The emergence of SARS-CoV-2 brought a wide array of symptoms beyond respiratory illness. Among the less common findings were various changes within the mouth, collectively termed “Covid tongue.” This phrase describes oral manifestations that appear during or shortly after infection. Recognized as an inflammatory response, the condition highlights the systemic reach of the pathogen. Although not a primary indicator of infection, it became a notable signal of the body’s reaction to the virus.
The Appearance of Covid Tongue
The visual presentation of Covid tongue is highly variable, involving changes to the texture, color, and comfort of the organ. One common manifestation is the appearance of smooth, red patches, known as depapillation or atrophic glossitis. This occurs when the small, finger-like projections on the tongue’s surface, the filiform papillae, are lost, creating a slick, bald appearance in localized areas.
These depapillated areas sometimes present with white borders, resembling geographic tongue. Another frequent symptom is a thick, white, or patchy coating on the dorsal surface. This coating can be accompanied by noticeable swelling (edema), which may cause the tongue to press against the teeth, resulting in indentations along the sides.
Patients also report painful lesions, including small bumps or ulcers on the tongue and surrounding oral mucosa. These sores, sometimes referred to as aphthous-like ulcers, contribute to a burning sensation and general discomfort.
How SARS-CoV-2 Affects Oral Health
Tongue changes are rooted in the interaction between SARS-CoV-2 and specific host cells. The virus gains entry by binding to the angiotensin-converting enzyme 2 (ACE2) receptor. High concentrations of ACE2 receptors are present on the epithelial cells of the tongue, particularly the dorsal surface, and within the salivary glands, creating a direct entry point.
Viral entry into these oral cells triggers a localized inflammatory response, accounting for the swelling and redness observed. The infection can also cause systemic inflammation, sometimes leading to an excessive immune reaction known as a cytokine storm. This broad inflammatory environment contributes to the damage and alteration of tissues, including the surfaces of the tongue.
A common secondary effect is xerostomia (dry mouth), reported by many patients. This can occur due to direct damage to ACE2-expressing salivary gland cells, or it may be a side effect of treatment medications. Reduced saliva flow disrupts the oral microbiome balance, potentially leading to opportunistic infections, such as oral thrush, which appears as white patches.
Prevalence and Symptom Recognition
The prevalence of oral manifestations related to SARS-CoV-2 infection varies across studies. A large-scale analysis found that approximately 25.65% of individuals had some finding within the oral cavity. Lingual lesions, such as swelling and depapillation, were present in up to 11.5% of hospitalized COVID-19 patients.
A study in Spain indicated that about a quarter of hospitalized patients exhibited changes to their mouth or tongue. Despite frequent reports, “Covid tongue” is generally not recognized as a primary, officially listed symptom by major public health organizations. It is categorized as a less common or secondary manifestation, appearing alongside well-known signs like loss of taste or smell.
Management and Recovery Time
Management of Covid tongue is primarily supportive, focusing on easing discomfort until the underlying viral infection resolves. Patients should maintain rigorous oral hygiene, including gentle brushing of the tongue and using mild, non-irritating mouthwashes. Staying well-hydrated is also recommended, as this mitigates the effects of dry mouth, which exacerbates symptoms.
Over-the-counter pain relievers or anti-inflammatory drugs, such as ibuprofen, can manage the pain and reduce swelling. For persistent or severe lesions, a healthcare provider may suggest a topical steroid or antifungal treatment.
The duration of Covid tongue symptoms is variable but temporary, resolving as the body clears the infection. For many, the changes disappear within a few weeks. However, some studies document that these tongue pathologies can persist longer, lasting anywhere from four weeks up to several months in rare cases.