Exodontia.Info
Exostoses & Tori
What is an Exostosis & Torus?

These are bony swellings that develop in the mouth.

These are not that unusual.  They come in a number of
shapes, sizes and positions (that is, either in the midline of
the roof of the mouth, the tongue side of the lower jaw or
the cheek side of both upper and lower jaws).

These bony swellings are given the ‘technical’ names of
exostoses or tori.

The
torus is considered to be a developmental anomaly,
although it does not present until adult life and often will
continue to grow slowly throughout life.
Photos of bony swellings in the roof of the mouth (palate),
Tori Palatinus
The Torus Palatinus commonly forms towards the back of the hard palate (roof of
mouth) in the midline.  The swelling is rounded and symmetrical, sometimes with a
midline groove.  It is not usually noticed until middle age and, if it interferes with the
fitting of a denture, it can be removed.

Most
palatal tori are less than 2 cm in diameter but their size can change
throughout life.

The prevalence of
palatal tori ranges from 9% - 60% of the population and are
more common than bony growths occurring on the mandible (lower jaw), known as
torus mandibularis (ranges from 5% - 40%).

The prevalence rate for
tori is 27 / 1,000 adults.  These bony lumps are not
present until the late teen and early adult years and many, if not most, continue to
slowly enlarge over time.  Fewer than 3% occur in children.  Taken as a group,
these bony lumps are found in at least 3% of adults and are more common in
females than in males.
Photos of bony swellings in the floor of the mouth, Tori Mandibularis.
Superficial bony masses / lumps found in another site (of the mouth or body) are
typically given the catch-all name of
exostosis or osteoma.  They are considered
to be trauma-provoked inflammatory responses or true (benign)
neoplasms.  
Unless such a bony prominence is specifically located, is stalked or is associated
with an
osteoma-producing syndrome such as the Gardner syndrome, there may
be no means by which to differentiate an
exostosis from an osteoma, even under
the microscope.


What are the signs & symptoms of an exostosis & torus?

Tori can be categorised by their appearance.

  • Arising as a broad base and a smooth surface, flat tori are located on the
    midline of the palate and extend symmetrically to either side.

  • Spindle tori have a ridge located at their midline.

  • Nodular tori have multiple bony growths that each have their own base.

  • Lobular tori have multiple bony growths with a common base.

The
torus may be bosselated or multi-lobulated but the exostosis is typically a
single, broad-based, smooth-surfaced mass, perhaps with a central sharp, pointed
projection of bone producing tenderness immediately beneath the surface
mucosa.


Slowly enlarging, recurrent lesions occasionally are seen, but there is no
malignant transformation potential.  The patient should be evaluated for Gardner
syndrome
should there be multiple bony growths or lesions not in the classic torus
or
buccal exostosis locations.  Intestinal polyposis and cutaneous cysts or
fibromas are other common features of this autosomal dominant syndrome.


What are the causes of an exostosis & torus?

Tori / buccal exostoses may be the outcome of mild, chronic peri-osteal
ischæmia
secondary to mild nasal septum pressures (palatal torus) or the
torquing action of the arch of the
mandible (mandibular torus) or lateral pressures
from the roots of the underlying teeth (
buccal exostosis) but this is largely
speculation.

The most similar bony growth outside the jaws is the bunion of the lateral foot.

They are more common in early adult life and are associated with bruxism (tooth
grinding).

The size of the
tori may fluctuate throughout life and in some cases the tori can be
large enough to touch each other in the midline of mouth.  Consequently, it is
believed that
mandibular tori are the result of local stresses and not solely on
genetic influences.

How are they treated?

Neither the torus nor the exostosis requires treatment unless it becomes so large
that:

•        it interferes with function or denture placement
•        suffers from recurring traumatic surface ulceration (usually from sharp
foods, such as potato chips or fish bones)
•        contributing to a periodontal condition

If removal of the
tori is needed, surgery can be done to reduce the amount of
bone, but the
tori may reform in cases where nearby teeth still receive local
stresses.

When treatment is elected, the
tori may be chiseled off of the jaw or removed via
bone-burr cutting / smoothing through the base of the bony lump.


Useful Articles:

J Cont Dent Practice 2006.  Torus Palatinus and Torus Mandibularis in Edentulous
Patients

New England J Medicine 2013.  Images in Clinical Medicine.  Torus Mandibularis

New England J Medicine 2013.  Images in Clinical Medicine.  Torus Palatinus

JOMS 2013.  Oral Tori are associated with Local Mechanical & Systemic Factors.
A Case-Control Study



Useful Website:

Bond's Book of Oral Diseases (4th Edition) / The Maxillofacial Center for
Diagnostics & Research
Tori mandibularis form on the tongue-side of the lower jaw, in the region of the
premolars / bicuspids (and above the location of the mylohyoid muscle's
attachment to the mandible).  They are typically (90% of cases )
bilateral (i.e on
both sides) forming hard, rounded swellings.  The management is the same as that
of the same as that of the
torus palatinus.
A buccal exostosis is the formation of an exostosis (bone mass) on the outer,
cheek-facing side of the
maxilla (upper jaw) just above the teeth or the
cheek-facing side of the
mandible (lower jaw).  They are less common on the
lower jaw.  They begin to develop in early adulthood and may very slowly enlarge
over years.  They are painless and self-limiting but may contribute to
periodontal
disease
(gum disease / pyorrhoea) if they become too large.  They can be
removed with surgery.  
Buccal exostoses have no malignant potential.
Last Updated 26th February 2014