COVID-19 can cause tooth pain through several distinct pathways, some involving the virus itself and others stemming from the pandemic’s broader effects on stress, healthcare access, and oral health. The connection is real and well-documented: the virus that causes COVID-19 can directly infect oral tissues, irritate the nerve that supplies sensation to your teeth, and trigger inflammatory cascades that worsen existing dental problems. Roughly one in seven people in one large study developed facial or oral pain during a COVID-19 infection, and the explanations go well beyond a simple sore throat.
How the Virus Gets Into Your Mouth
SARS-CoV-2 enters human cells by latching onto a surface protein called ACE2 using a helper enzyme called TMPRSS2. Both of these are found throughout the oral cavity, including in the salivary glands and the mucous membranes lining your mouth and gums.1PubMed Central. Covid-19 and oral diseases: Crosstalk, synergy or association? Transcriptome analysis has confirmed that salivary gland cells express both ACE2 and TMPRSS2, meaning they can serve as direct targets for viral entry and replication.2PubMed Central. Systematic analysis of ACE2 and TMPRSS2 expression in salivary glands reveals underlying transmission mechanism caused by SARS-CoV-2
Once the virus starts replicating in oral tissue, it can provoke local inflammation and tissue destruction. This matters for tooth pain because the structures surrounding your teeth, including the gums and the deeper periodontal tissues, are part of the same vulnerable territory. Even the dental pulp, the soft tissue inside each tooth that contains nerves and blood vessels, appears affected. RNA sequencing of inflamed dental pulp from people who had recently recovered from COVID-19 found hundreds of genes expressed differently compared to people who had never been infected, with the majority of those genes being upregulated, suggesting a heightened inflammatory state that persisted after the acute infection cleared.3PubMed Central. Differentially Expressed Genes in Dental Pulp Tissues of Individuals With Symptomatic Irreversible Pulpitis With and Without History of COVID-19
When the Pain Is in Your Nerves, Not Your Teeth
One of the more unsettling aspects of COVID-related tooth pain is that your teeth may be structurally fine. In documented cases, patients reported sharp or aching pain in specific teeth, yet clinical exams and X-rays showed nothing wrong: no cavities, no cracks, no exposed roots, no swelling. The explanation appears to be neuropathic pain, meaning the problem lies in the nerve carrying the signal rather than in the tooth itself.4PubMed Central. Two Cases of COVID-19 With Concomitant Unexplained Dental Pain: Coincidence or Related?
The trigeminal nerve is the main player here. It is the largest cranial nerve and is responsible for sensation across your face, including your teeth, gums, jaw, and sinuses. SARS-CoV-2 can reach the trigeminal nerve by several routes. The virus can travel in a retrograde fashion along nerve fibers, essentially crawling backward from the nasal cavity toward the brain. It can also spread through the bloodstream and cross into neural tissue. Researchers have found viral RNA in the trigeminal ganglion, the cluster of nerve cell bodies that serves as a relay station for facial sensation, providing direct evidence that the virus physically reaches this structure.5PubMed Central. Trigeminal neuropathy presenting secondary to SARS-CoV-2 infection
The inflammation generated by a COVID-19 infection compounds this problem. The intense immune response, sometimes called a cytokine storm in severe cases, can activate the trigeminal-vascular system, a network linking the trigeminal nerve to blood vessels in the face and head. That activation produces headache and facial pain, which many people experience as toothache because the upper teeth share nerve branches with the sinuses and surrounding facial structures.6Archives of Clinical and Experimental Ophthalmology. A case of trigeminal neuralgia after COVID-19 In the two case reports described earlier, both patients had pain in upper front teeth, which are innervated by the superior alveolar branch of the maxillary division of the trigeminal nerve. The pain was real and significant, but it was being generated at the nerve level rather than in the tooth structure.4PubMed Central. Two Cases of COVID-19 With Concomitant Unexplained Dental Pain: Coincidence or Related?
Gum Disease and COVID Feed Each Other
If you already had some degree of gum disease before catching COVID-19, the infection may have made your mouth noticeably worse. Periodontal disease is fundamentally an inflammatory condition: the gums and underlying bone become inflamed in response to bacterial buildup, and the body’s immune response drives much of the tissue damage. COVID-19 triggers its own powerful inflammatory response, and research suggests the two conditions share overlapping inflammatory pathways. The flood of inflammatory signaling molecules released during a COVID-19 infection can amplify the destruction already happening in inflamed gum tissue.7The Saudi Dental Journal. Association between periodontitis and COVID-19 severity in a tertiary hospital: A retrospective cohort study
This relationship runs in both directions. People with more severe periodontal disease tend to have higher baseline levels of circulating inflammatory markers, which may contribute to worse COVID-19 outcomes. And a severe COVID-19 infection can worsen existing gum inflammation, creating a cycle where each condition exacerbates the other. For the person experiencing this, it can feel like their gums suddenly became much more sore or swollen during or after a COVID-19 infection, even though the underlying gum disease may have been building silently for years.
