An oral torus - also known as: dental torus - is an oral condition in which bony growth occurs in the mouth; there are three locations in which oral tori may appear: the hard palate (torus palatinus), in the lower jaw underneath the tongue (mandibular torus), and/or on the back or upper gums near the cheeks (buccal exostoses). While the growth is bony and hard at these locations, they are usually harmless and painless, so treatment is not required to treat this condition. However, while usually harmless and painless, oral tori may start to interfere with an individual's speech, swallowing, other functions, or dental procedures (in these circumstances, treatment is necessary). [1] [2] [3] [4]
These bony growths can vary in size and appear in groups; their size may also fluctuate throughout an individual's life. Some people are born with this condition while others may develop it -- the growth is usually slow in these cases and some individuals do not notice when they occur due to them being asymptomatic. [5]
Occurrences of tori are more frequent in women than in men. Tori are associated with adulthood and rarely appear before the age of 15. The palatal version of tori have a higher occurrence in Native American and Inuit populations. [6] [7]
Treatment is not necessary unless they become an obstruction to chewing or prosthetic appliances. [8]
Most individuals may not realize they have oral tori until a dental examination because they have no symptoms. [8] [5]
In the case there is painless symptoms they include:
Symptoms that in cases where the oral tori requires treatment include:
There are a combination of factors that may lead to the development of oral tori. These factors (or causes) are due to:
These factors may vary depending on the location of the oral tori or how severe this condition occurs in an individual. [2] [6] [10]
The exact pathophysiology or mechanisms of oral tori is not completely understood and this is believed to be due to a combination of different genetic and environmental factors. [11]
Oral tori due to genetics is believed to be inherited in an autosomal dominant way (indicating that the gene affecting the individual is on one of the non-sex chromosomes - "autosomal" - and that the single copy of the affected gene from either parent - "dominant" - is enough to cause the mutation in an individual); however, it is also seen that environmental factors have been associated in the development of more complex etiology than just genetics alone. Bone density factors may be due to the fact that individuals with higher bone density may be prone to development of oral tori. Vitamin deficiencies such as Vitamin D and calcium along with a diet that is too high or too low in calcium may induce the development of the oral tori due to bones needing calcium for growth. Teeth grinding, known as: bruxism, may cause pressure on the jaw bone which can result in excess bone growth. [12] [11] [6]
Diagnosis of oral tori are usually done during a dental examination by a dentist or a specialist in dentistry. The bony growth may be recognized during dental procedures, cleanings, or just regular check-ups.
During a routine exam, the dentist may be able to diagnosis this condition through a visual examination by inspecting the mouth for any irregularities such as bony growths. The dentist during this visual exam will focus on the palate, lingual side of the lower jaw, and the outer areas of the upper and lower jaws. Once visual examination indicates an oral torus, the dentist will then feel for palpation in the suspect area in order to further examine the size, shape, and firmness of the oral tori. Though imaging is not necessary to diagnose oral tori, the dentist may decide to do imaging to rule out cysts or tumors (which may cause similar symptoms or have similar factors) by taking an x-ray (for a 2D view) or CT scan (for a 3D view) of the mouth to get a better view of the exact size and location of the growth. [13]
Due to oral tori being benign (meaning it is harmless and painless), treatment is not required since many individuals do not have symptoms - and do not even realize they have this condition until told by a dentist - so there is no interference in quality of life or daily functions. Patients with oral tori may be told to monitor their condition to ensure no changes occur or symptoms develop. However, in the situation where the oral tori is painful, disrupting with daily activities, or interfering with quality of life, treatment is needed. [8] [13]
When treatment is necessary, the main treatment is oral surgery (known as: tori removal or exostosis removal). This procedure is done by an oral surgeon giving a localized anesthetic to numb the gums or affected area (in some cases to make a patient more comfortable and calm, the oral surgeon may offer sedation dentistry options); following the anesthetic, the surgeon will then make an incision in the gums or affected area in order to access the tori, and then surgically remove the tori along with any excess bone. The surgeon will then stitch the site of incision; these sutures will begin to dissolve within about 5-10 days after the surgery (in some cases, they may fall out early but this is usually not a call for concern). [13] [5]
While rare, complications following a tori removal may include:
As mentioned in the Causes section, oral tori may be due to a combination of genetic and environmental factors along with individual habits or lifestyle.
