Microsoft Word - 55 2016.docx   Vol  4,  No  1  (2016)   ISSN  2167-­‐8677  (online)   DOI  10.5195/d3000.2016.55           http://dentistry3000.pitt.edu     New  articles  in  this  journal  are  licensed  under  a  Creative  Commons  Attribution  4.0  United  States  License.     This  journal  is  published  by  the  University  Library  System,  University  of  Pittsburgh  as  part  of  its  D-­‐Scribe  Digital  Publishing  Program  and  is  cosponored   by  the  University  of  Pittsburgh  Press.     Prevalence  of  oral  tori  among  medical  and  dental  Students  at  the   University  of  the  West  Indies   Arvind  Babu  Rajendra  Santosh1,  Thaon  Jones1,  Hima  Venugopal1,  Keisha  Smith1,  J  Suzanne  Turpin  Mair1,  Mark  Edwards1,  Errol  Williams1     1Den$stry  Programme,  Faculty  of  Medical  Sciences,  The  University  of  the  West  Indies,  Mona,  Kingston,  Jamaica,  West  Indies.   Abstract   Objec&ve:    To  determine   the  prevalence  and  gender   varia2on  of   torus  pala2nus   (TP)   and   torus  mandibularis  (TM)  amongst  medical  and  dental  students  at  the  Mona  campus  of  the   University  of  the  West  Indies.  Subjects  and  Methods:  The  study  observed  335  medical  and   dental  students  from  the  Mona  campus  of  the  University  of  the  West  Indies.  Rou:ne  dental   examina'ons  were  conducted  to  check  the  presence/absence  of  TP  and  TM  by   inspec6on   and  palpa'on.  Results:  The   overall   prevalence   of   TP   and   TM  was   27.76%.   The   oral   torus   prevalence  was  as  follows,  torus  pala1nus  was  44.08%,  torus  mandibularis  was  36.55%  and   individuals   with   both   torus   pala*nus   and  mandibularis   was   19.35%.   The   study   observed   that   the   prevalence   of   TP   and   TM   in   females   was   16.11%   (54/335),   and   males   11.64%   (39/335).   It  was  also  found  that  bilateral  torus  mandibularis  (40.38%)  was  more  prevalent   than   unilateral   right   torus   mandibularis   (36.53%)   and   unilateral   le7   torus   mandibularis   (23.07%)  Conclusions:  The  prevalence  of  TP  and  TM  are  compara2vely  higher   than  neigh-­‐ boring   Caribbean   na+ons   and  West   African   countries.   Our   observa+ons   also   highlighted   that  TP  is  highly  prevalent  among  various  types  of  oral  tori.  The  study  also  recorded  higher   prevalence   of   oral   tori   among   females.   Due   to   higher   prevalence   of   oral   tori   among   the   study  group,  Jamaican  den3sts  need  be  knowledgeable  about  the  high  prevalence  and  clini-­‐ cal  significance  of  TP  and  TM  for  dental  treatment.       Cita%on:   Santosh,   et   al.   (2016).   Prevalence   of   oral   tori   among  medical  and  dental   Students  at   the   University   of   the   West   Indies.   Den$stry   3000.  1:a001  doi:10.5195/d3000.2016.55   Received:  July  12,  2016   Accepted:    July  23  ,  2016   Published:    October  3,  2016   Copyright:  ©2016  Santosh,  et  al.  This  is  an  open   access   ar!cle   licensed   under   a   Crea!ve   Com-­‐ mons   A"ribu"on   Work   4.0   United   States   Li-­‐ cense.   Email:  arvindbabu2001@gmail.com     Introduction   Torus  palatinus  [TP]  and   torus  mandibularis  [TM]  are  nor-­‐ mal  anatomical  variants,  which  are   categorized  under  developmental   alterations  of  the  jaw  bone.  