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ORIGINAL ARTICLE
Year : 2017  |  Volume : 20  |  Issue : 1  |  Page : 57-60

Prevalence of mandibular and palatine tori among the Ibos in Enugu, South-East Nigeria


1 Department of Preventive Dentistry, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
2 Department of Oral and Maxillofacial Surgery, Oral Pathology Unit, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria

Date of Acceptance12-Aug-2015
Date of Web Publication12-Dec-2016

Correspondence Address:
Dr. M C Nwoga
Department of Oral and Maxillofacial Surgery, Oral Pathology Unit, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1119-3077.178911

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   Abstract 

Context: Torus mandibularis (TM) and torus palatinus (TP) are believed to occur commonly among black Africans. There is a dearth of literature on Nigerians. The few reported studies were done in the South-West Nigeria. This is the first report of the prevalence of tori among the Ibo-speaking ethnic group in the South-East Nigeria.
Settings and Design: This is a prospective cross-sectional study of 3000 subjects of Ibo ethnic extraction attending a dental clinic in Enugu, South-East Nigeria.
Materials and Methods: Three thousand subjects were examined for the isolated and concurrent occurrence of TM and TP. The subjects were seen over a 4-year period. The age, sex, ethnic group, type of tori based on location, and symptomatic awareness of tori presence were documented.
Statistical Analysis Used: The data were analyzed with Statistical Package for Social Sciences (SPSS) version 17. The level of significance was P< 0.05. The Chi-square test showed no statistically significant difference between gender and type of tori (P = 0.34). Similarly, there was no statistically significant difference between the age groups and type of tori (P = 0.38).
Results: Two hundred and ninety-two subjects were clinically diagnosed with tori, of which females constituted 88%, and males constituted 12%. Isolated TM occurred in 56.8% (166 of 292) subjects, isolated TP in 17.5% (51 of 292) subjects, and concurrent tori (TM and TP) in 25.7% (75 of 292) subjects. The peak occurrence was in the fifth decade. The overall prevalence was 9.7%. The prevalences of TM (isolated and concurrent) and TP (isolated and concurrent) were 8.0% and 4.2%, respectively.
Conclusions: The prevalence values are within the range of values reported in other Nigerian studies but differ widely with values from other ethnic groups from other countries.

Keywords: Ibo, Nigerian, prevalence, tori


How to cite this article:
Maduakor S N, Nwoga M C. Prevalence of mandibular and palatine tori among the Ibos in Enugu, South-East Nigeria. Niger J Clin Pract 2017;20:57-60

How to cite this URL:
Maduakor S N, Nwoga M C. Prevalence of mandibular and palatine tori among the Ibos in Enugu, South-East Nigeria. Niger J Clin Pract [serial online] 2017 [cited 2020 Nov 28];20:57-60. Available from: https://www.njcponline.com/text.asp?2017/20/1/57/178911


   Introduction Top


Torus mandibularis (TM) and torus palatinus (TP) are painless benign bony outgrowths on the mandible and palate, respectively. TM is usually located at the lingual aspect of the mandible, above the mylohyoid line, while TP is located on the mid aspect of the hard palate. A number of studies have indicated a multifactorial etiology of tori in which genetics, the environment, diet, and parafunctional habits are important.[1],[2] There is no consensus on the pathophysiology of the preponderant occurrence in either gender: Males [3] or females.[4],[5]

The tori is of various sizes and shapes; they could be unilateral or bilateral, and single or multiple.[1],[6] TM and TP may occur concurrently on the same subject. Although they are located in accessible intraoral sites, the majority of the subjects are oblivious of their presence.[7],[8],[9] Rarely, tori may become symptomatic and may present with traumatic ulcerations [9] or impaired speech and mastication. Pain, irregular ulcers, and osteonecrosis of tori have been reported in some patients treated with bisphosphonate medications (inhibitors of osteoclastic action), such as alendronate, for osteoporosis, metastatic bone diseases, and other bone conditions.[10],[11]

Unlike TP, TM is not known to present before the first decade of life.[1],[12],[13] However, both may share similarities including the peak age of occurrence in the third decade.[1],[12]

The prevalence values of tori in the literature are widely variable depending on the country, the race, the ethnic group, as well as the objectives, of the study. The overall prevalence of tori could range from 0.4%[14] to 28.12%.[13] Depending on the group studied, the prevalence of TP has been reported to be as high as 66.5%[14] while that of TM was reported as high as 42.6%.[15]

There are few studies on the prevalence of tori among black Africans, with only three done in Nigeria, in the South-West.[12],[16],[17] This is the first study of torus prevalence among an Ibo-speaking population in the South-East Nigeria.


   Materials and Methods Top


The target population was people of Ibo ethnic group in Enugu, South-East Nigeria, with tori. The study population was all subjects with tori attending a dental clinic in Enugu over a 4-year period, from January 02, 2005 to December 31, 2009. The sample was from the consecutive attendee subjects at the clinic for dental check-up and treatment, of which 3000 met the inclusion criteria and were examined for TM and TP. Informed consent was sought and obtained from all the subjects attending the clinic for their participation in the study.

