Torus Mandibularis Research Articles

Prevalence and pattern of torus palatinus and torus mandibularis among edentulous patients of Saudi Arabia.

BackgroundThe most remarkable exostoses of the human jaws are torus palatinus (TP) and torus mandibularis (TM). The aim of the present study was to actuate the prevalence of TP and TM in relation to age and sex among the edentulous patients of Saudi Arabia.MethodsThe present study included 847 edentulous subjects (458 men and 389 women) aged between 51 and 79 years. The subjects were examined for the existence of tori by clinical inspection and palpation. Statistical analysis was performed using SPSS for Windows version.ResultsAmong the 847 subjects, 149 (17.59%) had either TP or TM. Sixty six (7.79%) subjects had TP, whereas 83 (9.80%) had TM. The maximum percentage (36.36%) of tori was observed in the age-group of 60–69 years. The percentage of males with either tori was higher (19.0%) when compared to females (15.94%). According to shape, the occurrence of flat-shaped TP (57.58%) and bilateral solitary TM (39.76%) was more common.ConclusionNo significant difference in the presence of tori with respect to sex and age was observed. A comparatively increased prevalence of TP and TM was however observed, and this should be taken into consideration while planning for prosthodontic and periodontal therapy in these patients.

Frequency of mandibular tori in prehistoric and historic Japanese island populations

The frequency and development of mandibular tori are distributed unevenly geographically and among fossil hominids, archaeological skeletal samples, and present-day populations. This suggests that tori frequencies may be influenced by both genetic and non-genetic factors. In order to clarify chronological changes in the frequencies of mandibular tori, the frequencies of tori in prehistoric and historic populations on the main island of the Japanese archipelago were examined. A total of 971 skeletal samples ranging from the Jomon to early-modern age were examined. The frequencies of mandibular tori were highest in the Jomon populations, but lower in the Yayoi, Kofun, Kamakura, Muromachi, Edo, and early modern populations. In addition, the frequencies tended to decrease over time. Among the Jomon populations, the frequencies were lower in Southwest Jomon (Chugoku district) and Central Jomon (Aichi Prefecture), and higher in East Jomon (Kanto district) and Northeast Jomon (Tohoku district). These results suggest that the development of mandibular tori could be influenced by both genetic and non-genetic factors (specifically diet) factors.

Mandibular tori are associated with mandibular bone quality: a case-control study.

Torus mandibularis (TM) is one of the most common oral exostoses. The presence of TMs has been correlated with high skeletal bone mineral density. This study aimed to evaluate the relationship between TM and mandibular bone quality based on the measurement of mandibular cortical index (MCI). A case-control study was designed for patients who attended the Department of Dentomaxillofacial Radiology at the University of Hacettepe for routine dental examination. Patients with TMs were defined as cases, and those without TMs were defined as controls. The presence of tori was assessed by visual inspection and digital palpation. MCI assessments were done based on Klemetti's classification. The associations between the presence of TMs, MCI, and the parafunctional activity were assessed. The sample consisted of 80 subjects with TMs and 80 control subjects. The presence of TMs was strongly associated with the parafunctional activity (p = 0.036) and a non-eroded mandibular cortex (MCI C1, p = 0.001). Parafunctional activity may be a factor related to the formation or existence of TMs. The association between TMs and mandibular morphology may suggest that subjects with TMs may have a higher mandibular bone quality compared to those without TMs.

Clinical and Cone-Beam Computed Tomography (CBCT) Evaluation of Patients with Torus Palatinus and Mandibularis

Clinical and Cone-Beam Computed Tomography (CBCT) Evaluation of Patients with Torus Palatinus and Mandibularis

Torus Palatinus as a Criterion for Sex Determination - a Study in 60 Adult Human Skulls

Torus palatinus is a bony protuberance which occurs in the midline of the hard palate. The prevalence of torus palatinus in dental patients and skulls of different races has been studied by many researchers because of its clinical significance. In addition, the correlation of torus palatinus with various factors like age, sex, torus mandibularis has also been studied. Most of the previous researchers have found sex differences in its prevalence. Few studies have been conducted with regard to torus palatinus in Indian population. Thus, in the present study, 60 adult human skulls of North Indian individuals have been studied to assess the reliability of the palatine torus development in sex determination. The palatine torus development has been graded on the basis of visual inspection. The data has been statistically analyzed by Logistic and Probit regression models. Subsequent to analysis, it has been found that the palatine torus development correctly classified 48.3% of the sample. The correlation between the palatine torus development and maxillo-alveolar index has also been studied. The factors which affect the palatine torus development and ultimately the reliability of palatine torus development in sex determination have also been highlighted in the present study.