TP   and  TM  are  slow  growing  osseous   outgrowths  (exophytic)  in  the  mid-­‐ line  of  the  hard  palate  (torus   palatinus)  and  in  the  lingual  corti-­‐ cal  bones  of  mandible  (torus  man-­‐ dibularis).  It  is  a  non-­‐pathological   condition  and  in  most  cases  they   remain  asymptomatic  [1].  TP  and   TM  are  clinically  identified  as  a   hard  palpable  bony  mass  localized   in  the  mid-­‐palatal  region  specifi-­‐ cally  posterior  hard  palate  and/or   lingual  cortical  bone  of  mandibular   jaw  [2].  TM  can  be  either  unilat-­‐ eral  or  bilateral,  where  as  TP  are   solitary  and  usually  occurs  over   the  posterior  hard  palate  in  the   mid-­‐palatal  suture  region  [3].   Morphologically  TP  and  TM  pre-­‐ sent  either  a  smooth  bony  projec-­‐ tion  or  multi-­‐nodular/lobular  bony   projections.    The  shapes  of  TP  and   TM  are  categorized  as  flat,  spindle,   nodular,  or  lobular.  TP  and  TM  are   considered  to  be  a  variant  of  exos-­‐ toses.  Exostoses  are  benign  bony   projections  arising  from  the  cortex   of  the  maxillary  or  mandibular  al-­‐ veolar  region  [4].  TP  and  TM   shows  female  predilection,  and   the  size  may  vary  between  less   than  1cm  to  greater  than  4  cms  in   the  greatest  diameter  [5].     Prevalence  of  oral  tori  among  medical  and  dental  Students  at  the  University  of  the  West  Indies   Vol  4,  No  1  (2016)        DOI  10.5195/d3000.2016.55    http://dentistry3000.pitt.edu   2   Etiology  of  TP  and  TM  are   not  clear,  but  the  majority  of  in-­‐ vestigators  believed  that  it  was   either  genetic  or  environmental   making  the  etiology  multi-­‐ factorial.  Studies  stated  the  etiol-­‐ ogy  of  TP  and  TM  were  related  to   genetics,  superficial  injuries,  envi-­‐ ronmental  factors,  masticatory   forces,  marine  diets,  drugs,  para-­‐ functional  habits  and  number  of   existing  teeth  or  abraded  teeth   due  to  occlusion  [4].    The  most   widely  accepted  etiological  associ-­‐ ation  of  TP  and  TM  was  of  a  genet-­‐ ic  cause.  Autosomal  dominant  in-­‐ heritance  pattern  was  proposed   for  TP  and  TM,  due  to  the  higher   vertical  transmission  rate  and   penetrance  [6].    Another  theory   hypothesized  that  TP  and  TM  was   a  functional  response  in  individu-­‐ als  with  well  developed  masticato-­‐ ry  muscles.  This  theory  suggested   that  masticatory  forces  transmit-­‐ ted  to  the  mid-­‐palatine  sutural   region  leads  to  increased  bony   growth,[7]    and  probably  proximity   of  ossification  center  in  maxillary   bone  may  contribute  in  initiation   of  osseous  growth.  Marine  dietary   habits  such  as  consumption  of  fish   or  salted  fish  promote  a  higher   prevalence  of  TP  and  TM  due  to   the  nutritional  substances  (poly-­‐ unsaturated  fatty  acid  and  vitamin   D)  that  can  enhance  osseous   growth  [8].  Drugs  such  as  Phenyto-­‐ in  were  linked  with  occurrence  of   TP  and  TM  because  of  the  influ-­‐ ence  of  the  drug  with  calcium  ho-­‐ meostasis  and  initiating  osteogen-­‐ esis  [9].  One  study  mentioned  that   ratio  of  un-­‐erupted  mandibular   canines  were  higher  among  indi-­‐ viduals  with  TM  [10].  