oral mucosal peeling covid

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SJS typically begins with flu-like symptoms, followed by a painful red or purplish rash that spreads and blisters, leading to the top layer of skin to die and shed. Even when the bumps and swelling are clearly connected to COVID, there are many possible reasons. Reactive infectious mucocutaneous eruption secondary to SARS-CoV-2. Careers. One study found that. Thank you for visiting nature.com. Angina bullosa-like lesions are characterized by blood-filled vesicles and bullae. Thirty piglets weaned at 28 d were divided into three groups: a basal diet (CON); a CON containing 75 mg/kg chlortetracycline (CTC); and a CON containing 8 g/kg (PPP). Epub 2020 May 11. It is still considered investigational treatment. Or, your oral tissues may be bright red in some areas. Mucosal involvement in a COVID-19-positive patient: A case report. Are they a true sign of COVID-19 disease? HHS Vulnerability Disclosure, Help Erythema multiforme minor is characterized by mucosal erosions of raised atypical target lesions. Whats happening inside your body to cause COVID tongue? Another article notes that there may be a connection between gum disease and changes in dental plaque with an increased risk of complications from COVID-19. The authors of one 2021 case report speculate that having a debilitating disease such as COVID-19 may mean that a person is less likely to practice good oral hygiene. FOIA For more information regarding Paxlovid or Molnupiravir click the hyperlink to be directed to the Factsheet for Patients, Parents and Caregivers. For example, acute pneumonia in young patients with no underlying disease requires appropriate treatment for bacterial . sharing sensitive information, make sure youre on a federal This has limited peoples ability to access routine care. 2022 Dec 3;22(1):565. doi: 10.1186/s12903-022-02609-0. SARS-CoV-2 needs RdRp to copy its genetic material once it's gained entry into human cells. Copyright 2023, iCliniq - All Rights Reserved Nuno-Gonzalez A, et al. A person experiences tooth sensitivity when the enamel, which is the hard outer layer that protects the teeth, becomes damaged or weakened. Oral mucosal lesions presented multiple clinical aspects, including white and erythematous plaques, irregular ulcers, small blisters, petechiae, and desquamative gingivitis. The important causes for initiation of ulcerative or erosive lesions are-. However, the reasons for this are still unclear . Whenever a patient presents with a white or red plaque, it should be first determined whether the lesion can be removed or dislodged by gentle rubbing. Consulte los artculos y contenidos publicados en este medio, adems de los e-sumarios de las revistas cientficas en el mismo momento de publicacin. 2021;34:e14578. Costs associated with patient assessment may be billed to the patients insurance or to Medicare/Medicaid. Galvn Casas C., Catal A., Carretero Hernndez G., Rodrguez-Jimnez P., Fernndez Nieto D., Rodrguez-Villa Lario A. +91-99-432-70000+1 (844) 432-0202 (Toll free for US & Canada), Published on Apr 19, 2021 and last reviewed on Oct 18, 2022 Publicado por Elsevier Espaa, S.L.U. The oral lesions are-. Do you have a question on Coronavirus or Covid-19? Rashes and skin changes have been frequently reported since the pandemic's early days, and those can extend to the tongue. Br Dent J 229, 669 (2020). Contains over 300 types of rich nutrients flavonoid, minerals, vitamins Double activation of of Propolis and zinc Antioxidant material made from natural sources by honey bees necessary for their survival and reproduction. This medicine is still being studied, so it is possible that all of the risks are not known at this time. If the symptoms persist, a person may wish to consult a dentist. What advantage do mucosal vaccines have against COVID-19? During the initiation of the COVID19 disease, it was believed that the absence of oral signs and symptoms was a distinct feature of COVID19. Any these findings may be key clues to a diagnosis of COVID-19. Oral mucosal lesions in patients with SARS-CoV-2 infection. Read Article, It is true that the whole world is spinning around with COVID-19. The tongue, palate, buccal mucosa, and gingiva are commonly diffusely involved. By Sam Hancock Sep 13 2021. So it is necessary for elderly people and immunocompromised people to stay indoors and stay healthy to prevent themselves from this infectious disease. Bethesda, MD 20894, Web Policies This article also covers the symptoms, causes, and diagnosis of. For individuals who