Skip to main content
Top
Published in: Indian Journal of Otolaryngology and Head & Neck Surgery 2/2022

06-01-2022 | Opportunistic Infection | Other Articles

Pathophysiology and Management of Tongue Involvement in COVID-19 Patients

Authors: Zeinab Mohseni Afshar, Mohammad Barary, Soheil Ebrahimpour, Alireza Janbakhsh, Mandana Afsharian, Amirhossein Hasanpour, Arefeh Babazadeh

Published in: Indian Journal of Otolaryngology and Head & Neck Surgery | Special Issue 2/2022

Login to get access

Abstract

Evaluate the lingual manifestations of COVID-19, and provide a clinical guide in managing these symptoms. Electronic databases, such as PubMed/Medline, and Scopus were searched until November 1, 2020, and only randomized controlled trials, cross-sectional and cohort studies, as well as case reports and series, and review articles in English were considered. A total of 40 studies were included in this study. Lingual involvement has been extensively reported in patients with coronavirus disease 2019 (COVID-19). The most common features of lingual involvements were red or light red, yellow coating, and greasy coating tongue, though other complications, such as pale, purple, white coating, grayish-black coating, rough, tender, puffy, spotty, prickles, fissured, and tooth-marked tongue was also reported. Poor oral hygiene, opportunistic infections (OIs), medications, and hyper-inflammatory response to infection are the most common predisposing factors for the onset of oral lesions in patients with COVID-19. In conclusion, the current review described the lingual manifestations of COVID-19, and as oral complaints are relatively common in COVID-19 patients, an intraoral examination should be conducted in all suspected cases of SARS-CoV-2 infection.
Literature
1.
go back to reference Javanian M, Bayani M, Shokri M et al (2020) Clinical and laboratory findings from patients with COVID-19 pneumonia in Babol North of Iran: a retrospective cohort study. Rom J Intern Med 58:161–167PubMed Javanian M, Bayani M, Shokri M et al (2020) Clinical and laboratory findings from patients with COVID-19 pneumonia in Babol North of Iran: a retrospective cohort study. Rom J Intern Med 58:161–167PubMed
2.
go back to reference Javanian M, Masrour-Roudsari J, Bayani M, Ebrahimpour S (2020) Coronavirus disease 2019 (COVID-19): What we need to know. Casp J Intern Med 11(2):18 Javanian M, Masrour-Roudsari J, Bayani M, Ebrahimpour S (2020) Coronavirus disease 2019 (COVID-19): What we need to know. Casp J Intern Med 11(2):18
3.
go back to reference Afshar ZM, Ebrahimpour S, Javanian M, Koppolu V, Vasigala VK, Hasanpour AH, Babazadeh A (2020) Coronavirus disease 2019 (COVID-19), MERS and SARS: similarity and difference. J Acute Dis 9(5):194CrossRef Afshar ZM, Ebrahimpour S, Javanian M, Koppolu V, Vasigala VK, Hasanpour AH, Babazadeh A (2020) Coronavirus disease 2019 (COVID-19), MERS and SARS: similarity and difference. J Acute Dis 9(5):194CrossRef
4.
go back to reference Amorim dos Santos J, Normando A, Carvalho da Silva R, Acevedo A, De Luca Canto G, Sugaya N et al (2021) Oral manifestations in patients with COVID-19: a living systematic review. J Dent Res 100(2):141–154CrossRefPubMed Amorim dos Santos J, Normando A, Carvalho da Silva R, Acevedo A, De Luca Canto G, Sugaya N et al (2021) Oral manifestations in patients with COVID-19: a living systematic review. J Dent Res 100(2):141–154CrossRefPubMed
