Black hairy tongue is a benign, usually self-restricting and asymptomatic condition, and is characterized by hypertrophy of filiform papillae on the dorsum of the tongue. Even though it is very common, it’s rarely diagnosed. The symptoms are not limited to black discoloration of the tongue, as the color may also be yellow, brown, green or blue. Poor oral hygiene, smoking, consummation of tea, coffee and alcohol and some medication are believed to be responsible for its etiology. In this paper, a black hairy tongue case wherein the patient had increased inflammation after the use of clarithromycin in our outpatient clinic is presented. With only oral hygiene improvement as treatment, regression of the black discoloration on the tongue is observed.