4.3 Clinical presentations and management
The majority of tori are asymptomatic and incidental finding during oral or dental examination. As they enlarge and become more prominent, however, they may cause a wide spectrum of problems. These include difficulty with placement and function of dentures, interference with mastication and speech, compression and displacement of the tongue causing snoring or sleep apnea.14 Furthermore, the tori can promote plaque formation and periodontal disease because of food retention hindering proper dental hygiene.3, 8
Patients with large tori often experience recurrent mucosal ulceration and inflammation resulting from trauma by hard food items (Figure 5). Prominent tori may also interfere with endotracheal intubation during general anesthesia.15 There have been several reports concerning painful ulceration and osteonecrosis of torus in patients receiving biphosphonate for treatment of osteoporosis.16 In some instances, the larger symptomatic tori may necessitate surgical removal.3,17This procedure was performed in 4 of our patients (Figures 2 and 4). The cited indications for the torus resection include interference with phonation or mastication, traumatic inflammation and ulceration, prosthetic instability, and in patients with cancerophobia.10 It may be of interest to note that a potential use of an excised torus has been its application as an autogenous bone graft in periodontal surgery and implants elsewhere.10, 18