What Is Mandibular Tori

Also referred to as dental tori, mandibular tori is an uncommon condition characterised by the appearance of dense and bony growths (tori) on either one side (unilateral) or, more commonly, both sides (bilateral) of the lower jaw (mandibula), under the tongue. 

Read on to find out whether mandibular tori is cancerous or may result in cancer if not surgically removed, the groups of people mandibular tori are more likely to affect, how mandibular tori is currently diagnosed and treated, and much more!

Introduction

Definition of mandibular tori

Mandibular tori are dense, bony outgrowths (dental tori) that form on either one side (unilateral) or, more commonly, both sides (bilateral) of the lower jaw (mandibula), under the tongue.¹ These growths can either be singular (torus mandibularis) or plural (mandibular tori). 

Although the term ‘growths’ might induce feelings of concern, mandibular tori² are not cancerous (benign) and are, in fact, considered harmless. They can grow back after they are surgically removed, but they do not spread elsewhere within the body, nor do they increase the risk of developing cancer in the future. 

Occurrence and prevalence 

Mandibular tori are quite uncommon,² affecting approximately 27 out of every 1,000 adults in the United States. 

Causes and risk factors

It is currently unclear what exactly causes mandibular tori. However, certain risk factors are thought to increase the risk of developing mandibular tori, including: 

• Genetic factors: having a family history of mandibular tori has been demonstrated to increase the likelihood of developing the condition.³
• Environmental factors: over 70% of mandibular tori cases are thought to be caused by environmental factors.³ These may include:
  • Bruxism: this refers to teeth grinding or clenching, which can put a strain on the jaws and lead to dental damage.¹
  • Vitamin deficiencies: deficiencies in certain vitamins, such as vitamin D, which is essential for bone growth, may increase the risk of developing mandibular tori.³ 
  • Calcium supplements: having extremely high calcium levels in the blood (hypercalcemia) may cause mandibular tori by stimulating osteogenesis or bone formation.³ It is very easy to exceed the daily calcium upper limit through calcium supplements, and therefore, calcium supplements should not be taken without a doctor’s approval or supervision. 

• Ethnicity: the prevalence of mandibular tori has been reported to be highest in Asian ethnic groups with Eskimo, Japanese, and Mongolian descent and lowest in Whites.³
• Age: research studies have shown that people over the age of 30 are more at risk of developing mandibular tori.³
• Sex: males appear more likely to develop mandibular tori compared to females.³

Signs and symptoms

For most patients, mandibular tori is asymptomatic (no symptoms) and is often discovered incidentally at a routine dental appointment. However, some patients may experience signs and symptoms, the main being:²

• One or multiple bony growths on either one side (unilateral) or both sides (bilateral) of the lower jaw, under the tongue,
• Chewing and swallowing difficulties, 
• Speech difficulties, 
• Difficulty inserting dentures or mouth guards, or 
• Food deposits constantly getting stuck around the bony growths 

Some patients with mandibular tori may also experience difficulty closing their mouth completely; however, this symptom is rare and not as common as the ones mentioned above. 

Complications of mandibular tori

Although not considered to be cancerous, infectious, or harmful, mandibular tori can result in complications that can be uncomfortable for some patients, including:²

• Dental plaque and cavities: having mandibular tori can make it difficult to brush the teeth properly, causing bacteria to build up around the dental tori, resulting in plaque and eventually, if not treated, cavities.
• Chewing and swallowing difficulties: understandably, mandibular tori may make it more difficult to chew and swallow certain foods, especially if they are large. 
• Speech difficulties: mandibular tori may impede tongue movement, resulting in difficulties with talking and forming certain speech words (articulation disorder). 
• Pain and discomfort: large mandibular tori, in particular, can make it difficult to close the mouth completely and also result in inflammation, which can be quite painful. 

Diagnosis 

Mandibular tori is often diagnosed via physical examination in a dental appointment.³ A dentist may also perform histological examination by taking samples of the bony growths, staining them, and observing them under the microscope. A diagnosis of mandibular tori is provided when the bony growths appear as dense as a normal bone with a spongy structure, normal osteocytes (bone cells found within lacunae) and lacunae (gaps and spaces that contain bone cells).

No further diagnostic tests are usually required to confirm the diagnosis of mandibular tori.² However, in certain cases, a computed tomography (CT) scan may be required to rule out any other dental issues. A CT scan is an imaging test that uses a computer (hence ‘’computed’’) and X-rays to take detailed images of internal structures such as bones and soft tissues.

