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This difference is offset in Finland, where smoking rates have been declining among men and young women are slightly more likely to be affected with BHT. This can be attributed to greater prominence of smoking and higher rates of poor oral hygiene in males. Men are about three times more commonly affected than women. BHT also shows clear gender and age predilection.
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Patients with oncological disorders, smokers, black tea drinkers, and those with poor oral hygiene are more likely to develop BHT. Selected populations are at a higher risk of developing BHT. Discordance of the observed rates may stem from difference patient’s demographics (age, sex, ethnicity, practices and habits) and interobserver variability in defining lesions in corresponding study populations. BHT occurred in 0.6% of Minnesota school-aged children in contrast to 8.4% patients in a young Finnish population. However, a cross-sectional study of 1901 Iranian dental patients only reported a prevalence of 1.2%. A large cross-sectional study of 5150 Turkish dental outpatients has reported an overall prevalence of 11.3% with increased rates in men (18%) compared to women (6%). Review of the medical literature shows that BHT is not uncommon. BHT remains an important medical condition which may result in additional burden on the patient and health care system and requires appropriate prevention, recognition and treatment. Prognosis is excellent with treatment of underlying medical conditions. Complications of BHT (burning mouth syndrome, halitosis, nausea, gagging, dysgeusia) typically respond to therapy. Treatment involves identification and discontinuation of the offending agent, modifications of chronic predisposing factors, patient’s re-assurance to the benign nature of the condition, and maintenance of adequate oral hygiene with gentle debridement to promote desquamation. Clinical diagnosis relies on visual observation, detailed history taking, and occasionally microscopic evaluation. Differential diagnosis includes pseudo-BHT, acanthosis nigricans, oral hairy leukoplakia, pigmented fungiform papillae of the tongue, and congenital melanocytic/melanotic nevi/macules. Clinical presentation varies but is typically asymptomatic, although aesthetic concerns are common.
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Known predisposing factors include smoking, excessive coffee/black tea consumption, poor oral hygiene, trigeminal neuralgia, general debilitation, xerostomia, and medication use. Its prevalence varies geographically, typically ranging from 0.6% to 11.3%. Black hairy tongue (BHT) is a benign medical condition characterized by elongated filiform lingual papillae with typical carpet-like appearance of the dorsum of the tongue.