Scalloped Tongue Causes, Meaning, Pictures, Diagnosis & Cure

Scalloped tongue is a condition that affects a number of individuals. In this article, learn what scalloped tongue edges means, especially in the context of Chinese Medicine, pictures, the causes including thyroid, Dehydration, Sleep Apnea. Also find out the symptoms & possible cures.

Wavy, Crenated or Scalloped Tongue-What does it mean?


In addition to wavy or crenated, scalloped tongue also goes by the names

  • Pie crust tongue
  • Lingua indentata
  • Crenulated tongue

What does it mean? This refers to a tongue appearance when it swells so much and indentations occur along the sides. The tongue appears scalloped as a result of compression alongside the adjacent teeth.

When your tongue gets too inflamed, it becomes too fat and big for the oral cavity it is meant to fit in and applies pressure on the dental arches. The dental arches make it scalloped leaving teeth marks on it edge.

The cause of scalloped tongue may be hypersensitivity reactions in which exposure to an allergen results in inflammation. There may be an underlying disease such as amyloidosis, hypothyroidism, canker sores and scarlet fever.

Whenever your tongue becomes larger than normal, it will press onto your teeth. This tends to cause indentations.

scalloped tongue causes thyroid-meaning, pictures, diagnosis and treatment
Tongue scalloping illustration

Chinese Medicine Meaning

In Chinese tradition medicine (TMC), “scalloping of the tongue is said to indicate qi vacuity” [] while in homeopathic, it indicates high blood pressure, according to many sources.

According to Chinese medicine, the tongue is believed to the ‘mirror’ of the internal state of the body. It is believed to be linked to other body organs and once this is understood, the tongue can be used in the diagnosis of underlying health conditions. Scalloped tongue; tongue casserole, in Chinese medicine rings towards a deficiency in qi (pronounced as ‘chi’) and yang in the body. The two are important in ensuring that the body traffic runs smoothly and orderly holding the organ in proper shape and condition. Failure of this maintenance of organ integrity results in improper shape of the tongue and its weakening. If the tongue is weak, it relaxes and bulges and may not resist pressure exerted by the denture.

The swelling of the tongue is attributed to the excess moisture accumulate in the body.

Since Chinese medicine believes the tongue is linked to the spleen, scalloping may explain organ failure. It says that when the spleen cannot exude moisture, it leads to a state of Yang Qi. Spleen dampness results thereof. If the tongue were just pale and moist without being pink and scalloped, then you would link it to alpine dampness.

Therefore, the wet tongue is formed by extrusion dentition linked to its tenderness, tongue body edema, yang of the spleen and its qi deficiency and tongue muscle relaxation. Expecting clinical studies to support the state of Qi and Qi weight thereof has been proven wrong since most people with scalloped tongue have no disease. However, the Chinese say that Qi is not sick weight but just blood imbalance.

The channel or meridian reaching the tongue from the spleen is the ‘Foot Taiyin’. This is an internal branch of the primary channel spreading over the lower tongue surface. The spleen divergent channel penetrates the tongue.

Pictures of Scalloped Tongue

Below are pictures of scalloped tongue.


scalloped tongue



Crenated tongue-picture
mild tongue scalloping


Severe tongue scalloping picture
Crenated tongue-severe

Symptoms of Crenated Tongue

Scalloped tongue manifests as:

  • Mouthful of red and inflamed, scalloped edges.
  • Hot and humid phlegm Yongzhi
  • Pale moist teeth marks (alpine dampness)
  • Qi deficiency pink and scalloped tongue

There has been associations between this tongue problem and loose stools, bloating, cold and fatigue too. This may be attributed to the spleen-gut interconnection in controlling body traffic and moisture content.

Pathological Symptoms of Scalloped Tongue

According to microscopy methods, scalloped tongue protrusions and changes in the morphology and performance of the tongue sides were observed. These changes include:

  • Thinning of the cortex showing a relation to local nutritional status
  • Cell damage manifesting as changes within the organelles of the cells
  • Scalloped tongue cells are poorly connected since there is reduction in the tension wire and therefore an increased intercellular gap.
  • Cell tissue edema showing lack of nutrition and also due to poor lymphatic drainage.
  • Reduced tolerance to the denture due to lack of elastic fibers.

Scalloped Tongue Causes-Thyroid, Dehydration & Sleep Apnea

What causes wavy Tongue?

Thyroid and hypothyroid

It has been pointed out that lack of thyroid hormone due to an underactive thyroid gland leads to dysregulation of the body metabolism processes. Little or no thyroid hormone leads to swollen face and tongue. The swollen face may in turn lead to swollen eyelids and thickened lips ( An inflamed tongue, as you have seen, is one of the causes of scalloped tongue. Diseases that affect the thyroid gland include:

  • Hashimoto’s disease
  • Thyroiditis
  • Congenital hypothyroidism

A scalloped tongue caused by low level of thyroid hormone is accompanied by other signs and symptoms such as fatigue, dry skin, hair thinning and loss of hair, constipation and increased sensitivity to cold.

According to NHS, It is important to note that many symptoms of an underactive typothyroidism are similar to those of other conditions, so it can easily be confused for something else.