Management and treatment

Since mandibular tori are often harmless and not a cause of concern, no treatment is usually provided.² However, surgical removal (oral surgery) may be required in certain cases where mandibular tori negatively interferes with quality of life and oral function by causing any of the following symptoms:

• Pain and/or discomfort,
• Ulceration: ulcers are painful sores or lumps that may lead to infection if not treated,
• Difficulty inserting dental appliances such as dentures or mouth guards, or
• Speech difficulties may be further exacerbated in people with certain speech disorders, such as articulation disorders. 

An oral surgery procedure for mandibular tori involves the following steps:²

1. The oral surgeon will provide the patient with local anaesthesia to numb the gums and alleviate any feelings of pain and discomfort
2. An incision or cut will be made in the gums to access the dental tori
3. The dental tori will be removed along with any excess bone
4. Finally, the oral surgeon will close the incision using stitches

Recovery after surgical removal of mandibular tori can be quite lengthy, requiring over four weeks to months for the wounds to fully heal. The recovery length depends primarily on the number and size of the dental tori.  

However, patients should expect to feel less discomfort within a week or two following oral surgery. 

To get the most out of the surgical treatment and decrease recovery time, patients are advised to:²

• Take all medications provided by their doctor: these would usually involve antibiotics, analgesics (painkillers), and/or anti-inflammatory drugs.³
• Avoid and limit any hard and crunchy foods. 
• Eat soft foods, e.g. mashed potatoes, yogurt, pudding, apple sauce, pasta etc.
• Use a mouthwash daily to prevent infection and contamination in the surgical site.  

Complications of mandibular tori surgical removal

Although quite rare, complications following surgical removal of mandibular tori can occur in some patients.² These may include:

• Excessive bleeding
• Prolonged swelling, lasting for more than a couple of days
• Infection, and
• Allergic reactions from local anaesthesia (incredibly rare)

Mandibular tori can also grow back after they are surgically removed. Fortunately, they do not grow to the extent that they become cancerous. 

Prevention  

Unfortunately, mandibular tori cannot be prevented because scientists do not know its exact cause.² However, it is possible to prevent mandibular tori from interfering with or disrupting quality of life by: 

• Having regular routine dentist appointments
• Maintaining good oral hygiene
• Avoiding and limiting teeth grinding or clenching (bruxism), and
• Keep up with the medication prescribed by your doctor. 

It is also worth making sure you are getting all the vitamins you need from your diet to avoid vitamin deficiencies, particularly vitamin D.³ Oily fish such as salmon, sardines, and mackerel are particularly rich in vitamin D, and therefore should be consumed regularly. Only take calcium supplements if advised by your doctor as they can easily lead to hypercalcemia, which is a big risk factor for mandibular tori. 

Prognosis and outlook

Most patients with mandibular tori live normal, healthy lives, and the bony growths do not hinder their ability to function, chew, swallow, speak, or socialise.² 

Patients typically do not need to consider surgical removal unless the mandibular tori starts to negatively impact their quality of life and oral function. 

When should you see a doctor?

See your doctor or healthcare provider if you:²

• Develop sores or lumps in your mouth: it is always worth checking lumps to make sure they are not cancerous.
• Notice an increase in the number or size of the mandibular tori
• Develop redness, irritation, or inflammation in the tissue covering the mandibular tori.
• Develop pain and/or discomfort
• Experience difficulties with speech
• Experience difficulties with chewing or swallowing food

Summary

Mandibular tori are uncommon, benign (non-cancerous), harmless, dense, bony growths (tori) with a spongy structure that develop on either one side (unilateral) or, more commonly, both sides (bilateral) of the lower jaw (mandibula) under the tongue. 

At present, the exact cause of mandibular tori remains to be elucidated. However, certain groups of people are thought to have a higher risk of developing mandibular tori, including:

• Males
• People over the age of 30
• People of Eskimo, Japanese, or Mongolian descent 
• People with excessive calcium and/or extremely low vitamin D levels
• People with a family history of mandibular tori, and
• People who grind or clench their teeth (bruxism) excessively

Mandibular tori often do not result in any symptoms (asymptomatic) or complications nor do they decrease the quality of or outlook on life. Therefore, most patients with mandibular tori do not require treatment. However, oral surgery may be performed in certain cases where mandibular tori results in: 

• Pain and/or discomfort
• Speech, chewing, and/or swallowing difficulties, or 
• Ulceration and/or infection

Despite its well-renowned success and safety, surgical removal does not always completely remove mandibular tori and, in rare cases, may even result in infections. 

There is no specific diagnostic test to diagnose mandibular tori as it is often discovered incidentally at a routine dentist appointment. Although often not necessary, diagnosis of mandibular tori may be confirmed via histological examination and/or a CT scan. 

See a doctor immediately if you: 

• Notice any lumps in your mouth, especially if they have increased in number or size
• Experience difficulties with speech, swallowing, and/or chewing food or 
• Experience pain/and or discomfort from the dental tori