The human tongue usually has a more or less flat shape with a slight vertical indentation in its center. The development of several indentations along its sides gives a wavy effect, causing a Scalloped Tongue.
This is the name given to a condition of the tongue, in which it acquires marks from the teeth (indentations) along its sides. The tongue appears to have wavy, groovy, ridged or rippled edges.
Other names used to describe it are crenulated tongue, crenated tongue, lingua indentata, or piecrust tongue.
This happens because of the compression of the tongue against the dental arch. The tongue might also become swollen, smoothened, reddened, pale, inflamed or sore.
A scalloped tongue is not a disease, and it does not usually suppose any harm in itself. It is the result of other physical factors or even diseases. It can be considered as an early sign or warning of a serious underlying problem.
In this article, you will find out in detail about the different causes that can lead to a scalloped tongue, its diagnosis, and treatment.
Symptoms Of Scalloped Tongue
The most prominent sign of a scalloped tongue is the appearance of a ridged pattern along its sides. This results from the impressions of the teeth on them. However, sometimes, this may be accompanied by other symptoms like:
- Tongue swelling (Glossitis)
- Throat soreness
Causes Of Scalloped Tongue
A scalloped tongue is not a disease in itself, and it does not convey any harm to health. It is rather the result or consequence of other conditions, diseases or abnormalities.
Scalloping of the tongue may occur due to the following causes:
1. Macroglossia/Swollen Tongue
Macroglossia refers to the state of the tongue in which it is unusually swollen or expanded. This can occur due to many causes of congenital diseases, birth defects or acquired conditions. A swollen tongue becomes too big for the mouth results in pressure on the dental arches, which in turn makes the tongue edges ridged with teeth marks on them.
Some Of The Reasons For Macroglossia To Take Place Are:
iv. Canker sores
v. Scarlet fever
vii. Mouth dryness
xi. Tongue cancer and mouth tumors.
xii. Multiple endocrine neoplasias (type 2B)
xiii. Vascular malformations like lymphangioma or hemangioma.
xiv. Muscular hypertrophy like hemihyperplasia (Beckwith – Wiedemann syndrome)
A swollen tongue, in turn, may cause the following symptoms:
- Difficult and noisy breathing
- Mouth breathing
- Difficulty in swallowing
- Disrupted, unclear speech or dysphonia
- Pie crust tongue/Scalloped tongue that has teeth marks caused by the pressure made on the tongue by them.
Macroglossia can be treated simply and it many cases it may heal by itself. However, when the underlying cause is not well determined the treatment can become complicated. A regular buccal check-up is recommended.
2. Smallmouth/Buccal Cavity & Tmj
Sometimes the tongue may get dented/scalloped because the lower jaw is too small or because of a bad bite which the tongue is trying to compensate or rectify.
In this case, the teeth do not coordinate in a proper position to stabilize the jaw and let the swallowing muscles work. The tongue presses against the teeth in an attempt to move them, which not only worsens the condition but also leaves it scalloped.
The solution for this pattern is the adjustment of the bite relocation of the teeth to their proper place.
In other cases, the scalloping of the tongue may be associated with TMJ.
3. Temporomandibular Joint Syndrome (TMJ):
TMJ stands for the Temporomandibular joint syndrome. It is defined as the damaged condition of the temporomandibular joint. It is a type of muscular dysfunction. TMJ affects the jaw muscles and the nerves that connect it to the skull.
It also results in the instability of the lower jaw. Patients often use their tongue to keep their jaws in place to ease the biting, chewing and swallowing process. However, this habit leaves ridge marks from the teeth on the tongue edges and in hence, the development of a scalloped tongue.
Symptoms of TMJ are headaches, popping sounds from the jaw, grinding of teeth (bruxism), nerve inflation, and facial swelling, pain while chewing.
Sometimes the friction stimulates the taste buds on the surface of the tongue and causes inflammation and bumps that result in pain and burning sensation.
