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Clinical Practice Points • Immune checkpoint inhibitors (ICIs) are associated with the development of unique immune-related adverse events (irAEs), which emerged primarily during post-marketing surveillance. Oral irAEs have already been reported, with the most common manifestations being mucositis and xerostomia. It has been suggested that a T-cell activation, similar to that observed in autoimmune conditions, may play a role. • Here, we report a case of black hairy tongue (BHT) in a patient receiving first-line pembrolizumab for advanced non–small-cell lung cancer (NSCLC). Although the BHT was symptomatic for burning mouth and dysgeusia, ICI use was continued due to its clinical and radiological benefit, which persisted for a long time. • BHT is characterized by hypertrophy and lengthening of the filiform papillae. Despite being a rare benign condition, it can often result in a significant burden on quality of life. • Many predisposing factors have been described, and cancer patients represent a population particularly at risk. Based on the temporal association and excluding possible alternative causes, we proposed that, in our patient, BHT was likely ICI related through the development of xerostomia, which represents a key factor in BHT pathogenesis. • To the best of our knowledge, this is the first report of BHT after ICI use, suggesting that it may represent an atypical oral irAE. To date, the oral irAEs have not been well explored, and further studies are needed to elucidate the underlying mechanisms and possible associations with anti-tumor responses, with significant implications on prognosis and quality of life. In the present context, our case emphasizes the need to remain vigilant for atypical and new irAEs.

Familiarity with common oral conditions allows clinicians to observe and treat patients in the primary care setting or refer to a dentist, oral surgeon, otolaryngologist, or other specialist. Recurrent aphthous stomatitis (canker sores) is the most common ulcerative condition of the oral cavity. Recurrent herpes simplex labialis and stomatitis also commonly cause oral ulcers. Corticosteroids, immunocompromise, antibiotics, and dentures can predispose patients to oral candidiasis. Benign migratory glossitis (geographic tongue) occurs in up to 3% of the population but generally lacks symptoms, although some people experience food sensitivity or a burning sensation. Hairy tongue is associated with a low fiber diet, tobacco and alcohol use, and poor oral hygiene in older male patients. Generally, hairy tongue is asymptomatic except for an unattractive appearance or halitosis. Tobacco and alcohol use can cause mucosal changes resulting in leukoplakia and erythroplakia. These can represent precancerous changes and increase the risk of squamous cell carcinoma. Mandibular and maxillary tori are common bony cortical outgrowths that require no treatment in the absence of repeat trauma from chewing or interference with dentures. Oral lichen planus occurs in up to 2% of individuals and can present as lacy reticulations or oral erosions and ulcerations. Traumatic buccal mucosal fibromas and labial mucoceles from biting can be excised.

Hairy tongue is a benign pathology, characterized clinically by hyperkeratinized plaques on the dorsal surface of the tongue, hairlike, whose coloration ranges from unpigment, whitish, yellowish, green, brown to black. Diagnosis is clinical, and, in cases of whitish plaques, it may be difficult to differentiate between oral hairy leukoplakia, potentially malignant leukoplakia or squamous cell carcinoma. Thus, widefield optical fluorescence complementary examination may allow a better visualization of the local hairlike pattern of hyperkeratinization, typical of the hairy tongue, facilitating the diagnosis. In this work, a 57-year-old man was referred to the Dental Specialties Department of the Divinópolis Health Department (MG, Brazil) by a general dental practitioner, aiming a differential diagnosis of possible malignant lesion on the dorsal tongue surface. The complementary examination by wide-field optical fluorescence was performed. For this, it was employed a device with high-power light-emitting diode emitting light centered at a wavelength of (400±10) nm and maximum irradiance of (0.040±0.008) W/cm2 was used for fluorescence visualization. Fluorescence images showed projections of hairlike appearance in tongue dorsal surface with no aspects of malignancy. Hairlike appearance is the principal feature of hairy tongue. In this way, the final diagnosis was established. In conclusion, in this case, the use of widefield optical fluorescence in oral diagnostic routine provided a differential diagnosis, with no need of an incisional biopsy. Resumo A língua pilosa é uma patologia benigna, caracterizada clinicamente por placas hiperqueratinizadas na face dorsal da língua, semelhante a pelos, cuja coloração varia de despigmentada, esbranquiçada, amarelada, verde, acastanhada a preta. O diagnóstico é clínico, e em casos de placas esbranquiçadas, pode ser difícil diferenciar entre leucoplasia pilosa oral, leucoplasia potencialmente maligna ou carcinoma de células escamosas. Assim, o exame complementar de fluorescência óptica de campo amplo pode permitir uma melhor visualização do padrão local de hiperqueratinização semelhante à pelos, os quais são característicos de língua pilosa, facilitando o diagnóstico. Neste trabalho, um paciente do sexo masculino, 57 anos, foi encaminhado ao Departamento de Odontologia da Secretaria de Saúde de Divinópolis (Minas Gerais) por um clínico geral, visando o diagnóstico de uma possível lesão maligna na face dorsal da língua. O exame complementar por fluorescência óptica de campo amplo foi realizado. Para isso, foi empregado um dispositivo com diodo emissor de luz de alta potência, com luz centrada em um comprimento de onda de (400±10) nm e irradiância máxima de (0,04 ±0,008) W/cm2 para visualização de fluorescência. As imagens de fluorescência mostraram projeções de aparência semelhante à pelos na superfície dorsal da língua, sem aspectos de malignidade. A aparência similar à pelos é a principal característica da língua pilosa. Dessa maneira, o diagnóstico final foi estabelecido. Em conclusão, neste caso, o uso da fluorescência óptica de campo amplo permitiu um diagnóstico diferencial, sem a necessidade de uma biópsia incisional.

