Tongue pain is a lesser-known symptom of COVID-19. It can cause swelling, a burning sensation, and rough, bumpy surface skin on the tongue.

COVID-19 affecting the tongue is a less common symptom, but doctors refer to the effect on the tongue as “COVID tongue.” Common symptoms may include swelling of the tongue and a burning sensation.

This article discusses COVID tongue and its symptoms, causes, treatments, and when to seek medical help.

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A person with COVID-19 may experience symptoms such as:

A less common symptom is COVID tongue.

In several reported cases of COVID tongue, symptoms have included:

  • tongue swelling
  • ulcers
  • burning sensation
  • pain

People experiencing COVID tongue may find that their tongue looks enlarged and has a rough, bumpy appearance on the surface. Deep grooves can also appear on the tongue, known as fissures. Additionally, ulcers may occur on the lips and inside of the cheeks.

White or yellow patches or ulcers may appear on the tongue and surrounding tissue. As a result of irritated and inflamed tissue, a person may also experience red patches, known as erythematous lesions.

A condition known as geographic tongue may be present with a COVID-19 diagnosis, or the virus may trigger it. Geographic tongue presents as smooth, glossy red patches surrounded by a white border.

There are several publications of case reports and small-scale studies regarding COVID tongue.

A 2020 study evaluated the symptoms of 666 patients with COVID-19. Overall, 11.7% of people reported symptoms in the oral cavity. Of these people, the following reported:

A 2021 study evaluating COVID-19 and oral health included a systematic review of relevant studies and case reports. There were reports of variations in the oral lesions, and they differed in type and location.

The study concluded that it was difficult to attribute the lesions to COVID-19 alone, and it may be due to other factors such as treatment reaction or a weakened immune system.

Due to the small number of studies investigating COVID tongue, further studies investigating the link between COVID and tongue symptoms are necessary to draw firm conclusions.

Various factors can cause COVID tongue, which may be the reason there is limited information regarding the condition. Infections, in general, can cause changes to the oral cavity. Therefore, COVID tongue can occur for many other reasons. Some of these include:

  • A high number of angiotensin-converting enzyme II (ACE2) receptors on the tongue: Studies have found that ACE2 receptors are the primary targets for SARS-CoV-2, the virus that causes COVID-19. ACE2 receptors are common in the tongue cells and can lead to swelling when infected.
  • Oral herpes: Several studies have shown that the inflammation caused by SARS-CoV-2 can reactivate a dormant herpes simplex virus (HSV-1), which causes oral herpes. This condition has symptoms similar to COVID tongue, such as:
    • mouth ulcers
    • redness
    • swelling
  • Dry mouth: A common side effect of antiviral drugs is that people with COVID-19 can experience dry mouth. Additionally, SARS-CoV-2 may cause damage to the salivary glands in some cases, so the glands secrete less saliva, leading to dry mouth.
  • Weakened immune system: Both viral and bacterial infections can cause changes in the body. Inflammation is a common response to fighting infection and can present all over the body, including the tongue.
  • Oral thrush: This is a fungal infection caused by an overgrowth of pathogens in the mouth. It is a common side effect of antiviral drugs, in addition to a weakened immune system. Common symptoms of oral thrush include:
    • white patches
    • swelling
    • redness

Several studies have evaluated the adverse effects of the COVID-19 vaccine. However, there are limited studies linking it to oral issues.

A 2022 case series reviewed reports from people who experienced oral adverse reactions after receiving the COVID-19 vaccine. Many had pre-existing conditions and were over 60 years old.

The study concluded that these factors could have contributed to the development of COVID tongue since they can both affect the immune system.

A 2022 study investigated oral adverse events following COVID-19 and seasonal influenza vaccinations. The most commonly reported symptoms included lip and tongue swelling, a tingling sensation, and dry mouth.

The study concluded that the oral adverse events reported following both vaccines were remarkably similar.

Since the exact cause of COVID tongue is still unknown, and various factors can affect its development, there is insufficient evidence to attribute the COVID-19 vaccine to COVID tongue.

A person may experience a condition or disease of the tongue that presents similar symptoms to COVID tongue. Therefore, a person may believe they have COVID tongue. Conditions that may cause similar symptoms as COVID tongue include:

There is no specific treatment for COVID tongue. However, treating COVID-19 has been shown to alleviate symptoms. Additionally, COVID tongue generally resolves itself after recovery from the disease.

For more symptom-specific treatments, several over-the-counter remedies have been shown to help, including:

If COVID tongue symptoms persist after 2 weeks, a person should seek medical help. Doctors can prescribe medication or therapies that can help alleviate symptoms. These may include:

It is currently unclear if COVID tongue is a symptom of COVID-19 itself or if it manifests as a result of disease progression. Researchers are conducting more studies to determine whether there is a correlation between the two. However, there is not enough evidence to currently make those conclusions.

Individuals experiencing COVID tongue usually recover independently, and very few cases have shown people in critical condition.

Other more common symptoms of COVID-19 include:

  • coughing
  • shortness of breath
  • fatigue
  • nausea

COVID tongue can present as swelling, redness, ulcers, and white patches.

While several studies have investigated COVID tongue, there is insufficient evidence to conclude its cause. Factors such as pre-existing conditions, age, and other infections can also impact its development.

Reported cases usually resolve with minimal medical attention. However, if symptoms persist after recovery from COVID-19, it is best to consult a doctor.