Many of you may experience some bony growths in your oral cavity! It is important to know that you should not panic as they may just be a benign condition of torus mandibularis which is not life-threatening, only a little uncomfortable and irritating. In the article below we have tried to solve some of your concerns about the same.

Torus mandibularis is a bony growth in the mandible along the surface near to the tongue. It is a sublingual protuberance. These single (one-sided) growths are made of bone – non-movable, smooth, and hard to the touch. Around 80% – 90% of these lesions are present bilaterally near the premolars and canine (teeth) and superior to the mylohyoid muscle, a paired muscle for mandibular attachment.

Mandibular tori are more common in Asian populations, and are more common in males, while they are rare in children. In the United States, the prevalence is 7% – 10% of the population.

It is believed that mandibular tori are the result of local stresses and not solely on genetic influences. Mandibular tori are usually a clinical diagnosis with no necessary treatment. Possibly, ulcers can form on the area of the tori due to trauma. The tori may also complicate the fabrication of dentures.

What Is The Tori In Your Mouth?

A torus is a harmless growth of bone. Tori tend to grow in three parts of the mouth: The inside of the lower jaw (tori mandibularis, or lingual tori), The roof of the mouth (palatal tori) or, the cheek side of the upper molars (buccal exostoses).

Torus mandibularis typically occurs in pairs, and its size can vary significantly. It may be a tiny bump, or sometimes can be a growth so large that touches one another. The lump may be enclosed in normal gum tissue and may be hard to feel.

They are benign and usually not serious. However, patients may need to seek medical attention if there is a sudden change in the size, color, or texture of the growth or if severe symptoms or specific health complications arise due to torus mandibularis.

DETAILED EXPLANATION

Torus mandibularis grow as nodules having many lobulated masses occurring as single or multiple growths. Their growth is up to 2mm, with the largest being up to 4cm in size. The growth varies from individuals, but sometimes it can extend up to the midline of the mouth.

On clinical and pathological evaluations, the torus has a dense bony appearance with a laminated pattern. The benign growth of this cartilaginous tissue has closely packed lamellar bone in compact concentric patterns. They consist of osteocytes (which are bone cells), cells of bone tissues scattered along the surface with tiny spaces infused with fat marrow or loose fibrovascular tissue layers.

They may also come with a thin lining of compact bone lying above the spongy bone with red or yellow marrow.

Sometimes this can be mistaken for other kinds of bone proliferating soft tissue lesions such as salivary gland malignancy or bone cancer. Hence proper diagnosis is necessary to differentiate it from other ailments.

CLASSIFICATION OF TORI:

Tori can be classified based on their appearance:

i. Flat tori: Arising as a broad base and has a smooth surface, and are located on the midline of the lower jaw and extend sideways, symmetrically.

ii. Spindle Tori: Has a ridge located at the midline.

iii. Nodular Tori: Many bony growths with each having their bases.

iv. Lobular Tori: These have multiple extensions with a common base.

The torus may have many nodules or a single nodule, but the exostosis (a benign outgrowth of tissue) is unique, smooth- surfaced mass with a broad base with sometimes a central sharply pointed projection of the bone. It causes tenderness to the mucosal lining.

Oral exostosis was further classified by Haugen. According to their sizes, they were classified into small, medium, and large.

i. Less than 2mm: small (In their largest diameter)

ii. 2-4mm: medium

iii. More than 4mm: Large

Haugen suggested that majority of the exostosis belonged to the small and medium categories, and very few had larger sizes.

