Oral Tori in Chronic Peritoneal Dialysis Patients

Abstract

BackgroundThe pathogenesis of oral tori has long been debated and is thought to be the product of both genetic and environmental factors, including occlusal forces. Another proposed mechanism for oral tori is the combination of biomechanical forces, particularly in the oral cavity, combined with cortical bone loss and trabecular expansion, as one might see in the early stages of primary hyperparathyroidism. This study investigated the epidemiology of torus palatinus (TP) and torus mandibularis (TM) in peritoneal dialysis patients, and analyzed the influences of hyperparathyroidism on the formation of oral tori.MethodIn total, 134 peritoneal dialysis patients were recruited between July 1 and December 31, 2015 for dental examinations for this study. Patients were categorized into two subgroups based on the presence or absence of oral tori. Demographic, hematological, biochemical, and dialysis-related data were obtained for analysis.ResultsThe prevalence of oral tori in our sample group was high at 42.5% (57 of 134), and most patients with oral tori were female (61.4%). The most common location of tori was TP (80.7%), followed by TP and TM (14.0%), then TM (5.3%). All 54 TP cases were at the midline, and most were <2 cm (59.3%), flat (53.7%), and located in the premolar region (40.7%). Of the 11 TM cases, all were bilateral and symmetric, mostly <2 cm (81.9%), lobular (45.4%), and located at premolar region (63.6%). Interestingly, patients with oral tori had slightly lower serum levels of intact parathyroid hormones than those without oral tori, but the difference was not statistically significant (317.3±292.0 versus 430.1±492.6 pg/mL, P = 0.126). In addition, patients with oral tori did not differ from patients without tori in inflammatory variables such as serum high sensitivity C-reactive protein levels (6.6±8.2 versus 10.3±20.2 mg/L, P = 0.147) or nutritional variables such as serum albumin levels (3.79±0.38 versus 3.77±0.45 g/dL, P = 0.790). Furthermore, there were no differences between patients with and without oral tori in dialysis adequacy (weekly Kt/Vurea, 2.14±0.39 versus 2.11±0.33, P = 0.533; weekly creatinine clearance rate, 59.31±17.58 versus 58.57±13.20 L/1.73 m2, P = 0.781), or peritoneal membrane transporter characteristics (P = 0.098).ConclusionSecondary hyperparathyroidism does not contribute to the formation of tori in peritoneal dialysis patients. Further studies are warranted.

Prevalence of oral tori and exostosis in Malaysian population – A cross-sectional study

“…5 Studies have been conducted to evaluate the influence of hyperparathyroidism on the formation of oral tori. 6,7 Hsu et al…”

“…6 Hematological, biochemical, and dialysis-related data were also obtained. The prevalence of oral tori was 42.5% and most patients with oral tori were females (61.4%).…”

“…The prevalence of oral tori was 42.5% and most patients with oral tori were females (61.4%). 6 However, no correlation was noticed between secondary hyperparathyroidism and formation of tori in peritoneal dialysis patients. Similar results were found in a study by Chao et al 7 Our study showed overall tori prevalence of 33% and were seen more in females (53%).…”

<p>Torus Palatinus in Taiwan Patients Receiving Peritoneal Dialysis and Hemodialysis: A Prospective Observational Study</p>

“…14,27 Different prevalence rates of TP have been reported for different population groups. 14,15 Chiang et al 17 19 a TP prevalence rate of 34.3% among peritoneal dialysis patients. In the current study, the prevalence of TP was 31.1% -28.3% for hemodialysis and 40.3% for peritoneal dialysis.…”

“…6,[14][15][16] According to Chiang et al, 17 the prevalence of TP in the general population of Taiwan was 21.1%. Also in Taiwan, the prevalence of TP in hemodialysis patients was 23.5% as found by Chao et al 5 and 28.9% reported by Tai et al, 18 respectively, and 34.3% in peritoneal dialysis patients according to Hsu et al 19 These studies 5,18,19 also concluded that neither hyperparathyroidism nor inflammation-malnutrition syndrome contributes to the risk of developing tori in dialysis patients. Meanwhile, Sisman et al 13 found evidence for the association between the peritoneal dialysis duration and the TP size.…”