Theories   have  mentioned  that  Para-­‐ functional  habits  such  as  thumb   sucking  or  tongue  thrusting  influ-­‐ ences  occurrences  of  TP  due  to   the  increased  pressure  over  the   mid-­‐palatine  suture  which  triggers   osteogenesis  [11].    Etiological  fac-­‐ tors  of  TP  and  TM  are  summa-­‐ rized  in  table  1.     The  importance  and  sig-­‐ nificance  of  TP  and  TM  are  ex-­‐ tensively  discussed  in  dental  lit-­‐ erature.  TP  and  TM  are  consid-­‐ ered  to  be  an  obstruction  while   fabricating  removable  (partial  or   complete)  dentures  for  dental   rehabilitation  procedures  [12].   Presence  of  TP  and/or  TM  pro-­‐ vides  a  significance  in  forensic   investigations  contributing  to   personal  identification  proce-­‐ dures  [13].  TP  and  TM  osseous   tissue  are  useful  as  autogenous   or  osseous  coagulum  during  os-­‐ seous  replacement  in  periodon-­‐ tal  procedures  or  alveolar  ridge   defect  correction  surgeries   [14,15].  TM  can  also  be  used  to   indicate  the  risk  of  appearance  of   temporomandibular  disorders   [16].  A  significant  relationship  be-­‐ tween  the  duration  of  renal  dialy-­‐ sis  and  the  size  of  TP  has  been  re-­‐ ported  [17].    One  published  report   revealed  a  relationship  between   autosomal  dominant  osteosclero-­‐ sis  with  TP  and  TM  [18].  Recently   TP  has  been  associated  in  a  new   anatomical  correlation  with  bone   density  in  postmenopausal  wom-­‐ en  [19].  Clinical  significance  of  To-­‐ rus  palatinus  and  torus  mandibu-­‐ laris  are  summarized  in  table  2.     Epidemiological  studies  of   TP  and  TM  from  Caribbean  and   West  Africian  countries  revealed   higher  prevalence  in  their  geo-­‐ graphic  location.  Therefore  the   purpose  of  the  present  study  is  to   determine  the  prevalence  of  torus   palatinus  and  torus  mandibularis   and  gender  variation  in  their  dis-­‐ tribution  among  medical  and  den-­‐ Table&1.&Etiology&of&torus&palatinus&and&torus&mandibularis& & A. Widely&accepted&etiological&factor&of&TP&and&TM& 1. Genetic)influence& & & B. Moderately&accepted&etiological&factors&of&TP&and&TM& 1. Environmental)factors) 2. Marine)dietary)habits) 3. Masticatory)forces) 4. Para=functional)habits) ) & C. Less&accepted&etiological&factors&of&TP&and&TM& 1. Drugs)(Phenytoin)) 2. Number)of)existing)teeth) 3. Abraded)teeth)due)to)occlusion) 4. Superficial)injuries.)) ) !1! Prevalence  of  oral  tori  among  medical  and  dental  Students  at  the  University  of  the  West  Indies   Vol  4,  No  1  (2016)        DOI  10.5195/d3000.2016.55    http://dentistry3000.pitt.edu   3   tal  students  at  the  Mona  campus   of  the  University  of  the  West  In-­‐ dies,  in  Kingston,  Jamaica.     Materials  and  methods:   The  study  was  approved  by   ethics  committee  of  the  University   of  the  West  Indies,  Mona  campus.   The  study  obtained  written  con-­‐ sent  from  all  participants  involved   in  the  present  study;  also  ethics   committee  of  the  University  of  the   West  Indies  approved  the  consent   form  that  was  used  in  the  present   study.  The  present  study  has  been   conducted  in  full  accordance  with   the  World  Medical  Association   Declaration  of  Helsinki.   Dental  examination  was   conducted  in  the  Dental  Teaching   Laboratory  at  the  Faculty  of  Medi-­‐ cal  Sciences  Teaching  and  Re-­‐ search  Complex  in  the  Mona  cam-­‐ pus  of  the  University  of  the  West   Indies,  Jamaica.  