Another person, Reichart modified this classification based on the size of tori.

i. Grade 1: Tori having up to 3mm (in their largest diameters)

ii. Grade 2: Tori having up to 6mm in their diameters

iii. Grade 3: 6mm and above

Symptoms Of Torus Mandibularis

Symptoms Of Torus Mandibularis
Symptoms Of Torus Mandibularis
  • Inflammation of the gums,
  • Mouth pain,
  • Pain around the bone,
  • Pain in the throat/tonsils,
  • Tingling in the jaw,
  • Poor oral hygiene (the bone blocking your brush),
  • Slurred speech,
  • Growth gets large enough to touch and irritate the tonsils,

Mandibular Tori Vs. Oral Cancer Symptoms

Usually, the symptoms of oral cancer and torus mandibularis are different. Both lower torus and oral cancer are caused by growths in the gums and mouth, but the growths significantly differ from each other. The warning signs of cancer are that the lips are squishy, along with symmetrical and unilateral growth on the jaw line. Oral cancer can cause a bad odor (halitosis) in the mouth and can cause severe pain

Mandibular Tori is different from oral cancer in many ways. Lower Tori symptoms include more symmetrical, smooth growth along the jaw. Also, instead of soft tissues, the torus growths will feel like heavy bones, and will not have a bubble-like appearance or texture.

Causes Of Torus Mandibularis

The absolute cause of torus mandibularis is unknown, but several factors are believed to contribute to its occurrence:

a. These bony growths have a genetic origin. They pass on through the autosomal dominant pattern and are very common in Inuit’s, Koreans and Asians.

b. The bony growths can also appear after long periods of elevated stress.

c. The torus mandibularis has a 12.5%-27% chance of occurring in adults while only a bare 3% chance to occur in children.

d. This condition is seen most commonly in men of around 40-50 years of age.

e. Another possibility is that teeth grinding can trigger the formation of such bony growths.

f. Masticatory stress and teeth were grinding tend to add to the occlusal load, especially in individuals who eat a coarse and granular diet. Hence, the following increased pressure and force on the periodontal ligament can then activate the formation of the new bone on the inner surface of the lower jaw near the premolar region.

g. Removal of the growths does not necessarily prevent them from growing once again. So, their reoccurrence is a sign that it could be part of the continuous process of bone formation in the oral cavity and is not a one time defect.

Torus Mandibularis And Dental Problems

Torus mandibularis usually does not cause medical issues which may need treatment. However, it can cause a variety of dental problems, some of which are mentioned below:

i. The bony protrusions may hamper the working of other dental procedures like dentures. If a patient has to be fitted with upper or lower dentures, then removal of the bony tori may be necessary. But as there is a possibility of them growing again, they may need to be removed again when they reoccur.

ii. The presence of periodontal pockets can only be treated effectively after the successful removal of the abnormal bony growths. Doing so can help promote better angles for efficient brushing, better dental care, and better oral hygiene/ management.

iii. Torus mandibularis may sometimes facilitate the occurrence of anomalies in the mouth, such as accumulation of plaque, which can then cause many dental problems.

iv. There could be stress exerted by food on the additional bone in the oral. Hence, it may have to be removed, thereby enhancing dental health.

v. Other complications are increased the risk of infections, oral pain/inconvenience, and airway management problems.

Torus Mandibularis Pain

The stretched tori gum tissue will pain when bruised, cut, irritated by dentures, braces, or food. In extremely rare cases, tori can grow big enough to touch each other, causing irritation and infection. If your mandibular torus has grown to rub together, or interferes talking, denture fit, or eating, contact your dentist.

How to avoid pain in the tori

  • Avoid eating sharp, hard, or acidic/gum irritating foods.
  • Reduce eating chips, crackers, and acidic foods such as lime juice or chili sauce, while you’re experiencing a flare-up.
  • Avoid small, tiny and hard food items that can get stuck up in the tori.
  • Keep up with good oral hygiene.
  • It may be difficult to brush or floss around the tori, but you can use a Waterpik after brushing to wash under the tori with warm salinized water. This will help prevent gum reducing gingivitis and painful dental abscess.
  • Use medium bristle toothbrush to brush as hard bristles would irritate the tori while the soft ones lack the ability of proper brushing.

COPING WITH TORUS MANDIBULARIS

Your dentist may advise against treatment if so, the bony growth will remain inside your mouth.

If the growth is small, it is possible that it may not bother you, but large bony growths can be irritating and distracting.

  • Try to avoid touching the growth with your tongue.
  • Rinsing your mouth with an antiseptic mouthwash can help keep your tori clean.