5.
go back to reference Vaira LA, Salzano G, De Riu G (2020) The importance of olfactory and gustatory disorders as early symptoms of coronavirus disease (COVID-19). Br J Oral Maxillofac Surg 58(5):615–616CrossRefPubMedPubMedCentral Vaira LA, Salzano G, De Riu G (2020) The importance of olfactory and gustatory disorders as early symptoms of coronavirus disease (COVID-19). Br J Oral Maxillofac Surg 58(5):615–616CrossRefPubMedPubMedCentral
6.
go back to reference Millsop JW, Wang EA, Fazel N (2017) Etiology, evaluation, and management of xerostomia. Clin Dermatol 35(5):468–476CrossRefPubMed Millsop JW, Wang EA, Fazel N (2017) Etiology, evaluation, and management of xerostomia. Clin Dermatol 35(5):468–476CrossRefPubMed
7.
go back to reference Pedrosa MDS, Sipert CR, Nogueira FN (2020) Salivary glands, saliva and oral findings in COVID-19 infection. Pesquisa Brasileira em Odontopediatria e Clínica Integrada 20 Pedrosa MDS, Sipert CR, Nogueira FN (2020) Salivary glands, saliva and oral findings in COVID-19 infection. Pesquisa Brasileira em Odontopediatria e Clínica Integrada 20
8.
go back to reference Biadsee A, Biadsee A, Kassem F, Dagan O, Masarwa S, Ormianer Z (2020) <? covid19?> Olfactory and Oral Manifestations of COVID-19: sex-related symptoms—a potential pathway to early diagnosis. Otolaryngol Head Neck Surg 163(4):722–728CrossRefPubMedPubMedCentral Biadsee A, Biadsee A, Kassem F, Dagan O, Masarwa S, Ormianer Z (2020) <? covid19?> Olfactory and Oral Manifestations of COVID-19: sex-related symptoms—a potential pathway to early diagnosis. Otolaryngol Head Neck Surg 163(4):722–728CrossRefPubMedPubMedCentral
9.
go back to reference Yan CH, Faraji F, Prajapati DP, Boone CE, DeConde AS (eds) (2020) Association of chemosensory dysfunction and Covid‐19 in patients presenting with influenza‐like symptoms. International forum of allergy & rhinology. Wiley Online Library Yan CH, Faraji F, Prajapati DP, Boone CE, DeConde AS (eds) (2020) Association of chemosensory dysfunction and Covid‐19 in patients presenting with influenza‐like symptoms. International forum of allergy & rhinology. Wiley Online Library
10.
go back to reference Soares CD, de Carvalho RA, de Carvalho KA, de Carvalho MGF, de Almeida OP (2020) Letter to Editor: oral lesions in a patient with Covid-19. Medicina Oral, Patologia Oral y Cirugia Bucal 25(4):e563PubMedPubMedCentral Soares CD, de Carvalho RA, de Carvalho KA, de Carvalho MGF, de Almeida OP (2020) Letter to Editor: oral lesions in a patient with Covid-19. Medicina Oral, Patologia Oral y Cirugia Bucal 25(4):e563PubMedPubMedCentral
11.
go back to reference Iranmanesh B, Khalili M, Amiri R, Zartab H, Aflatoonian M (2020) Oral manifestations of COVID‐19 disease: a review article. Dermatol Ther e14578 Iranmanesh B, Khalili M, Amiri R, Zartab H, Aflatoonian M (2020) Oral manifestations of COVID‐19 disease: a review article. Dermatol Ther e14578
13.
go back to reference Azmy V, Benson J, Love K, Steele R (2020) Idiopathic nonhistaminergic acquired angioedema in a patient with COVID-19. Ann Allergy Asthma Immunol Azmy V, Benson J, Love K, Steele R (2020) Idiopathic nonhistaminergic acquired angioedema in a patient with COVID-19. Ann Allergy Asthma Immunol
