You wake up, brush your teeth, and realize your tongue looks like a topographical map of a place you’ve never visited. It’s patchy. It’s weirdly white. Maybe it’s even a little swollen around the edges. Naturally, you grab your phone and start hunting for pictures of covid tongue to see if your mouth is trying to tell you that you’ve caught the virus. Honestly, it's a bit of a rabbit hole. Back in early 2021, Professor Tim Spector, a genetic epidemiologist at King’s College London, started tweeting about a massive uptick in "COVID tongue" and other strange oral ulcers. Since then, the ZOE Health Study has been a gold mine for this stuff.
It's weird.
Most of us think of COVID-19 as a lung thing or a "lost my sense of smell" thing. But the mouth is actually packed with ACE2 receptors—basically the "door locks" the SARS-CoV-2 virus picks to get into your cells. So, it makes total sense that your tongue would be one of the first places to show signs of a struggle. But here’s the kicker: not every weird bump is COVID.
What Pictures of COVID Tongue Actually Show
If you’re scrolling through medical journals or crowdsourced photos, you’ll notice that COVID tongue doesn't look just one way. It’s frustratingly vague. Some people get "geographic tongue," which looks like red, smooth islands surrounded by white borders. These patches can actually move around over a few days. Others see a thick, fuzzy white coating that won't budge even if you use a tongue scraper.
Then there are the indentations.
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Doctors call these "scalloped" edges. Basically, if your tongue swells up—which is a common inflammatory response—it starts pressing against your teeth. When you stick your tongue out, you see the literal imprints of your molars along the sides. It looks painful. Usually, it just feels "thick" or "heavy."
Researchers like Dr. Guy Leschziner have noted that while these symptoms aren't as common as a cough, they are incredibly persistent for some. We are talking weeks of a sore, inflamed mouth that makes eating spicy food feel like swallowing glass. You might also see small, red bumps (papillitis) or even "aphthous-like" ulcers, which are basically fancy talk for canker sores that show up in clusters.
Why Does This Happen?
It’s all about inflammation. When your body is fighting a systemic infection, it goes into overdrive. The oral mucosa is sensitive. It reacts to the viral load and the cytokine storm that everyone was talking about a few years ago. Interestingly, some experts suggest that the "white tongue" often seen in these photos might actually be a secondary issue, like oral thrush. When your immune system is busy fighting COVID, opportunistic yeast (Candida) can move in and throw a party.
Also, dry mouth. Xerostomia is a big one. If you aren't producing enough saliva because the virus is messing with your salivary glands, your tongue is going to look "off." It loses that healthy pink sheen and starts looking cracked or leathery.
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Real-World Comparisons: Is It COVID or Just... Life?
Before you panic because your tongue looks a little funky, remember that a lot of things cause "tongue weirdness."
- Dehydration: This is the big one. If you’re dehydrated, your tongue gets coated and white.
- Stress: Ever heard of "burning mouth syndrome"? Stress can make your mouth feel like it's on fire, and it can even cause those pesky canker sores.
- Vitamin Deficiencies: If you’re low on B12 or iron, your tongue might get "glossy" and red.
The difference with COVID tongue is usually the timing. If you have a scratchy throat, a weird fatigue that feels like you’ve been hit by a truck, and then your tongue turns into a map of Middle-earth, you should probably take a test. According to a study published in the British Journal of Dermatology, about 25% of COVID patients in a Spanish field hospital had "oral cavity findings." That is a huge chunk of people.
How to Manage the Discomfort
If you’ve confirmed it’s COVID and your mouth is a mess, you don't just have to sit there and suffer. Honestly, it's mostly about symptom management.
- Hydration is king. Drink more water than you think you need. It thins out the mucus and keeps your mouth from becoming a desert.
- Gentle hygiene. Switch to a "Sulfate-Free" toothpaste. SLS (Sodium Lauryl Sulfate) is a foaming agent that can irritate open sores.
- Saltwater rinses. It’s old school, but it works. A teaspoon of salt in warm water can kill some of the nasties and soothe the inflammation.
- Avoid the "Burn." Now is not the time for spicy wings, sourdough bread with sharp crusts, or acidic orange juice. Stick to soft, bland foods. Think smoothies, mashed potatoes, or yogurt.
The Long COVID Connection
Some people find that their tongue symptoms don't go away when the fever breaks. This is the "Long COVID" side of things. There are reports of people having "geographic tongue" for months after their initial infection. It’s like the body’s inflammatory "switch" got stuck in the ON position. If this is you, it’s worth talking to a dentist or a doctor specifically about oral medicine. They might prescribe a steroid rinse to calm things down.
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What to Do Next
Looking at pictures of covid tongue is a good starting point, but it's not a diagnosis. If you’re seeing these changes, the most logical next step is to check your other vitals. Are you running a fever? Is your oxygen saturation okay?
If you have those scalloped edges or weird white patches, take a high-quality photo of your tongue in natural light. This helps you track if the patches are moving or growing. Most importantly, if you start having trouble breathing or the swelling in your mouth makes it hard to swallow, stop reading articles and get to an urgent care.
For the majority of people, COVID tongue is just a weird, uncomfortable blip. It's a sign your body is working hard. Give it some rest, keep the fluids moving, and maybe lay off the spicy food for a week or two. Your taste buds will thank you later.