A 44-year-old man was referred for treatment of symptomatic sialolithiasis in the right Wharton duct. Intraoral removal could not be performed because of bilateral swellings on the lingual surface of the mandible. The patient was unable to recall when he first became aware of the lesions. He had no history of mandibular trauma or surgery. Physical examination showed two symmetric, nontender, bony outgrowths on the lingual surface of the mandible (Figure 1). We diagnosed mandibular tori. Although the lesions were causing only minor symptoms, we elected to remove them to gain access to the Wharton duct.
Figure 1:
Mandibular tori are bony outgrowths on the lingual surface of the mandible, often bilateral and symmetric, as in this 44-year-old patient.
Torus mandibularis is a nontender, bony outgrowth located on the lingual side of the mandible, in the canine or premolar region, above the attachment of the mylohyoid muscle. In most cases, bilateral tori are present.1 Torus mandibularis is usually asymptomatic and discovered incidentally. The prevalence varies substantially between ethnic groups, with lower prevalence in whites (about 8%) and blacks (about 16%) and higher prevalence in Asian and Inuit populations.2 Torus mandibularis is slightly more common in males than in females.3 Histologic examination shows dense bony tissue, with normal osteocytes and lacunae.3
Torus mandibularis is thought to be caused mainly by environmental factors, such as bruxism, vitamin deficiencies and calcium-rich supplements, although genetic background also plays a key role.1 Clinical diagnosis is usually straightforward, and investigations are generally not required. However, peripheral ossifying fibroma, osteoma, osteochondroma, osteoid osteoma, osteoblastoma and osteosarcoma should also be considered in the differential diagnosis of a unilateral, growing lesion.4 In particular, the presence of pain or paresthesia should prompt further investigation.
The growth of torus mandibularis is very slow and may stop spontaneously.1 Surgical resection is seldom necessary, but is indicated when ulceration, articulation disorder or problems inserting dentures are present.3
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Footnotes
Competing interests: None declared.
This article has been peer reviewed.
The authors have obtained patient consent.
References
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FAQs
Torus mandibularis is thought to be caused mainly by environmental factors, such as bruxism, vitamin deficiencies and calcium-rich supplements, although genetic background also plays a key role. 1. Clinical diagnosis is usually straightforward, and investigations are generally not required.
How to get rid of mandibular tori? ›
How are mandibular tori treated? You probably won't need treatment for mandibular tori unless they cause pain or interfere with function or quality of life. Surgeons can remove mandibular tori, when necessary, with an oral surgery procedure.
Is mandibular tori caused by stress? ›
Is mandibular tori caused by stress? The causes of mandibular tori are not fully understood, although environmental factors and diet are generally thought to be factors in developing these growths. Jaw stress is also related to tori growth, and emotional stress can be a contributor to jaw stress.
What percentage of people have mandibular tori? ›
Mandibular tori – or mandibular torus if it's a single bump – show up in the lower jawbone. About six percent of the U.S. population experience this condition, notes the Cleveland Clinic.
What ethnicity has mandibular tori? ›
Mandibular tori are more common in Asian and Inuit populations. They are slightly more common in males. In the United States, the prevalence is 7–10% of the population.
When should you have Tori removed? ›
Most people become aware of this condition only after a dental professional or doctor lets them know they have it. In most cases, tori does not require removal, but if you are experiencing painful symptoms or issues, an oral or maxillofacial surgeon may be used to remove tori.
How painful is mandibular tori removal? ›
Though the surgery itself won't be painful, tori removal can be a bit uncomfortable. Another method of tori removal is done via lasers. Though not appropriate in all cases, this method provides excellent accuracy and less palate trauma than traditional tori surgery.
Is Tori removal worth it? ›
Some toris become so large that food becomes trapped beneath them. This contributes to the accumulation of bacteria and ultimately leads to periodontal disease. Tori removal is recommended for the sake of maintaining good oral hygiene.
What can be mistaken for mandibular tori? ›
However, there are other uncommon bony growths that might be mistaken for mandibular tori, including:
- Fibromas.
- Osteomas.
- Mucoceles.
- Osteochondromas.
Believe it or not, clenching and grinding can actually change the shape of your bone. Though not particularly common, some people with bruxism develop bony growths on the inside of their lower jaw, under the tongue. These growths are called mandibular tori, and they are harmless and benign.
Beginning with genetics, it is more commonly found among men than women and may be passed down from father to son. Another common cause is bruxism, or teeth grinding that may cause stress in the jawbone. Mandibular tori are more frequently found during early adulthood.
Do mandibular tori keep growing? ›
When the extra bone is found in your hard palate, it is called your torus palatinus. If the tori are found on your lower jaw, they are considered to be mandibular tori. Most tori grow to a certain point and stop growing. Most growth stops after our jaws have developed in our late teenage years.
When should I be worried about mandibular tori? ›
Most of the time tori do not interfere with daily eating, drinking or speaking. Dental professionals generally monitor the size and shape of tori, but do not recommend treatment of the areas unless they begin to interfere with routine oral home care or basic daily functions.
Are mandibular tori genetic? ›
The most common bony outgrowth was torus mandibularis. Our results show that the genetic factor is dominant in the etiology of oral bony outgrowths.
What are the benefits of mandibular tori? ›
The present study show that the use of mandibular tori as bone grafting material may provide additional benefits in the treatment of advanced periodontal disease; and enhance the regenerative potential of periodontal intraosseous defects.
What causes extra bone growth in the mouth? ›
According to an article published in the Journal of International Oral Health, some causes could include genetic factors, environmental factors, excessive chewing (masticatory hyperfunction), teeth grinding (bruxism), and continued jawbone growth.
