What Is 'COVID Tongue'?

Key Takeaways

Since the start of the COVID-19 pandemic, reports have surfaced of symptoms of COVID-19 related to your mouth. Features of “COVID tongue” include tongue discoloration, enlargement, mouth ulcers, and more.

The reports initially came from England where Tim Spector, a researcher at King’s College London, was tracking COVID-19 symptoms in British patients. He began noticing an increasing number of patients with tongue discoloration, enlargement, and other mouth problems.

The Centers for Disease Control and Prevention (CDC) does not currently list oral manifestations as a symptom of COVID-19.

Is this an indicator of COVID-19 infection? Verywell asked experts whether COVID tongue is real and how worried the public should be.

Symptoms of COVID-19

Is “COVID Tongue” Real?

“Tim Spector recently reported COVID tongue as a ‘thing’ but said it affects less than one in 100 people in their research database of COVID cases," says Hills. In an interview withUSA Today, Spector said that one in five people will present with unofficial symptoms such as discolored orswollen tongues.

Hills says that in her mind, “it’s really difficult to make an association between a disease and a symptom that’s showing up that infrequently.”

Peter Gulick, DO, professor of medicine and infectious disease expert at Michigan State University College of Osteopathic Medicine, tells Verywell that he thinks it’s still too early to tell if COVID tongue is real—but he does think it’s possible.

Gulick points out that for safety reasons, healthcare providers reduced the number of exams they performed that require a patient to take their mask off.

“Maybe things weren’t seen because nobody did the exams, and maybe [patients] dismissed it as poor hygiene rather than looking at it specifically as a COVID issue,” Gulick says. “And if [doctors are] doing a lot of virtual screenings, then we never see the patient beyond the television monitor, so you can’t really see the mouth either.”

Telehealth During COVID-19

Studies Linking Mouth Problems to COVID

While research is ongoing, there have been numerous studies linking oral problems to the COVID-19 virus.

Studies from 2020 found oral symptoms in people with COVID-19 including tongue inflammation,mouth ulcers, and tongue discoloration.Tongue discoloration differed in patients with mild to moderate infections, who had a light red tongue with a white coating, while those with severe infections were associated with purple and yellow tongues.

A 2022 study published inBMC Oral Healthsuggested that stress experienced during the pandemic was a factor that led togeographic tongueand other oral problems.Still, a 2023 review published inInfection and Drug Resistancelooked at earlier studies investigating COVID-related oral symptoms, but the researchers did not come to the conclusion that the symptoms were a direct result of infection.

Other commonly reported symptoms with earlierCOVID-19 variantswere loss of taste and smell. After Omicron became the dominant variant, these symptoms were less likely to occur.

However, researchers have found loss of taste from COVID-19 can be long-lasting and recovery can take months. A 2022 study published inPLoS Onefound that around 30% of people who experienced loss of taste from COVID-19 did not fully recover their sense of taste eight months after having COVID.

Possible Causes of COVID Mouth Problems

Research has not conclusively determined the cause of the oral problems linked to COVID-19. However, there are several mechanisms that could explain the link.

Brain and Nerve Effects

Hills suggests that since thereisevidence of the COVID-19virus affecting the brain, it could also potentially injure or hijack the nerves that control the tongue.

Study Explores How COVID-19 Damages the Brain Without Ever Entering It

COVID-19 Treatments

There’s also a chance thatCOVID-19 treatmentscould be indirectly causing mouth problems. “For patients who aren’t able to eat or drink normally because of the illness, or for those who are in the hospital receiving breathing support or even requiring a breathing tube or a feeding tube, there could also be injury or irritation of the tongue tissues from trauma, dry air, or even nutritional deficits (like B12) from not being able to eat well,” Hills says.

Dry Mouth

Gulick says that a COVID-19 infection in the salivary gland could decrease secretion in the mouth and causedry mouth, also called xerostomia. Having a dry mouth, in turn, could prompt other oral issues that have also been linked to COVID-19, such as tooth decay and tooth loss.

Thrush

Gulick also says that reports of “furry tongues” could be from steroids such as dexamethasone that cause an immunosuppressed state, which can make a person susceptible tooral thrush.

Other Viral Infections

COVID-19 increases inflammation, which may indirectly activate other viral infections such as theherpes simplex virus, which can cause mouth ulcers.

