COVID Tongue: What You Should Know About This COVID-19 Symptom
An in-depth guide to COVID tongue, its symptoms, causes, and management for your well-being.
COVID-19 is widely recognized for its respiratory effects, but the disease can also manifest in many other ways—including with oral and tongue symptoms now referred to as COVID tongue. This lesser-known condition presents with swelling, sores, and a range of oral discomforts, and has become a point of curiosity and study since the earliest phases of the pandemic.
What Is COVID Tongue?
COVID tongue is not a single uniform condition but an evolving collection of oral and tongue changes seen in people infected with the SARS-CoV-2 virus. While not officially classified as a standalone disease, this cluster of symptoms is increasingly reported and recognized.
Symptoms most often associated with COVID tongue include:
- Swelling of the tongue (macroglossia)
- Inflamed, discolored, or depapillated (loss of bumps) surface of the tongue
- Mouth ulcers or sores that may be painful
- Loss or changes in the sense of taste (dysgeusia)
- Dry mouth or thick saliva
- Pain or burning sensation in the mouth or tongue
These symptoms can appear independently or along with the classic respiratory symptoms of COVID-19, such as cough, fever, and shortness of breath.
What Does COVID Tongue Look Like?
The presentation of COVID tongue may vary between individuals. The following features have been consistently observed:
- Redness, swelling, and inflammation: The tongue may appear enlarged, reddish, and tender to the touch.
- Ulcers or open sores: Painful or painless ulcers can develop on the surface or sides of the tongue.
- White patches or coating: White or yellowish patches (sometimes due to oral thrush) may cover the tongue.
- Smooth or patchy surface: Loss of papillae (the small bumps on the tongue) can make the surface look smooth or create map-like patches.
- Black hairy tongue: In rare cases, the surface may look black and fuzzy, especially with poor oral hygiene or superimposed fungal infection.
- Dysgeusia: Some people report a metallic, bitter, or otherwise altered taste.
What’s Happening Inside Your Body to Cause COVID Tongue?
The underlying mechanisms behind COVID tongue are not yet fully understood, but current research and clinical observations have highlighted several probable causes:
- ACE (angiotensin-converting enzyme) receptors in the tongue: The SARS-CoV-2 virus gains access to human cells via ACE receptors, which are found in high numbers on the tongue. This may explain why the tongue is directly affected during infection.
- Overactive immune response: The body’s response to viral invasion can produce inflammation and swelling throughout the body, including the tongue.
- Oral thrush as a secondary infection: COVID-19 and some therapies (like corticosteroids or antibiotics used during treatment) increase the risk of oral thrush—an overgrowth of the Candida fungus in the mouth. This can cause white patches and discomfort.
- Direct viral effects: Viral infection can alter the surface of the tongue, creating ulcers and sore spots.
- Dry mouth: COVID-19 may affect saliva production, causing a dry mouth which further complicates oral health and leads to discomfort and increased risk of sores or thrush.
- Activation of dormant viruses: Inflammation caused by COVID-19 can reactivate latent infections like herpes simplex virus, resulting in oral ulcers or cold sores.
- Irritation from medical treatment: Long-term use of breathing tubes, oxygen delivery systems, or certain medications during COVID-19 treatment may also irritate the tongue and oral cavity.
It’s important to remember that some symptoms of COVID tongue may also result from other viral or bacterial infections, medication side effects, or pre-existing oral conditions.
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Other Illnesses and Conditions That Can Cause Tongue Changes
Because the tongue is sensitive to various diseases, COVID tongue can sometimes be misattributed or overlap with other problems. Other causes of tongue changes include:
- Other viral infections: Herpetic lesions, Epstein-Barr virus, and influenza can all cause oral symptoms.
- Bacterial infections: Conditions like scarlet fever can cause a red, swollen tongue (sometimes called “strawberry tongue”).
- Autoimmune and inflammatory conditions: Lichen planus, geographic tongue, or Melkersson–Rosenthal syndrome.
- Fungal infections: Primarily oral thrush.
- Vitamin deficiencies: Low vitamin B12, folic acid, or iron can also cause tongue soreness and appearance changes.
- Allergies or medication reactions
It’s crucial to consider these possibilities, especially if COVID-19 has not been confirmed with a laboratory test.
Is COVID Tongue Contagious?
COVID tongue itself is not contagious. The underlying SARS-CoV-2 infection, however, is highly infectious, which is why any unusual oral symptoms appearing during a COVID-19 outbreak—especially if accompanied by fever, cough, or sudden loss of taste—warrant isolation and testing. The oral changes are not directly passed from person to person but are part of the individual’s immune response or secondary infections resulting from the viral illness.
How Long Does COVID Tongue Last?
The course of COVID tongue symptoms varies. In most cases:
- The swelling, ulcers, and discomfort typically resolve as the COVID-19 infection improves, usually within a few days to a couple of weeks.
- Secondary infections like oral thrush may linger and require specific antifungal treatment.
- Changes in taste may persist for several weeks even after other symptoms disappear.
