Black Spots on Tongue Side, Tip, Back and Under


Why do I have black spots on my tongue? What do they mean? If you have dark or black dots, patches, marks or spots, they could indicate a number of things. Discover the cause including those on the tip, side and under your tongue.


Black spots on tongue refer to small, tiny or little black or dark dots that could be on the tongue surface (but they can be bigger at times). They could be in babies (infants or children) as well as adults. They vary intensity with some so dark while others might have a lighter pigmentation i.e. grey or light grey.

They often begin sides of the tongue towards the center and in some cases, they may be bumpy (slightly raised up) and they could also be on your lips and other parts of your mouth and face.  It is also normal to have just one black spot on or many since they are caused by a number of things.

Sometimes, you might be having permanent dark marks or spots that won’t go away, those that come once and disappear or those that keep on coming and disappearing after some time (a few days, weeks or months).

In rare instances, they hurt (are painful or cause discomfort). This could be an indication they are caused by some sort of infection oral cancer.

What do they mean?

Having dark marks on tongue might mean any of the causes we will discuss later. Some people are superstitious about it and have attributed some explanations i.e. there are many superstitions and myths you might have heard of such as good or back luck, bad omen, being under a spell, curse, etc.

For instance, in India, it is believed that if you have them and they are little or tinny, whatever you say shall come to pass someday. These are just superstitions and myths. 

why do I have these spots or bumps?

If you have them, do not worry since many things could have caused them and most of the causes are harmless. So, why do you have them or what are their causes in humans?

1. Hyperpigmentation

This occurs when you have excessive or much pigmentation i.e. melanin.  Melanin pigments are what gives your skin, eyes, and hair their color. If you have much of them on your tongue, you might end up having harmless black spots. Tongue hyperpigmentation is caused by “pigmented cells called melanocytes” [].

At times, you could be suffering from melanoma, a cancer type that is formed from pigment cells. Melanoma is commonly caused by UV radiation from sunlight. The risk is more on people who are 40 years old, especially women.  Most of the melanoma is black or brown but they could be dark-colored, pink, red or purple.

Some people might find such an appearance unattractive and want to remove the dark spots. Laser surgery could be of help. Furthermore, a number of home remedies such as potato juice, lemon juice, aloe vera, rosehip oil and cucumber juice can help lighten it.

Going for products which have hydroquinone, soy milk, cucumber, calcium, azelaic acid, or kojic acid reduce melanin production. See a dermatologist for further advice.

2. Pregnancy in woman

In some instances, you might have them during pregnancy or when using some contraceptives. Contraceptives and pregnancy can cause hormonal changes that influence endocrine system and thus discoloration and hyperpigmentation might occur.

3. Oral fibroma

This is a common oral benign tumor characterized by dome or polyp shape i.e. “around, smooth, firm lump attached to its base or by a stalk to part of the oral cavity tissue” [] and it is similar to freckles and moles on the skin and it could be dark colored.

It can be caused by a number of things, one of it being constant irritation from your teeth, piercings or dental appliances.

To treat fibroma, you need to undergo surgical excision. However, surgical procedures do not guarantee you that they will not appear again. Do not ignore them since they can grow and pose oral issues. Furthermore, avoid tongue injuries especially re-injuring the area where a fibroma was removed since it can encourage it to grow again.

 4. Oral cancer

Although very rare, it is possible to have these black spots on the tongue due to oral cancer. When caused by cancer, you will tend to have other oral cancer symptoms such as a chronic sore throat, hoarseness of voice, swallowing, speaking and jaw movement difficulties, sores on your neck, mouth, and face that bleed easily among many other symptoms.

This is one of the rare side effects of oral cancer. You should not panic if you have a black-spotted tongue. Oral cancer treatment includes chemotherapy, radiations to destroy cancerous cells as well as surgical operations to remove any cancerous cells.

5. Tongue piercing

If you have tongue piercings, they could be behind the small black marks around the piercing. Sometimes, the area where you had a piercing might lose its pigmentation leaving some dark spots or patches. The black marks near the piercing are not only caused by the bruising during the piercing process but also by studs and jewelry you wear.

Treat any tongue piercing infection early enough, follow aftercare procedure, go for titanium or gold jewelry (they cause less allergic reactions) and avoid playing with your piercing.

6. Hairy black tongue

Excessive use of antibiotics, soft diets, poor oral hygiene, drinking and smoking tobacco can lead to hair-like black spots i.e. a hairy tongue due to elongated and irritated papillae.

