Relationship Between Torus Mandibu-laris, Torus Palatinus, Parafunctional Habits, and Anxiety in a Sample from Eastern Libyan Population

Abstract

Background: Torus is a benign, rounded, smooth-surfaced, non-neoplastic growth composed of nodular dense bone appears on the midline of the palate or the lin-gual aspects of the mandible. Its etiology is probably due to interplay of multifactorial ge-netic and environmental factors or may be associated with teeth grinding and parafunc-tional occlusal habits, or temporomandibular joint disorders (TMD) . Aims: The current study aims to describe the demographic and clinical features of oral tori, by measuring their dimensions, size, and shape beside the frequency of signs and symptoms of parafunctional oral activity (such as clenching, teeth grinding and/or brux-ism). It aims also to measure the level of blood calcium, vitamin D, and parathy roid hor-mone and the level of anxiety and depression in these patients. Subjects and Methods: This study included patients with clinical evidence of oral torus seen from October 2019 through December 2020 from routine consecutive patients in Northern East region of Libya to describe the clinical presentation of tori. Furthermore, a maxillary and mandibular dental impressions were taken by a rubber base butty and light body then dental casts were immediately fabricated in dental laboratory using gy psum ma-terial (Elite Model, Zhermack). The biochemical findings of Calcium+ level, Vitamin D, and PTH levels were investigated. The level of anxiety and stress in the study group is assessed by HAD scale. . Results: This study comprised 50 Libyan patients (39 females and 11 males) aged 16- 63 y ears. The facial muscle clenching and fatigue was reported by 32 (64%) and morning jaw/neck fatigue was reported by 23 (46%), teeth grinding in 20 (40% ), TMJ morning stiffness in 18 ( 36% ) patients, nocturnal habit of bruxism in 11 ( 22%) , diurnal bruxism in 9 ( 18% ), grinding sounds during sleep in 7 ( 14%). Only 18 ( 36% ) were aware of presence of tori in their mouths. No reported difficulties in speech or deglutition or interferences with sleep. The signs of a presumed parafunctional activity included attri-tion in 34 (68%) of the patients, presence of shiny facets in 32 (64%) of patients, fractured teeth or restorations in 23 (46%) patients, mobility of teeth in 20 (40%) of patients and wear on the occlusal surface appliance in only 11 (22%) patients who had such appliances . Forty -four (88%) of the patients have Angle class I occlusion, and all of them except three had U shaped dental arch. Teeth spacing was detected in 17 (34%) patients, teeth crowd-ing in 19 (38%), hy podontia of the upper lateral incisors in 2 (4%) patients and no super-numerary teeth were detected. Twenty six patients (52%) had TM, 10 (20%) had TP while a concurrence of TP and TM was noticed in 14 (28%) patients. The size of all TP exceeded 10 mm in its long-est dimension diameter regardless of its shape. 14 (58%) patients had spindle shaped TP, 7 (29.17%) heart shaped and 1 (4.17%) lobulated, and two of other shapes. Thirty five (87.5%) cases of TM were bilateral, 18 (45%) rounded, 10 (25%) lobulated, eight (25%), oval and 4 (10%) other shapes. Calcium, vitamin D and PTH levels all the levels were within normal values. The Hospital Anxiety and Depression Scale (HAD) scores didn‟t reveal any statistically significant as-sociation with any of the signs and symptoms of parafunctional activity , however, an as-sociation exists between the anxiety score and facial muscle clenching and tigue (p=0.002) Conclusion: Further controlled studies involving larger number of subjects and ing wider areas of the country should be undertaken to shed light on different aspects of this overgrowths. The likely benefits of oral tori as a potential source of bone auto graft for Ridge augmentation should be explored as well as their potential use as an indicator for higher bone quality of the subject should also be elaborated. As oral tori are benign outgrowths, the future studies should concentrate on their potential use in implantology and other medical uses as their clinical and epidemiological characteristics had long been investigated in the past.