Mandibular tori or “tori bone” is an atypical — yet totally common — bony growth in your mouth. It occurs just near the floor of your mouth on the tongue-side surfaces of your mandible (lower jaw bone.) Depending on what literature you read, mandibular tori occur in 5-10% of the population (but some studies show it as high as 40%). These bony overgrowths tend to be more common the older you get.
When they’re located on the outside of the mandible (lip or cheek side) they’re referred to as “exostoses”; a version can also take place on the roof of the mouth (palatal tori.) Their name varies depending on which part of the mouth they’re growing in. For simplicity’s sake, we’ll be focusing on the ones that are on the tongue side of your lower jaw.
Mandibular torus (tori bone) is a bony overgrowth just inside the floor of the mouth on the tongue-side surface of the mandibular bone (lower jaw.) Mandibular tori are bony extensions that form along the jaw next to teeth in 5-40% of individuals. Depending on their size, tori can interfere with eating or wearing a removable prosthesis, such as a denture or partial.
Mandibular tori bone is made up of the same type of bony structure that you would see in the mandible (jaw bone) it’s attached to. Usually, these bony extensions are slightly bulbous looking and located on the tongue-side surface of your lower premolars (those are the teeth just behind your canines but in front of your molars.) Depending on the size of your mandibular tori bone, they may only be the width of one tooth or extend all the way from the front floor of your mouth to the most very back teeth.
Typically with small mandibular tori, you really don’t even realize that they’re there. Since they don’t inhibit normal activities, your body is probably used to them. The fact that bone growth occurs so slowly over the years, mandibular tori can pop up without you ever thinking about them. It might take a comment from your dentist or hygienist for you to realize that they’re even there.
The larger your tori bone gets, the more problems they start to cause. You’ll see a ridge-like growth along your teeth or more bulbous areas pop up inside of your mouth. Although they’re not painful, the amount of space that they take up will put them at risk for injury while eating. You may be constantly cutting yourself on harder foods (such as chips). Depending on how large they are, food and bacteria can become wedged between the bony growths, placing you at risk for infections and other oral health problems.
There are a lot of theories out there as to what causes mandibular tori. Some include:
As you might guess, the majority of these causes are associated with some type of tension or overuse, placing physical strain on the bone in that area of your mouth.
Most mandibular tori are bilateral, that is, they’re located around the same area on both sides of your mouth. If for any reason they are unilateral (only on one side) your dentist will need to investigate further, as the growth could be something more dangerous. Especially if it hurts.
Since tori bone jet out away from your teeth and smooth mandibular structure, they’re at significant risk for injury. Typically, the injuries are coming from normal daily activities, as opposed to some type of accident that would hurt your teeth. We’re talking about eating and chewing different textures of food. Even though your teeth can bite straight into crunchy or hard foods, that same bite hitting straight up against the gingiva-covered bone can be extremely painful. It’s not uncommon to see cuts in the gum tissue around your tori after meals. On a much lower scale, you might also constantly hurt or irritate your gums over the tori from everyday activities like brushing your teeth!
The bulbous shape of mandibular tori makes it easy for food debris and plaque bacteria to become impacted or wedged around them. Unfortunately, it’s often impossible to brush or floss around some areas with severe bony growths. Just like the gums around your teeth, if buildup accumulates around your tori it can cause gingivitis, infections, or bad breath. Make sure you have a water flosser on hand and use it daily.
Do you have multiple missing teeth that need to be replaced? If so, dentures or partials may be out of the question if your mandibular tori are severe. Since these prosthetics have to comfortably rest immediately against your gum tissues, the bony protrusions could get in the way. Even if you made a fitted denture that accommodated for a torus, it could still rub it throughout the day and cause sores. Or the mandibular tori may grow over time (even if by fractions of a millimeter) causing severe chafing or an ill-fitting denture.
Some people have extremely large palatal tori, which is the torus version in the roof of your mouth. Depending on how large it is and the amount of space it’s taking up, this bony growth could potentially limit your speech patterns. However, lingual tori (the ones next to your tongue in the floor of your mouth) usually don’t affect speech patterns that much.
Side Note: On the other hand, mandibular tori can serve as a source for bone grafts (like when your implant specialist or oral surgeon needs to perform a sinus lift). Their density also provides additional structural support to the teeth in that immediate area, making them less “at-risk” for tooth loss in the future.
The most common treatment for a mandibular torus is the “watch and wait” option. Unless your tori bone is extremely large and interfering with normal everyday life, your dentist probably won’t recommend any type of treatment.
However, there are always exceptions to the rule. When someone’s mandibular tori are severe enough that something has to be done about them, the only option that’s really available is to have the tori surgically removed. This treatment is typically reserved for the most aggressive cases and only if they’re interfering with eating or smile reconstruction. Or maybe if they’re constantly getting injured whenever you’re brushing your teeth. Otherwise, the standard of care is to typically leave them alone.
Fortunately, these bony growths or tori-type growths usually don’t have to be removed. In most cases, you can just leave them where they’re at and they’ll never both you. But on the rare occasion that the growth is extensive and problematic, your dentist may refer you to a specialist to have them removed. Especially if you need dentures or are experiencing recurring injuries due to their size.
Now here comes the bad news. Mandibular tori almost always start to grow back after having them surgically removed. There is no way of knowing if there is a 100% chance either way, but if they’re genetic and someone else in your family had them grow back after surgical removal there is a good chance you will too.
As long as you’re regularly seeing a dentist every six months, you don’t need to plan any special trips to discuss your mandibular tori. Tori bone grows at such a slow rate that it’s fine to wait until your routine checkup to talk to your dentist. In fact, they might bring it up before you do, especially if you’re planning a tooth replacement treatment.
That being said, if you’re already starting to experience difficulty eating, getting food caught in your tori, or they seem to be getting infected, go ahead and bring up the issue during your exam.
If you only see a growth on one side of your mouth, schedule an exam with your dentist. Although rare, these unilateral formations could be some type of bone-related cancer. They may need to order a biopsy for further investigation.
Your dentist will want to assess the severity of your complications. From there, you can have a conversation about whether the risks and rewards of tori removal would be beneficial, given your situation. For most people, a “watch and wait” approach is best. Regular photographs and measurements can determine the extent of growth over the years to help you intervene if they become too severe.
You may never realize you have a small mandibular torus. But once mandibular tori become large and pronounced, they can interfere with normal daily activities like eating. In fact, tori bone may need to be removed if it’s going to interfere with wearing a denture (but there’s always a risk of it growing back.) You and your dentist will want to have a heart-to-heart about whether removal is in your best interest and what other options may be available. Especially if you’re at risk for infection or you need to replace missing teeth.
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