Introduction

Torus palatinus¹ (Tori palantini/tori for plural) is a bony growth seen on the roof of the mouth (hard palate) and/or the floor of the mouth. These growths vary in size and number, and although uncomfortable and painless, they’re considered harmless. They can be present from birth or may develop later in life, where both genetic and environmental factors contribute to their development. The chances of getting tori are higher in people whose biological parents, grandparents, or siblings have the condition.² Tori palantini affect between 20% to 40% of the population, and are most commonly seen in AFAB (assigned female at birth) individuals 40 years and older. Tori can affect a diverse range of ethnic groups, including West Africans, East Asians and Europeans. Abnormal bone mineral density, mouth anatomy, and habits such as teeth grinding are the potential risk factors for developing torus palatinus.^1,4

Torus palatinus usually doesn't require treatment, unless it interferes with swallowing, speech, or any other function. Tori usually present on the roof of the mouth. Due to the presence of these bony growths, it can be difficult to properly fit dentures, mouthguards, retainers, and other dental appliances.

Clinical considerations

There are two types:

• Torus palatinus (seen on the roof of the mouth)
• Torus mandibularis(seen on the floor of the mouth)

Tori often develop during puberty, but can remain unnoticed until later in life due to its slow growth. Most cases of torus palatinus are asymptomatic. Hence, diagnosis is based on clinical parameters. A huge lesion is seen in patients who have lost their teeth. The growths typically present as hard, symmetric lumps that can be:³

• Lobular (made up of round lumps)
• Fusiform (spindle-like, wider in the middle, thinner at the ends)
• Flat (level and smooth)
• Nodular (a single, small lump)

The presence of a hard lump on the roof of the mouth can cause discomfort, especially while eating and speaking. If the swelling is large, it may interfere with tongue movements, causing altered speech. Food deposited around the bony swelling leads to challenges in maintaining oral hygiene, resulting in plaque accumulation and, subsequently, tooth decay.  The growth makes it challenging to fit dentures, retainers, and mouth guards.

Diagnosis & assessment

Most cases of tori are discovered during routine dental exams. This is because individuals with tori present with no concerning symptoms and are unaware of their condition. Tori palatini are very clear unless they are very small, and are usually diagnosed at the centre of the roof of the mouth, in the hard palate.

An X-ray may be used to rule out other mouth growths, such as:

• Mucocele (mucus-filled cysts on the inside of the mouth)
• Fibroma (a benign growth made up of fibrous connective tissue)
• Osteoma (another type of benign bone growth)
• Osteochondroma (a specific type of benign bone growth involving cartilage)

If an X-ray is used, tori appear darker (more radiodense) compared to the surrounding bone.

However, X-rays are usually not helpful in diagnosing tori, and most clinicians will rely on other clinical findings. If there are any doubts, it is suggested to take a biopsy for confirmation.⁶

Impact on denture fittings 

The most common problem associated with torus palatinus is denture instability. Large tori can interfere with the placement of the tray during impression-taking and denture insertions, leading to the denture fitting poorly.⁷ Ulceration of the mucosa occurs due to the friction from the prosthesis.

Tori presents challenges to restoring teeth in patients who have lost their teeth. This is because the thin mucosal covering over the torus makes it challenging to tolerate normal pressure from the denture base. Sometimes, the tori will extend into the soft palate, preventing the creation of an adequate palatal seal for the denture.⁵

When a torus interferes with denture fitting, such as when it's large, dentists will either remove it or adapt the dentures to accommodate it by creating a window in the denture that fits around the growth. For a torus on the roof of the mouth, a technique called triple lamination may be used to help dentures fit comfortably. Dentures made from the direct mould of a patient’s mouth may fit around the torus too snugly, causing rubbing and pain. With triple lamination, the denture is made of three materials to ensure a secure but comfortable fit around the torus, thereby preventing trauma.⁷

Management strategies

Non-surgical approaches

Conservative treatment can be considered if the patient has no issues with the lesion.

Modified dentures are trialled first for patients who require them, if their torus causes no issues. The steps to make them include:^10,11

• Taking impressions of the upper and lower jaw using moulding material (alginate)
• A custom impression tray is used for comfort and accuracy, including capturing around the torus ridges (undercuts)
• The denture is shaped using acrylic (a type of plastic)
• The edges of the denture are shaped to ensure they stay in place comfortably (border moulding)
• Your “bite” (occlusal registration) is recorded using wax blocks, and teeth are selected based on their natural size and shape

The triple laminate technique is a type of modification made to dentures, where a combination of three materials is used to create a comfortable denture. Acrylic is typically used in all dentures to provide the base shape and stability of the denture. A thermoplastic material is used as it allows for flexibility and can be formed into shape when warmed up in the mouth. This is especially important in tori patients as it enables the denture to fit around the torus without causing rubbing or other trauma. A resilient material is used for shock absorption during biting and chewing, spreading the force generated across the denture instead of across the soft tissue (gums) and the torus.^5,9

In addition to modified dental prosthetics (such as dentures), patients with torus palatinus should receive education and reassurance about their condition, and, if necessary, take antibiotics in the event of infection.

Surgical intervention

A toriectomy is the surgical procedure used to remove tori that cannot be managed with conservative treatment. The procedure is performed under local anaesthesia, and the surgical approach is based on how the torus presents (lobular, fulsiform, flat or nodular). Although rare, complications can occur, including infection, pain, and bleeding.⁸

Large tori require more extensive surgery. Surgical removal is indicated if there is:

• Irritation or ulceration of the overlying tissues
• Interference with oral function
• Inability to maintain proper oral hygiene
• An increased risk of developing oral cancer following trauma

FAQs

What is the prognosis of torus palatinus?

Torus palatinus has a good prognosis;  it is non-cancerous and causes no health issues. But in some cases, it may offer discomfort.

How common is torus palatinus, and what are the chances of recurrence? 

Torus palatinus is relatively common and is typically seen in older adults, especially AFAB, and those with a history of bruxism (teeth grinding). Recurrence rate after surgery is rare.

Can torus palatinus affect the function of the mouth or cause any complications?

Torus palatinus can affect the functions of the mouth, particularly if it is large. In these cases, it can interfere with chewing and speaking, as well as making dental procedures more challenging.

Summary

Torus palatinus is common in denture-wearing patients. The cause of the condition is unclear, and various theories suggest that it is primarily due to a combination of environmental and genetic factors. It can present a unique challenge in denture fit & comfort. Torus palatinus is a bony prominence, usually found on the roof of the mouth, and is typically asymptomatic. Depending on its size and location, it may cause irritation, discomfort, or even affect the fitting of dentures. Surgical intervention is not usually indicated, as it is typically diagnosed during routine dental examinations, unless it causes significant problems. However, dental professionals should carefully evaluate this condition.

Dental prosthetic procedures, such as relining and redesigning of dentures, are performed to alleviate irritation, discomfort, and improve the fit. To achieve optimal comfort and function for denture-wearing patients with torus palatinus, it is essential to ensure a well-informed, personalised approach, accurate diagnosis, and effective patient education, along with appropriate treatment strategies.