Case Study - Lumps inside a man's mouth

Mr Anish Shah saw a patient who became concerned when he developed unusual-looking lumps in his mouth.

This 37-year-old patient asked to see his GP after becoming concerned about lumps in his mouth. The GP reassured him but he insisted on a referral to the local oral surgery unit.

Mandibular tori can be associated with parafunctional habits

Clinical findings
On examination, this patient presented with bilateral hard intra-oral bony swellings extending from the lower second molar teeth posteriorly to the lower lateral incisor teeth anteriorly. The overlying mucosa was normal.

No other intra-oral abnormalities were noted and no neck nodes were palpable. The patient did not report any pain or any problems with mastication.

Outcome
This patient has classic mandibular tori. These are uni- or bilateral bony lumps that appear lingual to the lower premolar teeth.1 A radiograph was taken to exclude any unerupted teeth.

Mandibular tori are developmental in origin and benign. One study found their prevalence at around 3 per cent of adults with the majority being women.2

They are thought to be associated with parafunctional habits. These are any habitual use of the mouth unrelated to eating, drinking or speaking. With regards to tori, bruxism is the habit that has been associated with tori formation.

This may well be due to increases in axial odontological pressure, which may cause lingual bone deposition.

No treatment is required unless the tori interfere with the provision of a prosthesis or are subject to repeated trauma. Regular trauma may lead to mucosal ulceration or they may interfere with a lower prosthesis, in which case the patient should be referred to an oral surgeon.

Removal is performed under a local anaesthetic with sedation if necessary. Following the reflection of a full thickness lingual mucoperiosteal flap, the bony protruberence is removed either with a chisel or a water cooled bur. Vicryl sutures for closure and antibiotics finish the procedure.

A lower standard occlusal radiograph can be useful and the patient should be advised to see their dentist.

Mandibular tori can become infected in rare cases where repeated trauma occurs, resulting in ulceration. Antibiotics and referral is advised.

  • Mr Shah is a specialist oral surgeon at Southend Hospital, Essex.

References

1. Neville B W, Damm D, Allen C, Bouquot J. Oral and maxillofacial pathology. 2nd Edition, 2002.

2. Bouquot J E, Gundlach K K. Oral exophytic lesions in 23,616 white Americans over 35 years of age. Oral Surg Oral Med Oral Pathol 1986; 62(3): 284-91

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