Scalloped Tongue

What Does Scalloped Tongue Mean?

Also known as the crenated tongue, this makes reference to the appearance of the tongue. Indentations are present along the lateral borders of the tongue, this being mainly caused by the compression realized by the adjacent teeth. In general, the mucosa of the tongue retains its normal color but, in some cases, a degree of erythema might be present (suggestive of excessive friction or pressure). There are no other symptoms associated with the scalloped tongue; moreover, this asymptomatic condition is harmless.

scalloped tongue

Picture of a Scalloped tongue

It is important to understand that this is not a disease per se but rather a modification caused by the habit of pressing the tongue against the dental arches. As you will have the opportunity to read below, this is often seen in people who present an enlarged tongue. This is known as macroglossia, being one of the characteristic features for those who suffer from Down’s syndrome. Other denominations for this modification include the pie crust tongue, lingua indentata or the crenulated tongue. It may found in association with other problems, such as bruxism, linea alba or morsicatio buccarum (parafunctional habits).

Causes

scalloped tongue pictures

Picture of Scalloped tongue edges

These are the most common causes that can lead to the appearance of the scalloped tongue:

  • Medical conditions that can cause the tongue to become enlarged:
    • Amyloidosis
    • Neoplastic growth
    • Canker sore
    • Scarlet fever
    • Thyroid disorders
      • Hypothyroidism (absence/insufficiency of thyroid hormones; underactive thyroid gland)
      • Autoimmune thyroiditis (Hashimoto’s disease)
      • Congenital hypothyroidism
  • Allergies
  • Angioedema (severe anaphylactic reaction to an allergen)
  • Dehydration (often accompanied by the dry mouth or throat sensation)
  • Temporomandibular joint syndrome – caused by:
    • Bruxism (excessive teeth grinding)
    • Chronic migraines or headaches
    • Neuralgias
    • Inflammation at the level of the jaw.
  • Spleen deficiency
  • Sleep apnea
  • Bad habits (tongue pressed against the dental arches)
  • Anxiety
  • Mineral/vitamin deficiency
    • Folate deficiency
    • Vitamin B12 deficiency
    • Iron deficiency
  • Gastrointestinal disorders (digestive process affected)
  • Arthritis
  • Inflammation of sinuses (sinusitis).

Symptoms of a Scalloped Tongue

According to the above-mentioned causes, the scalloped tongue can be accompanied by the following symptoms:

  • Mouth dryness (dehydration)
  • Inflammation at the level of the face, with visible swelling of the eyelids and lips (hypothyroidism)
  • In the situation that the person suffers from autoimmune thyroiditis (Hashimoto’s disease), the following symptoms are possible:
    • General state of weakness or fatigue
    • Change of voice (hoarse voice)
    • The hair loses its quality (thinning hair)
    • The skin becomes dry and flaky
    • Indigestion and constipation are frequent
    • Muscle and joint aches
    • Feelings of depression and anxiety
    • Increased sensitivity to extreme temperatures (especially the cold ones).
  • The symptoms associated with the temporomandibular joint syndrome are:
    • Jaw instability
    • The tongue is used to ensure the stability of the jaw (thus, the teeth are clenched and the indentation marks lead to the characteristic aspect of the tongue).
  • Spleen deficiency symptoms include:
    • Pallor of the tongue and face
    • Weight loss
    • Reduced hunger sensation.
  • Sleep apnea is associated with:
    • Paused breathing
    • Shallow breathing
    • Tongue in an improper position, with the dental arches pressing on the lateral sides.
  • Anxiety:
    • People who suffer from anxiety are always tensed and that is reflected in their muscles; the tongue is also a muscle, hence the associated symptom of muscular tension.
  • Vitamin/mineral deficiency:
    • Inflammation of the muscle tongue (folate and vitamin B12 deficiency – megaloblastic anemia)
    • Fatigue, muscular weakness and rapid heartbeat (iron deficiency anemia).

Diagnosis

These are the most common methods used for the diagnosis of the scalloped tongue:

  • Medical history of the patient
    • When was the scalloped tongue noticed for the first time
    • Associated or pre-existing conditions
    • Family history (for example, of thyroid dysfunction)
    • Bad habits, sleeping patterns, water intake etc.
  • Physical examination
    • Assessment of tongue appearance (identification of dental grooves on the lateral side of the tongue)
  • Laboratory testing
    • CBC (complete blood count) – identification of anemia
    • Thyroid hormone levels – suspicion of thyroid disorders
    • Other blood tests to confirm the diagnosis of a suspected underlying condition.

Scalloped Tongue Treatment

As the scalloped tongue is not a harmless modification, no treatment per se is required. However, the doctor might recommend certain treatment approaches for the underlying conditions. Also, it is necessary that one gives up bad habits, such as grinding the teeth excessively or keeping the muscle tongue tensed. If all matters are addressed, the tongue will regain its normal and characteristic appearance, without any treatments being necessary.

scalloped tongue pictures 2

Scalloped tongue – How to get rid of it?

These are the treatment approaches recommended for the underlying conditions that have led to the scalloped tongue in the first place:

Allergies

  • Identification of allergen and avoidance (if possible)
  • Antihistamines (oral administration) – reduce the inflammation and help the patient cope with the other symptoms of the allergies
  • Corticosteroids – recommended for more severe allergies and not for prolonged periods of time, due to the serious side-effects they can have over a person’s health

Angioedema

  • Emergency medical assistance is required, so as to ensure that the condition does not become life-threatening
  • Antihistamines and epinephrine should be immediately administered
  • Intubation and artificial ventilation (respiratory support) might be necessary in more serious cases

Hypothyroidism

  • Administration of thyroid hormone supplements
  • Stress management therapy
  • Diet change (foods that are rich in vitamin B)
  • Acupuncture
  • Traditional Chinese medicine
  • Homeopathic medicine
  • Biofeedback therapy
  • Osteopathy

Temporomandibular jaw syndrome

  • Surgical remodeling of the jaw
  • Correction of dental arch/jaw

Spleen deficiency

  • Natural herbal remedies
  • Diet change (tonic foods – carrots, cayenne pepper, radishes)
  • Traditional Chinese medicine

Sleep apnea

  • Continuous positive airway pressure
  • Expiratory positive airway pressure
  • Oral appliances
  • Surgical intervention
    • Tissue removal
    • Jaw repositioning
    • Implants (plastic rods)
    • New passageway (tracheostomy).

Anxiety

  • Psychological counselling
  • Stress management therapy

Mineral/vitamin deficiency

  • Vitamin supplements
  • Diet change (eating foods that are rich in folic acid, vitamin B12 or iron)
  • Recommended foods:
    • Poultry, cheese, eggs, fish (vitamin B12 and folate acid)
    • Leafy greens, beans, meats, fish, cereals (iron)

Oral cancer

  • Radiation therapy
  • Cancer therapy
  • Surgical intervention

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