Medical Challenge Question 4 Answer

Answer C: Tell the patient to brush the tongue.

Management of black hairy tongue consists of tongue brushing as part of aggressive oral hygiene.

The patient has black hairy tongue. The correct management is tongue brushing as part of aggressive oral hygiene. Black hairy tongue is a benign and self-limited disorder. Risk factors include alcohol and tobacco use, poor oral hygiene, and medications (such as bismuth, tetracycline, and linezolid). The appearance of black discoloration and a thickened tongue without other symptoms is characteristic. Treatment includes aggressive oral hygiene with tongue brushing and scraping and modification of any risk factors (smoking cessation, avoidance of alcohol or medications inducing the change).

Amoxicillin-clavulanate is an antibiotic that treats several oral infections. Black hairy tongue is not an infection and therefore does not require antibiotic treatment. The clinical appearance and the absence of oral or systemic symptoms make an oral infection as a cause of his findings unlikely.

A biopsy of the lesion is not indicated as this is a benign and self-limited condition. If the lesion is recalcitrant to therapy or if there are concerning manifestations such as leukoplakia or erythroplakia, a biopsy may be considered. Management with aggressive oral hygiene before biopsy is recommended.

Antifungals like fluconazole are used to treat candidiasis oral infections. This would be incorrect because black hairy tongue is a keratin build-up related to risk factors and poor oral hygiene.

Referecence:

Nisa L, Giger R. Black hairy tongue. Am J Med. 2011 Sep;124(9):816-7. PMID: 21854889