Case Report

Introduction • Black hairy tongue (BHT) is a benign condition characterized by a discolored, hairy appearance of the dorsal tongue. The prevalence of BHT is not known because its occurrence is highly variable among different populations and dependent on many factors; BHT is more common in men, elderly patients, smokers, HIV-positive patients, edentulous patients, and patients with cancer. The lesion is distributed on the dorsal aspect of the tongue and does not involve the lateral and the tip site of the tongue. The most common discoloration in this condition is black to blackish-brown, but it can present with green or yellow discoloration or con lack pigmentation altogether. This desease is often asyntomatic, but sometimes is associated with alitosis, limphoadenopathy, burning or tickling sensation. Besides poor oral hygiene, many substances and medications could cause, aggravate, or predispose a patient to BHT, tor example, smoking tobacco, excess consumption of beverages such as black tea, coffee, alcohol, oxidizing mouthwashes, and also intravenous drug use are linked to an increased prevalence of BHT.  This condition is benign, self-limiting, and the diagnosis is based on clinica! presentation. First-line

treatments include avoiding associated medications, practicing good oral hygiene, discontinuing habits predisposing to BHT, and gentle brushing or scraping of the tongue.The aim of this work is to report a case of hairy tongue treated through a device tor oral hygiene •Aquolab" that produce ozonated water.

Case Presentation. A 18 years old female patient, went to our private practise with a condition of tongue discoloration and a lingual burning sensation. She reported generai good health, but she was undergone to antibiotic therapy  tor 2 weeks  with Amoxicillin 1000  mg  2 times a day  tor a dental infection. A  diagnosis of hairy tongue was pertormed (fig. 1). We decided to try to  treate  this  condition  through  a  device  tor  oral  hygiene  •Aquolab"  that  produce ozonated water. It is a dental  water  jet  that mixes water and ozone,  resulting in an antimicrobial action on treated surfaces,  especially gums.  Water and   ozone levels are adjustable through 3 ozone concentration programs and 2 tor the water dispensing seconds. There are interchangeable nozzless of 0.6 and

0.8 mm opening diameter tor the water-ozone mixture dispensing. Two 60-second cycles with program 2 are pertormed tor both water and ozone regulation and then the patient does not pertorm any final rinse. The same told us the next day a significant improvement in burning sensation and the next one-week contrai, she returned with almost total remission of the lesion (fig 2).

Discussion. BHT is commonly an asymptomatic condition, patients seek treatment tor overall cosmetic reasons. Several medications are associated with an increased risk tor the development of BHT. Specifically, antibiotics such as penicillin, erythromycin, doxycycline, linezolid, and neomycin are well documented in the literature. First-line treatment consists of education on preventive techniques tor patients who are either at risk tor developing or who are receiving medications that have been associated with BHT. Reducing the risk of developing BHT may be achieved by practicing good oral hygiene, such as daily tongue brushing with a toothbrush or tongue scraping to promote desquamation of the hyperkeratotic papillae. Topica! application of baking soda or 3% hydrogen peroxide are also proven effective treatments tor BHT. Second-line treatments con include topical and arai retinoids, antifungals, such as fluconazole in the case of co-infection with Candida   and antibiotics, but there are no sufficient evidence to demonstrate their real effectiveness. In this case we have tried   to treat the condition without topical therapy but with a single session of cleaning tongue with ozonated water pertormed with AcquoLab. The use of ozonated water tor the treatment of oral infections is successfully documented in the literature. In a recent study is tested on Oral Candidosis and the authors demonstrated the effectiveness in the reduction of CFU values. The ozonated water is also successfully analized tor the treatment of periodontal desease. Some authors have tested this medication in patients with orthodontic therapy to reduce the bacteric load. An in vitro study demonstrated the activity of ozonated water on Streptococcus Mutans and Enterococcus Faecalis, and these results suggest that ozonated water application may be useful tor endodontic therapy. The successes of ozonated water therapy against various bacterial and mycotic species in the various fields of oral medicine and also the absence of adverse effects have led us to propose this device in the care of hairy tongue. We nave documented a case of therapeutic success against the hairy tongue which could be a starting point tor studying the phenomenon and looking tor an alternative to the most common treatments of a disorder that afflicts an important proportion of the generai  population.


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