The novel coronavirus, SARS-CoV-2, is primarily known for causing respiratory illness, but it impacts multiple body systems. As a systemic viral infection, it frequently produces unexpected symptoms, including manifestations in the oral cavity. Reports confirm that the virus can directly or indirectly affect the tongue, resulting in noticeable physical changes and sensory disturbances. The tongue is established as a site where the infection’s presence can be visually detected.
Specific Changes to the Tongue
The collection of observable changes has been colloquially termed “COVID Tongue,” encompassing physical and sensory alterations. Many individuals report inflammation of the tongue (glossitis), which can make the organ appear swollen or enlarged (macroglossia). The texture often changes, presenting as a thick, sometimes furry coating that may be white, yellow, or dark in color.
In some cases, the tongue’s surface loses its normal bumpy texture due to the damage or loss of the tiny projections called papillae (depapillation). This results in smooth, glossy, red patches, sometimes resembling geographic tongue. Sensory disturbances are also frequently reported, including a persistent burning or tingling sensation. These changes often accompany dryness of the mouth (xerostomia), which exacerbates discomfort and contributes to the visual appearance of a coated tongue.
How COVID-19 Causes Oral Symptoms
The reasons for these oral manifestations are linked to the virus’s mechanism of cellular entry and the body’s immune response. SARS-CoV-2 gains access to host cells by binding to the angiotensin-converting enzyme 2 (ACE2) receptor. This receptor is highly expressed in various oral tissues, including the epithelial cells of the tongue and salivary glands, making the mouth a potential site for direct viral infection and replication.
Direct viral activity triggers localized damage and inflammation in the tongue’s mucosal lining. This process is amplified by the body’s systemic inflammatory response, characterized by an elevated release of pro-inflammatory signaling molecules. This widespread inflammation can damage fine blood vessels and lead to the destruction of the papillae, causing the raw, smooth patches observed in some patients.
Secondary effects also contribute to symptoms, such as dry mouth caused by potential damage to the salivary glands or as a side effect of certain medications. Reduced saliva flow alters the mouth’s microbial balance, sometimes leading to opportunistic infections like oral thrush, which presents as white patches. These combined factors result in the diverse range of tongue symptoms.
Acute Symptoms Versus Long-Term Effects
Tongue symptoms vary significantly depending on the phase of the illness, separating into acute and post-acute categories. During the acute phase, symptoms such as inflammation, coating, and ulcers often emerge within the first ten days of infection. These physical changes typically resolve quickly, with most mucosal lesions disappearing within one to three weeks as the body clears the active virus.
A subset of individuals experience persistent oral issues that extend beyond the initial illness, falling under long COVID. The most commonly reported persistent symptom is taste alteration, known as dysgeusia, which can linger for weeks or months. This is thought to be caused by ongoing inflammation or lingering effects on the epithelial and taste receptor cells. Other long-term effects include chronic burning sensations or recurring patches, suggesting persistent immune dysregulation.
Management and Relief Strategies
Managing COVID-19-related tongue symptoms focuses on reducing discomfort and treating secondary issues. Maintaining meticulous oral hygiene is a starting point, involving gentle brushing and cleaning the tongue to remove coating or debris. This practice helps prevent the accumulation of bacteria or fungi that thrive on a compromised mucosal surface.
Staying hydrated is an effective strategy, as dry mouth often worsens pain and visibility of tongue changes. Individuals can use over-the-counter anti-inflammatory mouth rinses or warm saltwater rinses to soothe inflammation and burning sensations. If a secondary fungal infection, such as oral thrush, is suspected, a healthcare provider may prescribe a specific antifungal medication.
It is advisable to seek medical attention if:
- Tongue swelling is severe.
- Sores or ulcers interfere significantly with eating or drinking.
- Symptoms do not improve within a few weeks of recovering from the acute infection.
Persistent or severe symptoms may require specialized evaluation to rule out other causes or to treat underlying issues, such as prolonged dysgeusia, with targeted therapies like topical corticosteroids.