What Are the Causes and Treatments for Scalloped Tongue?

What is a Scalloped Tongue?

A scalloped or crenated tongue has wavy indentations along the sides. These indentations, called crenations or scalloping, result from pressure from the adjacent teeth.

When your tongue is compressed against the surrounding teeth, the edges bear most of the pressure, leading to a wavy or scalloped appearance.

Various health conditions can cause a scalloped tongue, including sleep apnea, anxiety, and certain autoimmune or endocrine disorders. However, it isn’t a major cause for concern in most cases.

What Does a Scalloped Tongue Look Like?

A scalloped tongue has edges that can be described as rippled, wavy, or dented. Other terms include pie crust tongue or lingua indent.

Medical image of a scalloped tongue

Medical image of a scalloped tongue

Medical image of a scalloped tongue

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What are the Symptoms of a Scalloped Tongue?

Aside from your tongue’s appearance, you may not notice any other symptoms from a scalloped tongue. 

However, it’s possible that you’ll experience:

• Soreness or pain in your tongue, mouth, or throat
• Tongue numbness
• Other changes in the appearance of your tongue, such as redness or an unusually smooth surface
• Difficulty breathing (if your tongue is enlarged)

Depending on the underlying cause of your scalloped tongue, you may also have non-tongue-related symptoms (see the causes above).

What Causes a Scalloped Tongue?

A scalloped tongue isn’t necessarily dangerous but can be a symptom of various medical conditions. We’ll discuss each of these below.

Stress and Anxiety

Chronic stress and anxiety can lead to bruxism and tongue swelling, both of which can contribute to a scalloped tongue.

Bruxism is the unconscious habit of teeth grinding or jaw clenching, which can put pressure on your tongue.^2,3 Many people experience bruxism during the day, while they sleep, or both. Bruxism can be caused by stress, anxiety, or other factors.

Some people experience tongue swelling, or the feeling of swelling, as a symptom of anxiety.⁴ If your tongue is swollen for a significant period, it can appear rippled or scalloped due to being pressed against your teeth.

Nutritional Deficiencies

A scalloped tongue can be a sign of vitamin deficiency or dehydration. If you’re dehydrated or aren’t getting enough iron or B vitamins, your tongue may become larger than normal. This can lead to rippling or scalloping where your tongue touches your teeth.

Dehydration, B vitamin deficiency, and iron deficiency can all cause other symptoms, such as:

• Lightheadedness or dizziness
• Weakness or fatigue
• Confusion
• Increased heart rate

You may also notice flushing, dry mouth, and darker urine with dehydration. An iron or B vitamin deficiency makes you more likely to notice pale skin, numbness or tingling, and shaky muscles.

Amyloidosis

Amyloidosis is a disease caused by a buildup of abnormal clusters of protein (amyloids) in different parts of the body. It can run in families or be a side effect of another condition, and most often begins between ages 55 and 60.

Symptoms of amyloidosis include:^5,6

• Enlargement or swelling of the tongue
• Abdominal or leg swelling
• Unintended weight loss
• Fatigue
• Frothy urine
• Skin that bleeds or bruises more easily than usual, including under eye bruises

Your brain, heart, kidneys, and other organs can be harmed by amyloidosis. Treatment may include chemotherapy, stem cell transplants, and various medications. These are all aimed at reducing inflammation and the buildup of amyloids.

Talk to your doctor immediately if you have any of the above symptoms.

Thyroid Disorders

The thyroid gland in your throat produces hormones and regulates metabolism. If you have low levels of thyroid hormone (hypothyroidism), you may experience tongue enlargement and scalloping.⁷ Other soft tissues, such as the lips and skin, may also be affected.

Other symptoms of hypothyroidism include:

• Fatigue or low blood pressure
• Unintended weight gain
• Hair loss
• Dry skin, which may bruise easily
• Joint and muscle pains or cramps
• Sensitivity to cold
• Depression
• Irregular periods in females

An inflamed or overactive thyroid (thyroiditis or hyperthyroidism) may also have an effect on your tongue. It may cause burning mouth syndrome.

See your doctor if you notice any unusual changes to the feeling or appearance of your tongue, especially if you also have other thyroid disorder symptoms.

Sleep Apnea

Some studies have found evidence of a link between a scalloped tongue and obstructive sleep apnea (OSA). One study found the link to be especially strong in people who were overweight.⁸

People with sleep apnea experience temporary pauses in breathing while they sleep. During these pauses, their tongue may push against their teeth as they struggle to breathe.

