Clinical presentation and differential diagnosis
A clinical examination and radiographic evidence should be used to make the diagnosis. These exostoses must be distinguished from pathology originating from the bone (osteomyelitis, osteoma and osteosarcoma) or the gingiva (enlargement of the gingiva). The absence of inflammation-related symptoms allows one to rule out inflammatory gingival hypertrophy and osteomyelitis. Osteoma, osteosarcoma, and other intra-bony pathologies may be identified based on radiographic and histological findings.36,37
Buccal exostoses are bilateral, smooth bony growths that form on the facial aspect of the mandibular and/or maxillary alveolus. It often occurs in the premolar-molar region.38 When palpated, the exostoses feel like a solid, bony mass. Although it seems to be stretched, the mucosa on top is still intact and has a normal color. Ulcerations may develop as a result of trauma or any mucosal lesion. They frequently start to appear throughout puberty and get larger over time. They usually do not self-limit or pain.37
Radiographically, exostosis appears as a distinct round or oval calcified mass on top of the tooth roots. A biopsy should be performed if the diagnosis is unclear in any way. Tori and other exostoses share the same histologic traits. Hyperplastic bone is the term used to describe these growths, which are composed of mature trabecular and cortical bone.3 Individuals with multiple bony growths or lesions that are not in the typical locations for torus or buccal exostosis should be evaluated for Gardner syndrome. Intestinal polyposis and cutaneous cysts or fibromas are further signs of this autosomal dominant disorder.39,40