Patient: Female, 3-month-old Final Diagnosis: Black hairy tongue Symptoms: Discolored tongue Medication:— Clinical Procedure: Gentle tongue brushing Specialty: Pediatrics and Neonatology Objective: Rare disease Background: Black hairy tongue is a self-limiting, usually asymptomatic, benign lesion that most often affects men and people aged over 30–40 years. The lesion is extremely rare among newborns and infants. Lingua villosa nigra is characterized by the presence of elongated filiform papillae of the dorsum of the tongue, which gives a hairy appearance. The overgrown papillae can accumulate fungi, bacteria, pigments originating from food, or any other debris that can contribute to the discoloration of the tongue. The prognosis for black hairy tongue is positive. Gentle tongue brushing or scraping as well as the elimination of predisposing factors usually leads to cessation of the lesion. Case Report: A generally healthy, exclusively breastfed 3-month-old female baby was admitted to the Oral Pathology Department of Wrocław Medical University due to a persistent tongue lesion. Intraorally, dark, blackish, elongated tongue papillae were observed. Three weeks earlier, the baby’s pediatrician had diagnosed thrush and prescribed systemic antifungal treatment with Nystatinum, without prior mycological examination. The lesion did not resolve and the girl was referred to the Department of Oral Pathology. A meticulous medical and dietary interview revealed that since the 28th day of life the baby had been supplemented with vitamin C. This, together with an intraoral examination, led to the diagnosis of black hairy tongue. The lesion disappeared partially after 4 weeks of tongue brushing. Conclusions: To prevent infants from undergoing persistent and unnecessary treatment (topical or systemic drugs) or additional diagnostic procedures, such as biopsy, it is essential to be familiar with the characteristics of lingua villosa nigra as well as its origin and management. The consideration of this condition is invaluable for babies’ health and safety.

Black hairy tongue (BHT) is a self-limiting disorder characterized by abnormal hypertrophy and elongation of filiform papillae on the surface of the tongue. The exact mechanism of drug-induced BHT is unknown. Several factors have been implicated and included smoking or chewing tobacco, drinking alcohol, poor oral hygiene and antibiotics such as tetracyclines and penicillins. We report a quite uncommon case of Linezolid-induced BHT in a patient with a long-lasting history of chest wall infection (www.actabiomedica.it)

Black hairy tongue (BHT) is characterized by a discolored, hairy tongue. We herein report two cases of BHT associated with antibacterial agents and review previous cases. In Case 1, a 17-year-old girl with a central neurocytoma was administered intravenous piperacillin–tazobactam for postoperative infection, and BHT developed 12 days later. Her symptoms resolved 8 days after she discontinued the piperacillin–tazobactam and brushed her tongue three times daily. In Case 2, a 65-year-old man was administered intravenous piperacillin–tazobactam and levofloxacin to treat multidrug-resistant Pseudomonas aeruginosa, and BHT developed 15 days later. The piperacillin–tazobactam was discontinued and the patient brushed his tongue, and the discoloration gradually subsided thereafter. However, the BHT reappeared after linezolid treatment. The patient had adverse drug reactions to both the piperacillin–tazobactam and linezolid treatments. The BHT might have been related to antibiotic use in both cases. We identified 19 cases of antibiotic-related BHT in a literature search, but none were related to piperacillin–tazobactam use. In all cases, symptoms resolved after discontinuation of the drug and brushing of the tongue. BHT may be a rare adverse effect of antibiotics. Treatment strategies include removal of the causative agents, mechanical debridement, and good oral hygiene.

