfeeding infants resulting in dark spots on the tongue.


Causes Symptoms 
Hyper pigmentation 
  • Weak intensity chemical trauma 
  • Anemia 
  • Chronic stress 
  • Fatigue 
  • Vitamin B deficiency 
  • Lack of nutrition  
  • Lack of oral hygiene 
  • Insomnia 
  • Lack of appetite 
Oral Cancer 
  • Sores do not heal for weeks 
  • Small wounds on the tongue 
  • A part of the tongue surrounding the wound gets hardened  if touched 
  • Discomfort 
  • Pain 
  • Lesions on the tongue 
  • Difficulty in eating 
  • Difficulty in talking 
  • Difficulty in controlling saliva 
  • Bleeding 
  • Foul smelling 
  • Ear pain in the temporal region 
Black Hairy Tongue 
  • Black spots of fur on the tongue 
  • Presence of black spots in the middle of the tongue  


It is advised to visit a dentist at least twice a year as they are trained to check the mouth and tongue for signs of oral problems.

In order to make an accurate diagnosis, the doctor must be informed about the following:

  • Consumption of any supplements or medications
  • Personal and family medical history
  • Smoking and alcohol consumption
  • Conditions of compromised immune system
  • Experience of symptoms such as lumps or pain in the throat, neck or mouth

The following medical tests could be prescribed:

  • X-rays
  • Positron emission tomography scans
  • Biopsy

Black Tongue Treatment

  • Maintaining Oral Hygiene: Keeping the mouth clean is the best way to avoid any kind of infection, dark spots, bad breathe, etc. Brushing twice a day, rinsing the mouth after every meal, flossing the teeth and using an antibacterial mouthwash helps to maintain oral hygiene.
  • Changes in Life Style: People must stop alcohol consumption, smoking and chewing of tobacco in order to avoid dark spots on the tongue. Also people are used to drinking tea or coffee must clean their mouth after consuming those beverages. Water must be consumed in adequate amounts to wash out debris of food present in the mouth.
  • Following the Doctor’s Advice: As mentioned above, a dentist must be consulted at least twice a year. Any medicines or changes in quantity that are suggested by the doctor must be taken and implemented, respectively. In case of a piercing, the area must be treated as deemed necessary by the doctor.
  • Surgery: In certain cases warts may appear on the tongue or in the mouth. They need to be removed surgically. In case of oral fibroma too, a surgery can be conducted to remove the unwanted mass. However, in spite of surgery they may reoccur within a certain period of time.

When to visit a Doctor?

Usually, black spots on the tongue are harmless and they disappear on their own even without any treatment. However, in certain cases, they may be symptoms of some other health condition which would require serious medical help.

Under the following circumstances an individual must seek medical help from a doctor:

  • Altered sense of taste
  • Discolored patches on the tongue, inside of the cheeks and roof of the mouth that remain for a long time
  • Persistent pain in the tongue
  • Difficulty in chewing and swallowing food due to mucoceles or lesions in the mouth

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