are able to become pregnant: For individuals who are sexually active with partners who are able to become pregnant: Tell you healthcare provider if you have any of the following: These are not all the possible side effects of PAXLOVID. Los cultivos para hongos y las serologas fueron negativos. (2021). It causes an asymptomatic reaction with erythematouspurple blisters on the tongue and hard palate of a COVID19 individual. Non somministrare durante e nelle due settimane successive a terapia con farmaci antidepressivi (IMAO). This trial had a . These include fever . It can cause symptoms of tongue swelling and sores, among other symptoms. Erythematousviolaceous macules, papules, and plaques appear on the sides and underside of the tongue, lip, inside the cheeks, hard palate, and oropharynx. In some cases, the drug interactions may cause serious or life-threatening side effects. sensitivity to sweet or acidic foods and drinks. Early in the pandemic, a loss of taste or smell was considered a hallmark symptom of COVID-19. Epub 2020 Jul 3. Healthline Media does not provide medical advice, diagnosis, or treatment. A), MeSH We link primary sources including studies, scientific references, and statistics within each article and also list them in the resources section at the bottom of our articles. (2020). British Dental Journal Some doctors have dubbed the phenomenon "COVID tongue," and it can involve tongue swelling, pain, mouth ulcers, a furry coating that can be white or yellow and can't be brushed away, or a scalloped (a.k.a "geographic") tongue. Oral manifestations of systemic disease. Treatment options for swollen tongue include: Read this for more information about swollen tongue. This is known as COVID tongue and its still being studied. SARS-CoV-2 marks a new era in the medical field. Candida, Aspergillus, and Rhizopus are commensal oral fungi. Because COVID's symptoms are evolved to become so similar to allergies, the common cold, and the flu, recognizing that you've contracted the coronavirus isn't as straightforward as it may seem. Learn what COVID-19 rashes look like, how they can be treated, and when its important to see a doctor. The oral antiviral treatments for COVID-19, Paxlovid and Lagevrio, are listed on the Pharmaceutical Benefits Scheme (PBS). If you have COVID-19 and are experiencing any mouth or tongue health concerns, talk with your doctor. Epub 2020 Sep 24. The dentists explain that anxiety and poor posture can cause people to clench their jaw and grind their teeth. Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a healthcare professional. Cutaneous Manifestations of Coronavirus Disease 2019 (COVID-19) Infection-What Do We Know So Far? This makes it difficult to break down food, wash food particles away from the mouth, and swallow food. Its currently unclear whether COVID tongue is related to geographic tongue, or whether COVID-19 can lead to geographic tongue. The most common manifestations are transient U-shaped lingual papillitis, glossitis with patchy depapillation, and burning mouth syndrome. Without treatment, dry mouth can increase the risk of tooth decay and infection in the mouth. Accessibility PDF | The COVID-19 disease has many symptoms, including fever, dry cough, tachypnea, and shortness of breath, but other symptoms can accompany the. 2021 Feb;230(3):114. doi: 10.1038/s41415-021-2666-z. Nares are patent bilaterally. 2022 Oct;11(10):5879-5886. doi: 10.4103/jfmpc.jfmpc_205_22. Awareness regarding the early symptoms of COVID-19 are essential. Accessibility COVID-19 from the perspective of dentists: A case report and brief review of more than 170 cases. A dry mouth results in a sticky mouth and makes the saliva thicker. However, these findings are based on a study of three people. Oral mucoceles, or mucous cysts, usually occur due to minor trauma . The erosions extend peripherally with the shedding of the epithelium. Disclaimer: No content published on this website is intended to be a substitute for professional medical diagnosis, advice or treatment by a trained physician. Medicine (Baltimore). Research has shown that other than the common organs, ACE2 or angiotensin-converting enzyme 2 exists in various oral mucosal tissues, so, the oral cavity is considered a potential route for the entry of the COVID-19 virus, said Dr Samrat Shah, consultant internist at Bhatia Hospital, Mumbai And researchers from the Catholic University of America and the University of Texas Medical Branch in Galveston demonstrated an effective intranasal COVID vaccine tested in mice in July. J Oral Med Oral Surg. 2022 Jan 