Oral tori does not change life-expectancy of an affected individual and usually does not result in any interferences to quality of life or life activities. In the case of symptom development, an individual may go to a dental surgeon or dentist for insight or for possible removal. While removal of oral tori is effective in lessening any symptoms that may have arose, there are rare cases in which they may grow back - however, this may be due to other underlying problems, genetics, or older age. [6]
The prevalence of oral tori varies widely within different populations, with racial differences appearing significant - with high prevalence within the Native American and Inuit people populations. There is also reported differences between genders. [4] [9]
Oral tori prevalence also widely varies depending on the type present within individuals.
While the majority of cases of oral tori are harmless, asymptomatic, and usually found during a dental examination or check-up by accident, recent research has found that there are rare cases in which oral tori can become infected, leading to osteomyelitis, especially in individuals who experience trauma to the oral cavity, individuals who have poor oral hygiene, individuals who have uncontrolled diabetes, and/or individuals who have comprised immune systems (especially related to autoimmune disorders or autoimmune dysfunction). This osteomyelitis related to oral tori is known as "osteomyelitis of tori." [14]
In the cases where osteomyelitis of tori occurs, treatment and management of this condition are adjusted. Instead of a scheduled oral surgery in regular cases where oral tori begin to cause discomfort or symptoms, the patient with osteomyelitis of tori requires prompt medical attention; a patient with this condition must be given intravenous antibiotics and anti-inflammatory drugs, (in some cases) receive a biopsy of the suspected or infected area, and receive surgery and management from an oral and maxillofacial surgeon. This is because osteomyelitis is an inflammatory process of bone and bone marrow which is caused by an infectious organism(s) which result in local bone destruction. These infections can vary from acute to chronic, with acute conditions being sudden and severe and chronic developing slowly and persistently. [14] [15]
While the prevalence of osteomyelitis of tori is very rare, it has recently been found possible related to oral tori, and due to its possibility and contributions to existing literature and research related to oral tori, this rare condition of oral tori serves many insights which may enhance the preventative practices of oral tori before it can result in osteomyelitis of tori. The existence and awareness of this condition is also vital for general dentists -- and not just oral surgeons -- in being able to recognize in order to be able to give proper care, attention, and monitoring to the affected area before it can become infected because osteomyelitis of tori can occur even in cases where oral tori is originally asymptomatic before having an acute onset, which is essential in preventative care. [14] [15]
Human teeth function to mechanically break down items of food by cutting and crushing them in preparation for swallowing and digesting. As such, they are considered part of the human digestive system. Humans have four types of teeth: incisors, canines, premolars, and molars, which each have a specific function. The incisors cut the food, the canines tear the food and the molars and premolars crush the food. The roots of teeth are embedded in the maxilla or the mandible and are covered by gums. Teeth are made of multiple tissues of varying density and hardness.
Trismus is a condition of restricted opening of the mouth. The term was initially used in the setting of tetanus. Trismus may be caused by spasm of the muscles of mastication or a variety of other causes. Temporary trismus occurs much more frequently than permanent trismus. It is known to interfere with eating, speaking, and maintaining proper oral hygiene. This interference, specifically with an inability to swallow properly, results in an increased risk of aspiration. In some instances, trismus presents with altered facial appearance. The condition may be distressing and painful. Examination and treatments requiring access to the oral cavity can be limited, or in some cases impossible, due to the nature of the condition itself.
A dentist, also known as a dental surgeon, is a health care professional who specializes in dentistry, the branch of medicine focused on the teeth, gums, and mouth. The dentist's supporting team aids in providing oral health services. The dental team includes dental assistants, dental hygienists, dental technicians, and sometimes dental therapists.
Alveolar osteitis, also known as dry socket, is inflammation of the alveolar bone. Classically, this occurs as a postoperative complication of tooth extraction.
