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Mark Bornfeld, DDS
Mark Bornfeld, DDS, Dentist
Category: Dental
Satisfied Customers: 5650
Experience:  Clinical instructor, NYU College of Dentistry; 37 years private practice experience in general dentistry, member Academy of General Dentistry, ADA
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I have a large ulcerated tori. My dentist sent me to a dental

Customer Question

I have a large ulcerated tori. My dentist sent me to a dental surgeon to have an operation. He said that it would be a recovery time of two months and to think about whether I might prefer to "live with it". He suggested salt water rinses. This condition has gone on for a couple of months and now my jaw and teeth are hurting. I have to be very careful while eating not to touch the roof of my mouth with food because of the pain. I have had cancer in the past, both breast and kidney, so am concerned. I wonder if an ENT Dr. would be helpful. I stopped taking Fosamax in February 2009. Thank you for your help.
Submitted: 4 years ago.
Category: Dental
Expert:  Mark Bornfeld, DDS replied 4 years ago.
Please clarify: have you already had your torus removed, or are you still just contemplating doing it in the future?
Customer: replied 4 years ago.

My dentist recommened removal but the dental surgeon thought it would take 2 months to heal and that I should reconsider

 

Expert:  replied 4 years ago.
Dear ,

I think your oral surgeon has provided good guidance.

In general, it is not customary to remove tori unless they are so large that they cause functional impairment (this is more common with tori on the lower jaw), or if they interfere with the construction or wearing of a
denture prosthesis.

Granted, the tissues that cover tori tend to be stretched quite thin, and are fragile and vulnerable to physical injury from hard-textured food. However, avoidance of hard foods, coupled with careful chewing, can reduce the risk of injury, and this is a far less labor-intensive (as well as a less risky) management strategy.

As for the Fosamax issue...
Drugs in the same class as Fosamax ("bisphosphonates") have been implicated in the development of a chronic and painful inflammatory condition of the jaw bones known as "bisphosphonate-related osteonecrosis of the jaw", or "BONJ". Although there are rare documented cases of BONJ developing in chronically irritated tori, the consensus is that the risk of BONJ development is considerably greater as a sequel to oral surgery, such as torus removal. The fact that you have discontinued your use of Fosamax 10 months ago does not necessarily eliminate this risk. (Although some protocols recommend a "drug holiday" to reduce BONJ risk, this guidance is not supported by the pharmacodynamics of bisphosphonates, which remain tightly bound to bone tissue for ten years or more.) Granted, the consensus is that orally-administered bisphosphonates such as Fosamax are thought to present less risk than similar medications that are given intravenously. However, there is some suspicion that the risk of these oral forms is greater than previously believed.

On balance, it may be wise to avoid surgery if possible. If the ulcers on your torus are slow to heal, you may wish to discuss with your dentist whether you might benefit from construction of a protective "stent"-- a thin removable acrylic appliance that covers the roof of the mouth. This could be used during eating, and will give the injured tissues an opportunity to heal. (If you currently wear an upper denture prosthesis, your dentist should verify that there is some "relief", or spacing, between the denture base and the torus so that the denture is protecting the area without exerting any pressure on it.).

Hope this helps...
Mark Bornfeld, DDS, Dentist
Category: Dental
Satisfied Customers: 5650
Experience: Clinical instructor, NYU College of Dentistry; 37 years private practice experience in general dentistry, member Academy of General Dentistry, ADA
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