Aim: The term hairy tongue was first coined by Amatus Lusitanus in the year 1557 as self-renewing hairs on the tongue. It is characterized by the presence of elongated filiform papillae of the dorsum of the tongue, which gives a hairy appearance, depends on two components: elongated filiform papillae and discoloration of the dorsal tongue as the result of both extrinsic and intrinsic factors. The hair-like projections in hairy tongue are thought to develop from a lack of adequate desquamation on the dorsal tongue. This prevents the breakdown of keratin layers on the dorsal tongue leads to their accumulation, known as hyperkeratosis. This occurs on the tips of the filiform papillae and leads to their elongation to be a suitable environment for bacterial growth by trapping microscopic food particles and bacteria themselves to thrive on the fermentation of amino acids and produce porphyrins, resulting in a black or brown color.Materials and Methods: The study design was case - control sample, among patients attending the Department of Oral Medicine at the Faculty of Dentistry at Damascus University during the period from February 2021 to January 2022.Patients (n = 20). Individuals with hairy tongue were included in the study. Tongue examination was performed according to WHO clinically without biopsy, then data were collected through the attached questionnaire in both case and control groups. It included demographic information and complete history of the patients. Results: We found that the prevalence of hairy tongue increased with male gender, and was more common with fissured tongue 15%, we reported 70% of hairy tongue patients had the lesion in the posterior third of the tongue. There was a true statistically significant correlation between the hairy tongue and predisposing as 70% smoking, 80% poor oral hygiene, 20% use oxidizing mouthwashes, 45% xerostomia and 30% use antibiotics for a long time. Although we reported 90% of hairy tongue patients had no pain, but we recorded 35% had a metallic taste and tickling sensations, 25% had burning sensation, and 55% had halitosis. There was not real statistically significant correlation between the colour of the hairy tongue and gender but on the other hand we showed that 30% black hairy tongue patients were smokers, 45% brown hairy tongue patients drank large amount of tea and coffee, and 25% creamy hairy tongue patients used medications.Conclusion: To conclude, hairy tongue is an asymptomatic condition involving the posterior third of the tongue, which can be easily diagnosed by clinical examination and triggered by predisposing factors. A thorough detailed history is always necessary to obtain an accurate diagnosis to investigate the risk factors for establishing the successful treatment of hairy tongue.