Black Spots on Tongue: Causes, Treatments, and When to See a Doctor

Black Spots on Tongue: Causes, Treatments, and When to See a Doctor

Noticing black spots on your tongue or other types of dark patches in your mouth can cause you to worry. Sometimes the cluster of black spots at the back of your tongue can resemble black hairs and is called a black hairy tongue. Other times the black or dark tongue spot could be due to a tongue injury that causes a blood blister to appear. Hyperpigmentation of the tongue is a side effect of some medications and can cause dark patches on your tongue. Sometimes, smoking or other conditions can cause staining in your mouth and cause your tongue, cheek, or other parts of the oral cavity to have a dark discoloration.

Most of the time, black spots and patches on your tongue are a temporary condition. Good oral hygiene, changing your medication, or stopping smoking is enough to get rid of the black spots on your tongue, inside cheeks, or lips. However, if you have a black or discolored lesion on your tongue that doesn’t go away, you should have it checked by your doctor or dentist. On rare occasions, a dark-colored lump or patch on or under your tongue or on the side of the tongue could be a sign of oral cancer.

This article examines the reasons of black spots, dark patches, or black small dots that appear on your tongue. These patches of dark spots could be on the tip of your tongue, side of your tongue, or underneath your tongue. However, wherever the black tongue spots appear, you will find out what they mean in this article.

Causes of Black Spots on Tongue

Your tongue is covered with tiny papillae which are tiny bumps on your tongue that help you taste food. Usually, these dots or bumps are red and are so tiny that you generally won’t notice them. However, sometimes they can become discolored and swollen and look like one black spot or a collection of small dark bumps on your tongue.

Your tongue can tell you a lot about your health and the reasons why dark bumps or dots can appear on your tongue are many and varied. Here are some of the most common conditions that can cause black spots on your tongue. In some cases, you will find out how to get rid of these unsightly lesions quickly.

Black Hairy Tongue

A black hairy tongue is a common reason for having a large collection of black spots at the back and middle of your tongue. Although the dark patches on the surface of your tongue look worrisome, it is usually caused by harmless conditions.

According to doctors from the Mayo Clinic, the long papillae on the tongue trap dead skin cells which discolor them black. This gives the tongue an appearance of black furry hairs and may cause you to become self-conscious. Along with the black patches on your tongue, you may have bad breath and a metallic taste in your mouth.1

There can be many reasons why you have temporary black spots on your tongue that look hairy. One of the most common reasons is a lack of good oral hygiene. Also, if you have been on a course of antibiotics, the changes in yeast or bacteria in your mouth could also cause these hairy dark patches to appear.

To get rid of a black hairy tongue, Dr. Michael Friedman on WebMD recommends practicing good oral hygiene and to drink plenty of water throughout the day. You can also scrape dead skin cells and bacteria from your tongue using a tongue scraper.2

If your hairy tongue persists, you should visit your dentist who can advise on the best oral hygiene practices for you.

Hyperpigmentation of tongue

Another reason why patches of black spots on your tongue can appear is because of hyperpigmentation. Too much pigmentation on your tongue can result in spots of dark patches that are harmless which may or may not go away.

Pigments give your skin and tongue their color and melanocytes (cells that contain melanin) are also present in your tongue. A report from 2012 on oral pigmented lesions said that some of the reasons for tongue pigmentation are age, your adrenal glands not producing enough hormones, or using certain medications. Also, some people who have more melanocytes are prone to hyperpigmentation on their tongue.3


Heavy smoking is often to blame for having black spots form on the side, top, and underneath of the tongue. One condition that smoking can cause is having a hairy black tongue. According to the Journal of the Canadian Dental Association, smokers are at more risk of having long black papillae on their tongue that look like hairs.4

Another reason why smoking can cause black spots to appear on the tongue is that smoking causes tongue hyperpigmentation. One study into the effects of smoking on the oral cavity found that most smokers had some kind of oral pigmentation.5

Preventing black hairy tongue and hyperpigmentation are some good reasons to give up smoking. However, as much research has shown, smoking puts a person at a greater risk of developing cancer.

Blood blister

A black spot on your tongue may be the result of an injury that has caused a blood blister. Very often, if you bite your tongue you can be left with a red or black spot on the side of your tongue or on the tip of your tongue. Blood blisters are usually harmless and will go away on their own as the injury heals.

According to the Annals of Dermatology, continuous biting of the tongue can result in injuries. This could cause a blood-filled bump on the tongue to form or an ulcer. A cause of chronic tongue and cheek biting could be stress.6 However, tooth damage or ill-fitting dentures could also be to blame for inadvertently biting your tongue and causing a blood blister.