Other possible symptoms include:

• Sleepiness or low energy during the day
• Irritability
• Morning headaches
• Waking up with a dry mouth
• Insomnia

Untreated sleep apnea can be life-threatening. If you suspect you have sleep apnea, see your doctor as soon as possible.

Macroglossia

Macroglossia is the technical term for an enlarged tongue.⁹ Some conditions we listed above can cause macroglossia to develop over time, but it’s also possible to be born with it.

You may be perfectly healthy and have a slightly larger tongue than the average person. However, many people are born with macroglossia as a result of genetic disorders like the following:

• Down syndrome
• Acromegaly
• Apert syndrome
• Beckwith-Wiedemann syndrome

Each of these conditions has a variety of other symptoms, which are often present at birth. It’s also possible to have relative macroglossia—in this case, the tongue is normal, but a small lower jaw makes it appear larger.

Other Causes

Scalloping is often the result of tongue swelling or enlargement (macroglossia). With an increase in size, the tongue presses against the teeth more than usual.

A swollen tongue can have various other causes, including:

• Allergic reactions or irritating foods
• Inflammatory or autoimmune conditions, such as Sjögren’s syndrome
• Other metabolic disorders, like mucopolysaccharidosis or lipoid proteinosis¹
• Certain cancers, including tongue cancer (though this is rare)
• An injury, such as a burn to the tongue
• An oral yeast infection

The conditions above typically involve significant oral pain and sometimes other bodily symptoms. If you notice wavy tongue edges but have no pain or other symptoms, these are unlikely to be the cause.

Even if your tongue isn’t swollen, temporomandibular joint disorders may create scalloped edges due to teeth clenching. It’s also possible for your tongue to have rippled edges due to missing teeth.¹⁰

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What Are the Causes and Treatments for Scalloped Tongue?

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How to Get Rid of a Scalloped Tongue

In most cases, a scalloped tongue isn’t a reason to worry. However, it can sometimes indicate a potentially serious underlying condition. The best course of treatment will vary from one condition to another.

Professional Treatments

Professional treatment will address the cause of your scalloped tongue. 

After arriving at a proper diagnosis, your doctor may recommend:

• Specific medications (for conditions such as amyloidosis or thyroid disorders)
• Chemotherapy (for amyloidosis or cancer)
• IV fluids (if you’re severely dehydrated)
• Anxiety medication
• Treatment for sleep apnea, such as a mouth guard or CPAP machine
• Tongue reduction surgery (if you were born with macroglossia)

Most of these conditions are rare (sleep disorders and anxiety being major exceptions). In addition, they’re likely to cause other symptoms and may have complications beyond tongue scalloping.

If you have a scalloped tongue and no other symptoms or concerns, you don’t necessarily have a condition that requires professional treatment.

Home Remedies

If your scalloped tongue is due to dehydration or a nutrient deficiency, you can take steps at home to reduce it.

Drinking more water throughout the day will help keep you from getting dehydrated. Consider drinking a sports drink or electrolyte solution (such as Pedialyte) if you’re dehydrated. This will help replenish lost fluids and important minerals like sodium and potassium.

If you’re deficient in B vitamins or iron, try adding more foods to your diet that contain these nutrients. Eggs, seafood, red meat, leafy greens, and fortified cereals can help raise your B vitamins and iron levels.

Your doctor may also recommend taking an oral supplement to replenish your body’s iron or vitamin B levels.

When to See a Doctor for a Scalloped Tongue

See your dentist or doctor if you notice any unusual or unexpected changes to how your tongue looks and/or feels.

While a scalloped tongue generally isn’t an emergency, a doctor can help you determine what may be causing it. Be sure to inform your doctor of any other symptoms you’ve been experiencing.

If you have severe oral pain or difficulty breathing, seek emergency care.

How Can I Make My Tongue Feel Normal Again?

This depends on the underlying cause. A wide variety of conditions, some of which are more serious than others, can cause changes in your tongue’s appearance and sensation.

Many people with tongue indentations don’t notice them until they look in the mirror. They’re rarely painful. But if you notice changes in how your tongue feels, see your dentist or doctor.

Summary

A scalloped or crenated tongue has wavy indentations along the sides. These indentations are created by pressure, often due to a person’s tongue being larger than normal or tension in the jaw or teeth.

In most cases, a scalloped tongue isn’t anything to worry about. However, tongue enlargement and crenation can sometimes be signs of a more serious illness. If this is the case, you’re likely to have additional symptoms.

Talk to your doctor if you notice any unusual changes in how your tongue looks or feels. Let them know if you’re experiencing any other symptoms as well.