Dry Mouth, Altered Taste, and the Oral Microbiome
Many people who have had COVID-19 report persistent dry mouth, and it is more than just an annoyance. In a survey of people with ongoing symptoms after infection, about half reported dry mouth, and a similar proportion experienced changes in taste or smell.8British Dental Journal. Oral manifestations of long COVID and the views of healthcare professionals Saliva does much more than keep your mouth comfortable. It buffers acid, washes away food debris, and delivers antimicrobial compounds to tooth surfaces. When saliva flow drops, teeth become more vulnerable to decay, and the gums can become irritated, both of which register as pain.
COVID-19 also reshapes the microbial community living in your mouth. Studies comparing the oral microbiomes of infected and healthy individuals have found that COVID-19 patients have lower microbial diversity and a rise in opportunistic pathogens.9Scientific Reports. Comparative metagenomic analysis of the oral microbiome in COVID-19 patients and healthy individuals Certain bacterial species shift in abundance: some potentially harmful species increase while protective species decline.10PubMed Central. Oral Microbiome Resilience During SARS‐CoV‐2 Infection and Diversity Shifts After COVID‐19 Vaccination in a Hispanic Population A less diverse, more pathogen-heavy oral microbiome combined with reduced saliva creates conditions that favor cavities and gum inflammation, both common sources of tooth pain.
Stress, Clenching, and Jaw Pain Mistaken for Toothache
Not all COVID-era tooth pain traces back to the virus itself. The pandemic brought enormous psychological stress, and stress has a well-established link to problems in the jaw and chewing muscles. Clenching and grinding your teeth, collectively known as bruxism, intensified across populations during the pandemic. One study found that symptoms of temporomandibular disorders (TMD) and bruxism appeared in the majority of subjects during social isolation, and stress levels were significantly higher in those experiencing these symptoms.11PubMed Central. Temporomandibular Disorders, Bruxism, Perceived Stress, and Coping Strategies among Medical University Students in Times of Social Isolation during Outbreak of COVID-19 Pandemic
The impact did not end when lockdowns lifted. Research comparing TMD and bruxism rates across pre-pandemic, during-pandemic, and post-pandemic periods found that the adverse effects continued even after restrictions eased.12PubMed Central. The continuous adverse impact of COVID-19 on temporomandibular disorders and bruxism: comparison of pre- during- and post-pandemic time periods Elevated stress drives higher cortisol levels and increased muscle tension in the jaw, which can cause dull, aching pain that patients often localize to their teeth rather than their jaw joint. If you woke up during the pandemic with sore teeth, especially molars, and your dentist could not find a cavity or infection, stress-driven clenching is a strong possibility.
Delayed Dental Care Made Everything Worse
During the early months of the pandemic, dental offices shut down or limited services to emergencies only. Routine cleanings, fillings, and check-ups were postponed, sometimes for many months. The consequences were predictable: small problems that would have been caught early grew into bigger, more painful ones. Data from the United States shows that patients received more invasive dental procedures due to delayed treatment and experienced a higher risk of stress-related dental conditions as the pandemic continued.13PubMed Central. Impact of COVID-19 on Dental Care Utilization and Oral Health Conditions in the United States
A similar pattern appeared internationally. A retrospective analysis from Poland found that the suspension of routine dental services and the prioritization of emergency care shifted dental practice away from preventive and conservative treatments, resulting in a lasting increase in surgical interventions like tooth extractions. That trend persisted even after the pandemic restrictions ended, partly because post-pandemic inflation made elective dental care more expensive.14International Dental Journal. Long-Term Impact of the COVID-19 Pandemic on Dental Care Delivery in Poland: A Single-Center Retrospective Analysis Risk factors for oral disease were elevated, access to care for the most vulnerable populations was limited, and economic pressures compounded the problem for both patients and providers.15Preventing Chronic Disease. Oral Health and COVID-19: Increasing the Need for Prevention and Access
The Socioeconomic Dimension of Pandemic Tooth Pain
The relationship between financial hardship during the pandemic and dental pain is striking. A large study found that household income reduction, reduced work hours, and job loss were each independently associated with dental pain. Job loss carried the strongest association, roughly doubling the odds of reporting dental pain compared to those whose employment was unaffected.16PubMed Central. Dental Pain and Worsened Socioeconomic Conditions Due to the COVID-19 Pandemic
The mechanisms linking economic hardship to tooth pain were not mysterious. The same study found that the relationship was mediated in part by psychological distress, which accounted for about a fifth of the effect. Postponing dental visits explained another portion, and changes in eating behavior, specifically more snacking between meals, also contributed.16PubMed Central. Dental Pain and Worsened Socioeconomic Conditions Due to the COVID-19 Pandemic In other words, losing income led to stress, skipped dental appointments, and worse dietary habits, all of which independently drive tooth problems. The pandemic did not just introduce a new virus that could hurt your teeth; it created economic conditions that degraded oral health on a population level.