When to see a doctor

Torus mandibularis is a harmless outgrowth of the bone in the sublingual region of your mouth. It is mostly painless and does not need any serious care or treatment. But there are some circumstances which may raise concern as to visit a doctor!

For your knowledge, you should seek medical help if:

a. These bony outgrowths are large enough to touch or irritate your tonsils

b. They are causing discomfort while you wear dentures,

c. You are unable to brush or maintain proper oral hygiene,

d. These outgrowths become painful,

e. You experience symptoms which are other than that of torus mandibularis or point towards the direction of any tumor developments.

NOTE: Any growths inside your mouth should always be examined by your dentist, just to be safe, though they may end up being only benign conditions like torus mandibularis which is not harmful or life-threatening.

What Are Treatment Of Torus Mandibularis?

Torus Mandibularis Treatment (removal/Surgery) It is usually unnecessary to remove mandibular tori unless the lesions are large enough to interfere with oral functions such as dental placement, dental procedures, or when food gets stuck under exostosis, and other masticatory functions.

Torus mandibularis can be managed by maxillofacial surgeons through mallet and chisel surgical removal.

This procedure involves burring or saw technique to reduce or stop the growth of these bony structures. Anastasia being induced numbs the area, and chiseling off the tori cortex or cutting off the mass through a burring procedure. Nerve block anesthesia that blocks inferior alveolar, lingual and mental nerves are prescribed.

Recurrent oral mucosal ulceration on the area is another sign for its removal, which could be associated with mastication of food that is hard or sharp.

SURGICAL COMPLICATIONS OF TORUS MANDIBULARIS:

There are complications that arise during the surgical removal of Torus Mandibularis. The risks are as follows.

  • Mandibular fracture
  • Injury to salivary ducts
  • Devitalisation of teeth
  • Injury to the lingual nerve
  • Flap laceration

POST SURGICAL COMPLICATIONS:

Post-surgical complications are minimalistic with the incidence of minimal bleeding, infection, and inflammation. It takes about 3-4 weeks for the patient’s full recovery.

Complications include

i. Hematoma

ii. Flap necrosis

iii. Wound infection

RECURRENCE:

Several cases state recurrence of lesions, but the growth has no potential for malignant transformations. Its reappearance is triggered by pressure exerted continuously against the surrounding mucosal region and the premolar or bicuspid teeth.

In cases of lesions which are bony and multiple and are not typical of tori, exostosis, and other lesions in the buccal cavity the patients must be evaluated for other syndromes like Gardner syndrome or ‘Familiar adenomatous polyposis’ which is an inherited disease. This is often identified by the formation of colorectal polyps and extracolonic lesions.

Torus Mandibularis Home Remedies:

There aren’t any natural remedies for the treatment of these benign growths as such. But the complications after surgical methods can be reduced drastically with these natural remedies.

1. Peppermint Oil:

It has antiseptic and anti-inflammatory properties and reduces pain and inflammation. It also prevents other bacterial infections like tooth abscess, reduces the swelling of the area that has been surgically removed.

Take some peppermint oil on a small cotton ball, and apply it over the infected area. You can also take fresh peppermint leaves; crush/grind to extract its juice. You will get instant pain relief and reduction in the infection with regular application. Also, you might experience less pain.

2. Clove Oil:

Clove oil has been used for many years for treatment of pain in the oral cavity. It is useful in treating bacteria, and also reduces other gum infections or infection in the mucosal lining of the salivary ducts.

Clove oil is an antibacterial, antifungal, analgesic and an antiseptic. It is rich in nutrients like manganese, omega-3s and fiber, and other antioxidants. It will help you get rid of infections and inflammations in your mouth.

a. Take some clove oil in your finger, and brush your teeth gently without applying force. You can also massage your gum gently to ward off infections.

b. You can even mix Hydrogen Peroxide with clove oil and use this with a cotton ball to reduce further infections.

c. You can also consider placing a clove inside your mouth and chew it after some time in a way that it releases the juice. Let the juice be in your mouth for about 30 minutes. You will feel the differences in the level of inflammation and pain.