Lack of sufficient water in the body means the body is not detoxing. Accumulation of toxins in circulation could put the tongue at risk of inflammation and scalloping.

Sleep Apnea

Sleep apnea is a common disorder whereby you have pauses in breathing during your sleep. The breathes may be shallow if not paused. According to the National Institute of Health (, the tongue may fall back into the oral cavity and this could make it scalloped[i]. Tongue scalloping without a swollen of the tongue is seen in obstructive sleep apnea and acts as a useful predictor of sleep pathology (Weiss TM, Atanasov S, and Calhoun KH)[ii].

Swollen tongue

An inflamed tongue occupies a large space in the oral cavity which is not present. This forces the application of pressure on the dental arches. When the tongue is too big to fit in the oral cavity, then marks are left around the tongue. Swollen tongues may be due to an allergic reaction of dehydration. Swollen tongue is known as macroglossia and is a non-specific sign with a possible association with infiltrative and inflammatory conditions such as Down syndrome, sarcoidosis, tuberculosis, amyloidosis, infection such as syphilis and angioedema (Byrd JA, Bruce AJ, Rogers)[iii].

Vitamin deficiency

Megaloblastic anemia has been associated with swollen and scalloped tongue. This is due to the production of red blood cells that are abnormal in folate and vitamin B-12 deficiency. There also lies some connection between crenated tongue and iron deficiency. You should consider beefing up your diet with some foods with the three of the stated nutrients linked to scalloped tongue.

Temporomandibular joint (TMJ) syndrome

Most people with this nerve-jaw muscle disorder try to clench their teeth using their tongue to keep the jaw in the right position. This disorder occurs when the temporomandibular joint (jaws connecting with the skull) is injured. It is characterised by bruxism, tooth grinding; headaches, swelling of the side of your face and chewing pain. When the teeth do not fit well, there is jaw instability. This is what leads to clenching to stabilize the jaw for swallowing. It is during this process that the tongue pushes against the teeth and ends up with crenations.

Painful and fissured indented tongue

If the scalloped tongue is accompanied by a painful fissure or sore, then cancer is a possibility. Oral cancer will be accompanied with other symptoms.

Digestive problems, arthritis or sinus

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

Scalloped Tongue Cancer, Amyotrophic Lateral Sclerosis (ALS) & HIV

A number of individual seek to know the link between tongue scalloping and cancer, ALS and HIV.

Cancer-As aforementioned, cancer can be a cause of this condition

HIV-Most people tend to think scalloped tongue may be a sign of HIV. It is actually not clear if this can be a sign or symptom. Refer above for the most common known symptoms.

Amyotrophic Lateral Sclerosis (ALS)- Is scalloped tongue a sign of ALS? Not really. Most experts agree that this cannot be a sure sign. Appearance of the tongue may have not much to do with ALS.

Wavy/Scalloped Tongue Edges & Side Diagnosis

Before you can decide on a treatment regimen, it is important that the underlying condition be diagnosed and treated.  Wavy or scallope tongue symptoms should be carefully examined and tests for certain possible causes done too.

According to the Center for Acupuncture and Herbal Medicine[iv], Qi and Yang has something to do with flabby and swollen tongues whereby there is excess damp and teeth marks on the side. It is worse in the morning. With Chinese medicine, the cause would have been determined and treatment given will be geared towards resolving the Qi of the body.

Intoxication is one major cause that hits medical practitioners. Scalloped tongue may indicate that the body is full of toxins and the tongue can be a harbinger of toxins. Toxins can hinder the thyroid by blocking the reception of thyroid hormone at the cellular level. These toxins are also capable of damaging the gland itself. These two possibilities make the thyroid gland less effective.

According to, optimization of detoxification procedures starts with making sure that the body is optimally hydrated. She recommends her patients work up to at least 80 ounces (2400 mLs) of water every day[v]. This is the approach she gives her scalloped tongue patients.

Tongue Scalloping Treatment/Cure

Main aim is treating the underlying disease and condition. If this is treated, then scalloping also resolves. Generally, good dental oral care is recommended besides the specific treatments

  1. Diet and supplements – if the scalloped tongue is pale, choose vegetables and barley, yams, sweet potatoes, pumpkins and chestnuts. According to Chinese medicine, taking raw fruits and cold drinks will damage the spleen Yang leading to heavier weight. To promote smooth blood flow, properly use some safflower and angelica root. For deficiencies in vitamin B-12, take foods such as poultry, eggs, fish and fortified plant foods. For iron deficiencies, have meat, fish, poultry, leafy vegetables and beans in your diet. Supplements may be used too to meet the Required Daily Amounts (RDA).
  2. Treatment of thyroid scalloped tongue involves hormone replacement therapy tablets daily.
  3. Jaw surgical remodeling and fixing teeth can be a solution to temporomandibular joint disorder.

Sources and References


[ii] The association of tongue scalloping with obstructive sleep apnea and related sleep pathology. Weiss TM, Atanasov S, Calhoun KH Otolaryngol Head Neck Surg. 2005 Dec; 133(6):966-71.

[iii] Glossitis and other tongue disorders. Byrd JA, Bruce AJ, Rogers RS 3rd Dermatol Clin. 2003 Jan; 21(1):123-34.



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