Scalloped tongue is a harmless condition where the sides of the tongue has indentations that look wavy and rippled. The amount and severity of these indentations may vary from person to person but it is often painless. In fact, those with more mild scallops on their tongue may not even realize that they have it. However, the presence of this tongue condition often signifies an underlying health condition that may need to be addressed.
This condition is also known by a couple of other names but the names basically describe the appearance of the tongue.
Wavy tongue
Pie crust tongue
Crenated tongue
Lingua indentata
Table of Contents:
What does it look like?
A scalloped tongue does not look smooth like a normal one does. It has grooves or notches that run all along the sides of it. The color of these ridges may be pink, white, or even red. The overall size of the tongue can remain normal but it can also be bigger than average. If the tongue is bigger than average, we refer to it as macroglossia. Therefore, the appearance of this condition can vary from person to person.
Here are some descriptions of what it looks like by non-healthcare individuals:
Ridges on side of tongue
Wavy tongue
Teeth marks on tongue
Tongue scalloping
Lines on side of tongue
Rippled tongue
Bite marks on tongue
Jagged tongue
Basically all of the words used to describe it are along the lines of it not being smooth. They're all variations of words that mean the scallops are uneven. Definitely does not share any similarities with a normal tongue.
We wouldn't describe it as bumps on the sides of the tongue. The definition of having bumps means that there is an additional increase in mass or size of the object. That is an inaccurate description of scalloped tongue because the indentations make it look like it is missing pieces of the tongue.
Diagnosis
You don't need tests to determine if you have a scalloped tongue because it is diagnosed purely based on its clinical appearance. To put it simply, if your tongue looks scalloped you have the condition and it doesn't get easier than that.
It is unnecessary to run tests to tell you that your tongue looks scalloped but if you insist, you can have these additional tests done:
Blood tests. To check proteins, vitamins, minerals, or toxins.
Biopsy. To visualize the tissue sample under a microscope.
CT scan. To obtain a radiographic image of the tongue.
MRI. Can detect certain diseases that a CT scan does not.
In our opinion, using tests to diagnose this condition is a poor value proposition for your time and your money. The only time we would recommend to proceed with tests is if we suspect a genetic condition that may be causing it.
Causes & Treatment for Scalloped Tongue
There are a variety of conditions which may cause the tongue to look scalloped and consequently the treatment for it will depend on what causes it. Therefore, there isn't one specific cure for it.
OSA - Obstructive Sleep Apnea
You may be surprised but OSA, which is commonly associated with snoring can cause a scalloped tongue. In fact, one study has shown that 44% of the patients being evaluated for obstructive sleep apnea had some degree of scalloping on the tongue. The conclusion of the study was that indentations on the tongue were indeed predictive of abnormal sleeping habits.
Here is a picture to demonstrate the role of the tongue when you have OSA.
What happens is the tongue slides back to the back of the throat and that blocks air flow from going in.
What it means is that you are unable to breathe.
In order to get oxygen, you will snore and concurrently thrust your tongue forward into your teeth so that it opens the airway back up in your throat.
This allows you to breathe but at the same time, is what causes the teeth marks on your tongue.
Treatment
There are a variety of methods to treat obstructive sleep apnea but your doctor may use a combination to address the condition.
Lose weight. Typically when you gain a lot of weight, your neck gets thicker and that causes the airway to close off more easily. Simply losing weight will help open up the airway because there is less fat around your neck compressing on the airway.
CPAP. A device called a CPAP (continuous positive airway pressure) can be worn at night time where it forcefully pushes air down your throat to prevent the airway from closing. One comment we often hear from patients using it is that it can get a little noisy.
Mouth guard made for snoring. There is a dental night guard that you can have specially made which pulls your lower jaw forward, thus helping you to keep the airway open.
Narrow Teeth Arch
This is a dental condition where the arches of your teeth are very constricted and narrow. When this happens, it decreases the amount of space your tongue can occupy in your mouth. Ultimately, the tongue gets pushed backwards towards the back of your throat and that can cause a decrease in your airway.
Therefore having a narrow arch for your teeth may cause you to snore more. This means that your body will try to thrust your tongue forward to create more space and open up the airway. This will cause teeth marks on your tongue, thereby giving you a scalloped tongue.
Treatment
In order to fix a narrow arch, you will actually need to expand it by doing either braces or Invisalign. Usually when we straighten the teeth, we want to give the arch a nice U-shape. This not only looks better cosmetically but also gives your tongue a lot more room. Your tongue doesn't have to be jammed up into the teeth and end up with indentations on them!
