Scalloped Tongue Causes, Pictures, Hypothyroid, Diagnosis & Treatment

What is a scalloped tongue? Does hypothyroid, swollen tongue, Spleen Qi deficiency, sleep apnea, or Temporomandibular joint syndrome cause it? What are its symptoms, treatment and diagnosis?

What is the meaning of a scalloped tongue (crenated tongue edges?)

The scalloped tongue also is known as a crenulated tongue, crenated tongue, lingua indentation or pie crust tongue 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. Some people often describe it as wavy tongue edges, an indentation on side of the tongue, rippled tongue edge, tongue ridges along sides, teeth marks on side of the tongue, among other descriptions.

Whenever your tongue becomes larger than normal, it will press onto your teeth. This tends to cause indentations. In Chinese traditional medicine (TMC), scalloping of the tongue is said to indicate qi vacuity while in homeopathic, it indicates high blood pressure, according to many sources.

Scalloped tongue symptoms

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When you have a tongue that is scalloped, it tends to be enlarged or be swollen with a groove like the impression of the teeth and fissures along the sides of the tongue. Although your tongue might retain its natural color, there might be some redness if there is pressure or friction on your tongue edges. Furthermore, it might also come with other symptoms that might be associated with its cause such as a sore throat, swollen tongue, tongue pain, halitosis, etc.

Scalloped tongue causes or why is my tongue scalloped?

A scalloped or crenated tongue 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 of scalloped tongue include:

Swollen tongue 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 a swollen tongue with scalloped edges i.e. when your tongue swells, becoming too big for your mouth, leaving teeth marks around its edge.

The swollen tongue could be due to allergies, some disease and conditions such as (amyloidosis, hypothyroidism, tongue cancer, canker sores, scarlet fever, angioedema, etc.), dehydration (can cause swollen tongue and a dry mouth), among many other causes.

Scalloped tongue thyroid or hypothyroid

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Deficiency or lack of thyroid hormone due to non-functioning or underactive thyroid glands (hypothyroidism) can affect normal body function since the thyroid hormone regulates the way in which the body uses energy – metabolism – and without enough of this hormone many of the body’s functions slow down.

Furthermore, when you have little or no thyroid hormone, you might have a swollen face and tongue i.e. “severe swelling of the face may cause swollen eyelids, thickened lips and an enlarged tongue”. As already seen, the swollen tongue is one of the causes of scalloping.

Thyroid disease or problems are caused by Hashimoto’s disease, Thyroiditis or Congenital hypothyroidism. Besides a scalloped and swollen tongue, you will also have other symptoms that include fatigue, hoarseness, hair thinning, dry skin, constipation, muscle aches, depression, and increased sensitivity to cold, among others.

Treatment of thyroid scalloped tongue will involve 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.

Temporomandibular joint syndrome

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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. 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 your tongue 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.

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 to energy. You will be fatigued, have a pale tongue and face, lose weight, and have a poor appetite in addition to a crenated tongue.

Sleep apnea

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A possible cause of tongue with 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. The disrupted breathing while asleep often makes one’s tongue ‘falls back into the oral cavity’ and this can make it scalloped.

Bad habits and scalloped tongue anxiety

Developing some habits such as clenching, grinding or pressing your tongue against dental arches over prolonged periods of time can result in this problem. Anxiety can also make people to press their tongue against their teeth leading to this problem since it often causes muscle tension.

Mineral and vitamins deficiency

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Folate and vitamin B-12 deficiency will cause abnormally excess red blood cell production that do not work well, a condition 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, “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”.

Painful and fissured indented tongue

Having a tongue that is scalloped 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.

Other causes

Having a pale or white scalloped tongue might be an indication of digestive problems, arthritis or sinus problem.
Scalloped tongue diagnosis

Before you embark on treatment, right scalloped tongue 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 with your tongue scalloping. Some tests for the various possible causes (diseases and conditions) might also be important.

Scalloped tongue edges Treatment

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Treatment of this condition involves treating the underlying problem. Once the correct diagnosis has been done, the next step will be treating the underlying condition since tongue scalloping is not a disease on its own. Generally, good dental oral care is recommended besides specific treatments.