Buccal exostosis is a non-cancerous, localized bony outgrowth that develops in the mouth. It is a common, benign overgrowth of bone tissue in the jaw, generally considered a developmental abnormality. Attention is only required when the growth causes specific problems. This article explains the nature of buccal exostosis, why it often develops unilaterally, and how it is managed by dental professionals.
Anatomy and Nature of Buccal Exostosis
Buccal exostosis is a bony prominence located on the outer surface of the alveolar bone, the part of the jaw that holds the teeth. This outgrowth appears on the cheek-side (buccal aspect) of the upper or lower jaw, typically near the premolars and molars. The exostosis is composed of dense, mature bone, often described as cortical and trabecular bone with a smooth outer surface.
These growths are considered benign hamartomas, which are non-malignant, localized tissue malformations. They appear as broad-based masses that feel like hard, non-tender nodules beneath the gum tissue. Although exostoses are commonly found bilaterally, a unilateral presentation is frequent and suggests a localized cause.
Factors Contributing to Unilateral Development
The development of buccal exostosis is linked to the body’s response to localized mechanical stress. Bone tissue adapts functionally by depositing new material in areas subjected to increased forces. This mechanism explains why an exostosis may form unilaterally, or on one side, rather than bilaterally.
The primary factor driving this asymmetrical growth is increased masticatory force, or excessive chewing pressure, on one side of the dental arch. Habits like teeth clenching and grinding (bruxism) create this focused stress. Favoring one side due to a missing tooth, a painful filling, or bite misalignment causes the bone on that side to experience greater strain.
This chronic trauma stimulates the bone to reinforce itself by depositing new osseous tissue, leading to the gradual appearance of the exostosis. Although genetics play a role in the tendency to develop bony growths, the asymmetry results directly from uneven chewing or clenching habits. Growth is a slow, progressive process that usually begins in adolescence and may continue into mid-adulthood.
Identifying Symptoms and Functional Interference
In most cases, a buccal exostosis causes no pain and is discovered incidentally during a routine dental examination. The overlying gum tissue is usually stretched but remains intact and healthy. However, the growth becomes problematic when it reaches a certain size, leading to specific functional interferences.
One common issue is difficulty maintaining proper oral hygiene. The bony outgrowth can shield the area, causing food debris and plaque to accumulate, which compromises the health of the adjacent gum tissue. Furthermore, the thin mucosa covering the bone is prone to irritation and ulceration from trauma, especially from sharp or hard foods during chewing.
A large exostosis becomes significant when a patient requires a removable dental prosthetic, such as a denture. The bony protrusion can prevent the prosthetic from seating properly, making it unstable, painful, or impossible to fit. In these scenarios, the exostosis becomes a clinical obstacle rather than a simple anatomical variation.
Management and Surgical Considerations
For an asymptomatic exostosis causing no functional issues, the standard approach is observation, often called “watchful waiting.” Professionals monitor the growth during regular check-ups to ensure it does not progress to interference. Patients are advised on good oral hygiene techniques to keep the area free of debris and reduce the risk of localized gum disease.
Surgical intervention is reserved for situations where the exostosis causes chronic problems or interferes with planned dental work. Indications for removal include recurring ulceration or trauma to the overlying mucosa, significant compromise to periodontal health, or the need for prosthetic preparation. Aesthetic concerns are also a valid reason for removal if the growth is highly visible.
The surgical procedure is straightforward, involving the removal or recontouring of the excess bone under local anesthesia. The oral surgeon exposes the bony mass by reflecting the gum flap and uses a bone-cutting bur to shave down the exostosis. Recurrence after surgical removal is uncommon, and recovery time is typically minimal.