Introduction Linezolid was approved for clinical use for methicillin resistant Staphylococcus aureus and vancomycin-resistant Enterococci. Additionally it is used in the management of drug resistant tuberculosis. It is well-tolerated however bone marrow suppression and neuropathies may occur in patients taking this antibiotic for more than 2 weeks. Black discoloration and black hairy tongue (BHT) due to linezolid is rarely reported. We report two cases of BHT. Case reports Two patients of drug resistant pulmonary tuberculosis developed benign hairy tongue with linezolid 600 mg per day. In both the cases black colored/hairy tongue was reported within 2–3 weeks of linezolid treatment. Both patients improved after withdrawal of linezolid. Subsequent reintroduction of linezolid with good oral hygiene was well tolerated and both patients completed the treatment of 2 years duration without any recurrence. Conclusion Black discoloration and BHT is a rare but transient adverse reaction with linezolid. Reintroduction of linezolid with good oral hygiene is well tolerated.

Black hairy tongue (BHT) developed in five patients (2.6%) among 192 patients undergoing chemotherapy for malignant brain tumors. Three patients with a history of diabetes mellitus developed BHT within 10 days after the initiation of chemotherapy. The other two patients suffered more than 100 days after induction and lymphopenia of grade 3 or worse developed for more than 20 days, which was not observed in the three patients with diabetes. We found that BHT could develop after chemotherapy for malignant brain tumors. Patients with diabetes mellitus presented early after chemotherapy, while patients with longstanding severe lymphopenia presented in late phase.

Black hairy tongue (BHT) is an unusual condition in adults characterized by marked accumulation of keratin on the dorsum of the tongue, resulting in a hair-like appearance. Herein, we have described 15 patients developing BHT after allogeneic stem cell transplantation (allo-SCT). BHT was generally accompanied by other cutaneous manifestations of cutaneous graft-versus-host disease (GVHD) or a precursor of GVHD. Our experience in this series emphasized that histopathologic evaluation is required for seemingly harmless eruptions like BHT in the posttransplantation period. Given the important prognostic implications of GVHD, physicians should be careful when confronted with BHT.

To determine the prevalence of tongue lesions in Malaysian dental outpatients from the Klang Valley area. A cross sectional study was conducted on 600 Malaysian outpatients (257 men, 343 women, mean age, 37.7 years) attending the Primary Dental Care Unit at the Faculty of Dentistry, University of Malaya. Demographic and medical data were recorded for all respondents. One hundred eighty-one patients (30.2%) (81 men, 100 women, mean age 42.0 years) were diagnosed with at least one tongue lesion (n = 207) at the time of examination. Of these, 24 patients (4%) had two or more tongue lesions present synchronously. Seven different lesions were diagnosed: fissured tongue (13.8%), crenated tongue (7.8%), pigmented tongue (6.2%), geographic tongue (2.2%), ankyloglossia (1.7%), hairy tongue (1.0%) and median rhomboid glossitis (0.2%). Their racial prevalences were Malays (n = 65, 10.8%), Indians (n = 62, 10.3%), Chinese (n = 53, 8.8%) and other race (n = 1, 0.2%). A significant relationship was observed between crenated tongue and race; between four types of tongue lesions (fissured tongue, geographic tongue, crenated tongue and pigmented tongue) and age; and between fissured tongue and gender (P 0.05).Distribution characteristics of tongue lesions in Malaysians are important as local reference data in the daily clinical practice.