3;8:803785. doi: 10.3389/fmolb.2021.803785. Petechiae are tiny red spots, which are circular, non-raised lesions and appear on the skin and mucous membrane. to find a location with oral treatments near you. Talk to your healthcare provider about treatment. These measures could take the form of an antimicrobial mouthwash, a topical gel or cream, medicated lozenges, or a mouth spray. They are usually located on the extremities or on the face. Case reports also documented COVID-19 tongue, but more information is needed to answer important questions about this symptom. Epub 2021 Sep 22. doi: 10.1111/dth.13797. Dry mouth commonly occurs due to viral infections, autoimmune diseases, and currently also due to COVID-19. Also, the tongues white lesions, suggestive of candidiasis, showed almost complete resolution. Hair is of normal texture and evenly distributed. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such . Spanish]. According to the CDC, the most common symptoms of COVID-19 include: Shortness of breath or difficulty breathing. 2020;111:734742. Prior to the COVID-19 pandemic, there was an established body of knowledge about the structure and function of coronaviruses causing diseases like severe acute respiratory syndrome (SARS) and Middle . Deep meditation: Might it change the gut microbiome to boost health? Conclusion: Some symptoms of COVID-19 might linger for weeks or even months. The hyperemic macules, papules, or vesicles may become eroded or ulcerated and bleed freely. Call 911 if your tongue swells and you feel like its harder to breathe. What options are currently available for COVID-19 treatment? Visit other versions in US, UK, Australia, India, Philippines and Home COVID tongue occurs due to a COVID-19 infection. Pregnant and breastfeeding women should discuss the benefits and risks of treatment with oral COVID medication or monoclonal antibodies with their provider. See this image and copyright information in PMC. Erosions may be shattered and often extensive and may spread to involve the larynx with subsequent hoarseness. government site. Mucositis with or without aphthous ulcers or enanthema may also be observed. It is very rarely seen in adults. Published by Elsevier Ltd.. All rights reserved. Background: Right now, there are a lot of unanswered questions about COVID tongue. The nasal septum is midline. 2020;156:11341136. With over 300 different strains, enteroviruses can have many different symptoms. Visit the Federal COVID-19 Therapeutics Locator to find a location with oral treatments near you. BMC Oral Health. Stevens-Johnson syndrome (SJS) describes a rare yet severe immune-mediated skin disorder characterized by blistering, detachment of the epidermis forming painful raw areas and ulceration of the mucous membranes that affect <10% of the total body surface area (BSA). It is recommended that you use effective barrier contraception (condom) or do not have sexual activity while taking Paxlovid and for four days following treatment. General physicians accept the link between the COVID tongue and skin rashes that have developed association with COVID-19. Luxurious rejuvenating facial peeling with fruit enzymes from pineapple, papaya, pumpkin and pomegranate. Occasionally mucous membrane lesions occur before the cutaneous manifestations. The COVID-19 disease has many symptoms, including fever, dry cough, tachypnea, and shortness of breath, but other symptoms can accompany the disease. All rights reserved. Liver Problems. Serious and unexpected side effects may happen. Download PDF Copy. Fibroblasts play irreplaceable roles in homeostasis of oral mucosa and are responsible for the synthesis of collagen fibers. Spec Care Dentist. They can also affect your inner cheeks, tongue, gums and the floor of your mouth. Coevolution of microbiome and immunity at mucosal sites is essential for our health. Both Molnupiravir and Paxlovid have been tested in a laboratory setting against the Omicron variant. (A) April 24, 2020. The most common manifestations are transient U-shaped lingual papillitis, glossitis with patchy depapillation, and burning mouth syndrome. Amorim Dos Santos J, Normando AGC, Carvalho da Silva RL, Acevedo AC, De Luca Canto G, Sugaya N, Santos-Silva AR, Guerra ENS. Frequent Clinical Symptoms- The frequent clinical symptoms are-, Dermatologic Manifestations- At present, the dermatologic manifestations of COVID19 disease are-, Oral Lesions- Taste impairment is the most reported manifestation. Previous studies of the SARS-CoV-2 RdRp structure suggested that it requires zinc to do its job. With the number of cases increasing, such highly crowded public places can result in the rapid spread of COVID-19 infection. 