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 Table of Contents  
ORIGINAL ARTICLE
Year : 2014  |  Volume : 1  |  Issue : 2  |  Page : 94-97

Prevalence of torus palatinus and torus mandibularis in an Indian population


1 Department of Oral Medicine and Radiology, Chhattisgarh Dental College and Research Institute, Rajnandgaon, Chhattisgarh, India
2 Dental Practitioner, Jodhpur, Rajasthan, India
3 Department of Oral Pathology and Microbiology, Desh Bhagat Dental College, Muktsar, Punjab, India

Date of Web Publication12-Aug-2014

Correspondence Address:
Dr. Santosh Patil
Department of Oral Medicine and Radiology, Chhattisgarh Dental College and Research Institute, Rajnandgaon - 491 441, Chhattisgarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1658-6816.138474

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  Abstract 

Background and Aim: Oral tori are bony growth present in the oral cavity and are not considered as pathological lesions. Smaller tori do not cause any problems, but larger sized tori can result in significant problems. The aim of this study was to determine the prevalence of torus palatinus (TP) and torus mandibularis (TM) in the Indian population.
Study Design: A total of 3087 patients were examined between August, 2010 and October, 2012 for the presence of TP and TM by inspection and palpation. The data were collected and analyzed using SPSS 12.0 (SPSS Inc., Chicago, USA).
Results: A total of 36 patients (1.3%) presented with TP, while 214 patients (6.9%) presented with TM. Tori were more frequent in males and this difference was statistically significant (P < 0.05). TP was more common in 31-40 years age group (13 patients, 36.1%), whereas TM was more in the 41-50 years age group (81 patients, 37.9%). The most commonly observed type of TP was flat shaped, whereas bilateral solitary types were the most common TM.
Conclusion: The results of this study showed a significantly higher prevalence of tori in males. No difference in the prevalence of TP and TM was noted regarding the age groups. Although, not pathologically significant, these bony overgrowths very often need surgical removal, especially when prosthesis are indicated.

Keywords: Indian population, prevalence, torus mandibularis, torus palatinus


How to cite this article:
Patil S, Maheshwari S, Khandelwal SK. Prevalence of torus palatinus and torus mandibularis in an Indian population. Saudi J Oral Sci 2014;1:94-7

How to cite this URL:
Patil S, Maheshwari S, Khandelwal SK. Prevalence of torus palatinus and torus mandibularis in an Indian population. Saudi J Oral Sci [serial online] 2014 [cited 2018 Nov 15];1:94-7. Available from: http://www.saudijos.org/text.asp?2014/1/2/94/138474


  Introduction Top


Tori are benign exostosis that is formed by a dense cortical bone and a limited amount of bone marrow. They are covered with a thin and poorly vascularized mucosa. The tori represent an anatomical variation rather than a pathological condition. Torus palatinus (TP) may be defined as an exostosis of the hard palate localized along the median palatine suture, involving both the processi palatini and the os palatinum. [1] Torus mandibularis (TM) is defined as a bony protuberance on the lingual surface of the lower jaw, situated mostly in the canine and the premolar region, above the mylohyoid ridge. [2] The etiology of the development of tori is still unknown and several factors have been proposed such as: Genetic, masticatory stress, developmental anomalies, infection, malnutrition, and discontinued growth. [3] Nowadays, the development of tori is considered as interplay of multifactorial genetic and environmental factors. [3],[4] TP is usually asymptomatic, slow growing benign outgrowth, commonly seen during the second and third decades of life. [5] According to the shape, TP is divided into flat, spindle-shaped, nodular and lobular, whereas TM can be classified as unilateral and bilateral solitary, unilateral and bilateral multiple and bilateral combined. [3] The aim of this study was to determine the prevalence of TP and TM in relation to age, gender, and shape in an Indian population.