14.
go back to reference Taşlıdere B, Mehmetaj L, Özcan AB, Gülen B, Taşlıdere N (2020) Melkersson-Rosenthal syndrome induced by COVID-19: a case report. Am J Emerg Med Taşlıdere B, Mehmetaj L, Özcan AB, Gülen B, Taşlıdere N (2020) Melkersson-Rosenthal syndrome induced by COVID-19: a case report. Am J Emerg Med
15.
go back to reference Scully C. Medicina oral e maxilofacial: Elsevier Brasil; 2011. Scully C. Medicina oral e maxilofacial: Elsevier Brasil; 2011.
17.
go back to reference Díaz Rodríguez M, Jimenez Romera A, Villarroel M (2020) Oral manifestations associated with COVID‐19. Oral Dis Díaz Rodríguez M, Jimenez Romera A, Villarroel M (2020) Oral manifestations associated with COVID‐19. Oral Dis
18.
go back to reference Riad A, Gad A, Hockova B, Klugar M (2020) Oral candidiasis in non‐severe COVID‐19 patients: call for antibiotic stewardship. Oral Surg Riad A, Gad A, Hockova B, Klugar M (2020) Oral candidiasis in non‐severe COVID‐19 patients: call for antibiotic stewardship. Oral Surg
19.
go back to reference Gomes SF, Esteves MCL (2012) Atuação do cirurgião-dentista na UTI: um novo paradigma. Rev Bras Odontol 69(1):67 Gomes SF, Esteves MCL (2012) Atuação do cirurgião-dentista na UTI: um novo paradigma. Rev Bras Odontol 69(1):67
20.
go back to reference Liang K, Huang X, Chen H, Qiu L, Zhuang Y, Zou C et al (2020) Tongue diagnosis and treatment in traditional Chinese medicine for severe COVID-19: a case report. Ann Palliat Med Liang K, Huang X, Chen H, Qiu L, Zhuang Y, Zou C et al (2020) Tongue diagnosis and treatment in traditional Chinese medicine for severe COVID-19: a case report. Ann Palliat Med
21.
go back to reference Shu Z, Zhou Y, Chang K, Liu J, Min X, Zhang Q et al (2020) Clinical features and the traditional Chinese medicine therapeutic characteristics of 293 COVID-19 inpatient cases. Front Med 1–16 Shu Z, Zhou Y, Chang K, Liu J, Min X, Zhang Q et al (2020) Clinical features and the traditional Chinese medicine therapeutic characteristics of 293 COVID-19 inpatient cases. Front Med 1–16
22.
go back to reference Pang W, Zhang D, Zhang J, Li N, Zheng W, Wang H et al (2020) Tongue features of patients with coronavirus disease 2019: a retrospective cross-sectional study. Integr Med Res 9(3):100493CrossRefPubMedPubMedCentral Pang W, Zhang D, Zhang J, Li N, Zheng W, Wang H et al (2020) Tongue features of patients with coronavirus disease 2019: a retrospective cross-sectional study. Integr Med Res 9(3):100493CrossRefPubMedPubMedCentral
24.
go back to reference Lavric CE, Dumitrescu SV (2018) Black hairy tongue due to antibiotic intake. RJMM 121(3):61CrossRef Lavric CE, Dumitrescu SV (2018) Black hairy tongue due to antibiotic intake. RJMM 121(3):61CrossRef
25.
go back to reference Tamam L, Annagur BB (2006) Black hairy tongue associated with olanzapine treatment. Mt Sinai J Med 73(6):891–894PubMed Tamam L, Annagur BB (2006) Black hairy tongue associated with olanzapine treatment. Mt Sinai J Med 73(6):891–894PubMed
27.
go back to reference Khasawneh FA, Moti DF, Zorek JA (2013) Linezolid-induced black hairy tongue: a case report. J Med Case Rep 7(1):1–4CrossRef Khasawneh FA, Moti DF, Zorek JA (2013) Linezolid-induced black hairy tongue: a case report. J Med Case Rep 7(1):1–4CrossRef
