What Is COVID Tongue?

COVID-19 tongue is a term for a variety of symptoms associated with the tongue and mouth that are experienced by some people during or after a COVID-19 infection. The symptoms include white patches on the tongue, bumps, ulcers, tongue swelling, red and swollen tongue and/or a burning sensation in the mouth. Researchers are still studying this affliction to better understand and treat it. One important question they hope to resolve is whether COVID-19 tongue might be an early symptom, allowing for earlier COVID-19 testing in individuals experiencing it.

How Many People Get COVID-19 Tongue?

It isn’t known exactly how many people get this condition. One small study showed that 11.7% of their hospitalized COVID-19 patients had symptoms relating to the tongue or mouth. Although more than 11% is a significant amount, there has not yet been enough analysis to determine if this percentage is consistent for all those with COVID-19 infections. It also remains to be seen exactly which instances of mouth and tongue symptoms are COVID-19 tongue versus from other causes.  

Because of the lack of distinct diagnostic criteria for COVID-19 tongue, it is difficult to determine which patients are experiencing an oral condition specific to COVID-19 infection. A metastudy performed by analyzing data from 17 different academic papers on COVID-19 that dealt with mouth and tongue symptoms found an array of different symptoms. There did not appear to be one unifying set of symptoms that always characterized a specific condition that  could be identified. The most common of these symptoms included:

• dry mouth, 
• mouth burning, 
• white tongue plaque, 
• oral thrush (fungal infection caused by Candida sp.), 
• painful ulcers, 
• muscle pain, 
• swelling of the mouth, tongue or gums, 
• herpes simplex viral lesions (cold sore). 

Another complicating factor is determining the percentage of people with a mild to moderate COVID-19 infection that may be affected. The studies cited have predominantly focused on patients who have been hospitalized as a result of COVID-19. Much less information is available for patients who test positive for the disease but are not hospitalized. More study is needed to better understand if these symptoms are occuring at a similar rate for COVID-19 positive individuals who are not hospitalized, or even asymptomatic in all other ways, compared to patients with severe symptoms that require hospitalization. 

What Causes COVID-19 Tongue?

More study is needed to understand the underlying cause of the oral symptoms among COVID-19 patients, but there have been several causes suggested (HealthLine article). It is as yet unknown if any one, or a combination of these conditions are the cause of oral COVID-19 symptoms.

• Salivary Gland Disruption: Viral infection could affect the salivary glands and cause a reduction in saliva production. Reduced saliva is correlated with a variety of oral health issues.
• General Immune Response: The immune system responds to infection in a variety of ways, some of which include inflammation and lesions.
• Oral Thrush: Caused by the Candida fungus, this is a form of yeast infection in the mouth. This can be triggered by other infections, and is known to be more common on certain medications.
• Cold Sores: COVID-19 may increase the likelihood of an oral herpes outbreak. Although most people with the Herpes simplex virus will never have an outbreak, almost 80% of the world’s population does have it, according to the World Health Organization (WHO). Since the WHO estimates that 66.6% of the world’s population have HSV-1 (the Herpes simplex virus most common in oral outbreaks), if the COVID-19 virus increases the likelihood of outbreaks associated with HSV-1, it could result in a large number of oral cold sores in COVID-19 positive individuals.
• COVID-19 Treatment: Some treatments given to COVID-19 patients increase the chances of oral health problems. These include some medications, breathing tubes and ventilators.  
• Viral Cause of Mouth Ulcers: Some viruses are known to cause mouth ulcers in some patients.  More study is needed to know if this might include COVID-19. 
• ACE Receptors: ACE receptors are proteins found on cells that viruses can attach to, to gain entrance to the cell. There is a high number on your tongue, which may be a mechanism for COVID-19 having a more pronounced effect on the tongue.

Is There a Treatment for COVID Tongue?

It appears that oral symptoms associated with COVID-19 typically resolve on their own. If a patient is wondering how to get rid of COVID tongue symptoms, there are some options, however. Potential options for COVID tongue treatment at home include managing the discomfort of dry mouth with an artificial saliva mouth rinse, or using over the counter anti-inflammatory medication to minimize mouth swelling. Consult your health care provider with any symptoms before deciding what your best treatment options are.

In severe cases, doctor prescribed corticosteroids or other anti-inflammatory drugs may be offered as a treatment of COVID tongue to reduce swelling. If a specific condition is identified as causing symptoms such as thrush or cold sores, antibacterial, antiviral or antifungal mouth washes or other medication may be recommended as a covid mouth rash treatment. In extreme cases, low level laser therapy may be used to treat mouth or tongue ulcers. 

How Long Does COVID Tongue Last?

Because there is little concrete data on this condition, it is difficult to answer the question of how long COVID tongue after recovery takes to resolve. In the metastudy mentioned previously, that included 170 patients with oral symptoms concurrent with COVID-19, all cases with recorded beginning and end times of oral symptoms resolved within 3 weeks of onset. However, only 42 of the 170 patients’ information was complete enough to determine length of COVID-19 tongue, so more information is needed before this data can be used with confidence. 

COVID-19 Tongue or Not, Accurate Testing Matters Most

Ultimately, the CDC has not yet included COVID-19 tongue in the list of symptoms common with a COVID-19 infection. As more information continues to be collected about the relatively rare symptoms associated with COVID-19, we will gain greater understanding about what COVID tongue might indicate. If you have any symptoms you believe might indicate you have COVID-19, consult with your healthcare provider and the most recent recommendations from the CDC and WHO.  

If COVID-19 testing is the right choice for you, BioCollections is here to help. We have 20+ years of experience in medical testing, and we deliver accurate COVID-19 test results using the gold standard of testing, the PCR test. Contact us with any questions you have, or schedule an appointment with us online.