  Materials and Methods Top


A total of 3087 patients who visited the Department of Oral Medicine and Radiology, Jodhpur Dental College General Hospital were examined between August, 2010 and October, 2012 for the presence of TP and TM. The study comprised of 1589 male and 1498 female subjects. The mean age of the subjects was 29.7 ± 11.5 years. The subjects were divided into 6 age groups: 11-20, 21-30, 31-40, 41-50, 51-60 and >61 years. The examination of the tori was performed by clinical inspection and palpation. Changes in the middle part of the palate were analyzed and were recorded as flat, spindle-shaped, nodular or lobular [Figure 1]. TM was observed in the sublingual part of the mandible and recorded as unilateral solitary, bilateral solitary, unilateral multiple, bilateral multiple and bilateral combined [Figure 2]. Patients with questionable tori were excluded from the study. The data were collected and entered into SPSS 12.0 (SPSS Inc., Chicago, USA) Software program. The statistical analysis was performed using Chi-square test at P < 0.05 considered as statistically significant.
Figure 1: Clinical picture showing torus palatinus

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Figure 2: Clinical picture showing torus mandibularis

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  Results Top


Of the 3087 patients examined, 36 patients presented with TP and 214 patients with TM. The prevalence of TP was calculated to be 1.3%, while the prevalence of TM was 6.9%. Males more commonly presented with the tori (TP = 21 patients, TM = 126 patients), when compared to females (TP = 15 patients, TM = 88 patients). The gender difference was statistically significant (P < 0.05). TP was more frequent in the 31-40 years age group (13 patients, 36.1%) and TM more common in the 41-50 years age group (81 patients, 37.9%). The frequency of tori decreased with the increasing age [Table 1] and [Table 2]. [Table 3] and [Table 4] show the distribution of TP and TM according to the shape. The most commonly observed type of TP was flat shaped (18 patients, 50%), followed by spindle shaped tori (12 patients, 33.3%). Nodular and lobular shaped tori were seen in 3 patients each. TP most commonly occurred as bilateral solitary type (92 patients, 43%). Only 6 patients presented with bilateral combined TM.
Table 1: Distribution of torus palatinus according to age and gender

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Table 2: Distribution of torus mandibularis according to age and gender

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Table 3: Distribution of torus palatinus according to shape

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Table 4: Distribution of torus mandibularis according to shape

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  Discussion Top


Oral tori are bony growth present in the oral cavity and are not considered as pathological lesions. Smaller tori do not cause a problem in terms of eating, swallowing, speech and planning of partial and complete dentures, whereas larger sized tori can cause significant problems. [3] TP is a bony protrusion usually present on the midline of the hard palate and TM is seen on the sublingual part of the lower jaw. The size of the tori can change throughout life, but majority are <2 cm in diameter. Their size can range from a few millimeters to centimeters. They may increase in size in the early adult age group, but may decrease due to bone resorption in the older age group. The etiology is still unknown and several factors such as: Genetic causes, racial differences, developmental anomalies, masticatory stress, infection and malnutrition as well as growth disturbances have been considered to be the causative factors. Current researchers have suggested that palatal tori are an autosomal dominant trait. At present, the etiology of tori is considered to be multifactorial. [3],[5],[6]

The prevalence of TP has been reported to be as high as 66%. [2],[4],[7] The prevalence of TP varies in different populations. It is more common in Asian and Inuit populations. [6],[8-10] The prevalence of TP was reported to be 39.3% and 35.7% in the Japanese. [9],[11] The prevalence of TP in this study was 1.3%, which is much lower than the findings of other similar studies. Simunković et al. reported a prevalence of 42.9% in the Croatian population. [3] Yaacob et al. have reported a high prevalence of 24.4% of TP in the Malaysian population, but a much lower prevalence of TM (2.2%). [12] Shah et al. have reported a prevalence of 9.5% of TP, which is higher than the findings of this study. [13] A similar low TP prevalence was found in a study conducted by Salem et al. who showed a prevalence of 1.4%. [14] Sisman et al. also reported a low prevalence of 4.1% in the Turkish population. [15] The prevalence of tori is more in Mongolians than in the Caucasians. [12],[16] It has been reported that tori may be less frequently seen in blacks than in whites. [16] The prevalence of TM among whites and blacks ranges from 8% to 16%, respectively. [4],[17] No gender difference was observed in these populations. Eskimo females (25.3%) were shown to have TM more commonly than males (13.3%). [18] Simunković et al. reported a prevalence of 12.6% of TM in the Croatian population, which is higher than the findings of the present study (6.9%). [3] Shah et al. reported a much lower prevalence of 1.4% of TM. [13] The prevalence may vary among similar ethnic groups living in different areas, or different ethnic groups living in same areas. [7],[19]

