COVID tongue occurs due to a COVID-19 infection. It can cause symptoms of tongue swelling and sores, among other symptoms.

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Illustrations by Sophia Smith

In March 2020, the World Health Organization (WHO) declared a pandemic in response to the spread of the COVID-19 infection.

Since then, more than 50 million cases occurred in the United States alone. Medical professionals gathered data to determine the symptoms of COVID-19. The early symptoms observed included fatigue, shortness of breath, and fever.

But as COVID-19 cases continue, new symptoms are documented, including a rare symptom known as COVID tongue. People with COVID tongue have swollen tongues that might develop bumps, ulcers, and white patches. Read on to learn more about this unusual COVID-19 symptom.

Along with the more well-known symptoms of COVID-19, some people experience bumps, ulcers, swelling, and inflammation of the tongue. This is known as “COVID tongue.”

People with COVID tongue might notice that the top of their tongue looks white and patchy, or that their tongue looks red and feels swollen. They sometimes find bumps or open areas called ulcers on their tongue. Additionally, many people with COVID tongue report experiencing a loss of taste and a burning sensation in their mouth.

A 2021 study documented COVID tongue as a possible COVID-19 symptom. But just like many things about COVID-19, there’s a lot we don’t know right now about COVID tongue.

Case reports also documented COVID-19 tongue, but more information is needed to answer important questions about this symptom.

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Another reason there are many questions about COVID tongue is that there are several possible causes. It’s common for illnesses and infections to cause changes to your tongue.

What looks like COVID tongue could easily be a symptom of a different viral or bacterial infection. Even when the bumps and swelling are clearly connected to COVID, there are many possible reasons. COVID tongue might be caused by:

  • A high number of ACE receptors in your tongue. ACE receptors are proteins found on cells in your body. When the virus that causes COVID-19, SARS-CoV-2, attaches to ACE receptors, it can get into your cells. You have many ACE receptors in your tongue, which could lead to swelling when you have a COVID-19 infection.
  • Your immune system fighting COVID-19. When your immune system is fighting a bacterial or viral infection, it can cause swelling throughout your body. This could include the tongue swelling associated with COVID tongue.
  • COVID-causing oral thrush. Oral thrush is a fungus in your mouth that can be caused by a number of infections. This might include COVID-19. Plus, oral thrush is a side effect of some medications used to treat COVID-19.
  • Changes to the surface of your tongue. Infections sometimes lead to changes on the surface of your tongue, such as mouth ulcers and other symptoms. It’s possible COVID-19 can lead to this sort of change as well.
  • Dry mouth. COVID-19 can affect your salivary glands and cause them to secrete less saliva. This could lead to dry mouth. Research shows that dry mouth can lead to multiple other oral health concerns.
  • COVID-activating oral herpes. The inflammation caused by COVID-19 can activate other viruses in your body. This might include the herpes simplex virus, which lays dormant in your body even when you don’t have symptoms. COVID-19 could cause the herpes virus to activate and cause mouth ulcers.

COVID tongue could be caused by any one of these factors or by a combination of them. There’s also a chance that COVID tongue is sometimes caused by breathing tubes and other COVID treatments that could irritate your mouth and lead to a swollen tongue.

Until we know more about COVID-19, we won’t know the exact cause of COVID tongue.

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Illustrations by Sophia Smith

Currently, scientists don’t know how rare COVID tongue is. In one small study, up to 11 percent of people hospitalized with COVID-19 had COVID tongue, but such studies are too small to make a conclusion.

As more data from hospitals around the world come in, we might get a better idea of how common COVID tongue is.

Many people with COVID-19 have mild or moderate symptoms and can recover at home. But right now, even less is known about how many people in this group develop COVID tongue. Often they recover without contacting a doctor at all, so their symptoms are never recorded.

Even when people with mild or moderate COVID-19 do seek treatment, they often wear masks or use telehealth for a video appointment. That makes it difficult for medical professionals to see their tongues and document any abnormalities.

There is currently no single set treatment for COVID tongue. You might not need treatment targeted to COVID tongue. In some cases, the treatments you already receive for COVID will be enough to resolve COVID tongue.

When COVID tongue is more severe and doesn’t respond to overall treatment, you might receive specialized treatment. This could include:

  • corticosteroids or other anti-inflammatory medications to bring down tongue swelling
  • antibacterial, antiviral, or antifungal mouth rinses to treat bumps, patches, and ulcers
  • artificial saliva mouth rinses to help combat dry mouth and promote overall tongue healing
  • low level laser therapy to treat ulcers

Treatment for swollen tongue

COVID-19 may cause the tongue to swell. Tongue swelling can quickly become a medical emergency if your airway becomes blocked. If you think your tongue is swelling, seek medical attention immediately.

The treatment for a swollen tongue is designed to reduce the swelling and relieve pain and discomfort.

Treatment options for swollen tongue include:

  • over-the-counter medications such as ibuprofen (Advil)
  • prescription anti-inflammatory medications
  • medications to treat the underlying condition causing your tongue to swell

Read this for more information about swollen tongue.

What to do if your tongue swells

Call 911 if your tongue swells and you feel like it’s harder to breathe. Do not drive yourself to the ER because your condition could worsen on the way. For many people, calling 911 means help will reach you faster than going to an ER.

  • Have someone stay with you until help arrives.
  • Contact your healthcare professional immediately if you notice that your tongue swells.
  • If you have mild tongue swelling that gets worse, contact your doctor or healthcare professional immediately for an examination.
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It’s currently unclear whether COVID tongue is an early symptom of COVID-19, or a symptom that develops as the condition progresses.

No matter when it develops, you might also have other, more-common COVID-19 symptoms:

  • fever
  • cough
  • shortness of breath
  • fatigue
  • nausea
  • pain

Studies are being done to see if COVID tongue is an early or warning symptom.

Mild to moderate COVID-19

People with mild and moderate cases of COVID-19 usually recover at home without medical intervention. Rates of recovery are also improving for people hospitalized with COVID-19 as doctors learn how to best treat the infection.

But since COVID-19 is still a relatively new illness, we don’t know for sure right now what the long-term effects for people will be. Some symptoms of COVID-19 might linger for weeks or even months.

Geographic tongue

While research on COVID tongue is limited now, we do know that viral infections can sometimes lead to a condition called geographic tongue.

This condition causes smooth red patches with white borders to appear on your tongue and can last for months — or even years. Geographic tongue doesn’t generally cause pain or other health concerns, but flare-ups can make it difficult to eat spicy foods.

It’s currently unclear whether COVID tongue is related to geographic tongue, or whether COVID-19 can lead to geographic tongue. As more people recover from COVID-19 and more data become available, doctors will have a better understanding of COVID tongue and any possible long-term effects.

If you have COVID-19 and are experiencing any mouth or tongue health concerns, talk with your doctor.

Some people with COVID-19 develop bumps, white patches, and swelling on their tongues. This is known as COVID tongue and it’s still being studied.

Right now, there are a lot of unanswered questions about COVID tongue. We currently don’t know how many people get COVID tongue or what causes it. More information about COVID tongue will be available as doctors learn more about COVID tongue and more research occurs.