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Although the appearance of black hairy tongue is quite characteristic, asin the case described, whenever the objective examination is not so clear or there is not an aspect of lingual hairiness it is important to establish the differential diagnosis, especially with some pathologies that can be associated with dark pigmentation of the tongue, such as the pseudo-black hairy tongue caused by bismuth subsalicylate, melanoma, oral melanoacantoma, smoker's melanosis (melanocytic pigmentation), Addison's disease, hemochromatosis, acanthosis nigricans, Peutz- Jeghers syndrome, Laugier-Hunziker syndrome, as well as metals deposition if the clinical history is suggestive of this possibility [3,6,8]

Some common shapes you might have heard of include Billiard, Apple, and Poker pipes

Getting started is simple with the right steps and a bit of preparation

While some use these products as smoking cessation tools, they do not only carry potential risks but also pose a significant threat of leading users back to traditional tobacco cigarette smoking 6

Chewing tobacco comes in shredded or twisted leaves, plugs, or pellets

References The health consequences of smoking 50 years of progress: a report of the Surgeon General