The discovery of a hard, bony lump inside the mouth can be a source of anxiety, but these growths are frequently harmless anatomical variations. These extra pieces of bone are referred to collectively as oral exostoses, which are benign, non-cancerous overgrowths of bone tissue. They are common findings during routine dental examinations and are composed of dense, compact cortical bone. They typically develop slowly over many years, often becoming noticeable in early adulthood.
Identifying the Common Bony Growths
The most frequent type of these oral growths is called a Torus Palatinus, which develops along the midline of the hard palate, or the roof of the mouth. This growth presents as a smooth, firm elevation that varies significantly in size and shape. It can be flat, nodular, spindle-shaped, or a large lobulated mass, and it is usually a solitary growth. Prevalence studies suggest this palatal torus is more commonly observed in women than in men.
A second common form is the Torus Mandibularis, found on the inner, tongue-side (lingual aspect) of the lower jaw, typically near the premolar and molar teeth. Unlike the palatal growth, the Torus Mandibularis is often bilateral, appearing on both the left and right sides simultaneously. This growth can manifest as single nodules or multiple, clustered protuberances. These growths are covered by a thin layer of gum tissue, which can make them susceptible to injury or ulceration from trauma, such as eating hard or sharp foods.
Factors Influencing Their Development
The precise cause of these bony growths is not entirely known, but evidence points to a multifactorial etiology involving both genetic and environmental influences. A hereditary component is supported by the higher prevalence of tori in certain ethnic populations and their tendency to run in families.
Beyond genetic factors, mechanical stress is considered a significant environmental trigger that stimulates the bone to grow. Excessive forces from parafunctional habits, such as bruxism (chronic teeth grinding) or clenching, contribute to the development of tori. The constant, heavy pressure exerted on the jawbone encourages the slow, continuous deposition of cortical bone. This localized bone deposition is the body’s response to strengthen the bone against chronic masticatory forces. Tori typically begin to develop in adolescence or early adulthood and may continue to increase in size slowly throughout life.
Clinical Assessment and Management
Diagnosis of oral exostoses is primarily accomplished through a simple clinical examination, involving visual inspection and palpation to feel the hard, non-mobile nature of the growth. Dental professionals can easily identify these growths, which are usually asymptomatic and covered by normal-appearing mucosa. Radiographic imaging, such as dental X-rays, confirms the diagnosis by showing the growths as dense, well-defined areas of radiopacity, consistent with their compact bone structure.
Differential diagnosis is important to ensure the bony lump is not a more serious lesion. The characteristic location and hard consistency of tori usually make them distinct from other conditions like osteomas or malignant tumors. In the vast majority of cases, these growths require no intervention, and the standard approach is observation.
Surgical removal, which involves carefully trimming the bone, is generally reserved for specific circumstances where the growth actively causes complications. The most common indication for removal is when the tori interfere with the fabrication or placement of a removable dental prosthesis, such as a full or partial denture. Another reason for intervention is if the thin gum tissue covering the torus is frequently traumatized, leading to chronic, painful ulcerations. Furthermore, exceptionally large tori that interfere with normal functions like speaking, swallowing, or oral hygiene may warrant surgical reduction.