Belsky et al. showed that the occurrence and the size of TP is correlated with increased bone mineral density, which may be associated with a gene mutation. [17] Genetic factors may be one of the causes of the low tori prevalence in Indian population. Few authors have suggested that tori prevalence is related to the age difference. [6],[10],[20] Earlier studies revealed higher TP prevalence during the second and third decades of life. [1],[21] In this study, the prevalence of TP was lowest in the older age group. The 31-40 years age group showed the highest prevalence in this study (13 patients, 36.1%). This was similar to the findings of Yoshinaka et al. [8] The prevalence of TM was higher in the 41-50 years age group (81 patients, 37.9%) in the this study, whereas Simunković et al. noted a higher prevalence in the 60-69 years age group. [3] The presence of tori is related to the increasing age as suggested by Jainkittivong et al. Al Quran and Al-Dwairi also reported a higher prevalence of tori in the 81-90 years age group. [6],[22] The results of the present study are in line with the study conducted by Sonnier et al. who noted that the prevalence of tori decreased after 50 years of age. [23] Chohayeb and Volpe also found no relationship between age and the presence of tori, our results are similar to these. [24]

Palatal tori are twice as common in females. However, the findings of the present study showed a higher prevalence in males compared to females. The male to female ratio was 1.4:1. The finding of higher prevalence of tori in men is in concordance with Sonnier et al. [23] The findings of the present as far as gender is concerned differ from most of the previously mentioned studies, which showed a female predominance. [5],[8],[14] However, Simunković et al. showed a higher male prevalence, similar to the findings of the present study. [3] There is no specific reason for the female predominance, but genetics may be suggested as a major factor. Alvesalo et al. suggested that gender difference in the occurrence of TM might be the result of Y chromosome on growth, occurrence, expression and development of mandibular tori. [25] According to Haugen, genetics might be a factor for the gender difference in the prevalence of tori. [1]

The palatal tori are classified according to their shape as flat, spindle, nodular and lobular shaped tori. Flat-shaped tori were the most commonly seen in this study, followed by spindle-shaped tori. This agrees with other similar studies mentioned in the literature. [19],[21] However, Simunković et al., Jainkittivong et al. and Reichart et al. showed a higher prevalence of spindle-shaped tori. [3],[6],[26] The mandibular tori are classified as unilateral solitary, bilateral solitary, unilateral multiple, bilateral multiple and bilateral combined. The findings of the present study were in accordance with other studies that showed bilateral solitary type of TM to be the most commonly observed. [1],[3],[20],[26]

The effects of environmental, dietary and genetic factors including masticatory stress and nutritional factors have been reported in the literature. [1],[7],[26],[27] Eggen et al. have investigated the influence of nutrition in the etiology of tori and suggested that relatively higher prevalence of tori is seen in the coastal regions. [7] This might be explained by the fact that the people there eat a lot of fish and this possibly supplies higher levels of polyunsaturated fatty acids and vitamin D, which is involved in bone growth. This increases the occurrence of tori in the coastal population. Seafood consumption is not as common in the Indian sub-continent as in the other parts of the world. This might also be one of the reasons for the low prevalence in the population of the present study.

Tori are usually an asymptomatic clinical finding with no treatment normally necessary. It is possible for ulcers to form on the area of the tori due to repeated trauma. TP very often needs surgery to reduce the amount of bone present, as it causes chronic trauma, interfering with oral function or fabrication and replacement of denture base or framework. The inconsistent results of various authors possibly are due to the difference of the number of subjects, different geographic location, and standards.


  Conclusion Top


The results of the present study show that the prevalence of tori in the studied Indian population is low and that the presence of tori is significantly higher in males when compared to females. There is a trend toward higher prevalence of tori with increasing age, although not significant. These bony outgrowths are incidental findings on routine oral examinations, with no treatment indicated necessarily. Long-term prospective studies are required for further assessment of the prevalence of TP and TM.

At any time, changes in the architecture of the palate and the mandible could prove clinically challenging.

