A new systemic viral infection, such as the one caused by SARS-CoV-2, often raises questions about unusual physical symptoms. Many viral illnesses can manifest beyond the respiratory system, including in the mouth. The appearance of lesions or discoloration, such as white spots, prompts concern about a direct link to the infection. Clarifying whether these white patches are a direct result of the virus or a secondary issue requires careful clinical distinction.
Direct Association Between COVID-19 and Oral Symptoms
Current clinical data suggests that SARS-CoV-2 may cause white spots, though this is an uncommon manifestation. Some patients have reported a condition informally called “COVID tongue,” which involves changes like swelling, a bumpy texture, or white patches on the tongue’s surface. Studies suggest the virus may directly affect oral tissues, as white patches were reported by a small percentage of patients with oral symptoms.
The virus is known to infect cells in the mouth possessing the ACE2 receptor, which may contribute to blistering or lesion formation. These white patches are not a universal symptom, but rather one of several possible oral-mucosal changes during the acute phase of infection. Research is ongoing to determine if the lesions result from the virus attacking cells directly or from the body’s inflammatory response.
Common Causes of White Spots in the Mouth
Most white spots in the mouth are unrelated to COVID-19, representing common dermatologic or infectious conditions.
Oral Candidiasis (Thrush)
This frequent cause presents as creamy white patches resembling cottage cheese, typically found on the tongue or inner cheeks. These patches can often be scraped away, revealing a red, tender area underneath.
Leukoplakia
This involves thick, non-painful white patches that cannot be rubbed off, often developing on the gums, tongue, or inner cheeks. Leukoplakia is strongly linked to chronic irritation, such as tobacco use, and carries a risk of developing into oral cancer.
Aphthous Ulcers (Canker Sores)
These are painful, round or oval sores with a grey-white center surrounded by a distinct red border, appearing on soft tissues like the inside of the lips.
Oral Lichen Planus
This condition appears as fine, white, lace-like patterns, often symmetrically on the inner cheeks, and may be asymptomatic.
Viral Illnesses and Secondary Oral Issues
A major systemic viral illness, including COVID-19, often triggers opportunistic infections rather than directly causing white spots. The stress of fighting a significant infection temporarily weakens the immune defenses, allowing normally harmless microbes to overgrow. This creates an environment where Candida albicans, a yeast naturally living in the mouth, can multiply and cause oral thrush.
Thrush is often seen in hospitalized patients or those with a severe course of illness. Medications used to manage serious viral infections, such as broad-spectrum antibiotics or corticosteroids, can also contribute to these secondary issues. These treatments disrupt the normal microbial balance, increasing the risk of candidiasis. In these instances, the white spot is a side effect of the disease state and its treatment, not a lesion created by the virus itself.
Symptom Management and Medical Guidance
Managing mild oral lesions begins with simple home care and hygiene practices. Using warm saltwater rinses several times a day can help soothe inflammation and keep the area clean. Patients should temporarily avoid consuming foods that are overly spicy, acidic, or rough in texture, as these can irritate existing sores. Maintaining excellent oral hygiene, including gentle brushing, helps prevent secondary bacterial infections.
Any white patch or sore that persists for longer than two or three weeks requires a professional evaluation. Immediate consultation is necessary if the lesion is accompanied by severe pain, difficulty swallowing, or unexplained numbness. Urgent investigation is also warranted for patches that are mixed with red areas, are rapidly growing, or occur in individuals with a history of tobacco use. A medical professional can accurately diagnose the cause and determine if the symptom is benign or requires specific antifungal, antiviral, or other targeted treatment.