The effects of COVID-19 extend beyond the respiratory system, often presenting symptoms in unexpected areas. For many individuals infected with SARS-CoV-2, the oral cavity becomes a site of discomfort and visible changes. While the infection is commonly known for causing loss of taste and smell, it can also manifest as mouth sores and other oral lesions. These oral manifestations suggest the virus or the body’s reaction to it has a direct or indirect impact on oral tissues. Sometimes, these secondary symptoms appear even before more typical signs of the illness.
What Oral Symptoms Are Linked to COVID-19
The physical presentation of COVID-19 related oral issues is varied, affecting the tongue, gums, and soft tissues inside the mouth. One frequently reported symptom involves painful aphthous ulcers, commonly known as canker sores, appearing on the inner cheeks, lips, or the floor of the mouth. These sores can be singular or multiple and often make speaking and swallowing difficult.
Tongue changes are also a notable manifestation, sometimes referred to as “COVID tongue.” This can involve the tongue developing a patchy appearance, similar to geographic tongue, where areas lose their surface papillae and appear smooth and red. Other tongue symptoms include swelling, inflammation, or the presence of white patches resembling a yeast overgrowth.
Lesions may also present as red, pin-prick spots across the roof of the mouth, or as small blisters (vesicular lesions). Dry mouth (xerostomia) is another common complaint that compounds discomfort by reducing the protective lubrication provided by saliva. This dryness promotes secondary infections and makes oral tissues more susceptible to trauma.
How COVID-19 Causes Mouth Sores
The development of oral lesions during COVID-19 infection is attributed to two primary pathways: direct viral activity and systemic inflammatory response. SARS-CoV-2 gains entry into human cells by binding to the Angiotensin-Converting Enzyme 2 (ACE2) receptor. This receptor is present in high concentrations on cells within the oral mucosa, salivary glands, and tongue. The virus may directly infect these tissues, causing localized cellular damage and inflammation that results in ulcers and lesions.
This direct action can disrupt salivary gland function, leading to reduced saliva production and dry mouth. Furthermore, the body’s systemic reaction, characterized by an overproduction of inflammatory signaling molecules (a cytokine storm), contributes significantly to tissue damage. This widespread inflammation weakens the mucosal barrier, making the mouth prone to ulceration.
Many oral lesions are also linked to opportunistic infections that take advantage of a compromised immune system. The stress of the viral infection or the use of certain medications can disrupt the balance of the oral microbiome. This imbalance may trigger an overgrowth of fungi, such as Candida albicans, leading to oral thrush, or reactivate latent viruses like herpes simplex. These secondary infections are a common cause of the white patches and blister-like lesions.
Treating and Managing Oral Discomfort
Managing oral discomfort from COVID-19 symptoms focuses on relieving pain, promoting healing, and preventing secondary infections. Over-the-counter pain relievers, such as acetaminophen or ibuprofen, can help reduce generalized inflammation and manage the pain associated with widespread mouth sores. These systemic medications address the underlying discomfort and can improve the ability to eat and drink.
Localized treatment involves the use of medicated or soothing topical applications directly onto the sores. Oral rinses containing mild antiseptics or numbing agents can provide temporary relief from pain and help keep the ulcers clean. A simple home remedy involves rinsing the mouth several times a day with a solution of warm water and half a teaspoon of salt, which helps to soothe irritated tissues and encourages healing.
Dietary modifications are an important component of managing these painful lesions, as certain foods can exacerbate irritation. It is advisable to temporarily avoid substances that are highly acidic, very salty, or spicy, as these can sting and delay the recovery process.
Maintaining meticulous oral hygiene is also necessary, using a soft-bristled toothbrush to prevent minor abrasions that could trigger new sores or worsen existing ones. If the sores are severe, if secondary infection is suspected, or if the pain makes swallowing or drinking impossible, consulting a healthcare professional is necessary for potential prescription treatments, such as antivirals or antifungals.