During  this  study  a   routine  dental  and  oral  examina-­‐ tion  were  done  on  335  Medical   and  Dental  students  by  the  dental   surgeons  and  the  findings  were   systematically  recorded.  For  the   diagnosis  of  TP  and  TM,  TP  was   defined  as  a  bony  outgrowth  situ-­‐ ated  on  mid  palatal  region  and  TM   was  defined  as  a  bony  outgrowth   situated  on  lingual  cortical  bone  at   premolar-­‐molar  region  of  mandib-­‐ ular  jaw  bone.  The  size  and  shape   of  the  TP  and  TM  were  not  con-­‐ sidered  and  any  questionable   bony  outgrowths  on  mid-­‐ palate/lingual  cortical  bone  of   mandibular  jaw  were  excluded.   Study  participants  were  aged  be-­‐ tween  19-­‐30  years  and  the  study   was  conducted  during  the  period   of  April-­‐May,  2015.  All  the  data   were  transferred  to  Microsoft  Ex-­‐ cel  data  sheet  and  subjected  for   descriptive  analysis.       Results   A  total  of   335  participants   were  identified  in   the  present  study,   230  (68.65%)  were   female  and  105   (31.34%)  were   male.  The  preva-­‐ lence  of  all  tori  was   27.76%  (93  out  of   335  participants).   Higher  prevalence   of  tori  was  ob-­‐ served  among  fe-­‐ males  16.11%  (54   out  of  335  partici-­‐ pants),  than  the   males  11.64%  (39   out  of  335  partici-­‐ pants)  (Table  1)   Descriptive  analysis  of  the   study  population  according  to  to-­‐ rus  type  showed  that  TP  was  ob-­‐ served  in  12.23%  (41  out  of  335   participants),  TM  10.14%  (34  out   of  335  participants),  participants   with  both  TP  and  TM  was  5.37%   (18  out  of  335  participants).  The   distribution  of  the  study  popula-­‐ tion  according  to  gender  showed   that  TP  in  males  was  18.09%  (19   out  of  105  male  participants),  and   TP  in  females  was  9.56%  (22  out  of   230  female  participants);  TM  in   males  was  13.33%  (14  out  of  105   male  participants),  and  TM  in  fe-­‐ males  was  8.69%  (20  out  of  230   female  participants);  males  with   both  TP  and  TM  was  5.71%  (6  out   of  105),  and  females  with  both  TP   and  TM  was  5.21%(12  out  of  230   female  participants).  (Table  3)   !1! Table&2.&Clinical&significance&of&Torus&palatinus&and&torus&mandibularis& 1. #Interrupts#in#the#fabrication#of#removable(#partial/complete)#denture.## 2. #Contributes#in#personal#identification#procedures#in#forensic#investigation.## 3. #Osseous#tissue#from#TP#and#TM#can#be#used#as#autogenous#or#osseous# coagulum#during#osseous#replacement#in#periodontal#or#minor#oral#surgical# procedures# 4. #Indicates#the#risk#of#appearance#of#temporomandibular#disorders# 5. #Provides#significant#relationship#between#duration#of#renal#dialysis#and#size#of# TP.# 6. #New#anatomical#correlation#with#bone#density#in#postmenopausal#women.## 7. #Overlying#oral#mucosa#is#thinner#and#linked#with#traumatic#oral#ulcerations.## 8. #Phonetic#disturbance#specifically#palatal#sounds#while#pronouncing#the#words# by#the#articulation#of#the#body#of#the#tongue#towards#the#hard#palate## 9. #Extremely#large#TP/TM#may#cause#limitation#in#mastication#process.## 10. #Compromised#esthetic#appearance.