Mandibular tori are bony growths extruding from the tongue side of the lower jaw right above the floor of the mouth. They are usually located approximately in the area of where the premolars and canines are situated.
When they appear bilaterally on both sides of the mouth they are referred to as mandibular tori. If they appear on just one side such as the right or left, it is called a mandibular torus.
Their size may also vary greatly with some being barely noticeable while others are too large to ignore. Not to make it more complicated but their size and shape may fluctuate throughout the lifetime of the individual.
Nonetheless, one common trait shared among them regardless of their size or numb is that patients typically don't even realize that they're there. Yes, that means they are often asymptomatic and painless.
Table of Contents:
How common is a mandibular tori?
The prevalence of mandibular tori varied greatly depending on ethnicity and location. It was as low as 3.2% in the Nigerian population and as high as 65-97% in the Greenland/Icelander population. That just goes to show how genetics and location plays a large role in the presence and development of the bony outgrowth.
Here is a chart displaying various levels of prevalence in diverse populations:
Therefore it may or may not be common depending on where you live. If you live in a population that has a high incidence of it then it will be quite common to see your peers with it. It could also be rare if you lived in a population where most people did not have it.
It all depends on which ethnicity and geographic location you are talking about if you want to know whether or not it is common. Since we are in the US
What causes it?
There isn't a single definitive factor that causes an individual to develop mandibular tori because it seems to be multifactorial. That means it is caused by a mix of multiple components rather than from a single entity.
Studies have suggested that there is a genetic component to it. There has also been postulations that it may be due to forces that act on the jaw in a certain way such as bruxism (teeth grinding). Last but not least there seems to be a geographic component to it as well.
This study which used 82 sets of twins or 162 individuals found that there was a genetic predisposition to mandibular tori. It also seems like bruxism had an effect on developing it as well. The overall conclusion was that the condition had multifactorial origins.
Results from twin study:
93.6% of monozygotic twins either had or did not have mandibular tori together.
79.4% of dizygotic twins either had or did not have it.
Bruxers seem to have a strong association as well.
Bruxism and tori
This one study found that patients who grind their teeth were four times more likely to have mandibular tori compared to those who did not grind. In addition to that, they also found that individuals with wear facets on their teeth, which is a sign of bruxism had a 20x increase in risk of developing tori.
Due to these findings, the researchers concluded that there was a strong association between bruxism and tori development. It also appears that those who grind their teeth more were also more likely to develop larger tori in their mouth.
There is also a potential for misaligned teeth to contribute to the bony growth formation. Although it was difficult to find studies in relation to that but we can extrapolate it as a possibility based on grinding stress.
Geographic influences on mandibular tori
One study compared the prevalence of mandibular tori in the north atlantic populations of Greenland, Danish vikings, and medieval Norwegians. It turns out that there was a marked distinction of having tori among the different populations.
Prevalence of mandibular tori in the north atlantic popluation:
Greenlanders and Icelanders
According to the results of this study, there was a clear correlation between the presence of mandibular tori the higher the latitude. There seems to be a marked decrease when you compared to countries closer to the equator.
Overall, it is still not certain as to what exactly attributes to this discrepancy but here are some postulations from the study:
How to tell if you have mandibular tori
It is very easy to tell if you have tori in your lower jaw because the diagnosis is by clinical examination only. Your dentist just has to look at it and can tell you on the spot. There is no biopsy required or anything complicated for that matter. It is a visual examination.
Signs and symptoms of mandibular tori:
Bony growths or bumps in your lower jaw right underneath the tongue and above the floor of the mouth.
May look pink to white in color.
May be on one side or could be on both sides.
Can be one bump or multiple bumps.
The sizes can also differ greatly.
Here is a picture of what a lower jaw without any tori looks like. The bone looks flat without any bumps sticking out of it. You can look directly down into the floor of the mouth without anything blocking your view.
Mandibular tori pictures
These are all pictures of various mandibular tori in different shapes, sizes, and location (unilateral or bilateral). They were all taken at our long island city dental office.
Bilateral - mandibular tori on BOTH sides
Unilateral - mandibular tori on ONE side only
How do I get rid of mandibular tori?
The only way to remove mandibular tori is surgically with a dentist. There are two techniques that are currently being used to get rid of the bony outgrowth.
There is no home remedy which can accomplish this because tori is essentially excess bone. Excess bone can only be removed manually via physical means. We suppose you could try to cut it off yourself but that would be extremely painful and NOT recommended. You should see a dentist and just have them remove it surgically.
