What is a scalloped tongue? Does thyroid problems, swelling, Spleen Qi deficiency, sleep apnea, or Temporomandibular joint syndrome cause it? What are its symptoms, treatment, and diagnosis?
The scalloped, crenulated, pie crust, the crenated tongue also known, lingua indentata “is a descriptive term for the appearance of the tongue when there are indentations along the lateral borders (the sides), as the result of compression of the tongue against the adjacent teeth” [Wikipedia.org].
Some people often describe it as a tongue with a wavy, indentation on its side, rippled edge, ridges along sides or with teeth marks on its side, among other descriptions.
Whenever it’s scalloped it becomes larger than normal, it will press onto your teeth. This tends to cause indentations.
In Chinese tradition medicine (TMC), “scalloping of the tongue is said to indicate qi vacuity” [Wikipedia.org] while in homeopathic, it indicates high blood pressure, according to many sources.
When you have this problem, your tongue tends to be enlarged or be swollen with “groove-like impressions of the teeth and fissures along the sides of the tongue” [Tandurust.com]. Although it might retain its natural color, there might be some redness if there is pressure or friction on your its edges.
Furthermore, it might also come with other symptoms which might be associated with its cause such as a sore throat, swelling, pain, as well as halitosis, among others
It is important to note that this condition is harmless and it is not a disease on its own but a condition that results from other conditions and diseases. Some of the common causes include:
1. Swelling or macroglossia
When your tongue swells so much, it will tend to apply pressure to your dental arches which will, in turn, make it scalloped or you will have scalloped edges i.e. “when your tongue swells, becoming too big for your mouth, leaving teeth marks around its edge” [Newsmax.com].
The swelling could be due to allergies, some disease and conditions such as (amyloidosis, hypothyroidism, oral cancer, canker sores, scarlet fever, angioedema, etc.), dehydration (can also make it swell as well as cause a dry mouth), among many other causes.
2. Thyroid or hypothyroid problems
Deficiency or lack of thyroid hormone due to non-functioning or underactive thyroid glands (hypothyroidism) can affect normal body function since “thyroid hormone regulates how the body uses energy – metabolism – and without enough of this hormone many of the body’s functions slow down” [Medicalnewstoday.com].
Furthermore, when you have little or no thyroid hormone, you might have “severe swelling of the face may cause swollen eyelids, thickened lips and an enlarged tongue” [Ito-hospital.jp]. As already seen, swelling alone can cause scalloping.
Thyroid disease or problems are caused by Hashimoto’s disease, thyroiditis or congenital hypothyroidism. Besides a scalloped and a swollen tongue, you will also have other symptoms that include fatigue, hoarseness, hair thinning, a dry skin, constipation, muscle aches, depression, and increased sensitivity to cold, among others.
Treatment here will involve involving treating hypothyroidism using hormone replacement tablets taken daily, manage stress, eating foods rich in vitamin B, radiation therapy, “acupuncture and traditional Chinese medicine, naturopathic medicine, homeopathic medicine, biofeedback, and osteopathy” [Womentowomen.com].
3. Temporomandibular joint syndrome
This is a disorder of the nerves and jaw muscles connecting the skull and jaw due to the injured temporomandibular joint. It is characterized by tooth grinding (bruxism), headaches, nerve inflation, swelling on the sides of your face, chewing pain, clicking or jaw popping, etc.
This condition and/or teeth that do not fit well can cause jaw instability. Most people will try clenching their teeth using their tongue to keep the jaw in position i.e. if the “bite isn’t coming together properly to stabilize your jaw for swallowing… your tongue pushes up against your teeth to help stabilize them” [mjtreatmentsc.com]. This can result in a tongue with teeth marks or grooves.
It is worthwhile to note that if your tongue is not swollen but still has teeth marks, you might be having a narrower lower jaw or you have developed a habit of pushing it on your dental arches.
Jaw surgical remodeling and fixing teeth that do not fit well can be a solution if your case is due to the temporomandibular joint disorder.
4. Spleen QI deficiency
If your tongue is not only scalloped but also swollen and fissured, spleen qi deficiency could be behind it, i.e. according to traditional Chinese medicine.
When this happens, your spleen will unable to do its digestive functions especially transforming food into energy. You will be fatigued, have a pale tongue and face, lose weight, and have the poor appetite in addition to scalloping.
5. Sleep apnea
A possible cause of scalloped edges is sleep apnea which is a “common disorder in which you have one or more pauses in breathing or shallow breaths while you sleep” [nhlbi.nih.gov]. The disrupted breathing while asleep often makes one’s tongue ‘falls back into the oral cavity’ and this can make it scalloped.
6. Bad habits and anxiety
Developing some habits such as clenching, grinding or pressing your tongue against dental arches over prolonged periods can result in this problem.
Anxiety can also make people press their tongue against their teeth leading to this problem since it often causes muscle tensions.
7. Mineral and vitamins deficiency
Folate and vitamin B-12 deficiency will cause abnormally excess red blood cells production that does not work well, a condition is known as megaloblastic anemia. This can lead to a swollen and crenated tongue.
To solve the problem, take vitamin B-12 and folate supplements as well as foods such as poultry, fish, eggs, fortified plant foods, dairy, etc. that are rich in vitamin B-12.
Furthermore, iron deficiency has also been associated with this problem. According to livestrong.com, “iron deficiency may also cause a swollen and scalloped tongue … Meats, fish, poultry, leafy greens, beans, and fortified breakfast cereal can help you meet your daily iron needs”.
8. Painful and fissured indented tongue
Having a scalloped tongue might also indicate a possibility of oral cancer, especially if accompanied by a painful fissure or sore. Cancer has a lower likelihood and it will have many other oral cancer symptoms.
9. Other causes
Before you embark on treatment, the right diagnosis is very important i.e. ensure you know what causes this problem before treating the underlying cause. You should carefully examine the symptoms that come scalloping. Some tests for the various possible causes (diseases and conditions) might also be important.
Treatment of this condition involves treating the underlying problem. Once a correct diagnosis has been done, the next step will be treating the underlying condition since scalloping is not a disease on its own. Generally, good dental oral care is recommended besides specific treatments.