This is one of the situations where orthodontics is used to correct a problem that is not cosmetic and isn't that interesting?
Anxiety
Individuals who are extremely anxious may have parafunctional habits such as teeth grinding, teeth clenching, and even thrusting their tongue into their teeth. If they have a tendency to thrust their tongue, the tongue could acquire teeth marks in them if they do it for a long period of time.
The reason this happens is because some anxious people need a stress outlet. Some people will do kickboxing, while others will play around with their tongue. If you're doing this, that could just be what your body prefers to do in order to relieve stress.
Treatment
Treating anxiety usually involves a combination of approaches.
Medication. Your doctor can prescribe you an axiolytic, which is a medication that can help you become less anxious.
Lifestyle alterations. Typically stress stems from a particular source so it would be helpful if you could identify what it is and decrease the activity from it.
Alternative sources of stress release. In lieu of thrusting your tongue and causing your tongue to have a scalloped appearance, maybe take up yoga to help de-stress. There are a ton of alternative ways to relieve stress.
Dehydration
According to a variety of prominent online health sources, dehydration can lead to tongue swelling. Since the tongue swells up, it can push against the teeth which results in it acquiring a scalloped appearance.
However, we've been unable to find a single study on Google Scholar nor on PubMed that can verify such a phenomenon. Therefore, we will have to classify dehydration as a questionable cause for our tongue condition of interest.
TMJD - Temporomandibular Joint Disorders
Patients with TMJ disorders have a tendency to grind their teeth and clench their jaws at night. Sometimes they also push their tongue into their teeth, which can give it a ridged tongue.
Treatment
TMJ is a very complex condition that involves the joint that connects the jaw to the skull as well as the muscles that attach to the jaw. Therefore, you need to treat not only the joint but also the muscles.
Splint or night guard. Your dentist will make you a mouth guard to wear at night that can protect your teeth as well as reposition your joint into a more optimal position.
Physical therapy. You should see a physical therapist so that they can treat the jaw muscles. They'll also give you jaw exercises to do at home to strengthen the musculature.
Botox. If your muscles are very overactive, you could consider getting botox to freeze the muscles.
Stress relief. Partake in stress relieving activities and it should help you decrease the amount of parafunctional habits at night.
Amyloidosis - Nutritional Deficiencies
Amyloidosis is a rare disease that is characterized by a buildup of amyloid deposits within the body. In our case, we're most concerned with amyloid buildup in the tongue. Patients with this condition often present with macroglossia, an enlarged tongue due to amyloid deposits.
The enlarged tongue may end up becoming a scalloped tongue since there is not enough space in the mouth for it. It will often push against the back of the teeth, which gives it indentations and teeth marks.
A vitamin B12 deficiency is often found in patients with amyloidosis and macroglossia. Therefore it is of utmost importance to get enough vitamin B12!
Treatment
This condition will require the expertise of your medical doctor because your dentist will not be able to treat amyloidosis. There is currently no cure for the disease but the available treatment involves a combination of chemotherapy and heart medications.
Smoking
Smoking will not cause a scalloped tongue because it typically does not result in your tongue swelling up. A more likely outcome for your tongue from tobacco use is a different condition called hairy tongue.
The dark discoloration from the tongue can come from the tobacco tar.
It is the filiform papilla, which are hair-like structures on the tongue, which get stained.
Treatment
You either need to quit smoking or you need to start brushing your tongue. You can also purchase a tongue scraper that you can use to clean the discolored filiform papilla.
Genetic Disorders
There are certain genetic disorders which may cause you to have macroglossia, an enlarged tongue. Here are some disorders which have it as a symptom.
Down syndrome. Patients can have a large because patients tend to have a smaller jaw in relation to their tongue. That makes the tongue too large for their mouth.
Hypothyroidism. A symptom of this disease is a large protruding tongue as well as malocclusion.
Apert syndrome. The tongue can appear excessively large.
Overall, any genetic disorder that can lead to macroglossia have a possibility of developing scalloped tongue. That is just a natural consequence of the condition.
Takeaway
A scalloped tongue is when the sides of the tongue look like they have indentations and ridges in them. It is typically a harmless and painless condition but often signifies a greater underlying medical condition. Thus, you should still go get it diagnosed and checked out by scheduling a dental check up. You may need treatment for whatever caused it.
Author: Written by Dr David Chen, a dentist in long island city. If you are in the NYC area and need an oral pathologist, we refer all of our patients to Dr Scott Peters.
