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Oral Tori

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Oral Tori

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Tori are harmless bony outgrowths in the oral cavity, that interfere with daily activities like talking, chewing, and wearing dentures. Read to know more.

Medically reviewed by

Dr. Chithranjali Ravichandran

Published At April 27, 2021
Reviewed AtAugust 2, 2023

What Is Oral Tori?

Oral Tori, analogous to maxillary (upper jaw tori) and mandibular tori (lower jaw tori), are bony outgrowths that usually project inward (into the inner surface of the alveolar jaw bone) or outwards (into the outer surface of the alveolar bone). Most patients with dental tori report bilateral or two-sided distribution or presence of these outgrowths, but it would be unilateral too.

Are Dental Tori Cancerous?

Tori are frequently misunderstood and associated with cancerous growths, but that is not true. They are, in fact, benign growths or, in other words, merely a bony exostosis found in the jaw (upper or lower).

What Is Exostosis or Osteoma?

To elaborate about an exostosis or an osteoma - it is basically a benign outgrowth of new bone on top of the existing bone. It can occur in other parts of the body like the ear, the heel of the foot, sometimes even under nail beds and in sinuses as well. Research shows children and young adults are more likely to experience exostosis.

What Is the Clinical Presentation Of Oral Tori?

Tori are asymptomatic but may frequently be associated with eating and drinking issues for the patient due to the hardness or the uneven growths they feel with the tongue or the teeth in the jaw, depending on the location. Tori are composed of compact bone and are quite dense and mineralized. The cause of tori are not exactly traced or established, but research indicates that a genetic component may be likely. The possibility of tori existing in people with parafunctional habits like night grinding and clenching is also observed.

In Which Area Are Tori Usually Seen?

In the maxilla or the upper jaw, the tori are usually seen arising from the midline of the hard palate (often termed torus palatinus). In the mandible, the origin of tori is from the inner aspect of the alveolar bone of the mandible above the origin of the mylohyoid muscle. Bony exostosis also may rarely occur on the buccal aspect of the maxilla or mandible (Buccal Exostosis) but is less reported than the dental tori.

Are Oral Tori Slow-Growing?

Pathologically, whether it is maxillary or mandibular tori, they are considered slow-growing, harmless and non-invasive. Studies also indicate that the mandibular tori are not as prevalent compared to the maxillary palatal tori. The mandibular tori are further known to grow due to torsional stress (more in the area of the canine tooth) created by heavy mastication (chewing). When the maxillary or mandibular tori are covered by fibrous tissue or cartilage, or soft tissue, they are further prone to tissue irritation. For example -when the tori in the mouth are covered by soft tissue due to long-standing presence in the jaw with constant friction, then the overlying oral mucosa tends to get ulcerated.

What Are the Problems Caused by Tori?

The tori remain harmless and do not require dental management only so long as they do not cause these below explained issues. Tori most often do not require any form of surgical management, usually owing to the fact that it goes unnoticed in patients. They, however, do tend to create these issues in such cases:

  • Large tori interfere with speech or causes slurring or slurred speech if it keeps growing in size.
  • Eating hard food or food with sharp edges like crispy or fried foods can definitely ulcerate the overlying tori lining mucosa because of its friable nature.
  • Large palatal tori (maxillary tori/torus palatinus) cause obstruction to dental radiographic imaging, especially when the dental surgeon or physician needs to view the maxillary sinus. There may be a difficulty as well during the placement of intraoral films before taking a routine dental X-ray because of palatal tori.
  • Though not described in dental literature, medical cases where a patient’s airway management may be difficult, especially in emergencies, is also another concern of dental tori.
  • Denture fabrication in older individuals is particularly difficult without the removal of tori, more so in the maxillary region as the stability of denture will be affected. The tori instead become a fulcrum point that leads to improper rocking movements of the denture in the mouth.
  • In people with parafunctional habits like night grinding (bruxism) and tooth clenching, the tori pose a lot of problems by enlarging on and off because of unnecessary pressure on the tori and its thin mucosa.
  • Rarely but reportedly, tori also can be a cause for tooth mobility, inflamed gums, or sore throat infections if soft tissue growths over the tori get ulcerated and create chronic gum infections. Also, due to limited oral hygiene control, if a tori gets ulcerated as brushing would become painful in that area, gum infections and sore throat or tonsil inflammation can also be a sequel of infections due to compromised oral hygiene.

Are Tori of Any Use?

Despite the multiple disadvantages of having this dental exostosis or tori, they are an important asset for being used as autogenous bone grafts for dental procedures. For either dental implants or post-extraction of teeth-in order to fill certain bony defects and traumatic bone -it requires autografts (harvesting graft from the patient’s own body wherein the donor site is from the jaw or ileac crest or symphysis of jaw). In such cases, as these tori are quite firm and dense in origin, this extra tissue is hence useful as being an ideal autogenous bone graft material.

How To Diagnose Oral Tori?

Clinical diagnosis of these mineralized outgrowths is fairly straightforward by your dentist upon oral examination. But when the tori cause pain or loss of sensation in the affected area (paresthesia), then investigations should be further attempted by the dental surgeon.