28.
go back to reference Giri VP, Datta D, Devi P (2017) Olanzapine-induced black hairy tongue: a rare case. Int J Basic Clin Pharmacol 6(8):2091CrossRef Giri VP, Datta D, Devi P (2017) Olanzapine-induced black hairy tongue: a rare case. Int J Basic Clin Pharmacol 6(8):2091CrossRef
30.
go back to reference Rajarammohan K, Narayanan M, Ravikumar P, Fenn SM, Gokulraj S (2020) Hairy Tongue—a series of 4 cases. J Evol Med Dent Sci 9(35):2567–2571CrossRef Rajarammohan K, Narayanan M, Ravikumar P, Fenn SM, Gokulraj S (2020) Hairy Tongue—a series of 4 cases. J Evol Med Dent Sci 9(35):2567–2571CrossRef
31.
go back to reference Wang Z, Zhou J, Marshall B, Rekaya R, Ye K, Liu H-X (2020) SARS-CoV-2 receptor ACE2 is enriched in a subpopulation of mouse tongue epithelial cells in nongustatory papillae but not in taste buds or embryonic oral epithelium. ACS Pharmacol Transl Sci 3(4):749–758CrossRefPubMedPubMedCentral Wang Z, Zhou J, Marshall B, Rekaya R, Ye K, Liu H-X (2020) SARS-CoV-2 receptor ACE2 is enriched in a subpopulation of mouse tongue epithelial cells in nongustatory papillae but not in taste buds or embryonic oral epithelium. ACS Pharmacol Transl Sci 3(4):749–758CrossRefPubMedPubMedCentral
32.
go back to reference Riad A, Kassem I, Hockova B, Badrah M, Klugar M (2020) Halitosis in COVID‐19 patients. Special Care Dent Riad A, Kassem I, Hockova B, Badrah M, Klugar M (2020) Halitosis in COVID‐19 patients. Special Care Dent
33.
go back to reference Farshidfar N, Hamedani S (2020) Hyposalivation as a potential risk for SARS‐CoV‐2 infection: inhibitory role of saliva. Oral Dis Farshidfar N, Hamedani S (2020) Hyposalivation as a potential risk for SARS‐CoV‐2 infection: inhibitory role of saliva. Oral Dis
34.
go back to reference Babu S, Rajesh E, Malathi L, Babu NA, Masthan K (2019) Xerostomia-causes, diagnosis and management—a review. Indian J Public Health Res Dev 10(11) Babu S, Rajesh E, Malathi L, Babu NA, Masthan K (2019) Xerostomia-causes, diagnosis and management—a review. Indian J Public Health Res Dev 10(11)
35.
go back to reference Fantozzi PJ, Pampena E, Di Vanna D, Pellegrino E, Corbi D, Mammucari S et al (2020) Xerostomia, gustatory and olfactory dysfunctions in patients with COVID-19. Am J Otolaryngol 41(6):102721CrossRefPubMedPubMedCentral Fantozzi PJ, Pampena E, Di Vanna D, Pellegrino E, Corbi D, Mammucari S et al (2020) Xerostomia, gustatory and olfactory dysfunctions in patients with COVID-19. Am J Otolaryngol 41(6):102721CrossRefPubMedPubMedCentral
36.
go back to reference Vinayachandran D, Balasubramanian S (2020) Is gustatory impairment the first report of an oral manifestation in COVID‐19? Oral Dis Vinayachandran D, Balasubramanian S (2020) Is gustatory impairment the first report of an oral manifestation in COVID‐19? Oral Dis
37.
go back to reference Dziedzic A, Wojtyczka R (2020) The impact of coronavirus infectious disease 19 (COVID‐19) on oral health. Oral Dis Dziedzic A, Wojtyczka R (2020) The impact of coronavirus infectious disease 19 (COVID‐19) on oral health. Oral Dis
38.
go back to reference 周耿标, 黄东晖, 蔡彦, 黄凯锋, 谢东平 (2020) Relationship between tongue features and clinical classification of patients with novel coronavirus pneumonia. 中医杂志 周耿标, 黄东晖, 蔡彦, 黄凯锋, 谢东平 (2020) Relationship between tongue features and clinical classification of patients with novel coronavirus pneumonia. 中医杂志