Orthognathic surgery, also known as corrective jaw surgery or simply jaw surgery, is surgery designed to correct conditions of the jaw and lower face related to structure, growth, airway issues including sleep apnea, TMJ disorders, malocclusion problems primarily arising from skeletal disharmonies, and other orthodontic dental bite problems that cannot be treated easily with braces, as well as the broad range of facial imbalances, disharmonies, asymmetries, and malproportions where correction may be considered to improve facial aesthetics and self-esteem.
A dental extraction is the removal of teeth from the dental alveolus (socket) in the alveolar bone. Extractions are performed for a wide variety of reasons, but most commonly to remove teeth which have become unrestorable through tooth decay, periodontal disease, or dental trauma, especially when they are associated with toothache. Sometimes impacted wisdom teeth cause recurrent infections of the gum (pericoronitis), and may be removed when other conservative treatments have failed. In orthodontics, if the teeth are crowded, healthy teeth may be extracted to create space so the rest of the teeth can be straightened.
An oral medicine or stomatology doctor/dentist has received additional specialized training and experience in the diagnosis and management of oral mucosal abnormalities including oral cancer, salivary gland disorders, temporomandibular disorders and facial pain, taste and smell disorders; and recognition of the oral manifestations of systemic and infectious diseases. It lies at the interface between medicine and dentistry. An oral medicine doctor is trained to diagnose and manage patients with disorders of the orofacial region.
Gigantiform cementoma is a rare, autosomal dental tumor. The tumor is benign, but without intervention it can result in severe disfigurement of the jaw and of the facial skeleton. It is commonly found in the mandible and the maxilla but it is less commonly found in the maxilla. The tumor can be found between the premolars and the molars. The cause of this tumor is currently unknown but there has been new research that there is an overlap between gigantiform cementoma and Gnathodiaphyseal dysplasia (GDD).This is an exceedingly rare tumor with only a handful of documented cases worldwide. The most famous case is of Novemthree Siahaan, a young Indonesian boy from Batam Island who received medical care in Haulien, Taiwan through a Buddhist missionary from the Tzu Chi Foundation, which was documented on the Discovery Health Channel. Another famous case is a young Korean girl named Ayun Lee and her father Young-hak Lee whose case has shown that the tumor can be heritable. She is currently under treatment, which she may need to continue until her growth stops in her early 20s. Cases like Novemthree Siahann and Ayun Lee are included to illustrate the condition's worldwide and heritable nature. It is seen mostly in females with a mean age of 42 years old. The condition typically affects adults between the ages of 20 and 50, which there is a higher incidence in women compared to men. Although it can technically occur in both males and females, it is more frequent in females. There is a chance to get passed down but in recent research it is said that most cases are sporadic and not inherited. The term has been used in the past to describe florid cemento-osseous dysplasia, but it is now reserved for an autosomal dominant condition affecting the maxillae. There is still not enough research to confirm whether it predominately affects on specific group but it is a rare condition and it is not strictly associated with any one ethic group. Treatment is difficult. Surgical removal of the affected bone is needed, and has to be followed by reconstruction.
Dilaceration is a developmental disturbance in shape of teeth. It refers to an angulation, or a sharp bend or curve, in the root or crown of a formed tooth. This disturbance is more likely to affect the maxillary incisors and occurs in permanent dentition. Although this may seem more of an aesthetics issue, an impacted maxillary incisor will cause issues related to occlusion, phonetics, mastication, and psychology on young patients.
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. In 90% of cases, a torus is on both inner sides of the mandible ; however, they may differ in size.
A torus palatinus, or palatal torus, is a bony protrusion on the palate. Palatal tori are usually present on the midline of the hard palate. Most palatal tori are less than 2 cm in diameter, but their size can change throughout life.
Osteonecrosis of the jaw (ONJ) is a severe bone disease (osteonecrosis) that affects the jaws. Various forms of ONJ have been described since 1861, and a number of causes have been suggested in the literature.
A buccal exostosis is an exostosis on the buccal surface of the alveolar ridge of the maxilla or mandible. More commonly seen in the maxilla than the mandible, buccal exostoses are considered to be site specific. Existing as asymptomatic bony nodules, buccal exostoses don’t usually present until adult life, and some consider buccal exostoses to be a variation of normal anatomy rather than disease. Bone is thought to become hyperplastic, consisting of mature cortical and trabecular bone with a smooth outer surface. They are less common when compared with mandibular tori.
