MAXILLOFACIAL DISORDERS

LESSON
9
BY ESTHER MURIUKI O.T/MSC SENSORY INTEGRATION
TORUS PALATINUS &TORUS MANDIBULARIS

Torus palatinus is a bony protrusion on the palate, usually

present on the midline of the hard palate.
Torus mandibularis is a bony growth in the mandible along
the surface nearest to the tongue.
Mandibular tori usually are present near the premolars and
above the location on the mandible of the mylohyoid
muscle attachment.
TORUS PALATINUS
AND MANDIBULARIS
Torus palatinus and mandibularis are common
developmental benign exostoses more common in Asians,
especially Koreans. They appear in late teens or adulthood
and may become more apparent with increasing age. They
have a smooth or nodular surface, and are of no
consequence apart from occasionally interfering with
denture construction.
** The two types are not necessarily associated one with
another:
Torus palatinus occurs in the centre of the hard palate, is of
variable size and configuration. Torus mandibularis is lingual
to the lower premolars and usually bilateral .
TORUS PALATINUS
(PALATAL TORI)

Torus palatinus refers to a bony growth on the roof of the

mouth.
These growths are harmless, but can be uncomfortable and
inconvenient.
These growths, which vary in size and number, are harmless
and generally don’t cause pain.
You can be born with torus palatinus or develop it later in life.
Removal isn’t necessary unless the growth causes
complications or interferes with speech or swallowing or
other functions.
You can get torus (singular) or tori (plural) under your tongue,
too — on the floor of your mouth.
HOW COMMON ARE ORAL
TORI?

Between 20% and 30% of the general population has palatal

tori. The condition is more common in women and people
assigned female at birth. It’s also more prevalent among
certain ethnic groups, including East Asians, Europeans and
West Africans.
SYMPTOMS AND CAUSES

What are the symptoms of torus palatinus (palatal tori)?

A torus palatinus almost always forms in the center of your hard palate
(the roof of your mouth). You might be born with it, or it might develop
gradually over time.
Torus palatinus symptoms may include:
One or more bony growths (bumps) in the center of your hard palate.
Difficulty getting a proper fit with mouth guards, retainers, dentures or
other dental appliances.
Food getting stuck around the bony growths.
Speech difficulties.
Trouble chewing, swallowing or closing your mouth (rare).
Additionally, many people with palatal tori feel self-conscious about
their condition. If you have anxiety about living with torus palatinus, tell
your healthcare provider. They can discuss appropriate treatment
options with you.
WHAT CAUSES TORUS
PALATINUS (PALATAL TORI)?

Experts don’t really know what causes palatal tori or why

some people are more likely to get them.
However, they’ve identified some potential risk factors, which
we’ll explore below.
TORUS PALATINUS RISK
FACTORS

Possible risk factors for torus palatinus include:

Mouth anatomy. Tooth crowding, jaw shape and the way
your teeth fit together may contribute to the presence of palatal
tori.
Teeth grinding (bruxism). People who clench or grind their teeth
might be more likely to develop palatal tori.
Bone mineral density. Higher bone density or changes in your
bone density may increase the likelihood of developing palatal
tori.
Age. Most people with palatal tori are over the age of 30.
Genetics. Research indicates that you’re more likely to develop
palatal tori if your biological parents, grandparents or siblings
have the condition.
WHAT ARE THE COMPLICATIONS OF
TORUS PALATINUS (PALATAL TORI)?

Palatal tori aren’t harmful or dangerous. They don’t mean you have an
infection or cancer. But when palatal tori grow very large, or if they develop
near other oral structures, they may cause complications, such as:
Eating or chewing difficulties. Depending on the location and size of the
growths, food may become lodged in the area and make it difficult to chew
properly.
Difficulty swallowing. Some people may have trouble swallowing, especially
if the growth is near the back of your hard palate.
Poor oral hygiene. If you have tori near your teeth, it can be difficult to brush
and floss properly. This can result in an overgrowth of plaque and bacteria.
Speech difficulties. If torus palatinus interferes with
your tongue’s movement, it could have a negative impact on your speech.
Discomfort. While most people don’t have pain with palatal tori, these
growths may grow so large that you have trouble closing your mouth
comfortably.
DIAGNOSIS AND TESTS

Palatal tori are usually obvious unless they’re very small. In

most cases, a dentist makes the diagnosis during a routine
exam.
What tests can help diagnose torus palatinus (palatal tori)?
Testing may not be necessary to diagnose torus palatinus.
However, your dentist may take a CT (computed tomography)
scan to rule out any other issues.
MANAGEMENT AND
TREATMENT

Healthcare providers don’t usually recommend treatment unless

oral tori interfere with function or your quality of life. When
necessary, oral surgery is the go-to torus palatinus treatment.
Surgical torus palatinus removal
Oral surgeons usually perform torus palatinus removal. During
this procedure, a surgeon will:
Give you local anesthesia to numb the area. (You can also ask
about sedation dentistry options to keep you comfortable.)
Create a cut (incision) on the roof of your mouth to access the
bony growth.
Remove excess bone.
Close the incision with stitches.
COMPLICATIONS OF TORUS
PALATINUS REMOVAL