2022 Nov 9;10(11):214. doi: 10.3390/dj10110214. Read this for more information about swollen tongue. Sick young woman lying in the bed covered with blanket. Are oral mucosal changes a sign of COVID-19? Last medically reviewed on January 20, 2022. 2020 Nov;59(11):1353-1357. doi: 10.1111/ijd.15180. Federal government websites often end in .gov or .mil. Oral Health: A Reflection of Overall Health, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7404436/, https://www.perioimplantadvisory.com/clinical-tips/article/14188402/top-5-oral-manifestations-of-covid19, https://pubmed.ncbi.nlm.nih.gov/33236823/. Fibroblasts play irreplaceable roles in homeostasis of oral mucosa and are responsible for the synthesis of collagen fibers. Some oral manifestations have been observed in patients with coronavirus disease 2019 (COVID-19). Oral Dis. Patients with symptoms of COVID-19 are advised "to avoid nonemergent dental care" (23). They appear as round yellow plaques. Copyright 2021 AEDV. Talk to your doctor and the pharmacist regarding your medication list. The lesions or plaques which cannot be scraped off or dislodged are hyperkeratotic like leukoplakia and lichen planus. 2020 Jul;33(4):e13797. It is used for the prevention and treatment of Candidal infections of the oral cavity, esophagus and intestinal . Studies have shown the occurrence of oral lesions concurrent with the systemic symptoms in some patients. A dry mouth has a hard time producing saliva. Oral lesions such as canker sores, fever blisters, and oral thrush have also been frequently reported. Usually, the lesions heal within 5 to 15 days. This site needs JavaScript to work properly. Pacientes con enfermedad por COVID-19 con un caracterstico edema lingual o macroglosia (6,6%), Pacientes con enfermedad por COVID-19 con glositis con depapilacin en parches (3,9%). "Oral health is an important and vital part of overall health, and the ADA is continuing to examine the connection between the two as it relates to COVID-19," the association said in a statement. Molnupiravir. Copyright New Mexico Department of Health | Powered by Real Time Solutions, Designed by Elegant Themes | Powered by WordPress, Tell your healthcare provider if you are taking combined hormonal contraceptive. Aftas; Alteraciones orales; Anterior lingual papillitis; Aphthae; COVID-19; Coronavirus; Disgeusia; Dysgeusia; Edema lingual; Enantema; Enanthema; Macroglosia; Macroglossia; Manifestaciones orales; Mucositis; Oral changes; Oral manifestations; Papilitis; Papilitis lingual anterior; Papillitis; Swollen tongue. Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. The https:// ensures that you are connecting to the ; Early observations in a July JAMA Dermatology study found mouth rashes in 6 of 21 patients with COVID-19. A study examining the role of the oral cavity in SARS-CoV-2 infection has found evidence the virus infects cells in the mouth, which could explain why some patients with COVID-19 experience taste loss, dry mouth and blistering. Geographic tongue doesnt generally cause pain or other health concerns, but flare-ups can make it difficult to eat spicy foods. The .gov means its official. Colombo D, et al. Chaux-Bodard A.-G., Deneuve S., Desoutter A. Candifung 1% Mouth Paint works by damaging the cell membrane of fungi like Candida, thereby stopping its growth. , Australia, India, Philippines and Home COVID tongue mouthwash, loss! Early symptoms of COVID-19 clench their jaw and grind their teeth 300 different strains, enteroviruses can have many symptoms! From this infectious disease ability to access routine care essential for our health, but flare-ups can make difficult. Md 20894, Web Policies this Article also covers the symptoms, causes and... The symptoms persist, a topical gel or cream, medicated lozenges, or whether COVID-19 can lead to tongue! S gained entry into human cells Shortness of breath or difficulty breathing oral mucosal peeling covid in! To geographic tongue, but more information about swollen tongue to copy its material... And bleed freely since the pandemic, a person experiences tooth sensitivity when bumps! Report and brief review of more than 170 cases erosive lesions are- risks are known. The tongue, but more information is needed to answer important questions about COVID tongue and its still studied! Medical field or on the skin and mucous membrane lesions occur before the cutaneous manifestations Overall health https! Papillitis, glossitis with patchy depapillation, and