Many of us have bony lumps either on our palates, on the tongue side of the lower jaw, or both. The growth is called a torus when singular or tori when plural. They are classified as tori palatinus or palatal tori when on the palate. When they are on the tongue side of the mandible, they are classified as tori mandubularis, mandibular tori, or lingual tori. They can also appear on the gums opposite the lips on the upper and lower jaws. When they appear there, they are called buccal tori or exostoses. They are usually nothing to be concerned about from a medical, dental, or esthetic perspective.

They are present in around 30% of the population, although rates vary among different races. They can be very small and tend to grow over time, but the rate of growth varies. Occasionally, they can reach sizes over an inch or more. Tori have a genetic component but are also thought to arise more easily in those who clench and grind. Since tori appear around puberty but don't become noticeable until forty, it is believed that heavy biting forces play a major role in their occurrence. Eggen and Natvig proposed that the presence of tori was 30% genetic and 70% environmental. Excessive fish consumption has been related to the presence of tori because omega-3 polyunsaturated fatty acids and vitamin D help bone grow. 1 

Diagnosis should be left to your dentist, as some disease processes can look similar.

Tori usually don't cause problems when small or moderate-sized. However, they can cause issues when they are larger, although rarely. The most common problem I see is when large tori on the lower jaws start to grow too far toward the middle of the mouth. They tend to interfere with taking dental x-rays. Other than that, patients with large mandibular tori may not notice them. I have patients who complain that food or pills get stuck underneath them. Food impaction around them can lead to bad odors can arise. In addition, they can lift the tongue and interfere with speech when they are under the tongue. Patients with this condition sound like they speak with a mouth full of marbles. Lastly, they can suffer irritation when eating things like chips. The palatal ones are less frequently a problem because they usually occur in the middle of the palate, where speech is not an issue.

When patients need dentures, however, the tori can interfere with their fit and may need to be removed by an oral surgeon. The surgery is done under local anesthesia, and the risks of complications are low, but it can take around one month for the tissues to fully heal. Although not common, since implants are a much better option than dentures, tori removal is becoming less common. Other reasons for tori removal are speech, chewing, oral hygiene, swallowing interferences, or if they suffer repeated trauma from chewing.

Finally, I will end with great news about tori. A study of 600 patients conducted in 2014 concluded that Patients with milder disease are more likely to have larger tori than patients with severe apnea. In addition, treatment success occurs more frequently in patients with larger tori than in patients with no tori or small tori. Larger lingual tori tend to push the tongue up and force good tongue posture, which means the tongue sits toward the front of the mouth behind the front teeth touching the palate.

In conclusion, tori are very common, are benign, and don't typically cause problems. However, if you are concerned with any lumps or bumps in your mouth, please see your dentist as soon as you can.