Mandibular Tori: Symptoms, Types, Causes and Treatment

Mandibular tori are intriguing bony growths that often surprise both patients and dental professionals. While usually benign and asymptomatic, these protuberances can occasionally affect oral function and require clinical attention. In this comprehensive guide, we’ll explore the symptoms, types, causes, and treatment options for mandibular tori, drawing upon the latest research to provide clear, evidence-based information.

Symptoms of Mandibular Tori

Mandibular tori may go unnoticed for years, but when symptoms do arise, they can impact comfort and oral health. Recognizing these signs is crucial for timely management and understanding when intervention might be needed.

Symptom	Description	Prevalence/Notes	Source(s)
Discomfort	Sensation of pressure or soreness	Often mild, can be aggravated by trauma, dentures, or food	10
Interference	Issues with speech or denture fit	Notable when tori are large or bilateral	10, 5
Ulceration	Mucosal injury over tori	Due to repeated trauma from food or appliances	10
Asymptomatic	No noticeable symptoms	Most common presentation	10, 2

Table 1: Key Symptoms

Common Presentations

Most individuals with mandibular tori are asymptomatic, discovering the growths incidentally during dental exams. The tori are usually hard, smooth, and covered with healthy mucosa. They are most often found on the lingual (tongue-side) surface of the mandible, typically near the premolars 10.

When Symptoms Develop

• Discomfort: While generally painless, tori can become sensitive if traumatized by hard foods or dental appliances.
• Speech and Chewing Interference: Large or bilateral tori may alter tongue space, impacting speech or making chewing awkward, especially if dentures are worn 10, 5.
• Ulceration: The thin mucosa overlying tori is prone to injury, potentially leading to chronic ulcers if repeatedly irritated.
• Prosthetic Complications: Tori can interfere with the design and fit of removable dentures, sometimes necessitating surgical removal to allow comfortable prosthetic placement 10.

Red Flags

Rarely, mandibular tori may mimic or mask other oral pathologies. Any rapid change in size, persistent pain, or ulceration that does not heal should be evaluated to rule out malignancies or other bone lesions.

Types of Mandibular Tori

Mandibular tori are not all the same—they vary in size, shape, and laterality. Understanding these distinctions helps clinicians assess the need for intervention and tailor treatment plans.

Type	Location	Frequency/Pattern	Source(s)
Bilateral	Both sides of mandible	Most common (80%+)	3, 2
Unilateral	One side of mandible	Less common	3
Single/Multiple	One or more nodules	Multiple may occur	3, 2
Size Variation	Small, medium, large	Growth possible over time	2, 3, 10

Table 2: Types and Patterns of Mandibular Tori

Bilateral and Unilateral Tori

• Bilateral Tori: The vast majority of mandibular tori are found on both sides of the jaw, near the premolars and above the mylohyoid line. Studies show that bilateral presentation is far more common than unilateral 3, 2.
• Unilateral Tori: These are less frequently observed and may be mistaken for other localized bony growths.

Single vs. Multiple Nodules

• Single Nodule: Some patients present with only one growth.
• Multiple Nodules: Others may have several, which can merge into larger masses over time 3.

Size and Shape

• Size: Tori can be categorized as small, medium, or large. Growth tends to occur slowly and may stabilize after reaching adulthood, but some continue to enlarge with age 2, 10.
• Shape: Mandibular tori can be nodular, lobular, or irregular in contour, but there is no universally accepted shape classification for mandibular tori, unlike palatine tori 2, 3.

Age and Demographic Patterns

• Onset: Mandibular tori typically appear before the age of 30, with a “leveling off” phenomenon in later decades 3.
• Sex Distribution: Some studies show a slight male predominance, while others find no significant sex difference 2, 3, 5.

Causes of Mandibular Tori

Why do some people develop mandibular tori while others do not? The answer lies in a complex interplay of genetics, environmental factors, and functional stresses.

Factor	Role	Evidence Level	Source(s)
Genetics	Strong hereditary predisposition	Twin/family studies	6, 8, 9
Parafunction	Bruxism, clenching linked to tori	Epidemiological, clinical studies	1, 4, 8, 7
Masticatory Stress	Excessive chewing/tooth wear	Observational data	1, 6, 9, 7
Age/Sex	Onset before 30, slight male bias	Population studies	2, 3, 5

Table 3: Main Etiological Factors

Genetic Factors

Research strongly supports a hereditary component:

• Family Studies: Mandibular tori often run in families, with high concordance rates in monozygotic twins compared to dizygotic twins 8, 9.
• Inheritance Patterns: Some studies suggest autosomal dominant inheritance with variable penetrance, but the exact genetic mechanisms are still under investigation 6, 9.

