Several things may cause dark black spots on the tongue, including a benign condition called hairy tongue, some medications, and some health conditions. Dark spots on the tongue may also be caused by normal human tongue differences, which are common in people with dark skin.

Dark black spots on the tongue may go away on their own, or you can help treat them by addressing any underlying cause.

There are several reasons why you may have black spots on your tongue. Most are not serious or harmful. The most common causes of dark black spots on your tongue may include:

Normal Tongue Differences

The most common cause of black spots on your tongue are normal variations in how tongues look. This is known as a benign (not harmful) oral pigmentation variant. It means that some people normally have more pigment (color) on their tongues.

This variant is more likely to occur in people with darker skin. The tongue may have dark spots on it, but it may also have pink or red spots. You may be more likely to first see these spots in your 20s or 30s.

Hairy Tongue

Hairy tongue is a condition in which dark spots appear on the tongue. Small, hair-like growths may also appear on the tongue. While the appearance can be alarming, it’s not harmful.

Several factors may increase the risk of hairy tongue. These include:

• Poor oral hygiene
• Fungal infections
• Use of certain antibiotics
• Smoking
• Drinking large amounts of tea or coffee
• Dyes in foods or medications
• Overuse of some mouthwashes
• Receiving radiation treatment to your head or neck

Medications

Some medications can cause dark black spots on your tongue. For example, medications that contain iron or gold can have this effect. Other medications that can cause dark black spots on your tongue include:

• Some antibiotics
• Pepto-Bismol (bismuth subsalicylate) and medications that decrease stomach acid
• Certain antipsychotic medications
• Certain medications that treat seizures
• Drugs to treat malaria

Underlying Health Conditions

Some underlying health conditions can cause dark black spots on your tongue as a symptom. These conditions include:

• Addison’s disease (adrenal insufficiency)
• Peutz-Jeghers syndrome (a rare genetic disease)
• Hyperthyroidism (high levels of thyroid hormones)
• HIV
• Tuberculosis
• Candidiasis (fungal infection)
• Benign or cancerous growths on the tongue

Your tongue may have one or several spots that look dark brown or black. These spots may be on different areas of the tongue. Their appearance and location can vary from one person to another. In most cases, people have no other symptoms besides the black color.

If you have hairy tongue, which about 13% of all people will experience in their lifetime, you will likely also notice a dark coating on your tongue. This coating can often look brownish or blackish, but it can also appear white, pink, or green. In some cases, small hairlike growths will occur on the tongue.

If you have dark spots on your tongue that don’t go away on their own after a few days, consider visiting your healthcare provider for their guidance. If your tongue symptoms cause you difficulty with eating or breathing, seek care right away.

At your visit, your provider will likely examine your tongue. They may ask you questions about when you first saw the dark spots, whether you’ve had them before, and what other symptoms you might be experiencing. Your provider may ask you about any medications you take, as well as your habits around smoking and oral hygiene.

A healthcare provider may sometimes need to take a blood sample or remove a small amount of tissue from your tongue for a biopsy.

Treatments for dark black spots on the tongue typically depend on the cause. If a health condition is causing the dark spots, treating the health condition will usually cause the spots to go away.

If the spots are caused by a medication you take, it may help to stop taking the medication or switch to a different one. Talk to your healthcare provider for guidance before you stop or change prescribed medications.

Sometimes, at-home care can help treat dark black spots on your tongue. Some at-home care tips include:

• Brush and floss regularly
• Use a tongue scraper
• Visit a dentist for oral care tips and cleanings
• Eat a nutrient-rich, balanced diet
• Stop smoking
• Drink less coffee or tea
• Treat bacterial or fungal infections

It’s not always possible to prevent dark black spots on your tongue, such as when they’re a normal tongue variation.

If your dark spots are caused by black hairy tongue, you may be able to prevent the spots by changing some of your habits. It may help to ensure you brush your teeth regularly, drink less tea and coffee, and cut out tobacco.

Some people find that brushing their tongue with a toothbrush or using a tongue scraper can prevent dark spots on the tongue.

Normal human variations in tongue color, as well as a harmless condition called dark hairy tongue, can cause dark black spots on the tongue. Less commonly, medications or health conditions can cause dark spots on the tongue.

If your dark spots don’t go away on their own in a few days, consider visiting a healthcare provider to help you understand what’s causing them and how you can best treat them.