A case report published in June 2020 documented a similar scenario.One patient tested positive for COVID-19 and soon after experienced a series of conditions, including a herpes infection, oral thrush, and a geographic tongue.

Loss of Sense of Smell May Be Best Sign of COVID-19, Studies Find

Why Good Oral Health Matters

Your mouth is teeming with bacteria. Keeping it as clean as possible is essential to mitigate ulcer formation and any other potentially COVID-related inflammation. At the very least, if there was an acute inflammatory response, Gulick says thatgood oral healthwon’t make the problem any worse.

As doctors and researchers learn more about COVID tongue, there are some things that you can do. For one, stay abreast of any changes to your oral health and if you notice anything unusual, tell your healthcare provider.

If you think you have COVID-19, whether or not you have any mouth-related symptoms, the best thing you can do isget tested. “If it was me and I didn’t know why my mouth was like this, I would go and do a COVID test just to cover all the bases," Gulick says.

What This Means For YouIt’s not clear whether “COVID tongue” and other mouth symptoms are really indicators of infection with the virus. However, good oral hygiene and mouth care are essential to your overall health. If you have any unusual mouth or tongue changes, tell your healthcare provider. If you think you could have COVID-19, the best step you can take is getting tested.

What This Means For You

It’s not clear whether “COVID tongue” and other mouth symptoms are really indicators of infection with the virus. However, good oral hygiene and mouth care are essential to your overall health. If you have any unusual mouth or tongue changes, tell your healthcare provider. If you think you could have COVID-19, the best step you can take is getting tested.

Transient Lingual Papillitis (Lie Bumps)

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit ourcoronavirus news page.

11 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.ZOE Health Study.What is ‘COVID tongue’ and what does it look like?.Centers for Disease Control and Prevention (CDC).Symptoms of Coronavirus.Nuno-Gonzalez A, Martin-Carrillo P, Magaletsky K, Rios M, Mañas CH, Almazan JA, et al.Prevalence of mucocutaneous manifestations in 666 patients with COVID‐19 in a field hospital in Spain: oral and palmoplantar findings.British J Dermatol. 2021;184(1):184-185. doi:10.1111/bjd.19564Jimenez-Cauhe J, Ortega-Quijano D, de Perosanz-Lobo D, et al. (2020).Enanthem in patients with COVID-19 and skin rash.JAMA Dermatol. 2020;156(10):1134-1136. doi:10.1001/jamadermatol.2020.2550Pang W, Zhang D, Zhang J, et al.Tongue features of patients with coronavirus disease 2019: a retrospective cross-sectional study.Integrative Med Resear. 2020;9(3):100493. doi:10.1016/j.imr.2020.100493GetSarruf MBJM, Quinelato V, Sarruf GJM, Oliveira HE, Calasans-Maia JA, Quinelato H, Aguiar T, Casado PL, Cavalcante LMA.Stress as worsening of the signs and symptoms of the geographic tongue during the COVID-19 pandemic: a pilot study. BMC Oral Health. 2022 Dec 3;22(1):565. doi: 10.1186/s12903-022-02609-0Sarasati A, Agustina D, Surboyo MDC.The Oral Lesion in the COVID-19 Patient: Is It True Oral Manifestation or Not?. Infect Drug Resist. 2023 Jul 4;16:4357-4385. doi: 10.2147/IDR.S411615von Bartheld CS, Wang L.Prevalence of Olfactory Dysfunction with the Omicron Variant of SARS-CoV-2: A Systematic Review and Meta-Analysis. Cells. 2023 Jan 28;12(3):430. doi: 10.3390/cells12030430Hintschich CA, Fischer R, Hummel T, Wenzel JJ, Bohr C, Vielsmeier V.Persisting olfactory dysfunction in post-COVID-19 is associated with gustatory impairment: Results from chemosensitive testing eight months after the acute infection. PLoS One. 2022 Mar 23;17(3):e0265686. doi: 10.1371/journal.pone.0265686Tsuchiya H.Characterization and Pathogenic Speculation of Xerostomia Associated with COVID-19: A Narrative Review. Dent J (Basel). 2021 Nov 10;9(11):130. doi: 10.3390/dj9110130Amorim Dos Santos J, Normando AGC, Carvalho da Silva RL, De Paula RM, Cembranel AC, Santos-Silva AR, Guerra ENS.Oral mucosal lesions in a COVID-19 patient: New signs or secondary manifestations?. Int J Infect Dis. 2020 Aug;97:326-328. doi: 10.1016/j.ijid.2020.06.012