Though uncommon, complications are possible. They

include:
Infection.
Excessive bleeding.
Swelling that lasts more than a few days.
Perforating (making a hole) in your nasal cavity.
Allergic reaction to anesthesia (rare).
RECOVERY PERIOD
How long does it take to recover from torus palatinus
removal?
It can take up to one month to fully heal after torus palatinus
surgery. To foster a speedy and comfortable recovery:
Take all medications exactly as prescribed.
Eat soft foods like yogurt, pasta, applesauce, pudding and
mashed potatoes.
Avoid hard and crunchy foods.
Keep the surgical site clean with antibacterial mouthwash.
PREVENTION

There’s nothing you can do to prevent palatal tori. If you have

torus palatinus, let your healthcare provider know if you
notice any major changes.
Addressing issues early can reduce your risk of further
complications.
OUTLOOK / PROGNOSIS

If you have torus palatinus and it’s not interfering with your
quality of life, you don’t need to do anything. You should,
however, make sure you mention it to your dentist or
healthcare provider so they can confirm the diagnosis and
rule out other conditions.
TORUS MANDIBULARIS

Torus mandibularis is a bony protuberance located on the

lingual aspect of the mandible, commonly in the canine
and premolar areas.
Most studies show that the torus mandibularis is less
common than the torus palatinus with a general prevalence
of about 6% with a bilateral presentation in about 80% of
cases.
It can appear as a single elevation or as a group of fused
tubercles varying in size , Some studies simply classify the
size of the torus as “palpable, visible, or large.”
 TORUS MANDIBULARIS
A synonym for torus mandibularis is mandibular torus.
Disease Mechanism
Torus mandibularis is a hyperostosis that protrudes from the lingual aspect of the
mandibular alveolar process, usually near the premolar teeth.
Clinical Features
Tori occur less often on the lingual surface of the mandible than on the palate, with
the former occurring in about 8% of the population. These tori develop singly or
multiply, unilaterally or bilaterally (usually bilaterally), and most often in the premolar
region. The size also varies, ranging from an outgrowth that is just palpable to one
that contacts a torus on the opposite side. In contrast to torus palatinus, torus
mandibularis develops later, being first discovered in middle-aged adults. However, it
has the same gender predilection as torus palatinus. In women, the occurrence of
torus mandibularis correlates with that of torus palatinus, but this apparently is not
the case in men. As with torus palatinus, torus mandibularis may occur more often in
individuals of Asian ancestry.
Genetic and environmental factors seem to be involved in the development of torus
mandibularis, but masticatory stress is reported as an essential factor underlying its
formation. The high prevalence among Eskimos and other subarctic peoples who
make extraordinary chewing demands on their teeth seems to support this
suggestion. Also, a patient with a torus mandibularis has, on average, more teeth
present than a patient without a torus.
WHAT IS TORUS MANDIBULARIS (MANDIBULAR
TORI)?

Torus mandibularis refers to a bony growth on the floor of your mouth,

under your tongue. These growths, also called dental tori, are harmless and
typically don’t cause pain. You can have mandibular tori on one side or both
sides of your mouth. Torus mandibularis generally doesn’t require treatment
unless it interferes with chewing, speaking or other functions. You can be
born with the condition or develop it later in life.
Dental tori vary in number and size. You can have one growth or several. You
can get torus (singular) or tori (plural) on the roof of your mouth, too.
Healthcare providers call these bony growths palatal tori (torus palatinus)
because they form on your palate (roof of your mouth).
Is it normal to have mandibular tori?
Mandibular tori are somewhat uncommon, affecting about 27 out of every
1,000 adults in the United States. Mandibular tori are much less common
than palatal tori. In addition, about 80% of people with mandibular tori have
these growths on both sides of their mouth.
While dental tori aren’t common, there’s nothing wrong with having them.
They’re not harmful or cancerous.
 Torus mandibularis refers to a bony growth on the floor of your mouth,
under your tongue. These growths, also called dental tori, are harmless

Healthcare providers call these bony growths mandibular tori(torus

mandibularis) because they form on your mandibular (lower) jaw.
.
SYMPTOMS AND CAUSES

What are the symptoms of torus mandibularis (mandibular tori)?

You can develop mandibular tori on one or both sides of your
lower jaw. You might be born with these growths, or you may
develop them gradually over time.
Mandibular tori symptoms may include:
One or more bony growths on your lower jaw, under your
tongue. (This can happen on one side or both.)
Difficulty chewing or swallowing.
Difficulty getting dental appliances to fit correctly, such
as dentures and mouth guards.
Food particles getting stuck around the bony growths.
Speech difficulties.
Trouble closing your mouth all the way (rare).
CTN…
What causes torus mandibularis (mandibular tori)?
Healthcare providers don’t really know what causes mandibular tori or why some
people are more likely to develop them. There are, however, certain identifiable risk
factors.
Torus mandibularis risk factors
Risk factors for mandibular tori include:
Teeth grinding (bruxism). If you clench or grind your teeth, you might be more likely to
have mandibular tori.
Mouth anatomy. The way your teeth fit together, as well as your jaw shape, can have an
impact on the presence of dental tori.
Bone density. People who have higher bone density — or experience a significant
change in bone density — may be more likely to have mandibular tori.
Vitamin deficiencies. Some research indicates that a lack of certain vitamins can
contribute to dental tori.
Genetics. You’re more likely to have dental tori if there’s a family history of the
condition.
Age. People over the age of 30 are more likely to develop mandibular tori.
IMAGING FEATURES