All subjects of Ibo ethnic group, of all ages and both sexes were included. Subjects with a previous or present history of oral tumors and oral surgical treatment for intra-oral swellings were excluded. Also excluded were subjects with any degree of trismus or mandibular or maxillofacial fracture or bone injuries. Subjects of other ethnic groups were excluded as well as subjects not resident in Enugu.

The examination was done while subjects were seated on a dental chair in a dental clinical setting under aseptic conditions. Each subject was examined with sterilized dental examination instruments that included a dental tray containing a pair of disposable examination gloves and a dental mirror. For each subject examined, clinically visible and digitally palpable intraoral palatal and/or mandibular tori where present, were recorded only once for the purposes of this study. The age, sex, ethnic group, type of tori based on location, and symptomatic awareness of tori presence were documented.

Statistical analysis

The data were analyzed with Statistical Package for Social Sciences (SPSS) version 17 Chicago: SPSS Inc. Prevalence and frequency of values were obtained. The test of significance was set at P < 0.05.


   Results Top


Of the 3000 subjects examined for tori, 292 (9.7%) subjects had tori on the palate, mandible, or concurrently. Males constituted 12% of subjects with tori and 88% for females, giving a male: female ratio of 1:7.3. [Table 1] shows the peak detection period was in the fifth decade of life. The minimum age at detection was 14 years, while the maximum age was 86 years. The age range in males with tori was 14–79 years, while in females it was 16–86 years. In subjects with tori, the mean age was 39.72 ± 13.4 years while the mode was 40 years. The Chi-square test showed no statistically significant difference between gender and type of tori in this study (P = 0.34). Similarly, there was no statistically significant difference between the age groups and type of tori with P = 0.38. There were six groups based on the age range: 10–19 years, 20–29 years, 30–39 years, 40–49 years, 50–59 years, 60 years, and above. There were two groups based on sex: Male and female. There were also three groups based on tori location: TM, TP, and Concurrent (TM and TP). TM and TP occurred concurrently in both the minimum age of occurrence of a 14-year-old male and the maximum age of occurrence of an 86-year-old female. [Figure 1] shows bilateral mandibular tori in a male subject. Isolated TM occurred in 56.8% of the 292 subjects, Isolated TP in 17.5% and concurrent TM and TP in 25.7%. [Table 2] shows a total of 367 tori (isolated on the mandible or palate and concurrent in both) distributed among 292 subjects: 241 (65.7%) in the mandible and 126 (34.3%) in the palate.
Table 1: Frequency of tori occurrence by age group

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Figure 1: A male subject with bilateral mandibular tori (torus mandibularis)

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Table 2: Distribution of 367 tori in 292 subjects by location and sex

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Of the 292 subjects with tori, only 3 (1%) had symptomatic awareness of tori presence. These subjects presented with anxiety related symptoms and complained primarily of the presence of intraoral bony outgrowths. [Table 3] shows the prevalence of tori was 9.7% (292 of 3000). The prevalence of TM was 8.0% (241 of 3000) while the prevalence of TP was 4.2% (126 of 3000).
Table 3: Prevalence of tori by location

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   Discussion Top


The tori prevalence of 9.7% obtained among the Ibos in Enugu is within the range of values of 3.7–13.6%, reported by other Nigerian studies.[12],[16],[17] This value, however, contrasts with values from other national and ethnic studies [7] which reported widely varying ranges of tori prevalence as high as 28.12%.[13] Regarding the types of tori based on location, the values of 8.0% for TM and 4.2% for TP obtained among Ibos in Enugu, are also within the ranges of values by other Nigerian studies of 1.8–8.8% for TM and of 2.5–7.2% for TP.[12],[16],[17] The reported prevalence values of 42.6% for TM [15] and 66.5% for TP [14] are widely in contrast to the values obtained among the Ibos in Enugu and Nigeria. The multifactorial roles of genetics, diet, and environment [1],[2] in the relative low prevalence values obtained with the Ibo population and other Nigerian studies could not be ascertained, being outside the scope of this study. However, the Ibos are black Africans with a diet that is presently a mixture of Western and local food based on wheat, cassava, yam, rice, beef, fish, fruits, legumes, and vegetables among others. Often the staple food based on cassava is swallowed with minimal mastication of accompanying vegetables and meat or fish.

The preponderance of females with tori, is consistent with results of all other Nigerian studies,[12],[16],[17] and this may not only be attributed to higher female dental awareness and clinic attendance. The consideration of genetic factors, dietary, and parafunctional habits in the etiology are documented findings.[1],[2] Other national studies, however, reported varying gender preponderances of tori in either males [3] or females.[4],[5] The factors that would determine preponderance in either gender are presently not clear, and outside of the generally reported etiological factors.[1],[2] Among the Ibos in Enugu, all types of tori distribution occurred predominantly in females. Some other studies, however, reported TP to be more frequent in females,[4],[5] and TM to be significantly commoner in males,[1],[3],[6] therefore, underlying the need for further research on the role of gender in etiology of specific types of tori. Among the Ibos of Enugu, the support for the predominance of TM in subjects of African descent [6],[12],[16],[17] is further reflected where TM constitutes 65.7% of all tori seen.

