Ask an Expert: Excessive Oral Bony Growths

Dental and Oral Health (Adults)

Excessive Oral Bony Growths
09/15/2010

Question:

I am a dental hygienist, and have encountered a pt.who continues to present with a dry mouth and an abundance of bony growths in the oral cavity. We are talking exostosis, maxillary and mandibular, mandibular tori and palatal torus. These growths are visibly larger at each 6 mo. Check up. He pt. Now mplains of migraine, an cannot open her jaw fully. She is in constant pain in her lower jaw. A referral to an oral surgeon stated arthritis. Is there a connection with these symptoms and any systemic disorders I might investgate? Gardners syndrome came to mind, but my pt.is 45 years of age and it is my understanding that gardners syndrome has a life expectancy of 35-45.

Answer:

Some people will develop rather prominent exostoses and tori, and the pain issue could be unrelated.
Have odontogenic sources of pain been ruled out? A complete review of the medical history would be necessary. For example, is the patient on renal dialysis?
Renal osteodystrophy can cause jaw enlargement.
What are the radiographic features? A "cotton wool" pattern would be suggestive of osteitis deformans, florid cemento-osseous dysplasia or Gardner syndrome, but this would have to be correlated with the clinical findings.
Constant pain in the lower jaw could be consistent with osteosarcoma, and the exostoses and tori are coincidental.
Given the limited amount of information that is provided, it is impossible to say what this represents. It would probably be appropriate to refer this woman to an oral pathologist for further evaluation.

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Response by:

Carl M Allen, DDS, MSD
Professor of Oral Pathology
College of Dentistry
The Ohio State University