The aim of the present study was to assess the oral mucosal health status of young male adults (aged 18 to 24 years) in Switzerland and to correlate their clinical findings with self-reported risk factors such as tobacco use and alcohol consumption.Data on the oral health status of 615 Swiss Army recruits were collected using a standardised self-reported questionnaire, followed by an intraoral examination. Positive clinical findings were classified as (1) common conditions and anatomical variants, (2) reactive lesions, (3) benign tumour lesions and (4) premalignant lesions. The main locations of the oral mucosal findings were recorded on a topographical classification chart. Using correlational statistics, the findings were further associated with the known risk factors such as tobacco use and alcohol consumption.A total of 468 findings were diagnosed in 327 (53.17%) of the 615 subjects. In total, 445 findings (95.09%) were classified as common conditions, anatomical variants and reactive soft-tissue lesions. In the group of reactive soft-tissue lesions, there was a significantly higher percentage of smokers (P0.001) and subjects with a combination of smoking and alcohol consumption (P0.001). Eight lesions were clinically diagnosed as oral leukoplakias associated with smokeless tobacco. The prevalence of precursor lesions in the population examined was over 1%.Among young male adults in Switzerland, a significant number of oral mucosal lesions can be identified, which strongly correlate with tobacco use. To improve primary and secondary prevention, young adults should therefore be informed more extensively about the negative effects of tobacco use on oral health.

A 71-year-old man presents for evaluation of an asymptomatic black discoloration of the tongue. What is the most likely diagnosis?

Black hairy tongue (BHT) is a benign disease characterized by elongated filiform lingual papillae, with a carpet-like appearance of the dorsum of the tongue. It is has been reported to occur with a prevalence ranging from 0.6% to 11.3%. Although its etiology is not fully understood, BHT may be triggered by smoking, excessive coffee or black tea drinking, poor oral hygiene, trigeminal neuralgia, general debilitation, dry mouth as well as certain drugs. We present here a case of a patient with psychosis, depression, and benign prostatic hyperplasia, who developed BHT following treatment with a fixed dose combination (FDC) of olanzapine and fluoxetine and recovered within 3 months after withdrawal of treatment with FDC.

The purpose of this study was to determine whether there are any differences in the appearance of tongue-surface structure in different kinds of collagen diseases, because red tongue is well known to be a very important feature of suspected Sjogren's syndrome (Sjs). To clarify some features of the filiform papillae on the dorsal surfaces of the tongues of patients with speculated Sjs, we observed a total of 565 individuals with primary Sjs (n = 24, M/F = 0/24), secondary Sjs (n = 16, M/F = 1/15), possible Sjs (n = 96, M/F = 21/75), collagen diseases (CD) (n = 55, M/F = 15/40; 15 SSc, 10 SLE 10, two MCTD, six dermatomyositis, and 22 others), various cutaneous disorders (n = 324, M/F = 118/206), and healthy controls (HC) (n = 50, M/F = 32/18) by using a dermopscope. The average ages of the patients with Sjs, CD (non-Sjs), cutaneous disorders (non-Sjs/CD), and HC were 56.4 ± 14.8, 55.1 ± 116.4, 51.1 ± 121.2, and 37.1 ± 110.6 years of age, respectively. The filiform papillae were classified into four patterns by their structural characteristics: normal papillae (no abnormality with clear comified tips) (pattern I, n = 162), slightly rounded papillae with unclear cornified tips (pattern II, n = 239), rounded papillae without cornified tips (pattern III, n = 86), and completely flattened papillae (pattern IV, n = 28). Their patterns were reversely related to the volume of salivary fluid (gum test) (P = 0.046) and the degree of furor coating of the tongue (P = 0.051). Pattern IV is predominant in definitive Sjs (primary and secondary Sjs) (n = 15; 53.6%) with positive anti-SS-A or -B antibody (n = 8) with a specificity of 53.6% and a sensitivity of 36.6%. The present dermoscopic finding that the completely flattened pattern (IV) is predominant in definite Sjs patients may indicate a useful marker for suspicion of Sjs.

Black hairy tongue (BHT) also called as lingua villosa nigra, is a self limiting benign condition characterized by hypertrophy and elongation of filiform papillae of tongue with brown or black discoloration. Smoking, poor oral hygiene, xerostomia, using peroxide containing mouth washes, substance abuse and drugs (steroids, methyldopa, olanzapine, etc) are the predisposing factors. However its occurrence in relation to linezolid ingestion among south Indians has not been reported in PubMed database. Here we report a case, where significant association of linezolid intake with BHT was found in a 10-year-old boy, who was treated with tablet linezolid for post surgical infection of left side radial neck fracture. This case is reported for the rarity of occurrence with linezolid therapy. According to Naranjo adverse drug reaction (ADR) causality scale, the association of BHT due to linezolid in our case was probable.

