Torus Mandibularis in Patients Receiving Hemodialysis

Reports on the prevalence of torus mandibularis among dialysis patients have been limited and inconclusive. A wide variety of oral manifestations has been found in patients with hyperparathyroidism. Furthermore, uremia-related changes in facial bone structures have been described in the literature. This prospective observational study examined 322 hemodialysis patients treated at the Chang Gung Memorial Hospital from 1 August to 31 December 2016. Two subgroups were identified: patients with torus mandibularis (n = 25) and those without (n = 297). Clinical oral examinations including inspection and palpation were employed. Our study found that most mandibular tori were symmetric (84.0%), nodular (96.0%), less than 2 cm in size (96.0%), and located in the premolar area (92.0%). Poor oral hygiene was observed among these patients, with 49.7% and 24.5% scoring 3 and 4, respectively, on the Quigley-Hein plaque index. More than half (55.0%) of patients lost their first molars. Multivariate logistic regression analysis revealed that blood phosphate level (odds ratio = 1.494, p = 0.029) and younger age (odds ratio = 0.954, p = 0.009) correlated significantly with torus mandibularis. The prevalence of torus mandibularis in patients receiving hemodialysis in this study was 7.8%. Younger age and a higher blood phosphate level were predictors for torus mandibularis in these patients.

Giant torus mandibularis causing submandibular duct obstruction and sialadenitis

Torus mandibularis is a benign osseous overgrowth arising from the lingual surface of the mandible. It is a common, incidental finding on imaging due to its relatively high prevalence. In the majority of cases, mandibular tori are asymptomatic. We report a novel presentation of a giant torus mandibularis causing bilateral obstruction of the submandibular ducts and consequent sialadenitis. Our patient presented with progressive pain centered in the floor of his mouth and had bilateral submandibular glandular enlargement on exam. Computed tomography showed a giant right torus mandibularis, which was causing obstruction and dilation of the bilateral submandibular ducts. Although conservative management was attempted, he ultimately underwent surgical resection of his torus with symptomatic improvement. This patient highlights a novel complication of torus mandibularis and illustrates successful treatment. Though not previously described, this complication may be underreported and should be considered in the appropriate clinical setting.

Mandibular tori interfering with the mobility of the lingual frenulum: a short case report

Introduction: Tori are benign hamartoma-like bone excrescences, usually asymptomatic. Their removal should not be systematic. Observation: A 62-year-old patient showed bilateral tori only leaving a 1.5 mm space for the lingual frenulum path between them. The direct functional consequence was a frequent blockage of the salivary caruncles below the tori. Tori resection was performed under local anaesthesia. Surgical outcome was simple with conventional analgesic treatment and oral care. Comfort and function were immediately restored. Discussion: The originality of this case does not lie in the nature of the lesions but in the uncommon size of their hypertrophy, which caused a lingual functional impairment. We have not found a similar case described in the literature.

Assessment of oro-dental manifestations in a series of acromegalic patients, the AcroDent study

Objective: The dental and periodontal impact of GH/IGF-1 hypersecretion has been poorly investigated until now. Our aim is to precisely describe the oro-dental state of acromegalic patients and to study the impact of GH/IGF-1 hypersecretion on patients’ reported oral health-related quality of life (OHRQoL). Methods: After collecting characteristics of their disease, acromegalic patients answered the GOHAI questionnaire assessing their OHRQoL, the AcroQoL questionnaire and then benefited from a complete stomatological and radiological examination (orthopantomogram systematically, retro-alveolar radiography or Cone Beam CT if necessary). Results: In total, 29 patients aged 59.1 ± 16.0 years were included. The average DMFT index (sum of Decayed, Missing and Filled Teeth per patient) was 19.0 ± 7.8. 16/29 patients had a gingivitis and 18/29 a mild to moderate chronic periodontitis, but no case of severe chronic periodontitis was found, probably because the frequency of a protective thick gingival biotype was increased (9/29). No case of generalized gingival hypertrophy or diffuse hypercementosis was observed. According to the Add-GOHAI score, only 8/26 patients had a satisfactory OHRQoL. This parameter was correlated to the acromegaly-specific quality of life according to the AcroQoL score. Interestingly, 11/29 patients had bulky oral bony outgrowths (OBO), such as large maxillary or mandibular tori and multiple vestibular exostosis. Conclusions: The unsatisfactory OHRQoL reported by acromegalic patients contrasts with a rather good objective oro-dental state and annual oral examination seems relevant in this population. Finally, we report that huge OBO could be helpful signposts for the diagnosis of acromegaly.

Osteonecrosis of Bilateral Mandibular Tori After Direct Laryngoscopy

A 36-year-old man underwent direct laryngoscopy with routine general anesthesia for a knee procedure. Several days later, he experienced pain involving an ulceration along the medial aspect of the right mandible in the floor of the mouth. This evolved to a painful bony mass, and subsequently, a bony sequestrum was spontaneously shed. The initially misdiagnosed pathologic process occurred several more times on both sides of the mouth. A computed tomography scan eventually revealed large bilateral mandibular tori, a feature that likely predisposed the patient to this course of events. Pain in the floor of the mouth after airway manipulation should be carefully evaluated and the possibility of osteonecrosis considered.

Treatment of Symptomatic Mandibular Tori: A Case Report

The aim of this paper is to describe a case of a young. [...]

Palatal and Mandibular Tori: diagnosis, clinical significance and conceptual basis

Os toros palatino e mandibular são distúrbios do desenvolvimento do tipo anomalia de forma, com manifestação tardia no crescimento e maturação dos maxilares. Os casos familiares e a persistência dos toros com a idade e em desdentados lhes atribuem uma origem genética, que começa a ser desvendada. Há uma dificuldade para interpretar os toros como uma resposta adaptativa à sobrecarga oclusal, bruxismo e outros fatores externos, pois os toros não são hiperplasias e hipertrofias adaptativas. Os toros são protuberâncias ósseas sem cápsula fibrosa, o que os diferencia dos osteomas e lhes tira a natureza neoplásica, mesmo que benigna, especialmente porque também não apresentam crescimento contínuo e sem controle por parte do organismo. O tamanho dos toros se estabiliza ao final do crescimento dos maxilares, por volta dos 22 a 24 anos de idade. Os toros são constituídos de osso normal, do ponto de vista funcional e estrutural, e podem ser utilizados como sítio de origem de transplante ósseo autógeno para outros locais ou como sede de implantes osseointegráveis, se houver conveniência clínica para tais procedimentos. A sua remoção pode ser feita quando impedem procedimentos odontológicos terapêuticos.