Removal of tori with a hammer and chisel
It is precisely what you imagine this to be, your dentist will first peel the gums back with a scalpel. Then they will drill through the bone and hammer it off with a chisel. Afterwards they will stitch the gums back up.
This is the traditional method of getting rid of tori but a newer technique which involves a laser has surfaced recently. The laser is much preferred since the sensation of getting hammered and chiseled is not the most pleasant at least in the patient's perspective.
Er:YAG laser for tori removal
A new technique which has been recently developed for mandibular tori removal is the use of a Er:YAG laser. Instead of using a hammer and chisel, your dentist will zap it with a laser to remove the excess bone.
According to that study, it took about 12,702 laser pulses to remove the tori. It may sound like a lot but it goes very quickly at about 30 shots per second. That means it took a grand total of 421.4 seconds to get rid of the tori.
We believe that patients prefer this newer method just because you don't get hammering in your skull. The laser is quick and a lot less physical.
Is it painful to have it removed?
Your dentist will definitely numb you prior to beginning the procedure. Since you'll be adequately anesthetized you shouldn't feel any pain during the treatment at all.
As you can imagine, having it surgically removed with a laser or mallet and chisel wouldn't be pleasant without being numb. If for whatever reason the numbing wears off during the procedure, please let your dentist know so that they can administer more numbing.
Does the tori come back after removal?
Unfortunately there has been case reports about mandibular tori which were surgically removed but returned many years later.
One patient had it return after about 11 years.
A second patient had it return after about 14 years.
Just be aware that treatment for the removal of mandibular tori may not be permanent. There is a chance that it may come back and then you'll have to undergo the removal procedure once again!
Should I worry about mandibular tori?
The tori in your lower jaw is a benign condition so you don't really have to worry about it per say. It holds true regardless of the number of tori and the size of them. They are all harmless and should not adversely affect your life.
Your dentist will also not actively try to remove them whenever they see them. It is not an emergency and does not affect what they need to do with your mouth most of the time. There is an exception for when they would remove them and that is if you need dentures.
Will the tori go away on its own?
Unfortunately, the tori will not go away on its own because once you have it, it will usually stay for life. After all it is made of bone and bone does not simply disappear on its own without any cause.
However, the size and shape of the tori may change throughout your life albeit very slowly. They won't disappear completely but they may get ever so slightly bigger or smaller over the years. That just goes to show that they are affected by multiple factors and it may be linked to your lifestyle.
One big postulation is that your teeth grinding habits, nutrient, and environment has a big impact on tori. Thus, if you change one of those factors you may expect to see a change in the condition of your mandibular tori as well.
When does it need to be removed?
Tori are not removed whenever they are present because they are not malignant. This is a benign condition so that makes it harmless and there is no need to remove them just because they are present. The only two instances where they would need to be removed would be for denture fabrication or if they bother you.
However, they will be removed if it gets in the way of denture fabrication. That means if you are missing teeth in your lower jaw and you want to replace them with a denture, the bony outgrowths may potentially interfere with wearing the denture.
If it is interfering, your dentist will send you to the oral surgeon to have the tori surgically removed. If they aren't completely removed, they will at least be filed down and smoothed so that it doesn't prevent the denture from fitting and seating down on your teeth.
They bother you
Aside from that, there really isn't any other reason to remove them. Perhaps if they become an inconvenience such as being perpetually getting injured by the foods that you eat since they stick out. That could be a reason for removal.
Mandibular tori/torus is a harmless condition that affects your lower jaw. They are a painless bony outgrowth that protrudes on the tongue side where the premolars and canines are located. Most patients don't even notice that they're there until their dentist points it out to them.
The vast majority of time, nothing needs to be done for it because they don't affect your everyday life. The only time they would interfere with the quality of your life is if you needed dentures because they prevent them from seating down on your teeth. The bony outgrowths make it difficult for dentures to be made and thus will need to be removed.
If you don't need false teeth any time soon, there is absolutely nothing for you to worry about. You can just proceed with your life as is and pretend that they don't exist. They don't really bother you but if they do for whatever reason, you can always consult your dentist and have the oral surgeon surgically remove them.
That of course is an elective procedure so only do it if it affects the quality of your life. Nonetheless, if you think you have this you should consult your dentist just to make sure that they are tori because you don't want them to be cancer instead! That would be catastrophic if you left it alone...