The knowledge that most subjects are oblivious of tori presence [1],[7],[8],[9] except when symptomatic,[10],[11],[15] corroborates our finding of only approximately 1% being symptomatically aware of the presence of TM or TP. The lack of awareness of tori presence, we propose, may be attributed to inadequate dental health education and dental visits, as well as slow and asymptomatic tori growth. Our subjects conscious of their tori, exhibited anxiety-related symptoms, which constituted the reason for treatment. Other rare reasons for tori treatment would include prosthetic indications, the source of autogenous cortical bone for grafts, speech disturbance, traumatic ulcer, or obstructive sleep apnea.[15],[18] Surgical treatment by excisional biopsy, bone shavings, or investigative incisional biopsy usually showed normal compact bone with marrow spaces.[18]


   Conclusion Top


The painless benign bony outgrowths on the lingual aspect of the mandible and the middle of the hard palate of Ibos in the South-East Nigeria are consistent with mandibular and palatal tori respectively, reported in other studies. The prevalence is within the range of values reported in other Nigerian studies but lower than values of other population studies reported in the Asian and European literature.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Al-Bayaty HF, Murti PR, Matthews R, Gupta PC. An epidemiological study of tori among 667 dental outpatients in Trinidad and Tobago, West Indies. Int Dent J 2001;51:300-4.  Back to cited text no. 1
    
2.
Unterman S, Fitzpatrick M. Torus mandibularis. West J Emerg Med 2010;11:520.  Back to cited text no. 2
    
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Simunkovic SK, Bozic M, Alajbeg IZ, Dulcic 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
    
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Al-Sebaie D, Alwirikat M. Prevalence of torus palatinus and torus mandibularis in Jordanian population. Pak Oral Dent J 2011;31:214-6.  Back to cited text no. 4
    
5.
Mirza D, Khokhar NH, Katpar SJ, Khan Y, Hakeem S, Musani MA. Prevalence of torus mandibularis among various ethnic groups in Karachi: A cross sectional study. Pak Oral Dent J 2013;33:277-80.  Back to cited text no. 5
    
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Bruce I, Ndanu TA, Addo ME. Epidemiological aspects of oral tori in a Ghanaian community. Int Dent J 2004;54:78-82.  Back to cited text no. 6
    
7.
García-García AS, Martínez-González JM, Gómez-Font R, Soto-Rivadeneira A, Oviedo-Roldán L. Current status of the torus palatinus and torus mandibularis. Med Oral Patol Oral Cir Bucal 2010;15:e353-60.  Back to cited text no. 7
    
8.
Mirza D, Hakeem S, Omer SA, Rizvi KF. Frequency of torus palatinus; a study done in a teaching hospital in Karachi. Pak Oral Dent J 2013;33:58-62.  Back to cited text no. 8
    
9.
Rasjasekaran SA, Chauhan R. Mandibular tori, a case report. Dent Impact 2012;4:25-9.  Back to cited text no. 9
    
10.
Godinho M, Barbosa F, Andrade F, Cuzzi T, Ramos-E-Silva M. Torus palatinus osteonecrosis related to bisphosphonate: A case report. Case Rep Dermatol 2013;5:120-5.  Back to cited text no. 10
    
11.
Goldman ML, Denduluri N, Berman AW, Sausville R, Guadagnini JP, Kleiner DE, et al. A novel case of bisphosphonate-related osteonecrosis of the torus palatinus in a patient with metastatic breast cancer. Oncology 2006;71:306-8.  Back to cited text no. 11
    
12.
Dosumu OO, Arotiba JT, Ogunyinka AO. The prevalence of palatine and mandibular tori in a Nigerian population. Odontostomatol Trop 1998;21:6-8.  Back to cited text no. 12
    
13.
Jainkittivong A, Langlais RP. Buccal and palatal exostoses: Prevalence and concurrence with tori. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;90:48-53.  Back to cited text no. 13
    
14.
Apinhasmit W, Jainkittivong A, Swasdisonc S. Torus palatinus and torus mandibularis in a Thai population. ScienceAsia 2002;28:105-11.  Back to cited text no. 14
    
15.
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. 15
    
16.
Agbaje JO, Arowojolu MO, Kolude B, Lawoyin JO. Torus palatinus and torus mandibularis in a Nigerian population. Afri J Oral Health 2005;2:30-6.  Back to cited text no. 16
    
17.
Adeyemo WL, Emeka CI, Taiwo OA, Adeyemi MO. Prevalence and pattern of presentation of mandibular and palatine tori in a Nigerian population. Niger Dent J 2009;17:16-8.  Back to cited text no. 17
    
18.
Castro Reino O, Perez Galera J, Perez Cosio Martin J, Urbon Caballero J. Surgery of palatal and mandibular torus. Rev Actual Odontoestomatol Esp 1990;50:47-50, 53-6.  Back to cited text no. 18
    


    Figures

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    Tables

  [Table 1], [Table 2], [Table 3]



 

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