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ANSWERED on Sat 16 Feb 2008 - 4:03 am UTC by byrd

Question: Mandibular tori (extoses) -- surgical removal

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 15 Feb 2008 17:11 UTCFri 15 Feb 2008 - 5:11 pm UTC 

I have multiple tori, one of which bothers me a good deal. The dentist tells me the standard treatment is to slice the gum open and basically just chisel them off my jawbone and upper palate.

That sounds so painful and barbarous I've put off having the one or all of them removed for years and years.

Just wondering if any advances have come along in recent years to treat this condition? I keep thinking one might be able to use a laser to ablate the bony growth.

Thanks for any insight you can provide.




 16 Feb 2008 04:03 UTCSat 16 Feb 2008 - 4:03 am UTC 

Hello Ophelia,

Most sources agree that mandibular tori are benign growths that require no treatment unless they begin to interfere with function or get in the way of proper fitting of dentures or other dental devices.

See this recent post where a dentist answers an inquiry from someone on behalf of a relative about this type of surgery, saying, "I can't imagine any benefit that your father would derive from such a procedure ... Your father can safely save his money (and his tori); he will be no worse off with them than without them."

The American College of Surgeons (ACS) Surgery: Principles and Practices contains a paper entitled "Approach to Oral Cavity Lesions," which states (on p.8)," "Surgical management is required only if the tori are interfering with denture fit." http://www.acssurgery.com/acsonline/pdf/ACS0201.pdf

The same paper is quoted on Medscape, here: http://www.medscape.com/viewarticle/535613

However, if it is determined the tori must be removed, then surgical excision remains the standard treatment for this type of growth, according to the sources I located.

 One of the most authoritative is "Bond's Book of Oral Diseases," on the site of The Maxillofacial Center for Diagnostics and Research." It says, "Neither the torus nor the bony exostosis requires treatment unless it becomes so large that it interferes with function, interferes with denture placement, or suffers from recurring traumatic surface ulceration (usually from sharp foods, such as potato chips or fish bones). When treatment is elected, the lesions may be chiseled off of the cortex or removed via bone bur cutting through the base of the lesion." There are further references cited at the end of the article.

There is a brief summary with photos of the surgery in this student handout from the Division of Oral and Maxillofacial Surgery at the University of Minnesota. See p. 3 and ff.

Of course, this standard type of surgery is what you're hoping to avoid. So with that in mind, I searched specifically for any mention of lasers or other techniques used in conjunction with this type of tissue removal. There does not appear to have been a great deal of research done in this area apart from individual case studies and statistical studies on the occurrence of the lesions. This may be partly because surgery is so infrequently indicated.

However, though I could find no mention of lasers in connection with mandibular tori removal, I was able to locate a little information on some other new advances related specifically to this surgery having to do with use of new devices to improve both the surgical technique and make the outcome better and safer.

This article describes a case study involving surgical removal of a mandibular exostosis using a "device that serves as an alternative to a scalpel." There are color photos of the surgery. The report concludes that using this new device is superior to traditional surgical methods. It says (in part), "Excision of exostosis in the mandible is a safe, predictable procedure with minimal postoperative sequela. As an alternative to a scalpel, the bipolar electrosurgical unit provides an incision without charring of the flap edges as would be seen with monopolar electrosurgical units. The bipolar electronic surgical tip produced a smaller temperature ... compared with the monopolar electrosurgery tip .... Additionally, arcing that is commonly seen with monopolar electrosurgery units when cutting near metallic restorations or dental implants is not observed with the Bident bipolar surgical unit, making it safe. The Bident bipolar tip also provides coagulation of the capillaries transected during the incision, and hemostasis is maintained, providing better visibility in the surgical field than would be expected with a scalpel incision."
"A Technique for Surgical Mandibular Exostosis Removal"
Compendium of Continuing Education in Dentistry, October 2006

This article describes another device that improves the overall efficacy and outcome of this type of surgery. It's described as having a "a half-spoon-shaped head," which was used in treating several cases for the purpose of evaluation. The conclusion was that "the elevated mucoperiosteum flap was safely protected lingually by using this retractor. Various mandibular tori were completely resected without damaging the surrounding tissues."
"A New Retractor for Surgical Removal of Mandibular Torus"Shigehito Wada, and Isao Furuta Department of Oral and Maxillofacial Surgery (Head: Prof. I. Furata, DDS, PhD), Faculty of Medicine, Toyama Medical and Pharmaceutical University, Toyama, Japan
Received 13 August 2003;  accepted 15 October 2004.  Available online 26 January 2005.
I was able to read only the abstract of this article but if you'd like to read the whole paper, it's available for purchase. Look for the link in the upper right of the page.

