A torus mandibularis is a benign bony growth that develops on the inner side of the lower jaw, beneath the tongue. These growths, often called mandibular tori, are typically harmless and painless. While often asymptomatic, their removal may be advised if they interfere with oral function or dental procedures. This surgical intervention aims to restore comfort and facilitate oral health.
Understanding Torus Mandibularis
Torus mandibularis presents as a hard, bony lump or multiple lumps on the lingual side of the mandible. These growths are most commonly bilateral, appearing on both sides of the mouth, though they can also be unilateral. They are covered by normal gum tissue and can vary significantly in size and shape, ranging from small nodules to larger, shelf-like formations.
The prevalence of mandibular tori is estimated to be around 7-10% of the adult population. While their precise cause is not fully understood, several contributing factors have been identified. Genetic predisposition plays a role, with tori often observed to run in families. Additionally, local stresses on the jawbone, such as chronic teeth grinding (bruxism), are strongly associated with their development.
Other factors linked to the formation of mandibular tori include jaw anatomy and bone density. These growths typically develop slowly over time and may fluctuate in size. Mandibular tori are non-cancerous and generally do not pose a serious health risk, often remaining unnoticed until they grow larger or interfere with daily activities.
When Removal is Recommended
While generally benign and often requiring no intervention, torus mandibularis removal is necessary or highly recommended in specific situations. A primary indication is when tori interfere with the fabrication or proper fit of dental prostheses, such as dentures or retainers. Large tori can prevent dentures from seating securely, leading to instability, discomfort, or even the inability to wear the appliance.
Another common reason for removal is chronic irritation or ulceration of the overlying gum tissue. This can happen due to trauma from chewing food, accidental biting, or pressure from dental appliances, leading to persistent sores and discomfort. Large mandibular tori can also impede normal oral functions, including difficulty with speech by crowding the tongue, or making chewing and swallowing challenging.
Tori may also cause concern regarding oral hygiene, making it difficult to brush or floss effectively, which can lead to plaque buildup. Tori might also be removed to facilitate other dental procedures, such as dental implant placement, where the bony growth could obstruct the site. If tori cause pain, functional issues, or compromise overall oral health, removal is often advised.
The Removal Process
The surgical removal of torus mandibularis is a routine outpatient procedure typically performed by an oral and maxillofacial surgeon. Before surgery, a thorough consultation includes reviewing the patient’s medical history and X-rays to assess the size and extent of the bony growths.
During the procedure, local anesthesia is administered to numb the surgical area, ensuring the patient experiences no pain. For anxious patients or more extensive removals, sedation options may be offered to enhance comfort. Once the area is numbed, the surgeon makes an incision in the gum tissue overlying the torus to expose the bone.
With the bone exposed, the surgeon carefully removes the excess bony growth. This is typically achieved using specialized dental instruments, such as high-speed rotary burs to grind down the bone. The goal is to reduce the bone to a smooth contour without sharp edges. After bone reduction, the surgical site is cleaned to remove any bone fragments or debris.
Finally, the gum tissue is carefully repositioned over the smoothed bone and closed with sutures. These may be dissolvable, meaning they will resorb on their own over time.
Life After Removal
Following torus mandibularis removal, patients can anticipate a recovery period with expected symptoms, including swelling, bruising, and mild to moderate discomfort. Pain medication, which may be prescribed or over-the-counter, helps manage post-operative pain. Applying ice packs to the face is recommended during the first 24-48 hours to help minimize swelling and discomfort.
Dietary adjustments are important during the initial healing phase. Patients are advised to consume soft, bland foods such as soups, yogurt, mashed potatoes, and scrambled eggs, avoiding anything hard, crunchy, spicy, or acidic that could irritate the surgical site. It is also recommended to avoid using straws for about a week, as the suction can dislodge blood clots and interfere with healing.
Maintaining proper oral hygiene is crucial for preventing infection and promoting healing, but care must be taken around the surgical area. Patients should avoid rinsing their mouth for the first 24 hours after surgery. After this initial period, gentle rinsing with warm saltwater several times a day can help keep the area clean and aid in recovery. Brushing and flossing can resume for untreated areas, with careful avoidance of the surgical site.
Most initial pain and swelling subside within about a week, though complete gum tissue healing can take approximately 7-10 days. Full recovery, including internal bone remodeling, may take several weeks. Potential complications like infection or temporary numbness in the lip or chin can occur. Patients should contact their oral surgeon if they experience excessive bleeding, severe pain, or persistent swelling.