Functional and Environmental Influences

• Bruxism (Teeth Grinding) and Clenching: Multiple studies indicate a significant association between mandibular tori and parafunctional habits like bruxism and clenching 1, 4, 8, 7. Individuals with these habits are more likely to develop tori, possibly due to increased masticatory load.
• Masticatory Stress and Tooth Wear: Tori are more common in populations with heavy tooth wear and strong chewing function, supporting the theory that bone forms in response to functional demand 1, 6, 9.
• Occlusal Factors: Certain dental arch forms and occlusal patterns (such as a flat or negative Curve of Wilson) may increase the risk 8.

Other Possible Associations

• Obstructive Sleep Apnea (OSA): Recent research suggests a possible link between larger mandibular tori and milder forms of OSA, with some hypothesizing that parafunctional activity (such as bruxism) is a compensatory response to airway compromise 13, 7.
• Ethnicity and Sex: Prevalence varies among ethnic groups and may be slightly higher in males, though findings are not entirely consistent across studies 2, 3, 5.
• Age: Tori typically develop before age 30 and rarely emerge de novo later in life 3.

Treatment of Mandibular Tori

Most mandibular tori require no intervention, but treatment is available and effective when symptoms or functional issues arise.

Treatment	Indication	Outcome/Notes	Source(s)
Observation	Asymptomatic, non-interfering	No treatment needed	10, 2
Surgical Removal	Pain, discomfort, prosthetic problems	Effective symptom relief; minor risks	10, 5, 14
Bone Grafting	Use of tori as autogenous graft	Enhances bone regeneration in dental surgery	12, 11, 14, 15
Prosthetic Adjustment	Minor modifications for denture fit	May delay or avoid surgery	5, 10

Table 4: Treatment Approaches

When to Treat

Mandibular tori do not usually require removal unless they:

• Cause chronic pain or ulceration
• Interfere with speech or chewing
• Prevent proper denture or prosthesis placement
• Are requested for use as autogenous bone graft in dental surgery 10, 5, 11, 12, 14, 15

Surgical Removal

• Procedure: Surgical excision is a straightforward outpatient procedure, typically performed under local anesthesia. The overlying mucosa is incised, and the bony growth is removed with rotary instruments or chisels.
• Risks: Minor risks include bleeding, infection, or temporary numbness. Healing is generally uncomplicated 10, 14.
• Recovery: Most patients recover quickly and can resume normal oral function within days to weeks.

Use as Autogenous Bone Graft

• Innovative Use: Mandibular tori can be harvested and used as a source of autogenous bone graft for periodontal or implant surgeries. This approach provides high-quality graft material with reduced donor-site morbidity and is especially useful when only a small volume is needed 12, 11, 14, 15.
• Effectiveness: Studies show significant improvements in bone regeneration and clinical outcomes when tori-derived bone is used, especially when combined with platelet-rich plasma or other adjuncts 11, 12.

Prosthetic and Non-Surgical Management

• Denture Adjustments: For patients with mild discomfort or interference, denture design modifications can sometimes accommodate tori without surgery 10, 5.
• Monitoring: Asymptomatic tori require no intervention and can be monitored during routine dental checkups.

Conclusion

Mandibular tori are fascinating anatomical variations that blend genetics, functional stress, and environment. Most are harmless, but when symptoms or functional issues occur, effective treatments are available.

Key points covered:

• Mandibular tori are benign bony growths on the inner surface of the mandible, usually asymptomatic and discovered incidentally.
• Symptoms, when present, include discomfort, interference with oral function, and ulceration.
• Types vary based on laterality (bilateral more common), size, and number.
• Causes are multifactorial, with strong genetic predisposition and a significant role for parafunctional habits like bruxism and masticatory stress.
• Treatment is typically conservative; surgical removal is reserved for symptomatic cases or when prosthetic fit is compromised. Excised tori can also serve as a valuable source of autogenous bone graft.
• Most individuals with mandibular tori require only reassurance and monitoring.

By understanding mandibular tori’s origins, presentations, and management, patients and clinicians can make informed decisions and promote optimal oral health.