11 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.ZOE Health Study.What is ‘COVID tongue’ and what does it look like?.Centers for Disease Control and Prevention (CDC).Symptoms of Coronavirus.Nuno-Gonzalez A, Martin-Carrillo P, Magaletsky K, Rios M, Mañas CH, Almazan JA, et al.Prevalence of mucocutaneous manifestations in 666 patients with COVID‐19 in a field hospital in Spain: oral and palmoplantar findings.British J Dermatol. 2021;184(1):184-185. doi:10.1111/bjd.19564Jimenez-Cauhe J, Ortega-Quijano D, de Perosanz-Lobo D, et al. (2020).Enanthem in patients with COVID-19 and skin rash.JAMA Dermatol. 2020;156(10):1134-1136. doi:10.1001/jamadermatol.2020.2550Pang W, Zhang D, Zhang J, et al.Tongue features of patients with coronavirus disease 2019: a retrospective cross-sectional study.Integrative Med Resear. 2020;9(3):100493. doi:10.1016/j.imr.2020.100493GetSarruf MBJM, Quinelato V, Sarruf GJM, Oliveira HE, Calasans-Maia JA, Quinelato H, Aguiar T, Casado PL, Cavalcante LMA.Stress as worsening of the signs and symptoms of the geographic tongue during the COVID-19 pandemic: a pilot study. BMC Oral Health. 2022 Dec 3;22(1):565. doi: 10.1186/s12903-022-02609-0Sarasati A, Agustina D, Surboyo MDC.The Oral Lesion in the COVID-19 Patient: Is It True Oral Manifestation or Not?. Infect Drug Resist. 2023 Jul 4;16:4357-4385. doi: 10.2147/IDR.S411615von Bartheld CS, Wang L.Prevalence of Olfactory Dysfunction with the Omicron Variant of SARS-CoV-2: A Systematic Review and Meta-Analysis. Cells. 2023 Jan 28;12(3):430. doi: 10.3390/cells12030430Hintschich CA, Fischer R, Hummel T, Wenzel JJ, Bohr C, Vielsmeier V.Persisting olfactory dysfunction in post-COVID-19 is associated with gustatory impairment: Results from chemosensitive testing eight months after the acute infection. PLoS One. 2022 Mar 23;17(3):e0265686. doi: 10.1371/journal.pone.0265686Tsuchiya H.Characterization and Pathogenic Speculation of Xerostomia Associated with COVID-19: A Narrative Review. Dent J (Basel). 2021 Nov 10;9(11):130. doi: 10.3390/dj9110130Amorim Dos Santos J, Normando AGC, Carvalho da Silva RL, De Paula RM, Cembranel AC, Santos-Silva AR, Guerra ENS.Oral mucosal lesions in a COVID-19 patient: New signs or secondary manifestations?. Int J Infect Dis. 2020 Aug;97:326-328. doi: 10.1016/j.ijid.2020.06.012