Condensing osteitis, also known as focal sclerosing osteomyelitis, is a rare periapical inflammatory condition characterized by the formation of sclerotic bone near the roots of premolars and molars. This condition arises as a response to dental infections, such as periapical pulp inflammation or low-intensity trauma. The lesion typically appears as a radiopacity in the periapical area due to the sclerotic reaction. While most commonly associated with non-vital teeth, condensing osteitis can also occur in vital teeth following occlusal trauma. The condition was first described by Dr. Carl Garré in 1893.
Macrodontia is a type of localized gigantism in which teeth are larger than normal. Macrodontia seen in permanent teeth is thought to affect around 0.03 to 1.9 percent of the worldwide population. Generally, patients with macrodontia have one or two teeth in their mouth that is abnormally large; however, single tooth growth is seen in a number of cases as well.
Cemento-osseous dysplasia (COD) is a benign condition of the jaws that may arise from the fibroblasts of the periodontal ligaments. It is most common in middle-aged females of African descent. The three types are periapical cemental dysplasia, focal cemento-osseous dysplasia (Caucasians), and florid cemento-osseous dysplasia. Periapical COD occurs most commonly in the mandibular anterior teeth while focal COD appears predominantly in the mandibular posterior teeth. Florid COD is an extensive variant of periapical COD where lesions occur in multiple quadrants which can encompass the maxilla and mandible, and infrequently can cause jawbone deformity.
Radium jaw, or radium necrosis, is a historic occupational disease brought on by the ingestion and subsequent absorption of radium into the bones of radium dial painters. It also affected those consuming radium-laden patent medicines.
Mouth infections, also known as oral infections, are a group of infections that occur around the oral cavity. They include dental infection, dental abscess, and Ludwig's angina. Mouth infections typically originate from dental caries at the root of molars and premolars that spread to adjacent structures. In otherwise healthy patients, removing the offending tooth to allow drainage will usually resolve the infection. In cases that spread to adjacent structures or in immunocompromised patients, surgical drainage and systemic antibiotics may be required in addition to tooth extraction. Since bacteria that normally reside in the oral cavity cause mouth infections, proper dental hygiene can prevent most cases of infection. As such, mouth infections are more common in populations with poor access to dental care or populations with health-related behaviors that damage one's teeth and oral mucosa. This is a common problem, representing nearly 36% of all encounters within the emergency department related to dental conditions.
A jaw abnormality is a disorder in the formation, shape and/or size of the jaw. In general abnormalities arise within the jaw when there is a disturbance or fault in the fusion of the mandibular processes. The mandible in particular has the most differential typical growth anomalies than any other bone in the human skeleton. This is due to variants in the complex symmetrical growth pattern which formulates the mandible.
Tricho–dento–osseous syndrome (TDO) is a rare, systemic, autosomal dominant genetic disorder that causes defects in hair, teeth, and bones respectively. This disease is present at birth. TDO has been shown to occur in areas of close geographic proximity and within families; most recent documented cases are in Virginia, Tennessee, and North Carolina. The cause of this disease is a mutation in the DLX3 gene, which controls hair follicle differentiation and induction of bone formation. All patients with TDO have two co-existing conditions called enamel hypoplasia and taurodontism in which the abnormal growth patterns of the teeth result in severe external and internal defects. The hair defects are characterized as being rough, course, with profuse shedding. Hair is curly and kinky at infancy but later straightens. Dental defects are characterized by dark-yellow/brownish colored teeth, thin and/or possibly pitted enamel, that is malformed. The teeth can also look normal in color, but also have a physical impression of extreme fragility and thinness in appearance. Additionally, severe underbites where the top and bottom teeth fail to correctly align may be present; it is common for the affected individual to have a larger, more pronounced lower jaw and longer bones. The physical deformities that TDO causes become more noticeable with age, and emotional support for the family as well as the affected individual is frequently recommended. Adequate treatment for TDO is a team based approach, mostly involving physical therapists, dentists, and oromaxillofacial surgeons. Genetic counseling is also recommended.