MANDIBULAR TORUS: SYMPTOMS, CAUSES, TREATMENT - ANATOMY AND PHYSIOLOGY - 2025

The mandibular torus is a solitary or bilateral bony growth that appears on the lingual surface of the mandible. It is usually located near the canines or premolars. The etiology is still imprecise, but it is believed that genetic and environmental elements are involved.

They are also known as mandibular bumps or bone exostoses. According to the investigations carried out, they do not seem to have an influence on the appearance of cancer in the oral sphere. The incidence of this condition ranges between 20 and 25% in the American population.

They can be classified according to their shape, size, location, and numbers. The therapeutic options are multiple and will depend on the symptoms, aesthetic and functional criteria, as well as the possibilities of prosthetic placement.

Symptoms

The mandibular torus is almost always asymptomatic. Only in some cases in which its size is very large or its location very bothersome, patients may manifest some kind of discomfort.

The main complaints of those with this pathology are occasional pain and bleeding, especially after some trauma, ulcers on or around the injury and in very severe cases, difficulty chewing.

There may also be discomfort when trying to place a dental prosthesis; in fact, this is one of the main causes of consulting the dentist before diagnosing the torus.

Anecdotal cases have been reported of anesthesiologists who have had difficulty intubating torus-bearing patients, but the literature on this is scarce.

Causes

As mentioned in the introduction, the etiology of the mandibular torus is unclear. However, there is an implicit universal agreement that gives the torus a multifactorial origin.

Several clinical studies have shown genetic predisposition in the appearance of the different exostoses. Many others involve environmental elements in the genesis of the torus and even functional factors related to the teeth, bite, and dental physiology.

In early life stages (stages in which they are very rare) they have been linked to bruxism.

There are also links between disorders in the regulation of calcium, vitamin D and vitamin K, and the torus, which may offer insights into their origin.

The appearance of torus after dental procedures such as gingival grafts has also been studied.

A new theory about the origin of the mandibular ridge was raised in 2013 by a group of researchers, who believe that there is a relationship between the formation of the jaw and the ossification of Meckel's cartilage in fetal age with the appearance of the torus.

Classification

According to the size

- Small: up to 3 cm in diameter.

- Medium: between 3 and 5 cm in diameter.

- Large: greater than 5 cm in diameter.

According to your location

- Mandibular.

- Palatino.

- Other intraoral locations.

According to their number

- Only.

- Multiple unilateral.

- Multiple bilaterals.

According to its shape

- Blueprints.

- Nodular.

- Fusiforms.

- Lobular.

Diagnosis

The diagnosis of the mandibular torus is primarily clinical. A complete dental evaluation should be performed, palpating the lesion to verify its bone consistency, evaluating the oral mucosa for ulcers or trauma, and verifying the vitality of the teeth near the lesion.

Complementary tests should also be requested, initially a periapical radiological study in which areas of high opacity are evidenced in relation to the root of the compromised teeth.

Pathological studies may be indicated if any other lesion that may be malignant is suspected or if the initial diagnosis is uncertain.

Histologically, it is described as a bone lesion with a very dense cortex, and spongy bone with calcified areas is evidenced in the center.

Differential diagnosis

Differential diagnoses of mandibular torus include abscess formation, bone cancer, salivary gland tumors, vascular tumors, Gardner syndrome, and fibroids.

Treatment

Most cases of mandibular ridge do not require specific treatment. In fact, many go unnoticed until the dentist detects them in a routine evaluation or in a consultation for another cause.

In some cases the treatment is conservative. Only the few symptoms that may appear are treated and surgical resolution is delayed, which is indicated in very specific situations.

Surgical treatment

Surgery for the extraction of the mandibular torus is performed by maxillofacial surgeons and is indicated only in the following situations:

Placement of prosthesis

If the torus interferes with a dental prosthetic procedure already carried out or to be carried out, it must be extracted.

Trauma

When, due to its size, the torus causes lesions in the oral mucosa with ulcers and bleeding, it must be removed.

Hygiene

Certain types and locations of torus can tend to accumulate food debris, which compromises the patient's oral health and causes bad breath.

Esthetic

If there is dental deformity or protrusion caused by the torus, many patients request its extraction due to the discomfort it generates.

Process

Exceresis of the mandibular torus is performed through a rare oral surgery in which a section of bone is removed that includes not only the bump but a clean bone edge to prevent reproduction, despite which it is always recommended to remove the smallest amount of tissue possible while keeping the periosteum intact.

This surgery can be performed under local anesthesia in a conditioned office or in an outpatient surgery unit.

However, some cases must be done under general anesthesia in the operating room due to the risk of compromising the airway, or if the torus is related to vascular or nerve structures that can be injured if the patient moves.

The procedure is carried out ensuring continuous aspiration, with the patient in supine position and with the artificial mouth permanently open.

Following a proper incision, dividing the bone with specialized drills coupled to a high-frequency ultrasonic motor, the lesion is removed with a chisel and the edges are carefully sutured.

Complications

As in any surgical procedure, complications may occur, among which we have:

- Nerve injuries.

- Vascular injuries.

- Infections.

- Hemorrhages.

- Hypertrophic scars

- Retention disorders.

References

1. Nolte, A. and Schirren, CG (1997). Torus Mandibularis. Der Hautarzt, June 1997, 48 (6), 414-416.
2. Unterman, Sarah and Fitzpatrick, Margaret (2010). Torus Mandibularis. The West Journal of Emergency Medicine, December 2010, 11 (5), 520.
3. Auskalnis, A. et al. (2015). Multifactorial etiology of Torus Mandibularis: study of twins. Stomatologija, 17 (2), 35-40.
4. Rodriguez-Vazquez, JF et al. (2013). Origin of the torus mandibularis: an embryological hypothesis. Clinical Anatomy, November 2013, 26 (8), 944-952.
5. Wikipedia (last edition 2018). Torus mandibularis. Recovered from: en.wikipedia.org
6. Prieto Castro, Karen (2015). Diagnosis and Treatment of the Palatine and Mandibular Torus. How to approach it? Recovered from: odontoespacio.net