To collect data on the prevalence of tongue lesions of Turkish schoolchildren in 3 different population samples in Ankara, and to analyze the relationship between tongue lesions and gender, oral hygiene, and income levels.Nine hundred and six schoolchildren aged 6-12 participated in this study between March 2004 and July 2004 in Ankara, Turkey. Of the 906 schoolchildren, 442 were girls and 464 were boys from 3 primary schools. We examined all the children for the presence of the following tongue lesions: 1) ankyloglossia, 2) bifid tongue, 3) fissured tongue, 4) geographic tongue, 5) median rhomboid glossitis, 6) lingual thyroid nodule, 7) atrophic tongue, 8) hairy tongue, 9) crenation tongue, 10) furred tongue, 11) macroglossia, 12) microglossia, and 13) lingual or sublingual varicosities.Of the 906 subjects, we detected 45 subjects with tongue lesions with a prevalence of 4.95%. We found lesions more frequently in boys (6%) than in girls (4.5%). However, these results were statistically insignificant. Oral lesions commonly found were geographic tongue (1.8%), ankyloglossia (1.3%), fissured tongue (0.9%), bifid tongue (0.4%), hairy tongue (0.2%) and macroglossia (0.2%), lingual thyroid nodule (0.1%). We did not find any of the following lesions: median rhomboid glossitis, atrophic tongue, crenation tongue, furred tongue, microglossia, lingual, or sublingual varicosities.The tongue has a special importance due to its localization. It can readily affect a patient's social life because of lesions and various symptoms. The localization of tongue may also play important role in diagnosis for systematic, hormonal, and allergic disorders.

Dental erosion has been reported in the literature with particular attention to etiology and diagnosis of the disorder. Unfortunately, little information exists to guide dental professionals in treatment planning predictable restorative outcomes for this patient population. This case report describes a unique presentation of severe dental erosion related to alcoholism and an eating disorder. Diagnosis and etiology of the condition are discussed and a comprehensive list of treatment options is evaluated. The interim occlusal overlay prosthesis is presented as a diagnostic and therapeutic appliance for use in this unique patient population.

Hairy tongue or black hairy tongue is a benign condition characterized by hypertrophy of the filiform papillae that give the dorsum of the tongue a furry appearance. The color of the elongated papillae varies from yellowish white to brown or black. The etiology is unclear, but the disorder has been associated with numerous predisposing conditions such as heavy smoking, poor oral hygiene, use of topical or systemic antibiotics, systemic corticosteroid therapy, yeast infections, and radiotherapy for head and neck malignancies. A case is presented in which a hairy tongue appeared in a 67-year-old man.

In a 59-year-old man with a swallowing problem and loss of weight, who used fluoxetine because of depression, gastroscopy revealed a black hairy structure on the dorsum of the tongue, known as black hairy tongue.

The aim of this study was to assess the prevalence of nine tongue conditions and relate to data obtained about oral hygiene or habits in Turkish dental outpatients.A total of 5150 subjects (2837 women, 2313 men) were included in this study.Of the 5150 subjects, 2690 subjects were detected as having tongue lesions with a prevalence of 44.2 and 62.0% for women and men, respectively. The difference was found to be statistically significant (P0.0001). There was a strong correlation between tongue lesions and increasing age. There was also a strong association between tongue lesions and smoking, black tea drinking, and fair or poor oral hygiene. Hairy and coated tongue was significantly higher in males. Contrary to this, papillary atrophy was more prominent in women.A strong correlation was found between tongue lesions and age, sex, oral hygiene and habits in Turkish dental outpatients. An efficient oral health program such as the elimination of risk habits and attention to cultural practices may improve tongue hygiene.

Black hairy tongue is characterized by an abnormal coating of the dorsal surface of the tongue. Although the cause is unknown, several precipitating factors may be implicated in the pathogenesis of this disorder. A case is presented in which black hairy tongue appeared subsequent to the administration of fluoxetine hydrochloride, thiothixene hydrochloride, benztropine mesylate, and clonazepam for bipolar affective disorder.