Since you say you've had these tori for some time, the following article on homeopathic treatment for exostoses may not be as much help to you as it would if they were more recent, but it nevertheless has some interesting information.

It says, "Even though nobody thinks of Homeopathy for exostosis, considering it as a pure surgical disorder, Homeopathy can do wonders in cases of exostosis (in the initial stages)." The article goes on to say that "treatment should be started as early as possible to arrest the growth of the exostosis and get disappearance or reduction in size. It will be easy to treat exostosis in the immature stage where exostosis has minimal core bone covered with thick fibrous cartilaginous sheath. Here exostosis can be made to disappear or reduced in size to near normal." The prognosis is not so good for mature exostoses, but since they do say that since post-surgical reoccurrences are common, it might be prudent to investigate this form of treatment further.

If you decide to go ahead with the surgery and your surgeon uses the typical procedure, you might find it prudent to arm yourself with a bit of knowledge beforehand.

Here is a PowerPoint slideshow that shows the entire surgery for removal of mandibular tori. It's a little graphic if you're not used to watching surgery, but it's well presented and very informative. You'll need to click through the first few slides first, which are for a different procedure.

And here is a report from someone on a health forum who has been through the surgery and is reassuring someone else who is nervous about having it done.

I hope the information provided is helpful. If anything isn't clear or you require further assistance, please ask for a clarification and I'll be happy to respond.





 16 Feb 2008 14:03 UTCSat 16 Feb 2008 - 2:03 pm UTC 

IOW, the answer is no -- unless you count a scalpel and retractor as an alternative to chiselling. Thanks for looking into this for me.




 24 Feb 2008 08:12 UTCSun 24 Feb 2008 - 8:12 am UTC 

Hi, Ophelia,

I've had this procedure done on both sides, lower.  This was about 18 years ago, so--I suppose it was ancient and barbarous, but it seemed pretty slick.  The tori were interfering with eating and also with speech by crowding the tongue.  The procedure sounded nasty, but I decided not to think about it.  I trusted my dentist's recommendation.  I would not have wanted as much information as you asked for.

I chose being knocked out rather than having to listen to the sound of it, so from my point of view there was nothing to it.  I was pretty wiped out afterward.  The area was as sore as blazes for a few days, but it all healed up nicely, and there's been no problem since.  I've never been sorry.

Just out of curiosity, how come you gave the researcher a C?  Looked like a pretty thorough response to me.



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 24 Feb 2008 14:50 UTCSun 24 Feb 2008 - 2:50 pm UTC 

Hi Archae0pteryx,

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 28 Feb 2008 07:34 UTCThu 28 Feb 2008 - 7:34 am UTC 

Two people I know who've had this done compared it to wisdom teeth removal. Hardly a picnic.but not too bad.




 24 Oct 2009 01:00 UTCSat 24 Oct 2009 - 1:00 am UTC 

Archae0pteryx and markymd, thanks for sharing your experiences

I'm know I could live through such procedures, but imagining them seems so viscerally unpleasant that my little limbic brainstem shudders even thinking about it.

I guess I'm just waiting for Dr McCoy wave a magic wand and then say, "They're gone, Jim!"





 28 Jan 2010 20:02 UTCThu 28 Jan 2010 - 8:02 pm UTC 

I have been through this myself on several occations and always with a local for pain. Mine were pretty bad, however, in all cases they. Ut the gum then just like drilling for a filling the surgeon ground down the Tori. I had to flush or gargle with salt water twice a day and about 5 days or so later the dead skin came out and fresh new skin relaxed what was lost due to soft tissue damage... NEVER once did I feel pain or any kind of discomfort except the decaying soft tissue kind of wigged me out but it's going to happen.. Don't freak out, just do the saline rinse and brush good... Can't wait to have it done again due to the pain Im in now... Mine actually are sharp like spurs and cut their way through the gum... Hope this helps anyone needing this done.




 7 Oct 2012 17:46 UTCSun 7 Oct 2012 - 5:46 pm UTC 

I just had the surgery Friday and had 4 torids removed it seems that they didn't sew the gums make into place. its very painful but did it so that I can get me some particl dentures. The balls were so painful when i would get hard foods or candy. I lived on Anbesol and Orajel for ages due to all my back teeth were removed. i dont think it was needed but more that it was a hungry dentist in need of money. Is my gums under my tongue sopposeto look floppy.


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