## 11. #Related#sleep#obstructive#apnea# Prevalence  of  oral  tori  among  medical  and  dental  Students  at  the  University  of  the  West  Indies   Vol  4,  No  1  (2016)        DOI  10.5195/d3000.2016.55    http://dentistry3000.pitt.edu   4   The  prevalence  of  torus   type  and  gender  variation  analysis   showed  that  TP  was  observed  in   44.08%  (41  out  of  93  participants),   TM  36.55  %  (34  out  of  93  partici-­‐ pants),  participants  with  both  TP   and  TM  was  19.35%  (18  out  of  93   partici-­‐ pants).  The   distribution   of  the  study   population   according  to   gender   showed  that   TP  in  males   was  48.71%   (19  out  of  39   male  partic-­‐ ipants),  and   TP  in  fe-­‐ males  was   40.74%  (22  out  of  54  female  par-­‐ ticipants);  TM  in  males  was   35.89%  (14  out  of  39  male  partici-­‐ pants),  and  TM  in  females  was   37.03%  (20  out  of  54  female  par-­‐ ticipants);  males  with  both  TP  and   TM  was  15.38%  (6  out  of  39),  and   females  with   both  TP  and   TM  was   22.22%(12  out   of  54  female   participants).   (Table  3)   Analysis   of  the  TM  oc-­‐ currence  type   and  gender   distribution   showed  that   unilateral  right   TM  was  ob-­‐ served  in   36.53%  (19  out   of  52  partici-­‐ pants);  unilat-­‐ eral  left  TM   was  observed   in  23.07%  (12   out  of  52  par-­‐ ticipants);  bi-­‐ lateral  TM  was   observed  in  40.38%  (21  out  of  52).   TM  distribution  according  to  gen-­‐ der  showed  that  unilateral  right   TM  in  males  was  30%  (6  out  of  20   male  participants),  and  unilateral   right  TM  in  females  was  40.62%   (13  out  of  32  female  participants);   Table&3.&Distribution&of&study&population&according&to&torus&type&and&gender&variation.& & Torus&type& Study&population& Male&population&in&the& study& Female&population&in&the& study&& Total& population& in&the& study&& (n&=335)& Total& population& with&oral& tori& (n&=93)& 27.76%& Male& (Total& population& n=105)& Male& population& with&oral& tori&(n=39)& 41.93%& Female& population& in&the&study& (n=230)& Female& population& with&oral& tori&& (n=54)& 58.06%& Individuals& with&torus& palatinus&only& 41# (12.23%)# 41# (44.08%)# 19# (18.09%)# 19#(48.71%)# 22#(9.56%)# 22# (40.74%)# Individuals& with&torus& mandibularis& only&& 34# (10.14%)# 34# (36.55%)# 14# (13.33%)# 14#(35.89%)# 20#(8.69%)# 20# (37.03%)# Individuals& with&both& Torus& Palatinus&and& Torus& Mandibularis& 18#(5.37%)# 18# (19.35%)# 6#(5.71%)# 6#(15.38%)# 12#(5.21%)# 12# (22.22%)# Total& 93#(27.76%)# 39#(11.64%)# 54#(16.11%)# !1! Table&4.&Distribution&of&torus&mandibularis&in&study&population&according&to&occurrence&type&and& gender.& Torus&mandibularis& distribution& Individuals&with&torus& mandibularis&(n=34)& and&individuals&with& both&torus&palatinus& and&mandibularis& (n=18)& (n=34+18=52)& Males& (n=20)& Females& (n=32)& Unilateral&right&torus& mandibularis& 19#(36.53%)# 6#(30%)# 13#(40.62%)# Unilateral&left&torus& mandibularis& 12#(23.07%)# 5#(25%)# 7#(21.87%)# Bilateral&torus& mandibularis& 21#(40.38%)# 9#(45%)# 12#(37.5%)# !1! Prevalence  of  oral  tori  among  medical  and  dental  Students  at  the  University  of  the  West  Indies   Vol  4,  No  1  (2016)        DOI  10.5195/d3000.2016.55    http://dentistry3000.pitt.edu   5   unilateral  left  TM  in  males  was   25%  (5  out  of  20  male  partici-­‐ pants),  and  unilateral  left  TM  in   females  was  21.87%  (7  out  of  32   female  participants);  and  bilateral   TM  in  males  was  40.38%  (21  out  of   52  male  participants),  and  bilateral   TM  in  females  was  37.5%  (12  out   of  32  female  participants)  (Table   4)     Discussion   Our  observations  recorded   that  overall  prevalence  of  TP  and   TM  was  27.76%  (93  out  of  335   study  participants)  and  the  most   common  type  of  oral   tori  is  TP  44.08%,  and   females  (58.06%)  were   more  commonly  ob-­‐ served  with  oral  tori   than  males  (41.93%.)    