Oral bony outgrowths: Prevalence and genetic factor influence. Study of twins

ObjectiveThe aim of the study was to verify the influence of a genetic factor on the etiology of oral bony outgrowths and to determine the prevalence and type of oral bony outgrowths (tori and exostoses) among a group of Lithuanian twins. Materials and methodsIn total, 162 twins (81 twin pairs) were analyzed for the presence or absence, type, and size of oral bony outgrowths. Statistical analysis was carried out to find the prevalence of bony protuberances and the relationship between zygosity and occurrence of oral bony enlargements. Zygosity of twins was confirmed by DNA analysis. Results59.9% of the subjects had oral bony outgrowths. Mandibular tori were found in 56.8% and palatal tori in 1.8% of the sample. Palatal exostoses and mandibular exostoses were present in 1.8% and 3.1% of the sample, respectively, whereas maxillary exostoses were not found. A higher percentage of tori and exostoses were found in the group of older subjects (>18 years old, p=0.025). No significant difference was found between men and women in the prevalence of bony outgrowths. High κ and r values (0.91±0.062) showed very good concordance of oral bony outgrowths between monozygotic and moderate concordance (0.58±0.141) between dizygotic co-twins (p<0.001). The calculation of heritability estimate verifies dominant influence of genetic factor on the etiology of oral bony outgrowths (h2=0.658). ConclusionThe most common bony outgrowth was torus mandibularis. Our results show that the genetic factor is dominant in the etiology of oral bony outgrowths.

Prévalence et caractéristiques cliniques des hypertrophies osseuses buccales dans une population marocaine

Oral bony outgrowths (OBOs) are localized bony protuberances that arise from the cortical plate. Various types of OBOs have been described, the precise designation of which depends on anatomic location such as torus palatinus, torus mandibularis, buccal exostosis, or palatal exostosis. We had for aim to determine the prevalence and clinical characteristics of OBOs in a Moroccan population. This cross-sectional study was conducted between March 15 and June 30, 2011 at the Rabat-Salé teaching hospital dental consultation and treatment center, in Morocco. Three hundred and fifty-three patients (160 female and 193 male patients), 11 to 82 years of age, were examined clinically and radiologically to determine the presence of OBO. Twenty-four patients (6.8%) presented with OBOs. The prevalence for exostosis, torus mandibularis, torus palatinus, and associated OBOs was 3.1%, 2%, 0.8%, and 0.9% respectively. There was a significant difference (P=0,01) between the average age for patients presenting with OBO (43.2±12 years of age) and the average age for patients without any OBO (36.5±16 years of age). The prevalence of OBOs in female patients (7.3%) was higher than in male patients (6.3%) but the difference was not significant (P=0.439). Patients with occlusal parafunctional activity presented with significantly more OBO (P=0.016). The reported prevalence of OBO is extremely variable, according to age, gender, and ethnic group. The occurrence of OBO could be triggered by genetic factors associated with environmental factors.

Unexpected Difficult Intubation in a Patient with Prominent Mandibular Tori

Bony exostoses such as mandibular tori are fairly common. They are asymptomatic, benign cortical bony protuberances occurring along the lingular aspect of the mandible. Large tori may interfere with direct laryngoscopy resulting in difficult intubation. This is a case report about a 66 year old, Caucasian male with a Mallampati class I airway who was un-intubatable initially, due to the presence of bilateral mandibular tori that formed a plate of bone beneath his tongue. He was intubated subsequently with the help of an Eschmann bougie.

Mandibular Tori Are Associated With Mechanical Stress and Mandibular Shape

The influence of mechanical stimulation on the formation of torus mandibularis (TM) is still poorly understood. We sought to understand the etiology of TMs by investigating the role of parafunctional activity and mandibular morphology on the formation of TMs. We designed a case-control study for patients attending the dental clinic of the present study (University of São Paulo School of Dentistry, São Paulo, SP, Brazil). Patients presenting with TMs were defined as cases, and those without TMs were defined as controls. Finite element analysis (FEA) was used in 3-dimensional mandibular models to examine the stress distribution in the mandibles with and without TMs. In addition, the associations of mandibular arch shape, mandibular cortical index, and parafunctional activity with the presence of T were assessed using odds ratio analysis. A total of 10 patients with TMs and 37 without TMs were selected (22 men and 25 women, mean age 54.3 ± 8.4 years). FEA showed a stress concentration in the region in which TMs form during simulation of parafunctional activity. The radiographic assessment showed that those with TMs were more likely to have a square-shaped mandible with sharp angles (P = .001) and a normal mandibular cortex (P = .03). The subjects without TMs had a round-shaped mandible with obtuse angles and an eroded mandibular cortex. Parafunctional activity could be causing the formation of TMs by concentrating mechanical stress in the region in which TMs usually form. Thus, mandibular geometries that favor stress concentration, such as square-shaped mandibles, will be associated with a greater prevalence of TMs.

