Mandibular tori are non-cancerous, bony growths most commonly found along the lower jaw bone. These benign growths are a relatively common finding during a routine dental examination, affecting an estimated 7% to 10% of the United States population. Mandibular tori are typically harmless and do not require treatment. Intervention is only considered when they begin to interfere with normal oral function or planned dental procedures.
Description and Location
Mandibular tori are exostoses, which are localized formations of new bone on the surface of existing bone. Composed of dense, compact cortical bone, they have a hard texture. They usually appear as lumps or nodules beneath the tongue, emerging from the lingual surface of the mandible (the side of the jaw facing the tongue). They are typically found near the premolar and sometimes the molar teeth. In approximately 90% of cases, these growths appear symmetrically on both inner sides of the lower jaw, and their size and shape vary significantly, ranging from small, smooth bumps to larger, lobulated masses.
Causes and Contributing Factors
The exact biological mechanism triggering mandibular tori formation is not fully understood, but evidence points toward a combination of genetic and environmental influences. A strong genetic predisposition is suggested because tori often run in families, indicating an inherited tendency for the jawbone to over-respond to stimuli. The primary environmental factor is local stress placed on the teeth and jawbone, often called masticatory hyperfunction.
Chronic habits like bruxism (involuntary grinding or clenching of teeth) place continuous pressure on the jawbone, stimulating the slow growth of the bone. Other contributing elements include dietary factors, jaw anatomy, and bone density. Tori size can fluctuate, often growing gradually, with onset typically in early to middle adulthood. Managing functional factors, such as teeth grinding, may help limit their growth.
Indications for Removal
For most individuals, mandibular tori remain small, asymptomatic, and require no surgical intervention. Removal is reserved for situations where the growths compromise oral health, function, or the success of planned dental work.
The most common reason for surgical reduction is interference with the fabrication and stability of removable dental prosthetics, such as full or partial dentures. Tori can prevent a denture from seating properly, causing instability or pain.
Other Indications for Removal
Surgical removal may also be necessary if the tori cause:
- Chronic trauma and recurring ulcerations on the thin gum tissue covering the growths, often caused by hard foods.
- Interference with tongue movement, leading to difficulties with normal speech, chewing, or swallowing.
- Difficulty maintaining proper oral hygiene in the area, leading to plaque buildup and potential gum disease.
The Surgical Procedure and Recovery
When removal is necessary, the procedure, known as tori reduction, is typically performed by an oral surgeon in an outpatient setting. Local anesthesia is used to numb the area completely, though patients may opt for additional sedation for comfort. The surgeon begins by making a small incision along the ridge of the lower jaw to create a flap of gum tissue, which is then carefully lifted to expose the underlying bony mass.
Once exposed, the excess bone is meticulously removed using a high-speed surgical drill and bur or, in some cases, a specialized bone chisel. The goal is to reduce the size of the torus until the inner surface of the jaw is smooth and flat, ensuring adequate space for future dental appliances or normal tongue movement. After the bone has been smoothed, the gum tissue flap is repositioned and secured with small sutures.
Initial recovery involves managing expected swelling and discomfort, which can be addressed with prescribed or over-the-counter pain medication and the application of ice packs. Patients are advised to rest for 24 to 48 hours and maintain a soft-food diet for one to two weeks to avoid trauma to the surgical site. Gentle rinsing with salt water after 24 hours helps keep the area clean, and the sutures are usually removed within 7 to 10 days. While initial healing is relatively quick, full recovery and tissue maturation can take several weeks.