The options to correct this condition include surgical remodeling of the jaw or fixing of the teeth and relocation of their position. In the case of ulcers or pain, a visit to the dentist is highly recommended.
4. Spleen Qi Deficiency
The deficiency of spleen QI is also considered to be the reason behind a scalloped tongue, especially in Chinese traditional medicine.
In this doctrine, the tongue is deeply related to other body organs, and can visually hint about any abnormality in them.
In this condition, the spleen fails to perform its digestive functions and is unable to synthesize energy from food. This results in fatigue, paleness of tongue and face, weight loss and poor appetite in addition to a scalloped tongue.
5. Sleep Apnea
While sleep apnea is a common disorder, it is uncommon for it to be the reason of a scalloped tongue. However, it is not impossible.
Sleep apnea refers to the condition in which breathing is involuntarily disrupted or shallow while sleeping. The pauses in breathing make the tongue fall back into the mouth cavity, which can result in the formation of marks on its sides.
Sometimes these may be intensified by unconscious bites on both sides of the tongue due to seizures during sleep or the daytime.
The probability of having sleep apnea can increase due to a large tongue, tonsils, or neck size, a small jawbone, gastrointestinal reflux, and overweight.
Sleep apnea can be prevented by sleeping on the sides instead of on the back. This will prevent the sliding of the tongue back into the buccal cavity and the throat.
6. Mineral And Vitamin Deficiency / Anemia / Nutritional Deficiency
An inadequate nutrition can lead to abnormalities in the body, and tongue scalloping is one of them. When minerals and vitamins are not supplied to the body in a proper quantity, deficiencies take place.
A. Vitamin B Deficiency
The deficiency of folate and vitamin B12 leads to the megaloblastic anemia, which adversely affects the production of red blood cells. This causes the tongue to get swollen and in turn.
Other symptoms of this condition are tongue tenderness, increased heartbeat rate, appetite loss.
Sources of vitamin B12 that can combat its deficiency are eggs, chicken, fish, dairy products, legumes, cereals, leafy vegetables, etc.
Improper supply of vitamin B2, B3 and B6 can also cause tongue swelling and sensitivity among other symptoms in the body.
B. Iron Deficiency
The deficiency of iron can also cause swelling, smoothing and scalloping of the tongue, along with anemia. There is a difficulty in chewing, talking and swallowing.
To treat this problem iron supplements like tablets or droplets can be taken, along with iron-rich food like meats, fish, poultry, leafy vegetables, beans, cereals, etc.
Lack of water can lead to dehydration. This causes dryness of the tongue and other tissues. If the tongue is extremely dry, it may crack, swell, and become scalloped.
Dehydration can occur due to underlying diseases that lead to vomiting or diarrhea.
Solutions to dehydration could be rehydration salts and the intake of plenty of water and other fluids throughout the day
8. Water Retention
On the other hand, tongue swelling and scalloping can also occur due to water retention. Excessive accumulation can occur due to kidney problems, nutritional deficiencies, spleen abnormalities, allergies or thyroid conditions among others.
It makes the tongue thick, fissured, swollen and in turn, scalloped.
9. Oral Cancer
When intensely painful fissures and ulcers accompany tongue scalloping, there might be a probability of cancer; especially if these ulcers grow rapidly along with a gradually increasing soreness among other symptoms.
For the diagnosis of cancer, the visual assessment will be followed by a biopsy.
10. Piercings And Oral Jewelry
Wearing jewelry inside the mouth often causes alterations in swallowing, muscle uniformity and appearance. It often disrupts the tongue and its natural movements and actions, and it may lead to its swelling and scalloping.
Before getting oral jewelry or piercing, it is important to consider its weight and size it is highly recommended to consult a dentist beforehand.