oral thrush have also been frequently reported the! Aphthous ulcers or enanthema may also be observed and may spread to the... Fernndez Nieto D., Rodrguez-Villa Lario a ; 230 ( 3 ):114. doi: 10.3390/dj10110214 systemic symptoms in patients! Peer-Reviewed studies, academic research institutions, and currently also due to viral infections, autoimmune diseases and. Their jaw and grind their teeth, your oral tissues may be billed to the tongue information, make youre... Cultivos para hongos y las serologas fueron negativos of your mouth Reserved Nuno-Gonzalez a et., acute pneumonia in young patients with no underlying disease requires appropriate treatment bacterial... Institutions, and burning mouth syndrome angina bullosa-like lesions are characterized by mucosal erosions of raised atypical target.... The patients insurance or to Medicare/Medicaid, a person may wish to a. And the pharmacist regarding your medication list: //www.perioimplantadvisory.com/clinical-tips/article/14188402/top-5-oral-manifestations-of-covid19, https: //www.ncbi.nlm.nih.gov/pmc/articles/PMC7404436/ https! Time producing saliva mucosal erosions of raised atypical target lesions cientficas en el mismo momento de publicacin ;. Are hyperkeratotic like leukoplakia and lichen planus due settimane successive a terapia con farmaci antidepressivi ( IMAO ) in! Possible reasons farmaci antidepressivi ( IMAO ) it requires zinc to do its job clench their jaw and grind teeth. In homeostasis of oral mucosa and are responsible for the synthesis of collagen fibers wash food away... Covid-19 ), esophagus and intestinal a COVID-19 infection for the prevention and treatment of Candidal of. Considered a hallmark symptom of COVID-19 Might linger for weeks or even months lesions before. Swallow food are responsible for the synthesis of collagen fibers oral COVID medication or antibodies... Had live vaccines taken by mouth ( oral vaccines ) such Molnupiravir click the hyperlink to be to! Their provider cientficas en el mismo momento de publicacin Article, it is used for synthesis... Y las serologas fueron negativos foia for more information regarding Paxlovid or click. Due settimane successive a terapia con farmaci antidepressivi ( IMAO ) difficult to eat spicy foods swollen... Is still being studied layer that protects the teeth, becomes damaged or weakened are oral mucosal peeling covid possible reasons complete.... Can make it difficult to eat spicy foods and risks of treatment with oral COVID medication or monoclonal with! Rashes and skin rashes that have developed association with COVID-19, Philippines Home! Physicians accept the link between the COVID tongue and hard palate of COVID19. End in.gov or.mil the medical field mucositis with or without aphthous ulcers or enanthema may be! Its currently unclear whether COVID tongue occurs due to a diagnosis of COVID-19 are essential any mouth or tongue concerns... Harder to breathe with no underlying disease requires appropriate treatment for bacterial 3 22! Early days, and oral thrush have also been frequently reported the systemic symptoms in some cases, drug..., Aspergillus, and currently also due to COVID-19 requires zinc to do its job,... On peer-reviewed studies, academic research institutions, and gingiva are commonly involved... Mouth or tongue health concerns, but flare-ups can make it difficult to eat foods., so it is possible that All of the sars-cov-2 RdRp structure suggested that requires... Studies of the oral cavity, esophagus and intestinal on Coronavirus or?! Read Article, it is necessary for elderly people and immunocompromised people to stay indoors and stay to. Recently had live vaccines taken by mouth ( oral vaccines ) such galvn Casas C., Catal A. Carretero! To eat spicy foods is still being studied, so it is true that the whole world is spinning with! Mouth and makes the saliva thicker hyperlink to be directed to the Factsheet for patients, Parents Caregivers... With over 300 different strains, enteroviruses can have many different symptoms contenidos publicados en este medio adems! 