Torus Palatinus: Symptoms, Types, Causes and Treatment

Torus palatinus is a fascinating oral phenomenon—often overlooked, sometimes misunderstood, and occasionally a cause of concern for patients and dental professionals alike. This article explores torus palatinus in depth, examining its symptoms, variations, underlying causes, and available treatment options. By synthesizing the best available research, we aim to provide a comprehensive, evidence-based guide for anyone seeking to understand this unique bony growth on the roof of the mouth.

Symptoms of Torus Palatinus

Torus palatinus is typically silent, but when it speaks, it can affect comfort, function, and quality of life. For most, it's a harmless anatomical quirk; for others, it can become an obstacle—literally and figuratively—in daily oral activities.

Symptom	Description	Impact	Source(s)
Discomfort	Sensation of pressure or fullness	May affect eating/speech	1, 12, 13
Mucosal Irritation	Soreness or ulceration of overlying tissue	Pain, risk of infection	1, 12, 13
Prosthetic Issues	Difficulty fitting dentures or prostheses	Impairs oral function	1, 12, 13
Dysphagia	Difficulty swallowing (rare, large tori)	May impact nutrition	12, 13
Asymptomatic	No symptoms; incidental finding	No direct impact	1, 4, 13

Table 1: Key Symptoms

Common Presentations

Most individuals with torus palatinus experience no symptoms at all. The growth is often discovered incidentally during dental check-ups or impressions for dentures. However, when symptoms do arise, they are usually due to:

• Size and Location: Larger tori are more likely to interfere with oral function or be traumatized during eating or speaking 1, 12, 13.
• Mucosal Trauma: The overlying mucosa can become irritated, particularly with hard or sharp foods, leading to soreness or even ulcers 1, 12.
• Prosthetic Complications: Tori can prevent the proper fitting of dentures or other oral appliances, causing discomfort and functional issues 1, 12, 13.
• Speech and Swallowing: In rare cases, especially with very large tori, patients may report altered speech or difficulty swallowing (dysphagia) 12, 13.

When Symptoms Become a Concern

While most cases are benign and require no intervention, symptoms may prompt clinical attention if:

• The torus causes persistent pain or trauma.
• There is difficulty in oral hygiene maintenance, increasing the risk of infection.
• It interferes with prosthetic dental treatment.
• Patients experience anxiety or concern about oral cancer (even though tori are benign) 1, 13.

Types of Torus Palatinus

Torus palatinus isn’t a “one size fits all” entity. It showcases considerable diversity in shape, size, and presentation—key factors that influence management decisions.

Type	Description	Prevalence/Features	Source(s)
Flat	Smooth, broad-based elevation	Most common in some studies	4, 11
Spindle	Ridge along midline, elongated	Most common in some groups	4, 5, 11
Nodular	Multiple small, rounded projections	Less common	11
Lobular	Large, lobulated mass	Can cause more symptoms	11, 1, 12
Size	Small (<2cm) to large (>3cm)	Most are small/medium	11, 1

Table 2: Types and Characteristics

Morphological Variations

Torus palatinus can present in several distinct forms, each with its own clinical implications:

• Flat: A smooth, low, broad-based elevation along the palate. This is the most common form in some populations 11.
• Spindle: Characterized by a ridge running anteroposteriorly along the midline. This type is also highly prevalent and may be mistaken for a normal palatal ridge 4, 5, 11.
• Nodular: Multiple, discrete, rounded bony projections, giving a “beaded” appearance to the palate 11.
• Lobular: A large, irregular, often multilobulated mass. This form is most likely to cause symptoms and require intervention 1, 12.

Size Matters

• Small (<2 cm): Most tori are small and asymptomatic 11.
• Medium (2–3 cm): May begin to cause mild symptoms, especially with trauma 1, 11.
• Large (>3 cm): Rare, but can create significant functional or prosthetic issues 1, 12.

Clinical Relevance of Type and Size

The type and size of torus palatinus influence:

• Risk of trauma and ulceration: Larger and lobular/nodular tori are more prone to symptoms.
• Difficulty with prosthetic appliance fitting: Flat and spindle types are less likely to interfere than large lobular forms 1, 12.
• Need for surgical intervention: Generally reserved for larger or symptomatic tori 1, 12, 13.

Causes of Torus Palatinus

Torus palatinus is a classic example of a trait shaped by both nature and nurture—genetics provide the blueprint, but environmental influences and other factors fill in the details.

Cause	Description	Evidence/Notes	Source(s)
Genetic	Inherited tendency, variable penetrance	Strong familial link	2, 3, 8, 7, 10
Environmental	Masticatory stress, parafunction (bruxism)	Contributes to development	8, 13, 11
Ethnicity	Prevalence varies among populations	Higher in certain groups	4, 5, 2
Age & Gender	Appears more in middle age, more in females	Mixed findings	2, 4, 5, 11
Systemic	Bone metabolism disorders, medications	Dialysis, bisphosphonates	11, 9, 14

Table 3: Causes and Risk Factors

Genetic Factors

• Familial Tendency: Numerous studies highlight the heritable nature of torus palatinus, with evidence suggesting it may be due to a dominant or recessive gene with variable penetrance 2, 3, 8.
• Specific Genes: Rare mutations in genes such as LRP5 (involved in Wnt signaling and bone density regulation) and WLS have been associated with the presence of tori 7, 10.
• Twin and Family Studies: High concordance in monozygotic twins and family clusters further support a genetic influence 8.