If stress is causing you to have a nervous habit of biting your cheek or tongue, then please read my article on the best natural remedies for getting rid of stress.

Staining from fillings

Small dark patches on the side of your tongue may simply be due to staining from fillings. Dr. Louise Newson on says that amalgam fillings can cause dark staining on your tongue and are sometimes referred to as amalgam tattoos.7

If you notice this, it is a good idea to mention it to your dentist at your next visit. Your dentist can check to make sure that the black tongue lesion isn’t something more serious.


Just like some people have darker brown spots on their skin, you can also get freckles on your tongue. These are harmless spots where darker pigments have appeared on your tongue.

The Singapore Dental Journal stated that melanocytic nevi (freckles) can affect different parts of your mouth causing an uneven discoloration. Although they are nothing to worry about, if you notice new brown-colored spots or small patches on your tongue, you should have it checked out by a doctor.8

Oral mucocele

A bump under your tongue that is a deep blue, almost black color, could be an oral mucocele. The bumps in the mouth form when a salivary gland gets damaged or blocked. This forms a cyst-like lump in your mouth.

According to the Journal of Oral and Maxillofacial Pathology, oral mucoceles are often caused by trauma or lip biting. Although oral mucoceles often affect the lip they can appear in other parts of the mouth. Therefore, the surface of the tongue, side of the tongue and floor of the mouth are also common places for these dark-colored lumps to appear.9

Dr. Alfred Wyatt on WebMD says that usually these harmless bumps in the mouth go away on their own and you shouldn’t try to remove them yourself. If they start to bother you, you should speak to your doctor or dentist who can recommend the best way to get rid of the mucoceles.10

Side effects of some medications

Black spots and dark patches on the tongue could be the side effect of taking certain medicines. Some medicines like antibiotics can disrupt the balance of bacteria in your mouth and cause patches on the tongue to appear black. Other medications can get trapped in the papillae and turn black if it’s not properly rinsed out.

Doctors from WebMD say that some medications to stop diarrhea can cause your tongue to turn black. Usually, your tongue should return to its normal color a few days after stopping taking the anti-diarrhea medication.11 Also, the World Journal of Gastroenterology reports that antibiotics can be a reason why small to large black patches appear on your tongue.12

If you are taking antibiotics, you should remember to take a course of probiotics to help restore “good” bacteria to your gut and prevent the side effects of antibiotic medicines.

Oral cancer and chemotherapy

You should talk to your doctor about any unusual lesions on the tongue or mouth that don’t go away. Generally, the first signs of oral cancer are white or dark red patches in your mouth. Dr. Donna Bautista on MedicineNet says that nodules or ulcerations may start to grow on these discolored lesions.13

However, black or brown pigmentation patches on the tongue are sometimes seen in patients undergoing chemotherapy treatment. Usually, the pigmentation disappears when the chemotherapy treatment is stopped.14

Black Spots on Tongue – When to See a Doctor

Generally, any black spots or discolored patches on your tongue should go away by themselves or when the underlying cause is addressed. However, in some cases, you should visit your doctor if your symptoms persist.

Dr. Josef Shargorodsky on MedlinePlus says that some signs of more serious conditions that affect the tongue include:15

  • Swelling of the tongue, especially if it affects your breathing.
  • You have difficulty chewing or swallowing food because of mucoceles or other lesions in your mouth.
  • Your taste buds and sense of taste has altered.
  • You have discolored patches on your tongue, the roof of your mouth, or inside of your cheeks that don’t go away.
  • You have pain in your tongue that doesn’t go away.

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Article Sources

  1. MayoClinic. Black hairy tongue.
  2. WebMD. What is black hairy tongue?
  3. Med Oral Patol Oral Cir Bucal. 2012 Nov; 17(6): e919–e924.
  4. J Can Dent Assoc. 2000; 66:252-6.
  5. N Y State Dent J. 1997 Oct;63(8):20-1.
  6. Ann Dermatol. 2012 Nov; 24(4): 455–458
  7. PatientInfo. Problems in the mouth.
  8. Sing Dent J. 2014 Dec;35:39-46.
  9. J Oral Maxillofac Pathol. 2014 Sep; 18(Suppl 1): S72–S77.
  10. WebMD. Mucocele.
  11. WebMD. Treating a black or coated tongue.
  12. World J Gastroenterol. 2014 Aug 21; 20(31): 10845–10850.
  13. MedicineNet. Tongue problems.
  14. South Med J. 1979 Dec;72(12):1615-6.
  15. MedlinePlus. Tongue problems.

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