Bony growths known as exostoses are common, usually benign formations found in the mouth. Mandibular tori are among the most frequently observed of these bony lumps, developing on the lower jaw. While people often become concerned when they discover these hard masses, they cause no issues for the majority of individuals. This article explains the nature of these growths and outlines the specific circumstances under which they may require professional attention and removal.
What Mandibular Tori Are
Mandibular tori are slow-growing, non-cancerous bony protrusions located on the inner side of the lower jawbone (mandible). They are typically found on the tongue-facing (lingual) surface, most often near the premolar and canine teeth. Tori are composed of dense, compact bone tissue covered by thin gum tissue.
These growths can appear as a single mound or as multiple, smooth or lobulated lumps along the jawline. Tori are a common finding during routine dental examinations, with prevalence rates estimated between 7% and 10% in the United States population. Approximately 90% of cases involve bilateral tori, meaning they are present on both the left and right sides of the lower jaw.
Factors Contributing to Their Development
The development of mandibular tori is multifactorial, involving genetics and mechanical stress. There is a clear genetic influence, as these growths often run in families, suggesting a hereditary predisposition. Studies involving twins indicate a high concordance rate, supporting a significant inherited component.
Mechanical factors also stimulate the bone to remodel and grow. Conditions involving excessive force on the jaw, such as bruxism (the grinding or clenching of teeth), are strongly associated with tori. Sustained, heavy chewing forces and resulting occlusal overload place local stress on the bone, triggering extra bone formation. Changes in bone density or mouth anatomy may also influence the location and size of these masses.
Daily Impact and Indications for Removal
For most individuals, mandibular tori are asymptomatic and do not require intervention or treatment. The growths are typically small, and patients live comfortably with them, often remaining unaware of their presence until a dental professional points them out. In these cases, the recommended course of action is watchful waiting, as the tori are harmless.
Intervention becomes necessary only when the growths interfere with oral function or quality of life.
Primary Indications for Removal
One primary indication for removal is chronic irritation of the overlying gum tissue, which can lead to recurring ulcerations from accidental trauma or sharp food particles. The most common reason for surgical removal is the need to accommodate a prosthetic device, such as a full or partial denture. Tori prevent a denture from seating properly, causing it to rock or irritate the tissue underneath, making surgical reduction necessary for a stable fit.
Other Reasons for Removal
Less common reasons for removal include interference with normal speech patterns, difficulty maintaining adequate oral hygiene, or preparation for other restorative procedures like dental implants. If the tori grow large enough to restrict the tongue’s movement or make swallowing difficult, their removal may also be considered.
Surgical Removal Procedures
When mandibular tori must be removed, the procedure is typically performed by an oral surgeon in an outpatient setting. This surgery, known as torus excision or reduction, usually begins with a local anesthetic to numb the area. Sedation options are often available to ensure the patient remains comfortable throughout the process.
The surgeon makes an incision in the gum tissue (mucosa) covering the bony growth to expose the excess bone. Specialized instruments, such as high-speed surgical drills or chisels, are used to shave down the dense bone mass until the jaw contour is smooth. After the excess bone is removed, the surgical site is rinsed, and the gum tissue is sutured closed, often with dissolvable stitches.
Post-operative care involves managing expected swelling and discomfort. Patients are advised to maintain a soft diet and follow specific oral hygiene instructions, which may include gentle salt water rinses. Most discomfort subsides within the first week, but complete soft tissue healing generally takes two to four weeks.