The public is increasingly aware of symptoms that might indicate a COVID-19 infection. A common question concerns oral manifestations, specifically whether mouth ulcers can be a symptom. Understanding the connection between mouth ulcers and COVID-19, along with their other common causes, helps individuals navigate health concerns and know when to seek medical advice.
Mouth Ulcers and COVID-19
Mouth ulcers have been observed in individuals with SARS-CoV-2, the virus causing COVID-19, though direct causation is still under study. Reports indicate oral manifestations, including ulcers, can occur. One study of 666 patients found over 25% experienced oral symptoms. Another smaller study identified oral lesions in 78.4% of 74 COVID-19 patients, with canker sores being the most frequent. The pooled prevalence rate for oral ulceration in COVID-19 patients is reported at 21%.
These oral lesions often present as aphthous-like ulcers: shallow, round sores with a reddish border. Other forms include petechial lesions (small red spots) and vesicular eruptions (blisters). These ulcers can appear in various mouth locations, including the tongue, palate, oral mucosa, lips, cheeks, and gums. They can be painful.
The timing of these ulcers varies; some emerge with or before other COVID-19 symptoms, while others develop later. Several mechanisms may contribute to their development. These include the virus’s potential direct impact on oral tissues, possibly via ACE2 receptors in the mouth. The body’s immune response, leading to inflammation, and secondary factors like illness-related stress or medication side effects are also considered contributing factors.
Common Non-COVID Causes of Mouth Ulcers
Mouth ulcers are common and often unrelated to COVID-19. The most common type, canker sores (aphthous ulcers), are not contagious. They often arise from factors like emotional stress, minor injuries such as biting the cheek, or consuming acidic foods. These sores typically heal on their own within a couple of weeks.
Cold sores, caused by the herpes simplex virus (HSV-1), are another common oral lesion. Unlike canker sores, they are contagious. They usually appear as fluid-filled blisters outside the mouth, often on the lips, but can also occur inside. Mechanical injuries, such as from ill-fitting dental appliances, sharp teeth, or vigorous brushing, can also cause ulcers.
Nutritional deficiencies, specifically a lack of iron, folate, or vitamin B12, can contribute to mouth ulcers. Oral thrush (candidiasis) is a fungal infection appearing as creamy white patches inside the mouth. This condition is more common in individuals with weakened immune systems, those taking antibiotics, or those using inhaled steroids. Certain underlying medical conditions like inflammatory bowel diseases (Crohn’s disease or ulcerative colitis), celiac disease, and various autoimmune disorders can also cause recurrent mouth ulcers.
When to Seek Medical Advice
While most mouth ulcers are harmless and resolve without intervention, specific situations warrant consulting a healthcare professional. If an ulcer persists for more than two weeks without healing, it needs medical attention. Similarly, ulcers that are unusually painful, very large, or recur frequently should be evaluated.
Medical advice is also recommended if mouth ulcers are accompanied by other systemic symptoms, such as fever, swollen glands, body aches, or a rash elsewhere on the body. Difficulty eating or drinking due to ulcers also signals a need for professional assessment. Persistent, non-healing oral ulcers can, in rare instances, indicate more serious conditions, including oral cancer, especially without an obvious cause like injury. Considering recent COVID-19 exposure or other COVID-like symptoms alongside mouth ulcers can help guide the decision to seek timely medical attention.