When Tooth Pain Lingers After COVID Clears
For some people, the oral symptoms do not resolve when the acute infection ends. In a cross-sectional study of over 1,500 participants, about 14% of those who had orofacial pain before infection developed pain that emerged or worsened during their COVID-19 episode.17International Dental Journal. The Effect of COVID-19 Infection on Orofacial Pain: A Cross-sectional Study A separate survey found that nearly half of people reporting oral conditions associated with COVID-19 had symptoms lasting more than three months, including dry mouth and mouth sores.8British Dental Journal. Oral manifestations of long COVID and the views of healthcare professionals
The neuropathic pain discussed earlier may be especially persistent. When a virus damages or sensitizes a nerve, the dysfunction can outlast the infection by weeks or months. Management of this kind of lingering pain typically requires a combination of approaches: anti-inflammatory medications, drugs originally developed for nerve pain like certain anticonvulsants and antidepressants, physical therapy, and sometimes psychological support for the toll that chronic pain takes on mental health.18PubMed Central. Post-acute sequelae SARS-CoV-2 infection and neuropathic pain: a narrative review of the literature and future directions If your tooth pain started around a COVID-19 infection and has not gone away despite a clean bill of dental health, this kind of nerve-based explanation is worth discussing with your dentist or doctor.
There is also emerging research into whether autoimmune responses triggered by COVID-19 play a role in persistent symptoms including pain. Studies have found that in a subset of long COVID patients, autoantibodies generated during the infection can directly drive symptoms such as pain and fatigue.19Cell. Autoantibodies in long COVID: A mechanistic foothold in a heterogeneous disease Whether this mechanism specifically contributes to ongoing oral pain is not yet established, but it fits the broader picture of an immune system that remains dysregulated long after the virus is gone.
Can COVID Vaccination Cause Tooth Pain Too?
A small number of case reports describe oral pain and discomfort following COVID-19 vaccination rather than infection. In a case series, nine patients reported symptoms including swelling and pain in the palate, gum pain, pain in the cheek lining, tongue soreness, and discomfort around specific teeth after receiving SARS-CoV-2 vaccines. The symptoms were generally mild and responded well to medication within a relatively short time.20PubMed Central. Various painful oral adverse reactions following COVID-19 vaccination: a case series These reports are uncommon enough that they exist mainly as case series rather than as findings from large surveillance studies, so they represent rare events rather than a typical vaccine reaction. Still, if you noticed unusual mouth pain in the days following vaccination, you are not imagining things, and the symptoms tend to be self-limiting.
What to Do If Your Teeth Hurt During or After COVID
The first step is a standard dental evaluation. Many causes of tooth pain during a COVID-19 infection turn out to be preexisting problems, like cavities or early gum disease, that the infection’s inflammatory load pushed into symptomatic territory. A dentist can rule out or treat structural issues that need attention regardless of the virus.
If the dental exam comes back clean and the pain persists, the possibility of neuropathic or referred pain should be raised with your provider. This is especially relevant if the pain is in upper front teeth, affects areas that correspond to branches of the trigeminal nerve, or has a burning or electric quality that does not match typical tooth decay. Standard dental treatments like fillings or root canals will not resolve nerve-level pain and may even make things worse if performed unnecessarily.
For jaw pain or teeth that feel sore in the morning, consider whether stress-related clenching is a factor. A night guard can help protect teeth from grinding damage, and stress-management strategies ranging from exercise to cognitive behavioral therapy can reduce the underlying muscle tension. The pandemic-era spike in bruxism has outlasted the pandemic itself, so this remains a relevant concern even years later.
Dry mouth warrants attention too. Staying hydrated, using sugar-free lozenges to stimulate saliva flow, and avoiding alcohol-based mouthwashes can help. If dry mouth is severe or persistent, prescription saliva substitutes or medications that stimulate salivary gland function are options your dentist or doctor can discuss. Protecting your teeth during a period of reduced saliva means being more vigilant about oral hygiene and limiting sugary or acidic foods that would normally be buffered by saliva.