Alveolar exostosis – revisited: A narrative review of the literature

Abstract An exostosis is a localized, peripheral overgrowth of bone of unknown etiology of benign nature. It may be a nodular, flat or pedunculated protuberance located on the alveolar surfaces of the jawbones. The etiology of oral bony exostosis is still not clear. Racial, autosomal dominant factors, dental attrition, and even nutritional factors have been suggested as having an influence. In the jaws, depending on the anatomic location they are named as torus palatinus (TP), torus mandibularis (TM), or buccal bone exostoses (BBE). The clinical importance of exostosis lies in surgical removal of these to permit proper flap adaptation, most importantly in the posterior maxilla, and to the potential use of the mandibular and palatal tori as sources of autogenous cortical bone for grafting.

Effect of Mandibular Tori on Glottic Exposure During Simulated Suspension Microlaryngoscopy

Mandibular tori have been identified as a contributing factor in difficult exposure during intubation. However, no investigation has measured the effect of mandibular tori on glottic exposure during suspension microlaryngoscopy (SML). The objective of this study was to measure how the size and location of mandibular tori affect glottic exposure during simulated SML at different thyromental distances. Suspension microlaryngoscopy was modeled on an anatomically accurate skull and larynx with thyromental distances between 6 and 12 cm. Mandibular tori were simulated by protruding screws 5 to 15 mm from the lingual aspect of the mandible. The tori were positioned either 15 mm (anterior) or 25 mm (posterior) from the midline of the symphysis. The glottic exposure for the various-size tori in each location was measured by recording the displacement of the glottiscope tip relative to the most anterior exposure achievable without tori. The glottiscope angle relative to the horizontal plane was measured for each condition. Mandibular tori of more than 10 mm had a significant impact on glottic exposure. Displacement of the glottiscope tip ranged from 2 to 9 mm for anteriorly placed tori and from 7 to 29 mm for posteriorly placed tori, with larger tori causing greater displacement. Increasing the thyromental distance increased the posterior glottiscope tip displacement regardless of torus size or location. The glottiscope angle increased with larger tori (12º to 28º), but this angle did not change with increasing thyromental distance. Larger size and more-posterior location of mandibular tori more significantly reduce glottic exposure during SML. The inner table of the mandible is the most relevant anatomic constraint on glottic exposure, which varies with the presence or absence of mandibular tori independent of thyromental distance.

Prevalence of torus palatinus and torus mandibularis in an Indian population

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 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.

Cone beam computed tomography for mandibular tori

Cone beam computed tomography for mandibular tori

Mandibular tori size is related to obstructive sleep apnea and treatment success with an oral appliance

Obstructive sleep apnea (OSA) is a common disorder characterized by repetitive upper airway obstruction during sleep. We aimed to investigate whether mandibular tori, exostoses that appear on the lingual surface of the lower jaw, are related to OSA and the effect of an oral appliance (OA) in OSA patients. Six hundred snoring patients with a mean age of 52 years (range 23-75 years) and a mean respiratory disturbance index (RDI) of 15 (range 0-76), who were consecutively referred for OA treatment, were included. The size of the tori was measured on plaster casts with a digital sliding caliper. Twenty-seven percent of the patients had mandibular tori, with a similar prevalence in snorers and patients with mild, moderate and severe OSA. Tori size differed between severity groups. Thick tori (≥2.9 mm) were associated with an RDI of <30, odds ratio (OR) 4.7 (p = 0.01), adjusted for age, gender and body mass index (BMI; kg/m(2)). Complete treatment response with OA was related to thick tori, OR = 2.5 (p = 0.02), adjusted for disease severity, age, gender, BMI (kg/m(2)), weight changes (kg) and mandibular repositioning. Patients with milder disease are more likely to have larger tori than patients with severe OSA. Treatment success with an OA occurs more frequently in patients with larger tori than in patients with no tori or small tori.