39.
go back to reference Mousquer CR, Della Bona A, Milani DC, Callegari-Jacques SM, Ishikawa K, Mayer MPA et al (2020) Are Lactobacillus salivarius G60 and inulin more efficacious to treat patients with oral halitosis and tongue coating than the probiotic alone and placebo? A randomized clinical trial. J Periodontol 91(6):775–783CrossRefPubMed Mousquer CR, Della Bona A, Milani DC, Callegari-Jacques SM, Ishikawa K, Mayer MPA et al (2020) Are Lactobacillus salivarius G60 and inulin more efficacious to treat patients with oral halitosis and tongue coating than the probiotic alone and placebo? A randomized clinical trial. J Periodontol 91(6):775–783CrossRefPubMed
40.
go back to reference Abdul MSM, Fatima U, Khanna SS, Bhanot R, Sharma A, Srivastava AP (2020) Oral manifestations of Covid-19-are they the introductory symptoms? J Adv Med Dent Sci Res 8(5):41–43 Abdul MSM, Fatima U, Khanna SS, Bhanot R, Sharma A, Srivastava AP (2020) Oral manifestations of Covid-19-are they the introductory symptoms? J Adv Med Dent Sci Res 8(5):41–43
41.
go back to reference Boscolo-Rizzo P, Polesel J, Spinato G, Fabbris C, Calvanese L, Menegaldo A et al (2020) Predominance of an altered sense of smell or taste among long-lasting symptoms in patients with mildly symptomatic COVID-19. Rhinology Boscolo-Rizzo P, Polesel J, Spinato G, Fabbris C, Calvanese L, Menegaldo A et al (2020) Predominance of an altered sense of smell or taste among long-lasting symptoms in patients with mildly symptomatic COVID-19. Rhinology
42.
go back to reference Elias MD, McCrindle BW, Larios G, Choueiter NF, Dahdah N, Harahsheh AS et al (2020) Management of multisystem inflammatory syndrome in children associated with COVID-19: a survey from the International Kawasaki Disease Registry. CJC Open 2(6):632–640CrossRefPubMedPubMedCentral Elias MD, McCrindle BW, Larios G, Choueiter NF, Dahdah N, Harahsheh AS et al (2020) Management of multisystem inflammatory syndrome in children associated with COVID-19: a survey from the International Kawasaki Disease Registry. CJC Open 2(6):632–640CrossRefPubMedPubMedCentral
43.
go back to reference Cariati P, Aporta LM, Martinez MAJ (2019) Lengua negra vellosa. Manejo clínico. Black hairy tongue. Clin Manag EMERGENCIAS 31(4) Cariati P, Aporta LM, Martinez MAJ (2019) Lengua negra vellosa. Manejo clínico. Black hairy tongue. Clin Manag EMERGENCIAS 31(4)
44.
go back to reference Handler MZ, Butler DF, Eisen D, Burgess J, Lynch DP, Stafford GL (2017) Hairy tongue Handler MZ, Butler DF, Eisen D, Burgess J, Lynch DP, Stafford GL (2017) Hairy tongue
Metadata
Title
Pathophysiology and Management of Tongue Involvement in COVID-19 Patients
Authors
Zeinab Mohseni Afshar
Mohammad Barary
Soheil Ebrahimpour
Alireza Janbakhsh
Mandana Afsharian
Amirhossein Hasanpour
Arefeh Babazadeh
Publication date
06-01-2022
Publisher
Springer India
Published in
Indian Journal of Otolaryngology and Head & Neck Surgery / Issue Special Issue 2/2022
Print ISSN: 2231-3796
Electronic ISSN: 0973-7707
DOI
https://doi.org/10.1007/s12070-021-03052-3

Other articles of this Special Issue 2/2022

Indian Journal of Otolaryngology and Head & Neck Surgery 2/2022 Go to the issue