Long COVID, or PASC, describes a condition where symptoms persist for weeks or months following the initial SARS-CoV-2 infection. While known for causing fatigue, brain fog, and respiratory problems, growing evidence suggests it can also significantly impact oral health. Many people recovering from the virus are reporting new or worsening dental and gum issues linked directly to the systemic effects of the illness. Understanding this connection is important for addressing these unexpected complications.
Identifying Oral Symptoms Associated with Long COVID
One of the most frequently reported oral concerns among those with PASC is extreme dry mouth, or xerostomia, affecting nearly half of patients in some studies. Saliva is a natural defense mechanism that washes away bacteria and neutralizes acids. Its absence can lead to a rapidly increased risk of enamel erosion and dental decay. This lack of moisture often results in a sticky feeling in the mouth, difficulty swallowing, and increased bad breath.
Patients report changes in their gums, which may appear swollen, red, or tender. This inflammation can cause gums to bleed easily during routine brushing or flossing, indicating the onset of gingivitis or an aggravation of existing periodontal disease. Some individuals also experience unexplained tooth pain or heightened sensitivity to hot and cold temperatures, often without a clear structural cause. This sensitivity may be attributed to weakened enamel protection due to dry mouth or underlying nerve inflammation.
Changes to the senses of taste and smell, known as dysgeusia and parosmia, are well-established symptoms of COVID-19 that can linger for many months. This altered perception of flavor can inadvertently affect oral care habits, as patients may avoid brushing due to distorted taste sensations or crave sugary foods more intensely. Less common, but still reported, are symptoms like recurrent mouth ulcers or sores. In rare, severe cases, reports of tooth mobility or loss have been noted.
Understanding the Biological Connection
The oral symptoms experienced during PASC stem from the body’s prolonged reaction to the viral infection. A primary mechanism involves systemic inflammation, which is a hallmark of Long COVID and can impact the tissues supporting the teeth. Chronic inflammation disrupts the delicate vascular supply to the gums and jawbone, potentially leading to the observed gum bleeding and tissue breakdown.
The virus has a direct pathway into the oral cavity via the Angiotensin-converting enzyme 2 (ACE-2) receptors, which are highly expressed in the salivary glands. When SARS-CoV-2 targets these receptors, it can damage the salivary gland cells, leading to their dysfunction and the resulting decrease in saliva production, which manifests as xerostomia. This dysfunction changes the entire oral environment, making it more hospitable for harmful bacteria.
PASC can alter the oral microbiome, shifting the balance toward a higher abundance of pro-inflammatory bacteria. This imbalance can perpetuate chronic gum disease and contribute to bone loss around the teeth. Indirect effects also play a role, as the chronic stress, anxiety, and pain associated with a prolonged illness often lead to increased nocturnal teeth grinding or clenching, known as bruxism. This habit places excessive force on the teeth, causing sensitivity, micro-cracks, and jaw pain (Temporomandibular Disorder or TMD).
Managing and Treating Long COVID-Related Dental Issues
Anyone experiencing new or accelerated oral health problems following a COVID-19 infection should schedule a consultation with their dentist promptly. Early intervention allows the dental team to distinguish between symptoms caused by lifestyle changes and those potentially driven by the underlying biological effects of PASC. Regular check-ups are important for monitoring changes in the oral microbiome, gum health, and enamel integrity over time.
For managing dry mouth, several specific strategies can help restore the mouth’s protective environment. The use of over-the-counter saliva substitutes and oral moisturizing gels can provide symptomatic relief by coating the tissues. Chewing sugar-free gum or lozenges stimulates natural saliva flow, and avoiding substances like caffeine, alcohol, and very dry or salty foods helps prevent further dehydration. In cases of severe, persistent xerostomia, a doctor may prescribe medications like pilocarpine or cevimeline to stimulate the salivary glands chemically.
Home care adjustments are necessary to combat the accelerated risk of decay. Using a high-fluoride toothpaste can strengthen enamel against acid erosion, and gentle brushing techniques are recommended to avoid irritating already inflamed gum tissues. If bruxism is suspected, a custom-fitted nightguard can be fabricated by a dentist to protect the teeth from grinding and alleviate associated jaw pain. Maintaining proper hydration and a balanced diet rich in vitamins supports the body’s overall immune function.