Imaging Features
Location.
Recognition of mandibular tori relies on their appearance and location. Their
presence bilaterally reinforces this impression, although they can occur
unilaterally. On mandibular periapical images, a torus mandibularis appears
as a radiopaque shadow, usually superimposed on the roots
of premolars and molars and occasionally over a canine or incisor. It usually
is superimposed over about three teeth.
Periphery.
Mandibular tori are sharply demarcated anteriorly on periapical images and
are less dense and less well defined as they extend posteriorly (Fig. 22-7).
There is no margin between the periphery of the torus and the surface of the
mandible because the torus is continuous with the mandibular cortex.
Internal Structure.
On occlusal images, a mandibular torus appears as radiopaque and
homogeneous .
COMPLICATIONS OF TORUS
MANDIBULARIS
What are the complications of torus mandibularis (mandibular tori)?
Though mandibular tori aren’t harmful or cancerous, they can cause
complications in some people — particularly if the growths interfere
with other oral structures or functions. These complications may
include:
Poor oral hygiene. Tori that are near your teeth may make it difficult to
brush and floss properly. This can result in a buildup of dental
plaque and harmful oral bacteria.
Difficulty chewing or swallowing. Large mandibular tori may interfere
with chewing, eating or swallowing your food.
Speech issues. Sometimes mandibular tori can hinder your tongue’s
movement, resulting in speech difficulties.
Pain or discomfort. If mandibular tori grow very large, they may prevent
you from closing your mouth completely. The tissue covering the bony
growths may also become irritated or inflamed, especially if you wear
dentures, mouth guards or other oral appliances.
DIAGNOSIS AND TESTS

Dentists usually diagnose dental tori during routine

examinations. They may take photos of the growths to
document their size and location.
What tests can help diagnose mandibular tori?
You might not need testing to diagnose mandibular tori.
However, your dentist may take a CT (computed tomography)
scan to rule out other dental issues.
MANAGEMENT AND
TREATMENT

Treatment
A torus mandibularis usually does not require treatment, although removal
may be necessary if a mandibular denture is planned.
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.
Surgical mandibular tori removal
Oral surgeons perform mandibular tori removal. During this procedure, a
surgeon will:
Give you local anesthesia to numb your gums. (In addition, most oral
surgeons offer sedation dentistry options to keep you calm and comfortable
during your procedure.)
Make an incision (cut) in your gums to access the tori.
Remove the tori and any excess bone.
Close the incision with stitches.
COMPLICATIONS OF MANDIBULAR
TORI REMOVAL

Complications following mandibular tori removal are rare, but

they can occur. These complications may include:
Excessive bleeding.
Infection.
Swelling that lasts for more than a few days.
Allergic reaction to anesthesia (rare).
RECOVERY PERIOD
How long does it take to recover from mandibular torus
treatment?
It can take up to four weeks to fully heal after mandibular tori
removal — sometimes longer, depending on the size of the
growths. But your overall comfort level should start to improve
within a week or two.
During recovery, you should:
Take all medications as directed.
Avoid hard and crunchy foods.
Eat soft foods, such as mashed potatoes, yogurt, pudding,
applesauce and pasta.
Use an antibacterial mouthwash daily to help keep the surgical
site clean.
CAN I PREVENT MANDIBULAR TORI?

There’s no way to prevent mandibular tori because experts

don’t know what causes it in the first place.
Let your dentist know if you have bony growths on the floor
of your mouth.
With early detection, they can keep an eye on the growths
and make sure they don’t cause any issues.
OUTLOOK / PROGNOSIS

What can I expect if I have mandibular tori?

Most people with mandibular tori don’t need to do anything.
Surgical removal isn’t necessary unless the growths interfere
with function or your quality of life.
If you have dental tori, you should let your healthcare
provider know so they can confirm the diagnosis and
monitor any growth that occurs over time.
GROW BACK AFTER YOU
REMOVE THEM?

Unfortunately, mandibular tori can grow back in some cases.

Treating any underlying issues, such as grinding or
clenching your teeth, can help reduce this likelihood.
WHEN SHOULD I SEE MY
HEALTHCARE PROVIDER?

You should tell your dentist or healthcare provider any time

you notice a lump or bump in your mouth. They can confirm
your diagnosis and rule out other conditions.
If you already have mandibular tori, you should call your
healthcare provider if:
The growths multiply or grow larger.
The tissue covering the tori becomes red and irritated.
You develop pain or discomfort.
The tori start to interfere with chewing or swallowing.
You have difficulty speaking.
OPEN FORUM
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centre
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