These black clusters are caused by the growth of fungi and it will disappear on its own if you stopped drinking and/or smoking. Poor hygiene has also been attributed to this problem among other causes.

The use of breath mints and mouthwashes at times might make the black or dark spots to turn white or pink. Do not be surprised if this occurs. Furthermore, when you have a hairy tongue, there is a likelihood of suffering from oral candida albicans or oral thrush infection.

Antifungals and some home remedies are known to cure this problem due to fungal growths. Ensure you get the right diagnosis and change your hobbies such as tobacco chewing and smoking, alcohol consumption as well as poor oral hygiene.

7. Injury and trauma

Tongue injuries are a possible cause of black patches especially if the injury cause sores. For instance, you could end up with bumps and black spots from biting or after biting it as well as from other injuries including those that are caused by dental appliances, piercings, etc.

8. Allergic reactions 

Exposure to some chemicals such as bismuth including Pepto-Bismol chewable tablets can make your entire tongue to be black or cause black patches.  Furthermore, allergic reactions to some allergens such as medications might cause a staining.

To deal with this problem, avoid getting contact with allergens, use antihistamines and go for further treatment in case the problem persists.

8. Chemotherapy

Some cancer patients may have noted black spots on the tongue during chemotherapy. This often occurs with nail pigmentation too. Although the problem does not happen to everyone, it is possible to have this discoloration after or during chemotherapy.

9. Being anemic

Anemia is a possible cause this condition. Many patients have reported this problem. The spots could be clustered or scattered on the tongue.  However, a pale discoloration is a more common symptom of anemia.

10. STD and HIV

Sexually transmitted diseases such as HIV and genital warts are known to cause some blemishes on tongue especially white spots (rarely black spots)  that can also be on the mouth, lips among other parts of the body. Before you conclude that they are related to STDs or HIV, you should be having other symptoms that might make you settle for such a conclusion.

11. Other causes 

Besides the above causes, this condition could be hereditary, caused by bacteria overgrowth, Laugier-Hunziker syndrome, Peutz-Jeghers syndrome,  adrenocortical insufficiency, poor oral hygiene or dilated blood vessels especially on the under tongue among many other causes.

Where do they appear?

The spots can appear on any part of your tongue. Common places you will notice them include the following: 

1. Under tongue

These ones can be caused by various things including those we have already mentioned such as oral cancer, tobacco chewing, excessive smoking and drinking, bacterial overgrowth, piercing, injuries such as tongue biting, melanoma, hyperpigmentation, among many causes.

In older people, this problem could be caused by dilated blood vessels especially if it appears black to blue in color.

The spots could also vary in size with some small (tiny) while others might be bigger. They could also be in other parts of your body including your cheeks. It is possible to have a single spot too. 

2. On tongue side 

Sometimes, they appear on the side of your tongue. They could be small, bigger, on one side (e.g. left or right side) or both sides. Dental issues and appliances are the most common causes.

In addition, this problem could be caused by many other causes such as adrenocortical insufficiency, malignant melanoma if they keep on growing in size, smoking, drinking, tobacco chewing, etc. 

3. On tongue tip 

If you have patchy or small spots on this location, they too could be caused by a number of things especially hyperpigmentation, smoking, acid reflux, poor oral hygiene, piercing, dental appliances among other causes. You will notice this problem in both adults and children.

In babies

in babies, infants or children, they could be due to allergic reactions, oral thrush (usually white but can also be black), debris build-up due to breastfeeding, antibiotic therapies (if hairy and black), among other causes

Small tiny or little ones 

There are no specific causes of small, little or tiny spots on the tongue on a human being. These tiny black dots caused by the same reasons we have already discussed.  Generally, they are painful and harmless. However, in some cases, especially when related to some diseases and conditions, they could hurt.

Treatment and cure options

If you notice some any serious symptoms alongside this problem, you need to get checked especially for cancer since early treatment such as early chemotherapy, surgery and radiation can resolve the problem.

Any temporary black spots on the tongue should be removed with normal oral care routine especially those caused by chemical exposures. Some foods such as coffee, licorice, tea can cause temporary darkening.

Ensure proper oral hygiene such as gently brushing your tongue twice with a soft brush to remove any buildups that can cause this discoloration. Eat a healthy and balanced diet full of roughages, vegetables, and fruits.

Finally, suck small pieces of pineapple and keep them on your tongue base for about 40 seconds before chewing them for 8 minutes will help fade them. Do this twice a day for a duration of about two weeks.

Sources and references

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