You might not think about it much, but your tongue can give you some serious clues about the state of your health. In fact, a swollen, scalloped tongue can often be one of the first signs of certain vitamin or mineral deficiencies. And sometimes, it could signal there's something more serious going on.
A scalloped tongue happens when the tongue becomes inflamed or swollen to the point that it pushes against the teeth on all sides, causing indentations or ridges on the tongue. In other words, the tongue looks wavy on the edges.
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Other symptoms that might come along with a scalloped tongue are soreness, tenderness and redness of the tongue, according to the Center for Occupational & Environmental Medicine.
Here's what causes a scalloped tongue and how it's diagnosed and treated.
Scalloped Tongue Causes
A wavy-looking tongue might mean you're not getting enough of a certain nutrient in your diet, or it could be a red flag of a developing disease. Here are the most common causes.
1. Teeth Grinding or Clenching
When you clench or grind your teeth (also called bruxism), it can cause you to press your tongue into your teeth, according to Timberlake Dental. You may do this in your sleep or even during the day without realizing it.
It's not totally clear why some people grind their teeth, per the Mayo Clinic, but the habit may be caused by higher levels of stress, anxiety, anger or frustration. It's also linked to certain antidepressant medications, smoking, drinking caffeine or alcohol and using recreational drugs.
Other symptoms of bruxism include:
- Chipped, fractured or flattened teeth
- Worn tooth enamel
- Sensitive teeth
- Locked jaw or tight jaw muscles
- Pain or soreness in the jaw, neck or ear
- Dull headaches
2. Vitamin B12 Deficiency
According to a small May 2016 study in BMC Oral Health, vitamin B12 is one of the most important nutrients for oral health.
In addition to a swollen, scalloped tongue, vitamin B12 deficiency may cause tongue pain, a red tongue, mouth ulcers, cracks in the corners of the mouth, itching and burning.
Low vitamin B12 doesn't just affect your tongue and mouth, according to Harvard Health Publishing. It can also cause:
- Numbness or tingling in the hands, legs or feet
- Difficulty walking
- Balance problems, like staggering
- Memory loss
- Difficulty thinking ("brain fog")
Because low vitamin B12 levels can cause such a wide array of symptoms, this condition can be tricky to diagnose. Early detection and treatment are important, though, because an untreated deficiency can lead to severe nerve damage and blood disorders, per Harvard Health.
3. Iron Deficiency
It's not just vitamin B12 deficiency that can cause indentations on the tongue. If you don't get enough iron, you may end up with a swollen, scalloped tongue and some other uncomfortable symptoms.
Although everyone is different, common symptoms of iron deficiency include the following, according to Johns Hopkins Medicine:
- Feeling tired or having low energy
- Looking abnormally pale
- Being irritable
- A higher heart rate
- Enlarged spleen
- A condition called pica, where you have a strong desire to eat non-food things like dirt
A swollen tongue with ridges on the edges could be a sign of hypothyroidism, a condition where your thyroid gland function is lower than it should be, per the Center for Occupational & Environmental Medicine.
In the early stages, people with hypothyroidism may not notice any symptoms, according to the Mayo Clinic. But over time, the condition can cause:
- Weight gain
- Hoarse voice
- Puffy face
- Muscle weakness or aches
- Stiff, swollen or painful joints
- Hair loss
- Slower heart rate
- Higher sensitivity to cold
If you notice these symptoms, it's important to tell your doctor and start treatment as soon as possible, because hypothyroidism can lead to obesity, infertility and heart disease.
5. Obstructive Sleep Apnea
Tongue indentations can indicate that your tongue doesn't have enough space. This can cause your tongue to fall back and obstruct your airways overnight, leading to sleep apnea, according to the Mayo Clinic.