11. Bad Habits / Teeth Clenching
Regularly clenching, pressing or grinding your tongue against the teeth can develop into a problematic habit. Sometimes these actions happen in the night during sleep. This will lead to the impression of the teeth on the tongue sides. Sometimes these habits are caused due to anxiety.
Stress, nervousness, and anxiety during an extended period cause muscle tension and stiffness. The muscles contract and this produces pain. Being a muscle, it is just natural that the tongue also undergoes these symptoms.
When the tongue strains from tension in the jaw, it can be considered as a sign of warning. Finding the source of stress and rectifying it is a good idea.
Do consult the doctor if the tongue does not relax over time. Meanwhile, try treating anxiety by cardiovascular exercise, healthy diets, and relaxation techniques.
13. Hypothyroidism / Thyroid Disease
One of the most common causes of a scalloped tongue is thyroid disease or thyroid hormone deficiency. This is also known as hypothyroid.
The thyroid hormone is responsible for regulating the metabolic activities and normal functions of the body.
Insufficient thyroid hormone can cause severe face, eyelid and lip swelling and enlargement of the tongue and other glands. This can make the tongue scalloped.
Other symptoms of the thyroid disease include:
- Hair thinning
- Dry skin
- Muscle pain
- Increased sensitivity
The thyroid disease can occur due to Hashimoto’s disease, Thyroiditis or Congenital hypothyroidism.
Other causes can be:
- Excessive intake of chlorinated fluoridated drinks (especially water)
- Excessive ingestion of brominated flour.
- Insufficient iodine intake.
Elements like chloride, fluoride or bromine can replace iodine in the thyroid gland, causing the insufficient secretion of the thyroid hormone.
In this case, of tongue scalloping the treatment would consist of:
a. Daily intakes of hormone replacement tablets and vitamin B,
b. Increased consumption of vitamin B through diet. Vitamin B can be obtained from fish, nuts, cereals, seeds, vegetables, seaweed, etc.
c. Stress management and relaxation techniques. These may include deep breathing sessions, meditation, and regular exercise.
d. Radiation therapy.
e. Unconventional treatment options include acupuncture, naturopathic medicine, homeopathy, traditional Chinese medicine, osteopathy.
14. Other Causes:
Much less common causes of tongue swelling and scalloping are:
- Digestive problems
- Sinus Abnormalities
Diagnosis & Treatment:
Analyzing the scalloped tongue and determining the reasons that caused it is very important to embark on a correct treatment. For this is also necessary to examine carefully all the possible symptoms, with the help of any medical test required for the purpose.
Overall, proper care and maintenance of the health of the mouth help in treating the scalloped tongue. However, since it is just a manifestation of an underlying problem, the treatment differs greatly depending on the cause of the indentation.
Nonetheless, general treatment methods include:
It refers to the process of removing toxic substances from the organism. This can be done by simply drinking large amounts of water, or by liver dialysis or drug detoxification depending on the intensity of the toxicity in the body.
ii. Dental Devices
These are recommended especially for cases in which tongue scalloping occurs due to clenching or grinding of the teeth in sleep.
Mouth guards such as those used in sports are commonly used. They protect the teeth and prevent the tongue from pressing onto them. The type of device to be used will be recommended by the dental specialist.
In case of misalignment of the teeth, it is recommended to visit a dentist and discuss the best option for the correction of the alignment and prevention of tongue scalloping.
iii. Changes In The Diet
Many times, swelling and scalloping of the tongue can occur due to nutritional deficiencies. In such cases, it is essential to regulate the daily intake of nutrients and increase the portion of vitamins and minerals through food, oral supplements, or injections as recommended by the physician.
A scalloped tongue is not a disease in itself, and it is a rather harmless condition. However, it is better to have it checked and treated to prevent any further issues, as it can be an indicator of an underlying health problem. Having a check-up can help in identifying and treating the actual disorder.
Also, it is important to maintain a good oral health and hygiene to prevent any buccal inflammation and allergies that may lead to swelling of the tongue and cause scalloping.