The COVID-19 pandemic introduced numerous symptoms beyond typical respiratory issues, including various manifestations affecting the mouth and skin. Among these presentations, “Covid Tongue” gained attention as a distinctive oral symptom associated with the infection. This term describes a range of physical changes and discomforts affecting the tongue that became an identifiable sign during the disease’s course. The presence of these symptoms has been documented by medical professionals worldwide, prompting investigation into the virus’s impact on the oral cavity.
Visual Characteristics of Covid Tongue
The appearance of Covid Tongue is highly varied, often involving noticeable changes to the color and texture of the tongue’s surface. The papillae, the small bumps on the tongue, may become swollen, enlarged, or inflamed, sometimes leading to transient lingual papillitis. Conversely, patients may observe patchy areas where the papillae are lost, creating a smooth or bald appearance.
The tongue may display unusual redness due to inflammation, or it may develop a thick white or yellowish coating. This coating can be patchy, which, combined with areas of redness, gives the tongue a “geographic” or map-like appearance. Swelling of the tongue (macroglossia) can cause the organ to press against the teeth, resulting in indentations or scalloping along the sides.
These visual changes are frequently accompanied by significant sensory discomfort. Many individuals report a burning sensation (glossodynia) or altered taste perception (dysgeusia). Dry mouth (xerostomia) and the presence of painful ulcers or canker sores on the tongue are also common features.
Underlying Causes and Prevalence
The biological mechanisms causing Covid Tongue involve the virus’s interaction with specific cell receptors and the resulting immune response. SARS-CoV-2 primarily uses the Angiotensin-Converting Enzyme 2 (ACE2) receptor to enter human cells. High concentrations of ACE2 receptors are found in various oral tissues, including the surface cells of the tongue and the salivary glands.
Direct viral activity in these cells may lead to localized inflammation, contributing to the swelling and physical changes observed. Systemic inflammation triggered by the infection, characterized by a cytokine response, can also impact tissues throughout the body, including the oral cavity. This widespread inflammation can damage blood vessels, potentially contributing to the painful symptoms.
In some cases, visible changes, such as a white coating, may be due to secondary infections, like an overgrowth of Candida fungus (oral thrush). This occurs because the immune system is preoccupied fighting the virus or due to the use of certain medications. While oral manifestations are a recognized symptom, prevalence varies; one large study found oral cavity findings in around 25% of COVID-19 cases.
Symptom Management and Medical Consultation
Managing the discomfort associated with Covid Tongue focuses mainly on local care and alleviating specific symptoms, as primary treatment targets the underlying COVID-19 infection. Maintaining gentle but thorough oral hygiene is recommended to prevent secondary issues. This includes using a soft-bristled toothbrush and considering an alcohol-free mouthwash to avoid further irritation to the inflamed tissues.
Dietary modifications can help reduce pain and sensitivity. Patients should ensure adequate hydration and consume soft, cool foods like yogurt or smoothies. They should also avoid known irritants, including spicy, highly acidic, or very hot foods and beverages, which can aggravate the tender tongue surface. Over-the-counter anti-inflammatory medications may reduce swelling and pain, while topical pain-relieving gels or rinses can provide temporary relief for localized ulcers.
It is important to consult a healthcare provider if the tongue symptoms are severe, interfere with eating or swallowing, or persist long after other COVID-19 symptoms have resolved. A medical professional can determine if the symptoms are caused by a secondary infection, such as oral thrush, which may require specific antifungal medication. In rare instances of severe swelling that could affect the airway, systemic anti-inflammatory drugs might be necessary.