Other symptoms to look out for include:
- Excessive sleepiness during the day
- Loud snoring
- Stopping breathing during sleep
- Abrupt awakenings accompanied by gasping or choking
- Waking up with a dry mouth or sore throat
- Headaches in the morning
- Difficulty concentrating
- Mood changes, such as depression or irritability
- High blood pressure
- Decreased libido
Scalloped Tongue Treatments
How a scalloped tongue is treated depends on the underlying cause:
1. Mouth Guard
Your dentist might suggest you wear a mouth guard if your tongue is scalloped due to teeth grinding, per the Mayo Clinic. A mouth guard is a device that fits over your teeth and keeps them apart, so you can't clench or rub them together. It might be worn at night or during the day, depending on when you tend to grind.
Other treatments for bruxism include anxiety or stress management, behavioral therapy and biofeedback, which teaches you to control the muscles in your jaw.
2. Foods or Supplements With Vitamin B12
If you're lacking B12, your doctor will likely conduct a series of tests to determine what's causing the deficiency and then recommend the best course of action. In most cases, a vitamin B12 deficiency is treated with either dietary supplements or vitamin shots.
If your diet was simply lacking adequate amounts of vitamin B12, you may be able to correct a deficiency with supplements. However, if you have difficulty absorbing vitamin B12 from food, you may need injections.
If your doctor recommends eating more foods high in B12, you could add the following to your diet:
- Beef (especially beef liver)
- Nutritional yeast
- Greek yogurt
- Chicken breast
- Caned tuna
- Fortified cereals, soy milk and tofu
In general, this nutrient occurs naturally in meat, fish and dairy. Therefore, vegans and vegetarians are more likely to develop deficiencies. Some cereal brands and other food products are fortified with vitamin B12, though, so make sure you choose those, especially if you don't eat animal foods.
3. Iron-Rich Foods or Supplements
For a swollen tongue caused by an iron deficiency, your doctor may prescribe a high-iron diet or iron supplements.
Foods high in iron include:
- Meats (beef, pork, lamb, liver and other organ meats)
- Poultry (chicken, duck and turkey — especially the dark meat)
- Oysters and mussels
- Leafy greens (spinach, kale, collard greens)
- Kidney beans
- Black beans
- Fortified cereals and bread
Your doctor may also run tests to determine if you have undiagnosed blood loss, which may cause iron deficiency since this mineral is a major component of your red blood cells.
4. Hormone Therapy
Your doctor can order blood tests to see if hypothyroidism is the culprit behind your wrinkled tongue. If that's the case, he or she will probably have you start hormone therapy, in the form of a daily oral medication, per the Mayo Clinic.
Most people with this condition will need to stay on hormone therapy for the rest of their lives in order to control symptoms, but the dosage may change based on the results of regular blood tests.
Diagnosing a Scalloped Tongue
The cause behind a scalloped tongue isn't always obvious, which is why it's important to see your doctor for a proper diagnosis. Through conversations about your general health and habits as well as possible blood tests, your doctor can help you figure out the underlying cause of your tongue woes and determine the right course of treatment.
Rarely, your doctor may want to perform a biopsy, which would involve taking a tissue sample from your tongue in order to examine it for other clues that might explain the wavy appearance.
- Harvard Health Publishing: "Vitamin B12 Deficiency Can Be Sneaky, Harmful"
- BMC Oral Health: "Oral Manifestations in Vitamin B12 Deficiency Patients With or Without History of Gastrectomy"
- Johns Hopkins Medicine: "Iron-Deficiency Anemia"
- Center for Occupational & Environmental Medicine: "Thyroid Disease: Do You Have a Scalloped Tongue?"
- Mayo Clinic: "Bruxism (teeth grinding)"
- Timberlake Dental: "High Risk for Teeth Grinding"
- Mayo Clinic: "Hypothyroidism (underactive thyroid)"
- Mayo Clinic: "Obstructive Sleep Apnea"
Is this an emergency? If you are experiencing serious medical symptoms, please see the National Library of Medicine’s list of signs you need emergency medical attention or call 911.