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