Ohio man whose tongue turned green and hairy due to rare reaction to cigarettes and antibiotics 

An Ohio man’s tongue turned green and hairy due to a rare side effect of smoking tobacco and taking a course of antibiotics. 

The man, 64, went to a primary care clinic a few weeks after noticing his tongue had started to change color. 

About three weeks before visiting the doctor, the man has completed a course of the antibiotic clindamycin for a gum infection. 

He also reported that he was a smoker. It’s unclear how long he had been smoking, and the case study authors did not indicate if the condition was caused specifically by smoking, antibiotic use, or a combination of the two.

But previous research shows that cigarettes can have a lasting impact on oral health, including causing plaque and bacteria to build up. Meanwhile, antibiotics can alter the mouth’s microbiome, altering bacteria and allowing them to accumulate on the tongue. 

Doctors diagnosed the man with hairy tongue, a condition characterized by an abnormal coating on the top surface of the tongue, also called the dorsal area. 

Hairy tongue is caused by a buildup of dead skin calls on the parts of the tongue that contain taste buds, known as papillae. Papillae then become longer than normal, making the tongue look hairy. 

They also trap other substances, like bacteria and yeast. 

There are usually no symptoms, though in some cases there is a burning sensation on the tongue. This is from the bacteria and yeast accumulating on the tongue’s surface.  

It affects about 13 percent of Americans, according to the American Academy of Oral Medicine (AAOM). 

Hairy tongue can occur at any age but is most often found in older age. It’s also more common in men than women. 

Though the discoloration is usually black, the tongue can also turn brown, yellow, or green.

Smoking has long been shown to have detrimental effects on oral health by causing a buildup of bacteria and plaque. 

Antibiotics, similar to the ones the patient was taking, can also result in new bacteria forming in the mouth, which may accumulate and result in hairy tongue.

Risk factors include smoking, dehydration, poor oral hygiene, and antibiotics, according to the case study authors. 

Patients who have had hairy tongue in the past are more likely to develop it again in the future.  

The condition is relatively harmless and usually temporary.  

Doctors advised the man to gently scrub the surface of his tongue with a toothbrush four times a day. He was also counseled on how to stop smoking. 

The AAOM advises practicing good oral hygiene to prevent hairy tongue. 

This means brushing the top of the tongue with a toothbrush or using a tongue scraper. 

After six months, the patient’s tongue went back to normal, even though he continued smoking.  

The case study was published in the New England Journal of Medicine.