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

ZOE Health Study.What is ‘COVID tongue’ and what does it look like?.Centers for Disease Control and Prevention (CDC).Symptoms of Coronavirus.Nuno-Gonzalez A, Martin-Carrillo P, Magaletsky K, Rios M, Mañas CH, Almazan JA, et al.Prevalence of mucocutaneous manifestations in 666 patients with COVID‐19 in a field hospital in Spain: oral and palmoplantar findings.British J Dermatol. 2021;184(1):184-185. doi:10.1111/bjd.19564Jimenez-Cauhe J, Ortega-Quijano D, de Perosanz-Lobo D, et al. (2020).Enanthem in patients with COVID-19 and skin rash.JAMA Dermatol. 2020;156(10):1134-1136. doi:10.1001/jamadermatol.2020.2550Pang W, Zhang D, Zhang J, et al.Tongue features of patients with coronavirus disease 2019: a retrospective cross-sectional study.Integrative Med Resear. 2020;9(3):100493. doi:10.1016/j.imr.2020.100493GetSarruf MBJM, Quinelato V, Sarruf GJM, Oliveira HE, Calasans-Maia JA, Quinelato H, Aguiar T, Casado PL, Cavalcante LMA.Stress as worsening of the signs and symptoms of the geographic tongue during the COVID-19 pandemic: a pilot study. BMC Oral Health. 2022 Dec 3;22(1):565. doi: 10.1186/s12903-022-02609-0Sarasati A, Agustina D, Surboyo MDC.The Oral Lesion in the COVID-19 Patient: Is It True Oral Manifestation or Not?. Infect Drug Resist. 2023 Jul 4;16:4357-4385. doi: 10.2147/IDR.S411615von Bartheld CS, Wang L.Prevalence of Olfactory Dysfunction with the Omicron Variant of SARS-CoV-2: A Systematic Review and Meta-Analysis. Cells. 2023 Jan 28;12(3):430. doi: 10.3390/cells12030430Hintschich CA, Fischer R, Hummel T, Wenzel JJ, Bohr C, Vielsmeier V.Persisting olfactory dysfunction in post-COVID-19 is associated with gustatory impairment: Results from chemosensitive testing eight months after the acute infection. PLoS One. 2022 Mar 23;17(3):e0265686. doi: 10.1371/journal.pone.0265686Tsuchiya H.Characterization and Pathogenic Speculation of Xerostomia Associated with COVID-19: A Narrative Review. Dent J (Basel). 2021 Nov 10;9(11):130. doi: 10.3390/dj9110130Amorim Dos Santos J, Normando AGC, Carvalho da Silva RL, De Paula RM, Cembranel AC, Santos-Silva AR, Guerra ENS.Oral mucosal lesions in a COVID-19 patient: New signs or secondary manifestations?. Int J Infect Dis. 2020 Aug;97:326-328. doi: 10.1016/j.ijid.2020.06.012

ZOE Health Study.What is ‘COVID tongue’ and what does it look like?.

Centers for Disease Control and Prevention (CDC).Symptoms of Coronavirus.

Nuno-Gonzalez A, Martin-Carrillo P, Magaletsky K, Rios M, Mañas CH, Almazan JA, et al.Prevalence of mucocutaneous manifestations in 666 patients with COVID‐19 in a field hospital in Spain: oral and palmoplantar findings.British J Dermatol. 2021;184(1):184-185. doi:10.1111/bjd.19564

Jimenez-Cauhe J, Ortega-Quijano D, de Perosanz-Lobo D, et al. (2020).Enanthem in patients with COVID-19 and skin rash.JAMA Dermatol. 2020;156(10):1134-1136. doi:10.1001/jamadermatol.2020.2550

Pang W, Zhang D, Zhang J, et al.Tongue features of patients with coronavirus disease 2019: a retrospective cross-sectional study.Integrative Med Resear. 2020;9(3):100493. doi:10.1016/j.imr.2020.100493Get

Sarruf MBJM, Quinelato V, Sarruf GJM, Oliveira HE, Calasans-Maia JA, Quinelato H, Aguiar T, Casado PL, Cavalcante LMA.Stress as worsening of the signs and symptoms of the geographic tongue during the COVID-19 pandemic: a pilot study. BMC Oral Health. 2022 Dec 3;22(1):565. doi: 10.1186/s12903-022-02609-0

Sarasati A, Agustina D, Surboyo MDC.The Oral Lesion in the COVID-19 Patient: Is It True Oral Manifestation or Not?. Infect Drug Resist. 2023 Jul 4;16:4357-4385. doi: 10.2147/IDR.S411615

von Bartheld CS, Wang L.Prevalence of Olfactory Dysfunction with the Omicron Variant of SARS-CoV-2: A Systematic Review and Meta-Analysis. Cells. 2023 Jan 28;12(3):430. doi: 10.3390/cells12030430

Hintschich CA, Fischer R, Hummel T, Wenzel JJ, Bohr C, Vielsmeier V.Persisting olfactory dysfunction in post-COVID-19 is associated with gustatory impairment: Results from chemosensitive testing eight months after the acute infection. PLoS One. 2022 Mar 23;17(3):e0265686. doi: 10.1371/journal.pone.0265686

Tsuchiya H.Characterization and Pathogenic Speculation of Xerostomia Associated with COVID-19: A Narrative Review. Dent J (Basel). 2021 Nov 10;9(11):130. doi: 10.3390/dj9110130

Amorim Dos Santos J, Normando AGC, Carvalho da Silva RL, De Paula RM, Cembranel AC, Santos-Silva AR, Guerra ENS.Oral mucosal lesions in a COVID-19 patient: New signs or secondary manifestations?. Int J Infect Dis. 2020 Aug;97:326-328. doi: 10.1016/j.ijid.2020.06.012

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