OR –

a. Put clove power that is freshly grounded in an empty tea bag and apply this to the infected area for about 15-20 minutes. Repeat this twice or thrice every day until the pain subsides.

OR –

Add few drops of clove oil to gauze and apply it to the infected area. Hold it onto painful areas for few minutes and repeat this for 5-7 times per day.

3. Clove with coconut Oil:

This reduces pain and inflammation. Add a teaspoon of coconut oil and 2-3 crushed cloves and fry them for a minute on slow flame.  In a blender, powder the fried cloves and apply this powder on the affected area and leave it for 30 minutes. You can repeat this procedure with sesame or mustard oil.

4. Clove oil and olive oil

This can be mixed and applied using a cotton ball and must be left as long as possible to reduce pain and inflammation.

5. Garlic:

Garlic has natural antibacterial properties and potent anti-inflammatory properties that will help prevent bacterial growth due to infections. It is abundant in Sulphur compounds that will alleviate pain and inflammation

a. Extract garlic juice from two pieces of clove and apply this to the affected area.

OR

Chew one or two pieces of garlic cloves till you completely get rid of the pain.

OR

Mix garlic juice extract with water and rinse your mouth with the juice. Repeat it 3 or 4 times a day to reduce pain and inflammation.

6. Salt Water:

This is one of the best natural remedies to get rid of the pain as quickly as possible. It prevents the infection from spreading throughout the mouth. It also has anti-inflammatory effects.

a. Mix one spoon of table salt/Epsom salt with a glass of lukewarm water and rinse your mouth with it. Repeat this several times a day or after meals to break free from the pain.

7. Turmeric:

Turmeric is rich in antibiotic, antiseptic and anti-inflammatory properties.

a. Mix a teaspoon of salt, half teaspoon of turmeric and lukewarm water to make a solution and rinse your mouth thoroughly with it. Repeat the process regularly for few days to get relief from pain.

OR

Make a paste with turmeric powder and water/oil of your choice and apply it to the infected area with a soft cotton ball. Repeat this application regularly until the pain subsides.

8. Raw plantain:

It helps reducing pain and swelling of any abscess present.

Take a few fresh plantain leaves and crush/grind them finely. Apply this ground paste on the affected area and leave it for about 20 minutes. Rinse your mouth thoroughly and repeat this several times per day to get relief from pain and swelling.

9. Baking soda:

Baking soda regulates the normal pH levels of saliva, thus making it resistant to any infectious agents. It is also an effective cleaner for teeth and gums.

Mix half a teaspoon of baking soda and salt. Now dip a cotton ball in water and then coat it with this mixture. Place this ball of cotton on the affected area for several hours to entirely do away with the infections.

OR

You can even use baking soda directly on the affected area to get rid of the pain.

OR

You can rinse your mouth with baking soda and water solution.

10. Herbal tea bag:

Tea is a rich source of a compound called tannin, which helps clear toxins. It also has astringent properties that help absorb pus/toxins. It is an effective home remedy.

Soak the tea bag in warm water and place this warm tea bag on top of the infected tooth. Leave it for few hours or overnight. Rinse your mouth with water, or salt-hydrogen peroxide solution to get rid of the pus. Repeat this process daily.

11. Apple cider vinegar:

It is a natural disinfectant and can be used for its anti-inflammatory properties.Take a spoon of organic apple cider vinegar solution and pour it into your mouth.Rinse your mouth thoroughly and repeat this several times to get relief from a tooth abscess.You can also consume apple cider vinegar in a glass of water every morning and evening.

12. Hydrogen peroxide:

It is a natural remedy effective in killing bacteria. It also lessens inflammation and pain in your oral cavity.

Mix 2 teaspoons of hydrogen peroxide with warm water and pour it into your mouth and swish for 2 minutes. Spit it out completely. Also, make sure that this liquid comes in contact with the area for the treatment to be effective.