The tori of the mouth and ear: A review

There is a great deal of literature regarding the tori of the mouth and ear. However, there is controversy regarding the etiology and prevalence of each. The torus palatinus is generally agreed to be the most common oral exostosis and is more frequently found in females. The torus mandibularis is also quite common, is more prevalent in males, and occurs bilaterally in 80% of cases. Far less data have been presented regarding the torus maxillaries primarily due to the lack of consensus regarding its nomenclature and classification. These oral tori are thought to be inherited in an autosomal dominant manner with a relatively high penetrance; however, environmental and functional factors have been postulated that may account for a more complex etiology than simply genetics. The torus auditivus is rarely acknowledged in clinical papers and most data are found in anthropological journals. Although there is an abundance of literature that addresses these traits individually, there is a lack of research that collectively acknowledges these. Therefore, the aim of this study was to present a composite review of the tori with regards to their anatomical features, prevalence, etiology and clinical relevance.

Oral mucosal lesions and developmental anomalies in dental patients of a teaching hospital in Northern Taiwan

Background/purposeOral mucosal lesions and developmental anomalies are frequently observed in dental practice. The purpose of this study was to evaluate the prevalence of oral mucosal lesions and developmental anomalies in dental patients in a teaching hospital in northern Taiwan. Materials and methodsThe study group comprised 2050 consecutive dental patients. From January 2003 to December 2007, the patients received oral examination and treatment in the dental department of the Chang Gung Memorial Hospital (Taipei, Taiwan). ResultsOnly 7.17% of dental patients had no oral mucosal lesions or developmental anomalies. Twenty-three different types of oral mucosal lesions or developmental anomalies were diagnosed. The most common lesion was Fordyce granules (82.8%), followed by buccal exostosis (34.1%), torus mandibularis (24.2%), torus palatinus (21.1%), lingual varices (16.2%), and recurrent aphthous ulcerations (4.3%). Fordyce granules, lingual varices, and buccal exostosis were the three most common oral developmental anomalies in elderly patients. Fordyce granules, buccal exostosis, torus mandibularis, lingual varices, and oral submucous fibrosis were more prevalent in men than in women. Fordyce granules occurred more commonly in adults than in children and were more commonly present in the labial and buccal mucosae than in any other oral mucosal sites. The anterior region of the jaws frequently contained buccal exostoses. Torus palatinus occurred more frequently in female patients than in male patients. Recurrent aphthous ulcerations were more common in patients under 18 years old. ConclusionThis study provides important data about the types and prevalence of oral mucosal lesions and developmental anomalies in dental patients in a teaching hospital in northern Taiwan.

Concurrence of Torus Mandibularis with Multiple Buccal Exostoses

Concurrence of Torus Mandibularis with Multiple Buccal Exostoses

Origin of the torus mandibularis: An embryological hypothesis

Torus mandibularis, a well-known protuberance in the dental field, has been defined as a hyperostosis in the lingual aspect of the body of the mandible above the mylohyoid line. However, the origin of the torus mandibularis has not yet been clarified. The aim of this study was to provide a better understanding on the origin of the torus in view of the specific development of Meckel's cartilage at the site corresponding to the adult torus. A total of 40 mid-term human fetuses at 7-16 weeks of gestation were examined. The 10-13 weeks stage corresponded to the critical period in which Meckel's cartilage with endochondral ossification underwent a bending at the beginning of the intramandibular course. At the level of mental foramen, which was located between the deciduous canine and the first deciduous molar germs, the medial lamina of the mandible protruded medially to reach Meckel's cartilage. Thus, the medial lamina covered the posterior and superior aspect of the bending Meckel's cartilage just above the attachment of the developing mylohyoid muscle (i.e., in the oral cavity). We considered a bony prominence, which composed the protruding medial lamina and the bending Meckel's cartilage as the fetal origin of the torus mandibularis. A new theory is proposed for the origin of the torus mandibularis based on the existence of an anlage formed during the development of the mandible, variable in morphology and size, but always constant.