If symptoms persist much longer or worsen, consult a healthcare professional to rule out other problems.
How Is COVID Tongue Managed?
There is currently no specific medication for COVID tongue, so management focuses on symptomatic relief and treating underlying or secondary infections. Here’s what’s typically recommended:
- Good oral hygiene: Brush twice daily, floss, and use an antiseptic mouthwash to prevent secondary infections.
- Saltwater or chlorhexidine gargles: Soothes discomfort and aids in reducing oral bacterial and fungal load.
- Hydration: Drink water frequently to maintain saliva flow and minimize dry mouth.
- Anti-inflammatories: Over-the-counter NSAIDs (as advised by your doctor) or topical pain-relieving gels can help manage pain and swelling.
- Antifungal medications: If oral thrush is suspected, your provider may prescribe a medicated mouth rinse or lozenge.
- Antiviral treatment: In rare cases of herpetic lesions, antivirals may be necessary.
- Artificial saliva products: For persistent dry mouth, saliva substitutes may be recommended.
- Avoiding irritants: Refrain from spicy, acidic, or rough foods that can worsen discomfort.
When Should You See a Doctor?
If you experience any of the following, seek medical evaluation:
- Swelling severe enough to make breathing or swallowing difficult
- Ulcers, sores, or changes that do not improve after two weeks
- Signs of a secondary infection (thick white coating, persistent pain, fever)
- Sudden or severe change in taste or inability to eat/drink normally
Let your healthcare provider know about your symptoms and COVID-19 status so they can determine the best management plan.
Self-Care and Home Remedies for COVID Tongue
- Maintain meticulous oral hygiene.
- Use a soft-bristled toothbrush and avoid harsh mouthwashes.
- Try gentle saline or prescribed mouth rinses.
- Avoid irritants: spicy or salty foods, tobacco, and alcohol.
- Stay well-hydrated, sipping water throughout the day.
- Consult your doctor before using over-the-counter topical anesthetics or pain relievers.
If you are prescribed medicines during your COVID recovery, follow your provider’s dosing and oral care recommendations carefully to minimize risk of thrush or additional mouth issues.
Understanding the Science and Continuing Research
Ongoing medical research aims to clarify exactly how COVID-19 affects oral tissues and leads to symptoms like COVID tongue. Some scientists suspect unique viral impacts on oral blood vessels or immune tissues, while others point to increased oral opportunistic infections among those with weakened immune responses.
As we learn more about the long-term impact of COVID-19, dental and medical professionals remain alert for new presentations—including COVID tongue—and continue gathering data to guide diagnosis and care.
Frequently Asked Questions (FAQs) About COVID Tongue
What are early signs of COVID tongue?
Early signs may include tongue swelling, loss of taste, pain, white patches, and ulcers. These can develop independently or alongside other COVID-19 symptoms.
Does everyone with COVID-19 get tongue symptoms?
No. While oral symptoms are noted in some patients, most people with COVID-19 will not develop COVID tongue. Prevalence rates are still being studied, but it appears relatively uncommon.
Can COVID tongue be prevented?
There is no guaranteed prevention for COVID tongue, but you can reduce risk by maintaining excellent oral hygiene, staying hydrated, and following your healthcare provider’s advice if you contract COVID-19.
Is COVID tongue dangerous?
In most cases, COVID tongue is not dangerous and resolves as the infection passes. Rarely, severe swelling can threaten airway safety and requires emergency care.
How is COVID tongue diagnosed?
Diagnosis is based on medical history, visible changes to the tongue and mouth, and confirmation of COVID-19 infection with laboratory testing. Doctors may rule out other oral conditions as needed.
Key Takeaways
- COVID tongue covers a set of oral and tongue symptoms associated with SARS-CoV-2 infection.
- Symptoms range from swelling, sores, and color changes to taste loss and dry mouth.
- It is not dangerous in most cases, but persistent, painful, or severe symptoms warrant prompt medical evaluation.
- Management focuses on good oral hygiene, supportive care, and treatment of secondary infections as needed.
- If you suspect COVID tongue and have underlying health concerns or unclear test status, contact your healthcare provider promptly.
References
- https://www.mdlinx.com/article/covid-tongue-is-real-heres-how-to-treat-it/7gvUxfXCH0Gel9PX1ncZXQ
- https://www.healthline.com/health/infection/covid-tongue
- https://aquoralspray.com/how-to-relieve-pain-from-covid-tongue/
- https://pmc.ncbi.nlm.nih.gov/articles/PMC9626792/
- https://ada.com/covid/covid-19-symptom-tongue/
- https://www.drscottfroum.com/blog/covid-19-tongue
- http://urologicalchoice.com/about-hh/news-center/news-detail?articleId=39036&publicid=395
- https://ijodontostomatology.com/en/articulo/oral-manifestation-covid-19-and-the-rapid-resolution-of-symptoms-post-phtalox-treatment-a-case-series/
- https://www.familydiagnosticclinic.com/do-i-need-a-treatment-for-covid-tongue/
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