 
  References Top

1.Haugen LK. Palatine and mandibular tori. A morphologic study in the current Norwegian population. Acta Odontol Scand 1992;50:65-77.  Back to cited text no. 1
    
2.Axelsson G, Hedegård B. Torus mandibularis among Icelanders. Am J Phys Anthropol 1981;54:383-9.  Back to cited text no. 2
    
3.Simunkoviæ SK, Boziæ M, Alajbeg IZ, Dulciæ N, Boras VV. Prevalence of torus palatinus and torus mandibularis in the Split-Dalmatian County, Croatia. Coll Antropol 2011;35:637-41.  Back to cited text no. 3
    
4.Gorsky M, Raviv M, Kfir E, Moskona D. Prevalence of torus palatinus in a population of young and adult Israelis. Arch Oral Biol 1996;41:623-5.  Back to cited text no. 4
    
5.Woo JK. Torus palatinus. Am J Phys Anthropol 1950;8:81-111.  Back to cited text no. 5
    
6.Jainkittivong A, Apinhasmit W, Swasdison S. Prevalence and clinical characteristics of oral tori in 1,520 Chulalongkorn University Dental School patients. Surg Radiol Anat 2007;29:125-31.  Back to cited text no. 6
    
7.Eggen S, Natvig B, Gåsemyr J. Variation in torus palatinus prevalence in Norway. Scand J Dent Res 1994;102:54-9.  Back to cited text no. 7
    
8.Yoshinaka M, Ikebe K, Furuya-Yoshinaka M, Hazeyama T, Maeda Y. Prevalence of torus palatinus among a group of Japanese elderly. J Oral Rehabil 2010;37:848-53.  Back to cited text no. 8
    
9.Ohno N, Sakai T, Mizutani T. Prevalence of torus palatinus and torus mandibularis in five Asian populations. Aichi Gakuin Dent Sci 1988;1:1-8.  Back to cited text no. 9
    
10.Kerdpon D, Sirirungrojying S. A clinical study of oral tori in southern Thailand: Prevalence and the relation to parafunctional activity. Eur J Oral Sci 1999;107:9-13.  Back to cited text no. 10
    
11.Sakai T. Anthroposcopic observations of palatine and mandibular tori in Japanese. Shinshu Med J 1954;3:303-7.  Back to cited text no. 11
    
12.Yaacob H, Tirmzi H, Ismail K. The prevalence of oral tori in Malaysians. J Oral Med 1983;38:40-2.  Back to cited text no. 12
    
13.Shah DS, Sanghavi SJ, Chawda JD, Shah RM. Prevalence of torus palatinus and torus mandibularis in 1000 patients. Indian J Dent Res 1992;3:107-10.  Back to cited text no. 13
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16.Summers CJ. Prevalence of tori. J Oral Surg 1968;26:718-20.  Back to cited text no. 16
    
17.Belsky JL, Hamer JS, Hubert JE, Insogna K, Johns W. Torus palatinus: A new anatomical correlation with bone density in postmenopausal women. J Clin Endocrinol Metab 2003;88:2081-6.  Back to cited text no. 17
    
18.Jarvis A, Gorlin RJ. Minor orofacial abnormalities in an Eskimo population. Oral Surg Oral Med Oral Pathol 1972;33:417-27.  Back to cited text no. 18
    
19.King DR, King AC. Incidence of tori in three population groups. J Oral Med 1981;36:21-3.  Back to cited text no. 19
    
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21.Bernaba JM. Morphology and incidence of torus palantinus and mandibularis in Brazilian Indians. J Dent Res 1977;56:499-501.  Back to cited text no. 21
    
22.Al Quran FA, Al-Dwairi ZN. Torus palatinus and torus mandibularis in edentulous patients. J Contemp Dent Pract 2006;7:112-9.  Back to cited text no. 22
    
23.Sonnier KE, Horning GM, Cohen ME. Palatal tubercles, palatal tori, and mandibular tori: Prevalence and anatomical features in a U.S. population. J Periodontol 1999;70:329-36.  Back to cited text no. 23
    
24.Chohayeb AA, Volpe AR. Occurrence of torus palatinus and mandibularis among women of different ethnic groups. Am J Dent 2001;14:278-80.  Back to cited text no. 24
    
25.Alvesalo L, Mayhall JT, Varrela J. Torus mandibularis in 45,X females (Turner syndrome). Am J Phys Anthropol 1996;101:145-9.  Back to cited text no. 25
    
26.Reichart PA, Neuhaus F, Sookasem M. Prevalence of torus palatinus and torus mandibularis in Germans and Thai. Community Dent Oral Epidemiol 1988;16:61-4.  Back to cited text no. 26
    
27.Gorsky M, Bukai A, Shohat M. Genetic influence on the prevalence of torus palatinus. Am J Med Genet 1998;75:138-40.  Back to cited text no. 27
    


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