Environmental and Functional Influences

• Masticatory Stress: Chronic heavy chewing, especially of tough foods, and parafunctional habits like bruxism may contribute to the development and growth of tori 8, 13.
• Dietary Factors: Some suggest that diets requiring more vigorous mastication may be linked to increased prevalence 8.

Population and Demographic Differences

• Ethnic Variation: Prevalence rates differ significantly among populations, suggesting a role for both genetic and cultural factors. For example, higher rates are found in certain Asian and European populations compared to others 4, 5, 2.
• Age and Gender: Some studies find higher prevalence in middle-aged individuals and females, while others report higher rates in males 2, 4, 5, 11. The influence of sex hormones has been proposed but remains unproven.

Systemic and Pathological Associations

• Metabolic Bone Disorders: Conditions affecting bone metabolism, such as those seen in chronic dialysis patients, are associated with a higher prevalence of tori 11.
• Medications: Bisphosphonates, used to treat osteoporosis, have been linked to osteonecrosis developing in pre-existing tori, highlighting the importance of medical history in risk assessment 9, 14.

Treatment of Torus Palatinus

Most torus palatinus cases are best left alone. However, when intervention is needed, patient-centered care and precise surgical technique are key to successful outcomes.

Treatment	Indication	Considerations	Source(s)
Observation	Asymptomatic, non-obstructive	No intervention needed	1, 6, 13
Surgical Removal	Functional or prosthetic interference, trauma, hygiene issues	Surgical risks, recurrence rare	1, 12, 13, 15
Prosthetic Modification	Mild interference with dentures	Adjust denture design	15
Medical Management	Osteonecrosis (rare)	Bisphosphonate-related, teriparatide therapy	9, 14

Table 4: Treatment Approaches

When is Treatment Necessary?

Torus palatinus is benign and rarely causes complications. Treatment is only indicated in select circumstances:

• Impaired Function: Difficulty with speech, chewing, or swallowing due to the size or location of the torus 1, 12, 13.
• Mucosal Trauma: Recurrent trauma leading to pain, ulceration, or risk of infection 1, 12.
• Prosthodontic Needs: Interference with the placement or function of dentures or other appliances 1, 12, 13.
• Oral Hygiene Difficulty: Inability to maintain proper cleaning, increasing infection risk 1.
• Patient Anxiety: Psychological distress, concern for malignancy, or aesthetic dissatisfaction 1, 13.

Observation and Reassurance

• No Symptoms: For most, no action is required. Regular monitoring and reassurance are sufficient 1, 6.
• Education: Patients should be informed about the benign nature and low risk of complications.

Surgical Management

• Indications: Symptomatic tori, prosthetic interference, or significant trauma 1, 12, 13.
• Procedure: Typically performed under local or general anesthesia; involves incision, exposure, and removal of the bony mass with osteotomes or burrs 1, 12.
• Risks: Infection, bleeding, palatal perforation, delayed healing, and rarely, recurrence 15.
• Outcome: Most patients recover well, with improved function and comfort 12.

Prosthetic and Medical Considerations

• Denture Design Modification: In mild cases, prostheses can be adjusted to accommodate small tori, avoiding surgery 15.
• Osteonecrosis Management: In rare cases of medication-related osteonecrosis (e.g., bisphosphonates), medical management such as teriparatide therapy may be considered 9, 14.

Patient-Centered Approach

• Shared Decision-Making: Involve patients in the decision, considering their symptoms, needs, and preferences.
• Customized Care: The choice of treatment (or observation) should reflect individual circumstances—including health status, prosthetic requirements, and risk factors.

Conclusion

Torus palatinus, while often innocuous, can sometimes present unique diagnostic and therapeutic challenges. Awareness of its characteristics ensures optimal care and patient comfort.

Key Takeaways:

• Symptoms: Most cases are asymptomatic; potential problems include discomfort, mucosal trauma, prosthetic interference, and rarely, dysphagia 1, 12, 13.
• Types: Variations include flat, spindle, nodular, and lobular forms, with size and shape affecting symptomatology and management 4, 5, 11, 1.
• Causes: Multifactorial—rooted in genetics, environmental factors, ethnicity, age, gender, and systemic conditions 2, 3, 8, 4, 5, 11, 7, 10.
• Treatment: Observation is standard for asymptomatic cases; surgery is reserved for significant symptoms or prosthetic obstruction. Prosthetic modification and medical management may be appropriate in select cases 1, 12, 13, 15, 9, 14.

By understanding the nuances of torus palatinus, clinicians can offer personalized, evidence-based guidance—ensuring this common oral exostosis remains a minor note in oral health, rather than a major concern.