The feeling of a hard lump or bony prominence in the mouth often leads people to search for information about a “bone spur in the gum.” While this term commonly describes the sensation, it is not a specific medical diagnosis. These bony bumps are usually one of two distinct conditions: a bony sequestrum or an exostosis/torus. Understanding which condition is present is key, as the prognosis for each type of growth is fundamentally different regarding natural resolution or the need for professional attention.
Understanding What the Bone Spur Is
Bony Sequestrum
A bony sequestrum is a small, detached fragment of dead bone that has separated from the surrounding healthy tissue. This condition is most often associated with the trauma of a recent tooth extraction or other oral surgery, where a tiny shard of the jawbone breaks off. The body recognizes this fragment as a foreign object. The natural healing process begins to push the fragment out through the gum tissue.
Exostosis and Torus
In contrast, an exostosis or torus is a slow-growing, benign overgrowth of normal, living bone firmly attached to the jaw. These structures are anatomical variations and are not the result of trauma or infection. They are categorized by location: a torus palatinus appears on the roof of the mouth, while a torus mandibularis is found on the tongue-side of the lower jaw. Exostoses generally appear on the cheek-side of the upper or lower jaw.
The exact cause of exostoses and tori is not fully understood, but factors like genetics, teeth grinding (bruxism), and the stresses of chewing may contribute to their gradual enlargement. These lumps are composed of compact bone and are generally painless unless the thin layer of gum tissue covering them becomes irritated. The distinction between a piece of dead, loose bone and a dense, structural overgrowth determines its likelihood of natural resolution.
Natural Resolution and When to Wait
Resolution of a Sequestrum
A bony sequestrum will frequently resolve without intervention, as the body actively works to expel this dead bone fragment. As the body attempts to reject the sequestrum, the fragment will loosen and migrate toward the surface of the gum. This process often makes the fragment visible or easily felt within a few weeks to a couple of months after the initial trauma. Once sufficiently loose, the small piece of bone may simply fall out on its own during eating or rinsing.
If the fragment is not causing significant pain or showing signs of infection, a dentist may recommend a period of observation to allow the body to complete this natural process. During this waiting period, maintaining excellent oral hygiene and using warm salt water rinses can help manage discomfort and prevent infection. Professional removal is necessary if the sequestrum has a sharp edge that repeatedly irritates the gum tissue, causes prolonged bleeding, or inhibits the healing of the extraction site.
Resolution of Exostoses and Tori
Natural resolution is not expected for an exostosis or torus because these are permanent, dense structures of normal bone. They are not foreign bodies that the mouth will expel; instead, they may continue to grow slowly throughout life. Since they are benign and typically asymptomatic, no treatment is needed unless they grow large enough to interfere with normal function. This interference might include issues with eating, speaking, or the placement of a dental prosthetic.
When Dental Intervention Is Required
When a bony lump causes complications, a dental professional must first confirm its identity through visual inspection, palpation, and sometimes X-rays to differentiate between a sequestrum and an exostosis. Management of a bony sequestrum is usually straightforward once the fragment is loose and protruding through the gum tissue. This minor procedure, called a sequestrectomy, involves the dentist grasping the shard with tweezers and simply lifting it out, often requiring only a topical anesthetic for comfort.
For fragments that are not yet loose, a small incision may be made to access and retrieve the bone, immediately relieving irritation. Prompt removal of a sharp sequestrum is important to prevent chronic irritation that could delay healing or introduce infection. If signs of infection are present, such as swelling or pus, antibiotics may be prescribed before or after the fragment is removed.
Surgical intervention for exostoses and tori is generally reserved for situations where the bony mass actively creates a problem. The procedure is called an ostectomy or surgical reduction, where the excess bone is carefully shaved or smoothed down to restore a normal contour. This is most often performed when the structure interferes with the fitting of a removable denture, is frequently traumatized by food, or complicates oral hygiene.