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jbmd, Board Certified Physician
Category: Medical
Satisfied Customers: 615
Experience:  Board Certified physician in Internal Medicine - 30+ years experience
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My tongue has black spots. Why is this?

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What causes some small black spots on my tongue? Spots are on the underside of tongue, not on top. I also have a very dry mouth.


I'll be glad to help you. However, if you can load up a photo that will help.

Are the spots flat or raised?

Do they look smooth or fuzzy?

Do you smoke or drink much alcohol (some alcohol is healthy!)

I need answers to these questions to narrow down for your specific problem.

Customer: replied 4 years ago.

They are raised and smooth. Have had these for about two-three weeks. Seem to be getting more of them. Do not smoke and only drink a beer occasionally.

Good for not smoking! Occasional alcohol is good for you, heart-wise.

Do you use a lot of Pepto Bismol? This can cause black tongue.

Have you brushed your tongue regularly to see it they will go away?

Do these bleed if brushed or bothered in some way?

Do you have any swellings otherwise in mouth or neck?

Have you taken antibiotics lately?

Customer: replied 4 years ago.

No antibiotics lately

Okay--I know this takes time but I like to give the depth of answers that I would in my office, tailored to the person so the best care results.

Black tongue spots or whole tongue turning black can be an inherited pigment situation or it can be from overgrowth of bacteria or fungus on the tongue (black hairy tongue). Smoking/tobacco use alone can cause it.

Brushing the tongue regularly does help overgrowth go away. It does nothing for hereditary pigmentation.

It is rare but it does happen that black spots on the tongue, especially raised black spots, is caused by mouth cancer. This is especially true in tobacco users or smokers of marijuana or other drugs (very unlikely that you do so from what you said above) as it's not only tar/other substances but heat that is implicated.

Therefore, I recommend that you get this checked out.

Now occasionally, what people think are black spots of the tongue, especially beneath the tongue, are actually blue--they are dilated veins (blood vessels) on the floor of the tongue. These are more prominent as you get older.

Regardless, I think that you should get these spots checked out. If there are other questions, please ask.

All the best to you!

Customer: replied 4 years ago.

Do you recommend a dentist or doctor to first check this out?

I'd see your dentist first--he/she can look at the spots and see if they're basically nothing. If they decide that further treatment is necessary, like a biopsy, he/she can send you to an oral surgeon or to your doctor to referral for head and neck. Your general physician probably would not even consider taking a sample of anything in the mouth, which often bleeds a lot, so I think it might be a waste of a visit to start with.

Any other questions?

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