What Are the Differential Diagnosis of Oral Tori?

The differential diagnosis of a slow-growing unilateral lesion would not be tori at all but rather serious conditions like osteochondroma, osteoblastoma or sarcoma, especially if it is invasive or causing pain and paresthesia.

Should Oral Tori Be Treated?

Surgical resection of dental tori are seldom recommended, but when they cause the above-enlisted problems or bleeding due to soft tissue outgrowths over the tori or oral health issues, then it needs to be removed by your dentist.

Conclusion:

To conclude, though developing tori may seem alarming and create anxiety in the patient, they are harmless to the maximum extent. New growths in the mouth, whether observed suddenly or for a long time, always hence needs to be investigated by the dental surgeon. It is important not to self-diagnose and visit your dentist to confirm that the outgrowths are tori and to make sure you have no potential serious issues associated with tori in the future.

Frequently Asked Questions

1.

How Is the Oral Tori Removed?

The oral tori is removed using laser surgery or surgical burs under local or general anesthesia. A cut is given in the soft tissue overlying the tori to expose the tori. Large tori is removed in multiple pieces. It is a painless surgical procedure.

2.

How Frequently Oral Tori Is Seen?

Oral tori is a commonly seen oral condition affecting the population. Oral tori affects 27 out of 1000 adults. Mandibular tori are more frequently observed in 4 to 10 percent of the population. Males are more likely to be affected than females.

3.

Do Oral Tori Go Away?

No, oral tori does not resolve itself over time. Tori needs surgical intervention for removal. Tori is benign and usually harmless. Removal of tori is needed before the fabrication of upper and lower dentures in patients requiring complete dentures.

4.

Are Dental Tori Cancerous?

No, oral tori are usually non-cancerous or benign and do not cause any harm. It does not require any urgent treatment. Oral tori is usually removed before the fabrication of upper and lower dentures.

5.

How Does Oral Tori Appear?

Oral tori are bony overgrowth seen in the mouth. These bony exostoses are covered by soft tissues. Oral tori grows gradually from small to large size and stops growing after reaching a certain size. It has an irregular shape and is flat. It can involve both u[per and lower jaw.

6.

Does Bruxism Cause Tori?

In some cases clenching or grinding of teeth results in changes in the underlying bony architecture causing mandibular tori most frequently. However further research is needed to understand how parafunctional habits result in the formation of the oral tori.

7.

What Are the Problems Caused by Tori?

 
Tori that are larger in size can result in functional disturbances like problems in chewing, speech difficulties, and breathing problems (sleep apnoea) in cases of larger tori that occupy the tongue space thereby reducing the airway.

8.

What Ethnic Groups Are More Affected by Tori?

Oral tori are most commonly observed among Hispanics, followed by the African -Americans population. It is seen very rarely among Caucasian groups. Torus palatinus or palatal tori are more common in females than males.

9.

Is Tori Removal Surgery Painful?

Removal of oral tori is done under anesthesia. Laser therapy for the removal of tori is a completely safe and painless procedure. Surgical removal of tori using the rotary handpiece and bur into multiple fragments for ease of removal and to prevent damage to underlying vessels. It is done under anesthesia and it is not painful.

10.

Will Tori Grow Back After Removal?

 
Yes, there are chances for the tori to grow back even after the removal. In a few cases where there is continuous stress or parafunctional habits present may result in changes in the underlying bony architecture resulting in the reformation of the tori again. Recurrence is most commonly seen with mandibular tori.

11.

Is Oral Tori genetic?

There are several reasons for the occurrence of oral tori like parafunctional habits such as bruxism or teeth clenching and stress. Among these one is the genetic factor. However, the exact reason behind the formation of tori is yet not known.

12.

Where Are Tori Most Commonly Seen?

Oral Tori is most commonly found in the lower jaw as compared to the upper jaw. Mandibular tori or torus mandibularis is most commonly found near the tongue. Mandibular tori can be bilaterally present in a few cases Torus palatinus are rare as compared to the torus mandibularis.

13.

Can Sleep Apnea Occur Due to Oral Tori?

Yes, the larger oral tori of the mandible can result in sleep apnea due to a decrease in the airway by occupying the tongue space. Large mandibular tori reduce the upper airway space resulting in sleep apnoea (breathing problems).

14.

Can Oral Tori get infected?

Larger tori if left untreated for a longer period may result in irritation or ulcerations of the underlying thin mucosa due to continuous trauma. Wounds on the underlying thin skin take longer to heal due to reduced vascular supply. Repeated trauma can result in infections of the oral tori.

15.

Can Oral Tori Result in Headaches?

Oral tori mostly occurs in individuals with parafunctional habits like teeth clenching or bruxism. People with bruxism may have temporomandibular joint disorders or severe headaches due to the grinding of teeth. Most patients with tori have parafunctional habits and also suffer from migraine according to the research.
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Dr. Achanta Krishna Swaroop
Dr. Achanta Krishna Swaroop

Dentistry

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