13. Sesame seeds:

These relieve pain and bacterial growth.In a saucepan, boil a cup of water and 4 teaspoons of sesame seeds for about 5 minutes. Cool this mixture and apply this over the affected area.

14. Calendula:

The leaves of calendula are effective in accelerating your healing process.Crush a few leaves and make a coarse paste. Apply it to the affected area and leave it for an hour. Repeat the process until you experience a reduction in pain and swelling

15. Oil Pulling:

This is an ancient Ayurveda practice that has proven to reduce or prevent tooth infections. Oi pulling prevents the growth of bacteria in the mouth. The lipids present in oil have anti-bacterial and antiviral properties. This helps in speeding up healing of the affected area that has been scraped off.

Take one tablespoon of coconut oil and rinse your mouth for about 15 minutes with it. Finally, spit it out and rinse again with warm water. Repeat this process 2-3 times a day

16. Oregano Oil:

Oregano oil is a highly effective remedy for relieving pain and infections as it has antibacterial, anti-fungal, antiviral properties. The oil increases the immunity of your body and speeds up the healing process.

It can be directly applied to the affected area or can be used as a mouthwash by mixing 3-5 drops in a 1/4th cup of warm water. This can be repeated 3-4 times a day to get relief from the pain and clear the infection.

Place a few drops of oregano oil inside your mouth in the affected area. Spit it out and then swallow colloidal silver. Colloidal silver improves your immunity and reduces pain. Colloidal silver can also be applied directly over your affected area or can be used as the mouthwash.

17. Olive Oil:

Olive oil has a special compound called eugenol that has anti-bacterial properties. It helps to heal the sores and prevents inflammation.Dip a cotton ball in 2 tablespoons of olive oil and apply this to the sores. Repeat the application at least 2-3 times a day.

18. Potatoes:

Raw potatoes can help get rid of the infection, but take the time to clear off the infection completely.Cut a raw potato into small pieces and place them in the area of infection. Make sure to do this overnight. The pain and swelling would have receded by morning.

19. Papayas:

Papayas are loaded with antioxidants and nutrients needed for the body. They can help eliminate bacteria and get rid of the pain.Rub a slice of papaya on the infected area and leave it to rest for an hour or so. Finally, rinse it with mouthwash.

20. Vanilla extract:

Vanilla extract can reduce pain and inflammation. It can be applied to the area or even be used as the mouthwash.

21. Cold compress:

Cold compress around the affected area helps in giving instant relief from the pain.

22. Goldenseal:

Take half teaspoon of goldenseal powder and apply it to the affected area. Leave it for about 30 minutes and wash your mouth with antiseptic mouthwash.

23. Antibiotics:

They can get rid of the excruciating pain. Paracetamol, amoxicillin, ibuprofen can help reduce pain and swelling.

24. Echinacea:

Take Echinacea in the form of tea internally to get relief from tooth pain.Or apply this powder regularly for few days to get complete relief from the infection.

Apply these methods, and you will get relief.

REFERENCES

1. Jainkittivong A, Langlais RP. Buccal and palatal exostoses: Prevalence and concurrence with tori. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000;90:48–53. [PubMed]
2. Garcia-Garcia AS, Martinez-Gonzalez JM, Gomez-Font R, et al. Current status of the torus palatines and torus mandibularis. Medicina Oral, Patologia Oral, y Cirugia Oral. 2010 Mar 1;15(2):353–60.
3. Durrani MA, Barwise JA. Difficult Endotracheal Intubation Associated with Torus Mandibularis. Anesth and Analg. 2000 Mar;90(3):757–9. [PubMed]
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Dr. Hitesh Sharma was instrumental in managing various capacties of Wellness/integrative medicine/Diagnostics & pathology for years together. After proving his skills and abilities in the Wellness domain, he then diversified into the Spa and Wellness domain working as an Ayurveda and Lifestyle Consultant.He is currently a Wellness Leader, Head of Body Sciences and manages the Wellness and Spa center at The BodyHoliday, LeSPORT @ Saint Lucia, North America