Santana D. VanDyke, BS, MS-III, and Barbara B. Wilson, MD
The University of Virginia School of Medicine, Charlottesville, Virginia
VanDyke SD, Wilson BB. Torus mandibularis and buccal exostoses. Consultant. 2018;58(6):e190.
A 25-year-old woman presented to a dermatologist for a skin check. Routine examination of the oral cavity revealed bilateral bony growths along the buccal aspect of the mandible and maxilla as well as the mandibular arch. The growths were covered with normal mucosa and were nontender. No erythema or discharge was present. The patient reported that the bony growths had been present for as long as she could remember, had been stable, and had never caused any pain or discomfort.
Discussion. Patients commonly seek medical care for abnormalities of the oral cavity that cause discomfort. However, some abnormalities, such as torus mandibularis and buccal exostoses, rarely cause symptoms and might only be discovered by meticulous history-taking and thorough physical examination.
Torus mandibularis is a bony overgrowth located on the lingual aspect of the mandible (Figure 1), while buccal exostoses are multiple bony nodules along the buccal aspect of the maxilla or mandible (Figures 2 and 3).1 Torus palatinus is another frequently observed bony overgrowth of the oral cavity, is located in the middle of the hard palate, and can be unilobular, polylobular, flat, or spindle-shaped.2 Although torus mandibularis, torus palatinus, and buccal exostoses differ by location, they are histologically identical,1 and the diagnosis is usually clinical. These conditions generally are asymptomatic but may cause discomfort in cases of extreme growth.2 Furthermore, they may cause difficulty for those patients who require dentures.2
The etiology of torus mandibularis, torus palatinus, and buccal exostoses is unknown, but several theories have been proposed. Genetics appears to have a significant role in the development of these abnormalities but does not fully explain their presence.1-4 Occlusal force, such as with bruxism, also seems to predispose patients to the development of these growths.1-6 Therefore, the development of tori and exostoses is likely multifactorial.1,2,4,6
Studies report a wide variation in the prevalence of torus mandibularis, torus palatinus, and buccal exostoses but confirm that these lesions are common findings on oral examination.1,7-9 Torus palatinus is the most common of these findings,8,9 and tori and buccal exostoses frequently occur together.1
Treatment of tori and buccal exostoses is usually not necessary. Patients should be reassured that these growths are benign and should be encouraged to maintain good oral hygiene. However, patients may require surgical removal if the growths cause pain due to ulcerations, difficulty eating or speaking, or difficulty wearing dentures.10
- Jainkittivong A, Langlais RP. Buccal and palatal exostoses: prevalence and concurrence with tori. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000;90(1):48-53.
- García-García AS, Martínez-González J-M, Gómez-Font R, Soto-Rivadeneira Á, Oviedo-Roldán L. Current status of the torus palatinus and torus mandibularis. Med Oral Patol Oral Cir Bucal. 2010;15(2):e353-e360.
- Eggen S. Torus mandibularis: an estimation of the degree of genetic determination. Acta Odontol Scand. 1989;47(6):409-415.
- Auškalnis A, Rutkūnas V, Bernhardt O, Šidlauskas M, Šalomskienė L, Basevičienė N. Multifactorial etiology of Torus mandibularis: study of twins. Stomatologija. 2015;17(2):35-40.
- Yoshinaka M, Ikebe K, Furuya-Yoshinaka M, Maeda Y. Prevalence of torus mandibularis among a group of elderly Japanese and its relationship with occlusal force. Gerodontology. 2014;31(2):117-122.
- Pechenkina EA, Benfer RA Jr. The role of occlusal stress and gingival infection in the formation of exostoses on mandible and maxilla from Neolithic China. Homo. 2002;53(2):112-130.
- Romanos GE, Sarmiento HL, Yunker M, Malmstrom H. Prevalence of torus mandibularis in Rochester, New York, region. N Y State Dent J. 2013;79(1):25-27.
- Šimunković SK, Bozić M, Alajbeg IZ, Dulčić N, Boras VV. Prevalence of torus palatinus and torus mandibularis in the Split-Dalmatian County, Croatia. Coll Antropol. 2011;35(3):637-641.
- Hiremath VK, Husein A, Mishra N. Prevalence of torus palatinus and torus mandibularis among Malay population. J Int Soc Prev Community Dent. 2011;1(2):60-64.
- Ness GM. Palatal and lingual torus removal. In: Kademani D, Tiwana P, eds. Atlas of Oral and Maxillofacial Surgery. St Louis, MO: Elsevier Saunders. 2016:120-126.