Clinicopathological Analysis of Common Oral Lesions

Oral health is important to the quality of life of all individuals. Oral lesions can cause discomfort or pain that interferes with mastication, swallowing, and speech. Oral disease is a health problem that is not only a matter of oral hygiene and local condition, but can also be a precursor to other dangerous and potentially life threatening illnesses. The present study was designed to analyze the main clinicopathological aspects of most common oral lesions in patients who visit the Oral Diagnosis Clinic of the College of Dentistry, University of Sulaimani, Kurdistan region, Iraq. Patients and methods: This prospective study was performed on 3144 patients from July 2009-July 2010. In this study a total of 3144 patients were examined. Of these 1507 (47.93%) were males and 1637 (52.06%) females. The patients' age ranged between 10 to 79 years. An interview was conducted to collect information using a structured questionnaire which was completed by each patient. The lesions that could not be diagnosed by clinical examinations alone were analyzed histopathologically. Results: Among 3144 patients, only 799 patients (25.41%) had oral lesions. Females constituted 49.81% (n=398) and males 50.18 (n=401). The age range of the patients was between 10-79 years with a mean age of 33.75 years. Anatomic changes and developmental anomalies were considered as linea alba (16.68%), Fordyce's granules (12.37%), torus mandibularis (0.66%), torus palatinus (0.55%). Common oral lesions after those considered being anatomic changes and developmental anomalies were fissure tongue (18.23%), cheek biting (12.15%), hairy tongue (6.51%), and recurrent aphthous stomatitis (5.85%) , ankyloglossia (3.75%) , lingual varicosities (2.87%) , frictional (traumatic) keratosis (2.87%) , denture stomatitis (2.54%), recurrent herpes simplex virus infection (2.43%), traumatic ulcer (2.43%), geographic tongue (1.98%), fibroepithelial hyperplasia (1.32%), denture induced fibrous hyperplasia (1.21%) , angular cheilitis (0.99%) , oral lichen planus (0.88%) , median rhomboid glossitis (0.88%) , peripheral giant cell granuloma (0.22%) , and gingival hyperplasia (0.33%) . Conclusion: Routine examinations of oral cavities are valuable in identifying several oral lesions and this will help to establish early diagnosis and treatment and better prognosis particularly early precancerous and other oral lesions.

A Triad of Developmental Anomalies-An Unusual Case

A fissured tongue and ankyloglossia or tongue-tie is a congenital anomaly of the tongue. Mandibular tori is a proliferation of the peripheral bone that results from a localized, excessive growth of ossein [1, 2]. A 27 years old male patient reported to the Department of Oral Medicine and Radiology, NIMS Dental College, Jaipur, with the complaints of a difficulty in swallowing food and difficulty in speaking, which were there since childhood. On intra-oral examination, a high and thick lingual frenum was observed, which restricted the tongue movements and caused a inability in protruding and touching the palate [Table/Fig-1]. The dorsum of the tongue presented with a deep vertical fissure which extended till the tip and multiple connecting grooves in the transverse direction [Table/Fig-2]. [Table/Fig-1]: Shows Ankyloglossia [Table/Fig-2]: Shows Vertical fissure on tongue till the tip and horizontal groves On examining the floor of the mouth, an oval swelling was found to be present on the right and left sides below the alveolar crest, which extended from the canine and the premolar regions, with the overlying mucosa being pale as compared to the surrounding mucosa. On palpation, the swelling was found to be hard in consistency, with the overlying mucosa being firm, non-tender and fixed [Table/Fig-3]. A mandibular occlusal radiograph was taken for the swellings and it revealed bulging of the bone with a normal radiographic bone pattern [Table/Fig-4]. A clinical examination revealed the reason for the difficulty in speech as ankyloglossia. Other additional findings were the presence of a fissured tongue and lingual swellings as Mandibular tori. [Table/Fig-3]: Shows bilateral Mandibular Tori [Table/Fig-4]: Show bilateral opaque bulge of bone with normal bone pattern Ankyloglossia or tongue-tie is a congenital anomaly in which a short, lingual frenum or a highly attached genioglossus muscle restricts the tongue movements, which has an incidence rate of 5% in the normal population. Ankyloglossia is associated with other syndromes, namely, the Pierre Robin Syndrome, the Oral-Facial-Digital Syndrome, Meckel’s syndrome, the trisomy 13 syndrome, the Robinow Syndrome, the short rib syndrome, the ATR-X Syndrome, Fraser’s Syndrome, the Wiedemann-Beckwith syndrome, van der Woude’s syndrome, and the glossopalatine ankylosis sundrome [1, 2, 3]. Fissured tongues occur in less than 10% of the normal population and they are characterized by grooves on the dorsal and lateral aspects of the tongues, that vary in depth. Fissured tongues are seen in some syndromes, namely, the Melkersson-Rosenthal syndrome, the Coffin-Lowry syndrome, Fraser’s Syndrome, Down’s syndrome, the Oral-Facial-Digital (OFD) Syndrome Type I, the Mohr Syndrome (the OFD syndrome, type II), the Pierre Robin Syndrome, the Maroteaux Lamy Syndrome, the ECC syndrome, etc. [1, 3, 4]. Mandibular tori is a proliferation of the peripheral bone, that results from a localized, excessive growth of the bone, whose incidence rate is 8% in the normal population and which is only seen in Gardner’s syndrome [1, 2]. To conclude, an unusual case of a triad of dental anomalies with ankyloglossia, fissured tongue and mandibular tori, has been presented. Although many syndromes are associated with the above mentioned findings individually, it remains unclear whether such a combination occurs by chance or whether it is a true syndrome.