Introduction – Problems related to SARS-CoV-2
The novel coronavirus disease COVID-19 was officially termed as severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2) (WHO, 2020) is brutally affecting the healthcare system again during the second wave. We’re already aware that the lungs are the primary site of infection for COVID-19. Patients present with symptoms ranging from mild flu-like symptoms to full-blown fulminant pneumonia and potentially lethal respiratory distress. It’s pertinent to diagnose and treat symptoms at the earliest to tackle the disease effectively.

Early dissemination of clinical data and manifestations about the emerging infection helped with the identification, diagnosis, clinical course, and management.

Manifestations of COVID-19
Many systemic disorders have marked oral manifestations. The oral manifestations may tend to precede the systemic presentation of a particular disease. Early diagnosis and management can often diminish the morbidity associated with a systemic disease. Careful oral cavity examination is a necessary component for the diagnostic work-up for any patient.

There have been some COVID-19 cases reporting oral manifestations (Chaux-Bodard et al.,2020; de Maria et al., 2020; Lechien et al., 2020; Martín Carreras-Presas et al., 2020;) resulting from systemic deterioration consequently due to increased risk of opportunistic infections and adverse reactions of treatments. Dysgeusia is the first recognized oral symptom of novel coronavirus disease (COVID‐19). The majority of patients also claim report significant anosmia. This results in an altered taste and smell sensation which tends to vary depending on the severity of the symptoms.

Therefore, the range of COVID19 manifestations in the oral cavity is considered of broad and current interest.

General Manifestations
The cause of novel coronavirus disease known as COVID-19,  severe acute respiratory syndrome coronavirus 2 (SARS-CoV- 2) is a single- chain RNA virus. The most common clinical symptoms are fever, headache, sore throat, dyspnea, dry cough, abdominal pain, vomiting, and diarrhea. Angiotensin-converting enzyme 2 (ACE 2) receptor is a known receptor for SARS-CoV2 that is found in the lung, liver, kidney, gastrointestinal (GI), and even on the epithelial surfaces of sweet glands and on the endothelia of dermal papillary vessels subsequently affecting all symptoms. Numerous cutaneous manifestations of COVID-19 disease have been described including varicelliform lesions, pseudochilblain, erythema multiforme (EM)-like lesions, urticaria form, maculopapular, petechiae and purpura, mottling, and livedo reticularis-like lesions1,2.

COVID Tongue
Oral manifestations included ulcer, erosion, bulla, vesicle, pustule, fissured or depapillated tongue, macule, papule, plaque, pigmentation, halitosis, whitish areas, hemorrhagic crust, necrosis, petechiae, swelling, erythema, and spontaneous bleeding. The most common sites of involvement in descending order were tongue (38%), labial mucosa (26%), and palate (22%). Suggested diagnoses of the lesions were aphthous stomatitis, herpetiform lesions, candidiasis, vasculitis, Kawasaki‐like, EM‐like, mucositis, drug eruption, necrotizing periodontal disease, angina bullosa‐like, angular cheilitis, atypical Sweet syndrome, and Melkerson‐Rosenthal syndrome.

Studies revealed that the oral lesions were symptomatic in 68% of the cases. According to the literature, the incidence of these lesions is equal in both genders (49% female and 51% male). Patients with older age and higher severity of COVID‐19 disease had more widespread and severe full blown oral lesions.

Lack of oral hygiene, opportunistic infections, stress, immunosuppression, vasculitis, and hyper‐inflammatory response secondary to COVID‐19 are the most important predisposing factors for the onset of oral lesions in COVID‐19 patients. Habits like smoking and alcoholism also significantly cause modulated body responses. It’s imperative to maintain good oral hygiene.

What is COVID Tongue?
Enanthema can develop in various types of viral diseases including dengue fever disease. Ebola virus disease, herpangina, human herpesvirus (HHV) infections, measles, and roseola infantum. Infectious diseases, especially of viral etiology, constitute approximately 88% of causes of enanthema of numerous kinds including aphthous-like ulcers, Koplik’s spots, Nagayama’s spot, petechiae, papulovesicular, or maculopapular lesions, white or red patches, gingival, and lip swelling have been reported with various viral infections.

Patients diagnosed as mild and moderate COVID-19 commonly had a light red tongue and white coating. Severe patients had a purple tongue and yellow coating. The proportion of critical patients with painful tongues increased to 75%. The presence of a greasy coating was a significant characteristic of patients with COVID-19.

COVID Tongue potentially can serve as an indicator for the evaluation of a patient’s condition and prognosis.

Management of COVID Tongue
The latency time between the appearance of systemic symptoms and oral lesions is usually between 4 days before up to 12 weeks after onset of systemic symptoms, in few cases, the oral lesions preceded the systemic symptoms and in some cases, oral and systemic symptoms appeared simultaneously. The longest latency period for manifestations of symptoms belonged to Kawasaki‐like lesions. Oral lesions healed between 3 and 28 days after appearance. Different types of therapies including chlorhexidine mouthwash, nystatin, oral fluconazole, topical or systemic corticosteroids, systemic antibiotics, systemic acyclovir, artificial saliva, and photobiomodulation therapy (PBMT) were prescribed for oral lesions depending on the main etiology.

Although, it’s imperative to note several limitations of the studies and research on COVID Tongue attributed to the ambiguity of the Novel Coronavirus

The long-term effects of the disease are still unknown although the research is spearheading it forward remarkably.