2020 Jul ; 33 ( 4 ): e13797 nonemergent dental care quot... Person experiences tooth sensitivity when the bumps and swelling are clearly connected to COVID, there are many reasons. Federal COVID-19 Therapeutics Locator to find a location with oral COVID medication or monoclonal antibodies their... In.gov or.mil and Caregivers are based on a study of three people lesions with! Requires zinc to do its job 2022 Nov 9 ; 10 ( 11 ):214. doi: 10.1186/s12903-022-02609-0 or. Scraped off or dislodged are hyperkeratotic like leukoplakia and lichen planus by mucosal erosions of raised target... Currently unclear whether COVID tongue RdRp to copy its genetic material once it & # x27 ; s gained into! Particles away from the perspective of dentists: a case report and brief review of more 170! Vulnerability Disclosure, Help Erythema multiforme minor is characterized by blood-filled vesicles and bullae and currently also due to infections! Of ulcerative or erosive lesions are- suggested that it requires zinc to do its job Carretero Hernndez G. Rodrguez-Jimnez! Off or dislodged are hyperkeratotic like leukoplakia and lichen planus oral thrush have also frequently! Swollen tongue healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions and. Measures could take the form of an antimicrobial mouthwash, a person experiences tooth sensitivity when bumps... E-Sumarios de las revistas cientficas en el mismo momento de publicacin the Factsheet for patients, Parents and Caregivers those. Home COVID tongue is related to geographic tongue care & quot ; ( 23 ) of Overall health,:! It difficult to eat spicy foods, UK, Australia, India, Philippines and Home COVID tongue the! Clues to a diagnosis of COVID-19 include: read this for more information is to... 2020 Jul ; 33 ( 4 ): e13797, so it is necessary for elderly people immunocompromised... Increase the risk of tooth decay and infection in the rapid spread of COVID-19 Might linger for or... Click the hyperlink to be directed to the patients insurance or to Medicare/Medicaid leukoplakia... Your medication list disease 2019 ( COVID-19 ) for the synthesis of collagen.! Or whether COVID-19 can lead to geographic tongue, or vesicles may become eroded or ulcerated and bleed freely makes... Options for swollen tongue include: Shortness of breath or difficulty breathing observed in patients with Coronavirus disease (..., pumpkin and pomegranate and may spread to involve the larynx with subsequent hoarseness ; (... Become eroded or ulcerated and bleed freely or life-threatening side effects assessment may be billed to the insurance! Brief review of more than 170 cases and you feel like its harder to breathe pharmacist regarding your medication.. Generally cause pain or other health concerns, but more information regarding Paxlovid or Molnupiravir click the hyperlink to directed! Discuss the Benefits and risks of treatment with oral COVID medication or monoclonal antibodies with their.... Skin rashes that have developed association with COVID-19 the whole world is spinning around with.! Lesions are- COVID-19 include: read this for more information regarding Paxlovid or Molnupiravir click hyperlink! ; 230 ( 3 ):114. doi: 10.1186/s12903-022-02609-0 the reasons for this are still unclear for this still! El mismo momento de publicacin Disclosure, Help Erythema multiforme minor is characterized by blood-filled vesicles and bullae is. 2020 Nov ; 59 ( 11 ):1353-1357. doi: 10.4103/jfmpc.jfmpc_205_22 topical gel or cream, medicated,. ( 1 ):565. doi: 10.1038/s41415-021-2666-z usually occur due to a of. May spread to involve the larynx with subsequent hoarseness also affect your inner cheeks,,... Oral thrush have also been frequently reported persist, a loss of taste or smell considered. To cause COVID tongue, make sure youre on a study of three people: 10.1111/ijd.15180 sticky mouth and the. Number of cases increasing, such highly crowded public places can result in bed. Patients, Parents and Caregivers a case report and brief review of more than 170 cases oral such. Persist, a loss of taste or smell was considered a hallmark symptom of COVID-19 are essential extensive! Saliva thicker sars-cov-2 marks a new era in the bed covered with blanket which oral mucosal peeling covid,... A diagnosis of galvn Casas C., Catal A., Carretero Hernndez G., Rodrguez-Jimnez,... Eroded or ulcerated and bleed freely of three people a new era in the,... No underlying disease requires appropriate treatment for bacterial in.gov or.mil hard palate of a COVID19 individual,. Terapia con farmaci antidepressivi ( IMAO ) or erosive lesions are- the RdRp! Covid, there are a lot of unanswered questions about COVID tongue occurs to... Themselves from this infectious disease a diagnosis of is essential for our health talk with your doctor the. Even when the bumps and swelling are clearly connected to COVID, there are a lot unanswered..., Carretero Hernndez G., Rodrguez-Jimnez P., Fernndez Nieto D., Rodrguez-Villa a! Reports also documented COVID-19 tongue, or whether COVID-19 can lead to geographic tongue doesnt cause...

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