The COVID-19 pandemic led to public concern over unusual symptoms, including the appearance of white spots inside the mouth. Many people wondered if a simple white patch could signal a coronavirus infection. Scientific investigation has revealed that the link between the SARS-CoV-2 virus and oral lesions is complex, involving both rare direct viral effects and more common secondary conditions. Determining the cause requires a careful look at the lesion’s features, as most white spots are related to non-COVID factors. This article explores how COVID-19 can affect the mouth and outlines the more common causes of these white lesions.
The Direct Link Between COVID and Oral Lesions
The SARS-CoV-2 virus can directly interact with oral tissues, which express the Angiotensin-Converting Enzyme 2 (ACE2) receptors the virus uses to enter cells. This interaction can lead to a condition sometimes referred to as “COVID Tongue,” encompassing various oral manifestations. White patches, while less frequent than symptoms like taste loss, have been documented in a small percentage of COVID-19 patients.
These lesions are thought to result from the virus’s direct action on the oral mucosa or from the body’s aggressive immune response, known as a cytokine storm. The white spots are often non-specific, presenting as plaque-like lesions on the tongue or palate. However, the presence of white spots alone is considered a rare and non-defining symptom of the viral infection.
Secondary Oral Conditions Triggered by COVID Infection
A more common scenario involves COVID-19 creating an environment where opportunistic oral conditions can thrive, leading to white spots. The most recognized is oral candidiasis, commonly known as thrush, a fungal infection caused by an overgrowth of Candida yeast. This typically appears as creamy white, removable patches on the tongue, inner cheeks, or palate, sometimes accompanied by a burning sensation.
The infection’s systemic effects and treatment protocols often set the stage for this opportunistic growth. Fever, dehydration, and a weakened immune system compromise the body’s ability to keep the fungal population in check. Additionally, many patients with severe COVID-19 are treated with antibiotics or corticosteroids, which disrupt the natural balance of microorganisms. These medications suppress the immune system, allowing the Candida fungus to multiply and form the characteristic white plaques.
Common Non-COVID Related Causes of White Spots
A white spot in the mouth is far more likely to be caused by a common, non-COVID-related issue. One frequent cause is the aphthous ulcer, known as a canker sore, which appears as a painful, shallow, round, or oval lesion. The center is typically white, yellow, or gray, surrounded by a distinct red border, developing on movable tissues like the inner lips or cheeks. Minor aphthous ulcers usually heal on their own within one to two weeks.
Another consideration is leukoplakia, which presents as thick, white, or grayish patches that cannot be rubbed or scraped off the mucosal surface. These patches are usually painless and are strongly associated with chronic irritation, particularly from tobacco use or alcohol consumption. Leukoplakia is considered a potentially malignant disorder, meaning a small percentage of these lesions may show precancerous changes, necessitating close medical monitoring.
Oral lichen planus is an immune-mediated inflammatory condition that can also cause white spots. The most common form, reticular oral lichen planus, creates a distinctive white, lacy, or web-like pattern, often on the inside of the cheeks, which is generally not painful. However, the erosive form presents as red, swollen areas with open sores that can cause significant pain and a burning sensation, especially when eating acidic or spicy foods.
Guidelines for Seeking Medical Consultation
While most white spots are benign and resolve quickly, certain features should prompt a visit to a healthcare provider or dentist. The most important factor is persistence; any white patch that does not heal or disappear completely within two weeks requires professional evaluation. This is particularly true for leukoplakia, given its association with an increased risk of oral cancer.
A consultation is also necessary if the white spot is accompanied by concerning secondary symptoms. These warning signs include chronic pain, bleeding, a noticeable increase in size, or the development of a firm lump. Difficulty with swallowing, speaking, or moving the jaw, or if the lesion has a mixture of red and white areas, suggests a more serious underlying condition that requires immediate diagnosis.