Mandibular tori (torus mandibularis) are benign, slow-growing bony growths that appear on the inner side of the lower jaw, typically along the surface nearest to the tongue. These formations are not cancerous and are covered by normal oral mucosa. They are a relatively common finding, affecting 7% to 10% of the U.S. population. Most people experience no pain or discomfort, and the tori remain a harmless anatomical feature. Surgical removal is generally reserved for situations where the growths interfere with normal oral function or necessary dental treatments.
Understanding Mandibular Tori
The exact cause of mandibular tori is not completely understood, but they are thought to result from a combination of factors. Genetic predisposition plays a significant part, as these growths often run in families, suggesting an inherited component. Environmental factors, particularly mechanical stress on the jawbone, are also believed to stimulate their development.
Heavy chewing forces or chronic teeth grinding (bruxism) are considered the most relevant environmental factors contributing to tori growth. The sustained stress from these habits triggers bone cells to slowly produce excess, dense bone tissue. Nutritional factors, such as high fish consumption or certain vitamin deficiencies, have also been suggested as potential influences, though the evidence is less conclusive.
Mandibular tori usually present as smooth, hard, dome-shaped, or lobulated masses, often near the premolars and above the attachment point of the mylohyoid muscle. They are most frequently bilateral, meaning they occur on both sides of the lower jaw, although the size can differ. The growths typically begin to appear in young adulthood and may grow slowly over many years, sometimes increasing in size during periods of high stress or intense jaw function.
Clinical Indications for Removal
While most mandibular tori do not require treatment, removal becomes necessary when they actively interfere with oral health or function. The most frequent reason for surgical intervention is to prepare the mouth for prosthetic devices, such as full or partial dentures. These bony protrusions can prevent dentures from fitting securely or comfortably, causing the appliance to rock or rub the underlying tissue.
Another common indication for removal involves chronic irritation of the overlying gum tissue. Because the tissue covering the tori is often thin and lacks a rich blood supply, it can easily become traumatized and develop painful ulcers from friction during chewing or accidental biting. If the tori are large enough to restrict tongue movement, they may interfere with normal speech or make swallowing difficult.
The size of the tori can make routine dental procedures, such such as taking X-rays, uncomfortable or impossible due to imaging film positioning. Furthermore, large tori can make it difficult to maintain adequate oral hygiene, leading to food entrapment and an increased risk of gum disease. When these growths actively impede daily life or necessary dental care, surgical reduction is recommended.
Detailing the Surgical Procedure
The process to remove mandibular tori, known as a torus mandibularis excision, is typically performed by an oral and maxillofacial surgeon in an outpatient setting. The procedure begins with local anesthesia to numb the surgical site, though sedation can be provided for anxious patients. The surgeon then makes an incision along the gum line on the inner, tongue-side of the lower jaw, creating a flap of soft tissue.
This incision allows the surgeon to gently peel back the gum tissue, exposing the underlying bony growth. The excess bone is reduced using a specialized surgical bur (a high-speed rotating instrument) or sometimes a surgical chisel and mallet. The goal is to smooth the remaining bone contour so the jawbone surface is even and flat.
After bone reduction is complete, the area is thoroughly flushed with a sterile saline solution to remove loose bone fragments. The surgeon repositions the gum tissue flap back over the newly contoured bone. Finally, the incision is closed using sutures, which are often dissolvable and disappear within one to two weeks.
Recovery, Healing, and Long-Term Outlook
Following surgical removal, patients should expect a period of focused recovery to ensure proper healing. Immediately after the procedure, minor bleeding and swelling are common, with swelling typically peaking between 48 and 72 hours. Applying ice packs to the jaw and keeping the head elevated helps manage initial swelling and discomfort.
Pain is managed with prescribed or over-the-counter medication. Patients must adhere to a soft-food diet for the first week or two to avoid irritating the surgical site. Foods like yogurt, scrambled eggs, and mashed potatoes are ideal, and drinking plenty of fluids is important for overall healing. Patients must avoid using straws for a few days, as the suction can dislodge the blood clot and disrupt healing.
Gentle oral hygiene is maintained by avoiding the surgical area when brushing and by rinsing the mouth gently with warm salt water after meals, starting 24 hours post-surgery. The soft tissue generally heals within one to two weeks, though complete bone maturation and full recovery of the area can take up to eight weeks. Recurrence of mandibular tori after proper surgical removal is rare, providing a favorable long-term prognosis.