Prosthodontics & Occlusion · patient case question
What do the firm, smooth, immobile nodules on the lingual mandibular alveolus most likely represent?
Patient case: Three Weeks Into New Complete Dentures
Patient: 62-year-old female
Chief Complaint: “My palate burns, and I whistle when I talk.”
Background: Edentulous for 6 years. New maxillary and mandibular complete dentures delivered 3 weeks ago. She wears them 24 hours a day and has not been removing them at night. Type 2 diabetes, well controlled.
Medications: Metformin 1000 mg twice daily
Vital Signs: BP 128/76 mmHg · HR 74 bpm · RR 16 · T 98.4°F
Findings: Diffuse bright erythema of the palatal mucosa conforming precisely to the outline of the maxillary denture base, with sharp demarcation at the denture border. Maxillary anterior teeth appear prominent; she cannot produce clear “f” and “v” sounds. Small, firm, smooth, immobile sessile nodules on the lingual aspect of the mandibular alveolus bilaterally, covered by normal-appearing mucosa, which she reports have been present “for as long as I can remember.”
Show answer and explanation
Correct answer: A. Normal mucosa overlying normal bone — mandibular tori
- A. Correct. Mandibular tori are developmental bony exostoses on the lingual aspect of the mandible above the mylohyoid line, typically bilateral, covered by normal thin mucosa. Their longstanding presence and their stability confirm the diagnosis; no treatment is needed unless they interfere with a prosthesis.
- B. Incorrect. Peripheral ossifying fibroma is a reactive gingival growth arising from the interdental papilla. It requires a tooth to be present, and she is edentulous.
- C. Incorrect. Osteosarcoma is a rapidly enlarging, often painful destructive lesion with paresthesia and radiographic bone destruction. A lesion stable over decades excludes it.
- D. Incorrect. Pleomorphic adenoma presents as a soft to rubbery, mobile submucosal mass, most commonly on the palate. It would not be bony hard or immobile against the alveolus.
Note: Relevance to her prosthesis: mandibular tori sitting above the mylohyoid line can undercut the lingual flange and cause soreness. If they interfere with denture design and cannot be relieved, surgical reduction before impressions is appropriate.
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