Long COVID, also known as post-COVID-19 condition, describes a wide array of persistent health problems that can last for weeks, months, or even years after the initial SARS-CoV-2 infection. These prolonged symptoms can affect various organ systems, ranging from fatigue and brain fog to respiratory and cardiovascular issues. Among the diverse manifestations reported, mouth ulcers have emerged as a notable oral symptom, causing considerable discomfort for many individuals experiencing Long COVID. These lesions can significantly impact daily activities, making eating, speaking, and swallowing challenging.
Understanding Long COVID Mouth Ulcers
Mouth ulcers associated with Long COVID often resemble common aphthous ulcers, presenting as painful, round or oval sores inside the mouth. These lesions typically feature a distinct appearance with a white or yellowish center surrounded by a bright red border. They can appear on the inner cheeks, lips, tongue, or the floor of the mouth. Individuals frequently report a burning or tingling sensation preceding the ulcer’s appearance, followed by localized pain that intensifies with movement or contact.
The discomfort from these ulcers can range from mild tenderness to severe pain, making it difficult to consume certain foods, especially those that are acidic, spicy, or hard. Unlike typical canker sores that usually resolve within one to two weeks, Long COVID-related mouth ulcers may exhibit prolonged healing times or recur frequently. Their persistence or recurrent nature distinguishes them, often becoming a chronic issue that impacts quality of life.
Potential Causes of Long COVID Mouth Ulcers
Mouth ulcers in Long COVID are thought to stem from the body’s prolonged response to the initial viral infection. One significant factor is immune dysregulation, where the immune system remains overactive or dysfunctional long after the virus is cleared. This can lead to chronic inflammation throughout the body, including the oral tissues, or even trigger autoimmune responses where the immune system mistakenly attacks healthy cells in the mouth. Such sustained inflammatory processes can disrupt the integrity of the oral lining, making it more susceptible to ulcer formation.
Another hypothesized cause involves viral persistence, where remnants of the SARS-CoV-2 virus or its genetic material may linger in various tissues, including oral mucosal cells. This continued presence, even at low levels, could perpetuate inflammation or directly damage cells. Furthermore, some medications used to manage Long COVID symptoms, such as certain antiviral drugs or immunomodulators, might have side effects that include oral ulceration. Medication-induced ulcers are a known adverse reaction and can contribute to their formation.
Nutritional deficiencies can also play a role, as chronic illness can sometimes impair nutrient absorption or increase metabolic demands. Deficiencies in specific micronutrients, such as B vitamins (particularly B12), iron, or folate, are known to contribute to the formation of mouth ulcers. Individuals with Long COVID may experience these deficiencies due to prolonged illness or altered dietary habits. Chronic stress and anxiety associated with Long COVID can lead to behaviors like teeth grinding or jaw clenching, which can irritate oral tissues. Additionally, stress can contribute to dry mouth (xerostomia), making the oral mucosa more vulnerable to trauma and ulceration.
Strategies for Relief and Treatment
Managing Long COVID mouth ulcers often involves a combination of home care and over-the-counter interventions to alleviate discomfort and promote healing. Rinsing the mouth with a warm saltwater solution can help cleanse the ulcers and reduce inflammation. Maintaining oral hygiene, including gentle brushing, is important to prevent secondary infections without irritating the lesions. Avoiding acidic, spicy, salty, or abrasive foods can prevent further irritation and pain.
Staying well-hydrated helps maintain oral moisture and can aid in healing. Applying a cold compress or sucking on ice chips can offer temporary pain relief. Over-the-counter options include topical anesthetic gels, which can numb the ulcer, or protective gels that form a barrier over the sore to reduce irritation. Oral rinses can also be used to keep the area clean and promote healing.
For more persistent or severe ulcers, a healthcare professional might prescribe stronger treatments. These can include corticosteroid mouthwashes or pastes, which help reduce inflammation and pain, or specific pain medications if the discomfort is significant. Addressing any identified nutritional deficiencies through dietary adjustments or supplements, especially for vitamins B12, iron, or folate, can also be an important part of the treatment strategy.
When to Seek Medical Guidance
Consult a healthcare professional if mouth ulcers associated with Long COVID do not heal within two to three weeks or if they frequently recur. Worsening pain, increasing size, or the development of new ulcers warrant medical evaluation. Signs of infection, such as fever, swelling around the ulcer, or pus, also indicate the need for medical attention.
Difficulty eating or drinking due to severe pain or the ulcer’s location is another reason to seek professional advice, as prolonged inadequate intake can lead to other health issues. A healthcare provider can accurately diagnose the cause of the ulcers, rule out other potential underlying conditions, and recommend appropriate prescription treatments or management strategies.