### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
hello, i have noticed a black sport on tongue (upper left side, size of a peanut) and similar, but small spots, in the neighborhood (only on left side).  After couple of weeks of thorough tongue washing and dental hygiene, it is still there. May be a coincidence but I ate 8 boxes!! of altoids over a period of 2 weeks prior to noticing this spot. I used to crunch alotids on the left side primarily (because i was suffering from tooth ache on the right side). I got crown done on a tooth to the right side of my mouth around the same time frame. My dentist looked at it and thought it was just pigmentation but not sure why it would develop all of a sudden. My doctor did a blood test and found me slightly anemic (didnt find any cancer). He put me on iron tablets but primarily because he thought my 2 week altoid craving was result of pica (i think). I have taken couple of cipro 500mg few weeks before noticing the spot just to get rid of cold. This may have killed good bacteria, so I started taking probiotics (bayer truebiotic).  All of this happened in a period of 1-2 months.  I am giving all these details because I am not sure (and neither are my dentist and MD) as to which of those may have caused these black spots to appear. My MD mentioned that after taking iron tablets for couple of months, if it still doesnt go away, i should see an ENT specialist.

### output:

Hello, welcome to Chat Doctor forum. There are several reasons that can cause black spots on the tongue. Practically without inspecting visually it is almost impossible to predict the correct diagnosis. A good picture may also help. But most common black spot on tongue which is of a pea size along with similar spot around it could be suggestive of "black hairy tongue". It is simply the elongated growth of the papillae present over the tongue and discolored by food stain and bacterial growth. Sometimes the elongation is so much that it looks like a bunch of hair over the tongue, hence its name. It is generally caused by some illness, some medicine intake and mostly due to some local constant irritation. Interestingly intake or using mouth wash containing MENTHOL for long time is one of the local factor of developing such condition. Which could happen in your case as you were taking Altoids (peppermint/menthol) for long time with one side. Doctor prescribed iron tablets because iron deficiency is also sometimes blamed for this kind of condition. Antibiotics generally does not cause this condition until taken for long time at a stretch.  Anyway, the condition is self limiting but may take time to regress. Continue your iron tablet, stop Altoids. Maintain your oral hygiene with proper brushing. Keep your tongue clean gently using a tongue scraper or using your tooth brush. Do not use any commercial mouthwash, warm salt water mouth wash can be used instead. Hope your problem will be relieved soon. Good luck.