Scalloped Tongue which is medically referred to as Crenated Tongue is a condition in which there is a significant change in the appearance of the tongue. They seem to have indentations on the sides mainly due to compression of the tongue against the teeth. There is no change in the characteristics of the oral mucosa around the affected region but if the tongue is exposed to increase friction there may be erythema noticed. Scalloped Tongue is a benign condition and tends to resolve on its own. Scalloped Tongue develops mostly out of habit rather than due to any medical condition when the individual presses the tongue on the teeth.[1]
Some people tend to develop Scalloped Tongue due to macroglossia which is a medical condition where the tongue gets enlarged. This happens mainly in people with a condition called Down syndrome. An individual with Scalloped Tongue will almost always have bruxism as has been noted in various studies. If Scalloped Tongue is caused due to an underlying medical condition then the individual may experience the symptoms of the condition as Scalloped Tongue is completely asymptomatic.[1]
In addition to the alteration in the appearance of the tongue, an individual with Scalloped Tongue will also experience erythema around the affected site, slight pain, and tenderness around the affected area. This article highlights some of the potential causes and treatment options for Scalloped Tongue.[1]
What Causes Scalloped Tongue?
Any condition which causes enlargement of the tongue may cause Scalloped Tongue. This is because the enlargement causes the tongue to be compressed against the teeth continuously. Other than this some of the other causes of Scalloped Tongue include:[2]
Habits: Habitual activities are the most prominent cause of Scalloped Tongue. These habits include teeth grinding, sucking on the cheek, and constantly picking the teeth. People get involved in these habits mainly due to stress, sleep problems, tooth infections, or trauma to the face.[2]
Infection/Allergic Reaction: This is yet another common cause for a Scalloped Tongue. The immune system gets activated whenever the body is subjected to trauma or if there is exposure to allergens. Certain infections may also cause the immune system of the body to act up. The immune response to these invaders results in inflammation because of which the tongue at times gets enlarged. This in turn results in the individual developing Scalloped Tongue.[2]
Nutrient Deficiencies: These are also one of the leading causes of Scalloped Tongue. People with vitamin and mineral deficiencies, especially vitamin B, tend to cause enlargement of the tongue. This ultimately leads to the tongue getting compressed by the teeth causing indentations as seen with Scalloped Tongue. Some of the other vitamins the deficiency of which can cause Scalloped Tongue include iron and vitamin B12.[2]
Dehydration: This is yet another cause for Scalloped Tongue. At times dehydration causes swelling of the tongue. When this happens, the tongue gets pressed against the teeth resulting in alteration in the appearance of the tongue which is the primary characteristic of Scalloped Tongue.[2]
Nicotine Use: Smokers are most at risk for developing Scalloped Tongue. Smoking irritates the mucosal tissues causing swelling and inflammation. It also promotes dehydration which is a common cause for Scalloped Tongue.[2]
Temporomandibular joint Dysfunction: If the TMJ gets infected or injured then it can cause indentations in their tongue. This happens mainly because of teeth grinding or because the teeth compresses against the teeth to accommodate the dislocated temporomandibular joint. It is seen that females tend to get affected more with Scalloped Tongue due to TMJ dysfunction than males.[2]
Sleep Apnea: This is also the most common cause of Scalloped Tongue. This is because lack of oxygen results in water to be retained by the body. Excess water retention causes swelling of the neck, head, and tongue. When there is swelling of the tongue, it again presses against the teeth causing Scalloped Tongue.[2]
A study conducted in Japan in 2017 in which around 1000 participants were studied discovered that majority of the people with Scalloped Tongue had nocturnal intermittent hypoxia which is the first sign of sleep apnea.[2]
Inflammatory/Infiltrative Pathology: This is also another cause of Scalloped Tongue. People who have chronic inflammatory conditions are at an increased risk of developing Scalloped Tongue. Infiltrative conditions are disorders which are caused due to abnormal buildup of cells. Certain congenital and inherited medical conditions also put an individual at risk for developing Scalloped Tongue. Some of inflammatory or infiltrative conditions include Down syndrome, hypothyroidism, sarcoidosis, tuberculosis, amyloidosis, angioedema, and multiple myeloma.[2]
How is Scalloped Tongue Treated?
With regard to treatment of Scalloped Tongue, the best way to manage this condition is by wearing a mouth guard. This prevents clenching and grinding of the teeth. It also does not allow constant friction of the sides of the tongue with the teeth thus preventing Scalloped Tongue. Other treatments for this condition depend on the underlying cause. In some cases, where infiltrative and inflammatory conditions cause Scalloped Tongue, surgery will have to be recommended to get the tongue back into is normal shape.[2]
Some of the treatment options for Scalloped Tongue include antiinflammatory medications to treat the inflammation that may have caused Scalloped Tongue. For hypothyroidism causing Scalloped Tongue, thyroid supplements will be given to normalize the levels of the thyroid hormone and restore the original shape of the tongue.[2]
Scalloped Tongue caused due to immune response of the body can be dealt with immunosuppressant medications. However, an individual on these medications will be at increased risk for developing infections since the immune system gets compromised on these medications and hence care should be taken. The surgery if recommended for treating Scalloped Tongue will aim at removing abnormal cell accumulation around the tongue.[2]
It will also focus on reducing the size of the tongue back into normal shape. For Scalloped Tongue caused by sleep apnea, this can be controlled by CPAP machine. For serious medical conditions like cancer causing Scalloped Tongue, treatment will depend on the stage and size of the tumor.[2]
There are also certain home remedies which can be tried to deal with Scalloped Tongue and include drinking plenty of fluids to stay hydrated, eating a balanced diet, practicing good oral hygiene. It is also recommended to maintain a healthy body weight and quitting smoking to prevent Scalloped Tongue. Avoiding triggers that may trigger an allergic reaction is also one of the ways to prevent Scalloped Tongue.[2]
Coping with stress in a healthful manner is also suggested to decrease the likelihood of developing Scalloped Tongue. In some cases, applying hot or cold compresses on the affected site for 15-20 minutes two to three times a day is a good way to manage Scalloped Tongue.[2]
In conclusion, Scalloped Tongue is a harmless condition of the tongue where the affected individual has an alteration in the appearance of the tongue. It is usually accompanied by erythema or pain in some cases. The oral mucosa around the affected region remains normal however. The primary causes of Scalloped Tongue are certain habits like grinding of the teeth or sucking of the cheeks. In some cases, certain medical conditions also cause Scalloped Tongue.[1]
In most cases, home remedies are good enough to treat Scalloped Tongue but in some cases a visit to a physician is required. It is recommended to seek medical consultation with a physician if an individual has Scalloped Tongue for a long period of time or is at risk for any serious underlying medical condition.[2]
If the appearance of the tongue does not get back to normal even after stopping habits like grinding the teeth or sucking the cheeks then also a consultation is necessary to get to the bottom of the cause of Scalloped Tongue and start treatment.[2]
It is very rare for Scalloped Tongue to be associated with any serious medical condition but the risk is there and should be ruled out by conducting various tests through a physician. Scalloped Tongue is a symptom of hypothyroidism and the presence of it may help diagnose thyroid abnormalities in many individuals who otherwise are completely asymptomatic.[2]
The physician will also help in managing habits that may cause Scalloped Tongue like grinding of the teeth or sucking of the cheeks by referring the individual to ta specialist. Otherwise, Scalloped Tongue is a completely benign condition in majority of the cases and can be treated easily.[2]