A 73-year-old male smoker attended a follow-up outpatient clinic 18 months after starting antibiotic therapy (rifampicin, isoniazid and clarithromycin) for a nontuberculous mycobacterial lung infection. His infection was clinically improving, but the patient had noticed that his tongue had become

The purpose of this investigation, which has been performed as two studies, was to evaluate the association between the daily exposure to nicotine (measured as cigarette smoking machine yields) and the actual uptake of nicotine by cigarette smokers, as well as the association between oral mucosal changes and the exposure to cigarette smoke. In Study 1, consumption data, soft tissue changes and nicotine intake were measured in 47 habitual smokers using cigarettes with tar and nicotine yields within the ranges 9.3-12.2 and 0.72-1.16 mg per cigarette, respectively. The subjects were divided into three groups based on daily cigarette consumption; group averages (standard deviation) were 10.8 (2.2), 17.9 (1.9) and 28.4 (6.1) cigarettes per day. The group averages of tar deliveries from their usual brands of cigarettes were 11.1, 11.0 and 10.5 mg per cigarette, and group averages of nicotine deliveries were 1.05, 1.05 and 1.06 mg per cigarette, respectively. In Study 2, the same data were measured in a group of 77 habitual smokers with an average individual consumption of 11-21 cigarettes per day. The participants in Study 2 were divided into three groups according to tar delivery from their usual brands to cigarettes, with group averages of tar being 6.4 (1.2), 11.0 (1.2) and 16.0 (1.1) mg per cigarette, and of nicotine being 0.70 (0.12), 1.05 (0.12) and 1.34 (0.08) mg per cigarette, respectively. The average consumption of all three groups was within the range 17.1 to 17.9 cigarettes per day. The daily exposures to nicotine and tar were measured as the smoking machine yields multiplied by the number of cigarettes smoked per day. Nicotine uptake was determined by monitoring nicotine and its seven main metabolites in 24-h urine samples. In Study 1 there were significant differences between the three groups in the total amount of nicotine and metabolites excreted in the 24-h urine. The average nicotine uptake was 14.9, 24.4 and 35.4 mg per day, respectively. In Study 2, the 24-h excretion of nicotine and metabolites was about the same in all three groups and averaged 24.5 mg per day. The nicotine uptake was significantly correlated to the number of cigarettes smoked per day but not to the smoking machine yields of tar and nicotine per cigarette. The average prevalences for each of the different oral mucosal lesions (leukoedema, smoker's palate and hairy tongue) were found to increase with increasing consumption and nicotine uptake (Study 1); they were also independent of tar and nicotine yields from the cigarettes smoked (Study 2). These results indicate that the actual uptake of nicotine by smokers could not be estimated from the smoking machine yields. Reduction in exposure to smoke components may best be accomplished if smokers are encouraged to smoke fewer lower-yield cigarettes and to avoid smoking more of each cigarette.

A 15-year-old boy presented with an eight-year history of painless black patches of the tongue that had persisted despite repeated consultations with …

Oral hairy leukoplakia in HIV-seropositive persons is considered as a highly serious sign and places the patient in the AIDS-related complex group according to the classification recommended by the Centers for Disease Control. Epstein-Barr virus (EBV) is thought to be the cause. Based on the investigation of 14 of our own cases and a review of the literature, we conclude that so called hairy leukoplakia does not have a specific histopathologic pattern. Identical lesions can be caused by fungus infection, or biting and other kinds of mechanical irritation. Both fungal infection and EBV infection have been proven in a high percentage of the lesions. However, EBV has been found also in apparently normal oral mucosa. This questions the assumption that the virus is the cause of the lesions. In our investigation the presence of "hairy leukoplakia" did not reflect the clinical status of the patient. The best indicator of the clinical status was the T-lymphocyte subset CD4+ number in the peripheral blood. It appears that low CD4+ counts, candidiasis and the presence of replicating EBV in the epithelial cells are parallel markers of increasing immunodeficiency.

– Over a period of 10 months, 1013 consecutive dental outpatients attending the Screening Clinic in Faculty of Dentistry, Jordan University of Science and Technology, in the city of Irbid were investigated for the presence of tongue lesions. All subjects were seeking treatment for caries and periodontal diseases and none was complaining of oral mucosal disorder. The results showed that 240 subjects (23.7%) had one or more tongue lesions. Geographic tongue and fissured tongue were detected in 6.8% and 11.4% of the examined population respectively, and an association of the two conditions was observed in 2.9% of the subjects. Hairy tongue was diagnosed in 3.4% of the subjects with significantly higher prevalence in males (P < 0.0005). A strong correlation was found between hairy tongue and smoking.