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Clinical Summary

Oral exostoses are benign boney growths on the mandible or hard palate, including tori and buccal exostosis. Tori are benign nodular overgrowths of cortical bone, occurring in the midline of the palate where the maxilla fuses (palatinus) or on the mandible, typically on the lingual aspect of the molar teeth (mandibularis). Although their physical appearance may be alarming, there is generally no need for concern. Tori are covered by a thin epithelium, which is easily traumatized and ulcerated. These ulcerations tend to heal very slowly because of the poor vascularization of the tori. Torus palatinus, in particular, is slow growing and may occur at any age; however, it is most commonly noted prior to age 30 in adults and affects women twice as frequently as men. Buccal exostoses are typically found on the buccal surface of the maxillary or mandibular alveolar ridge adjacent to premolar teeth. There are a variety of oral conditions that may be confused with exostoses. Gingival fibromatosis, fibroma formation secondary to irritation, granulomas, abscesses, and oral neurofibromatosis located on the palate may resemble torus palatinus. Nodular bony enlargement in the oral cavity may also result from fibrous dysplasia, osteomas, and Paget disease. Oral malignancies may manifest themselves on the palate as primary lesions, although these are rare. Oral radiographs, CT scans, and biopsy may aid in differentiating these conditions.

FIGURE 6.56

Torus Palatinus. Note the nodular appearance and characteristic central palatal location. (Photo contributor: Kevin J. Knoop, MD, MS.)

FIGURE 6.57

Torus Palatinus. Due to location, abrasions and ulcerations can occur on the thin overlying epithelium secondary to trauma. (Photo contributor: R. Jason Thurman, MD.)

FIGURE 6.58

Torus Mandibularis. The typical location of torus mandibularis, with exostosis on the lingual aspect of the molar teeth. (Photo contributor: Lawrence B. Stack, MD.)

FIGURE 6.59

Torus Mandibularis. Oral exostoses are benign overgrowths of cortical bone but can have an alarming appearance that mimics oral malignancies. (Photo contributor: Lawrence B. Stack, MD.)

Management and Disposition

Exostoses are normal structural variants and do not represent an inflammatory or neoplastic process. They require no treatment unless associated with a complication. Exostoses may enlarge enough to interfere with eating or speaking and impair proper fitting of dental prostheses. For some patients, the mere presence of exostoses may be bothersome and undesirable. Referral is indicated for further evaluation and definitive diagnosis.

Pearls

  1. Exostoses are nontender and otherwise asymptomatic unless traumatized.

  2. Buccal exostoses are commonly bilateral.

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