“…Development of black hairy tongue or lingua villosa nigra is established as occurring secondary to poor oral hygiene, tobacco or alcohol use, AIDS, cancer, antibiotics (penicillin, auremycin, mepazine, tetracycline, neomycin, doxycycline), antidepressants (fluoxetine), antipsychotics (thiothixene, olanzapine), anticholinergics (benztropine), or proton pump inhibitors (8)(9)(10). There are no documented instances of development of lingua villosa nigra following administration of RAI therapy, and the majority of literature discussing oral mucosal lesions does not discuss development of pigmentation of the fungiform papillae as an adverse event to medication (11)(12)(13).…”