A   higher  prevalence  of   oral  tori  was  recorded   in  the  present  study   while  comparing  previ-­‐ ous  reports  on  Jamai-­‐ can  blacks,  Trinidad   and  Tobago  or  West   African  population   studies.(Table  5)     Ogunsalu  reported  a   prevalence  of  oral  tori   as  6.6  percent  among   Jamaican  blacks  [20].   The  prevalence  of  oral   tori  is  12.3%  among   Trinidad  and  Tobago   population  [7].  The   overall  prevalence  rate   of  West  African  popula-­‐ tion  from  the  Ghanaian   community  was  14.6%   [21].    The  variation  in   the  prevalence  could   be  related  to  the  di-­‐ verse  ethnic  group  in   the  present  study.  The  prevalence   rate  of  the  present  study  results   may  not  be  generalized  to  the  Ja-­‐ maican  population  as  our  findings   demonstrate  University  students   come  from  areas  other  than  Ja-­‐ maica,  which  include  most  of  Car-­‐ ibbean  countries,  Latin  or  central   American  countries  and  the  North   American  mainland.    Further,  the   present  study  did  not  attempt  to   distinguish  between  ethnic  varia-­‐ tions  as  the  previous  study  from   Trinidad  and  Tobago  did  which,   mentioned  that  oral  tori  did  not   show  any  ethnic  difference.    How-­‐ ever,  higher  prevalence  of  oral  tori   could  be  possibly  due  to  the  rich   salt  fish  in  the  diet  of  Jamaican   and  other  Caribbean  countries  and   well  developed  masticatory  mus-­‐ cles  among  the  Jamaican  popula-­‐ tion.  Trinidad  and  Tobago  study   also  mentioned  that  higher  preva-­‐ lence  of  oral  tori  could  be  possibly   due  to  the  marine  diet  [7].     In  this  study  oral  tori  was   more  prevalent  in  females   (58.06%),  and  sub  group  analysis   of  torus  type  also  showed  higher   female  prevalence  of  all  torus   Table&5.&Comparative&table&showing&the&prevalence&rate&of&oral&tori&in&various&geographic&areas.& Study& Population& Sample& Prevalence& Gender& Predilection& Reference& Woo#JK.#1950# Eskimos# 0# 66%# 0# [23]# Kolas#et#al.#1953# United#states# 2478# 20.9%# 0# [24]# Vidic#B.#1966# Yugoslavian# 0# 49.7%# 0# [25]# Bernaba#JM.#1977# Brazilian#Indian# 200# 10%# 0# [26]# Chew#CL#et#al.#1984# Singapore# 0# 48%# Equal#distribution# [27]# Axelsson#G#et#al.#1985# Icelandic,#south#–# thingeyjarsysla# 763# 33.3%# 0# [28]# Axelsson#G#et#al.#1985# Icelandic,#North#–# thingeyjarsysla# 213# 14.6%# 0# [29]# Bouquot#et#al.#1986# White#Americans# 23616# 2.7%# 0# [30]# Salem#G#et#al.#1987# Saudi#Arabia# 1932# 1.4%# 0# [31]# Reichart##et#al.#1988# German# 1317# 13.5%# 0# [32]# Reichart#et#al.#1988# Thailand# 947# 32.3%# Male#predilection# [32]# Eggen#et#al.#1989# Norway# 326# 31.3%# 0# [33]# Haugen#LK#et#al.#1992# Norway,#Oslo#area# 5000# 9.2%# Female#predilection# [34]# Shah#DS#et#al.#1992# India# 1000# 10.9%# Female#predilection# [35]# Eggen#et#al.#1994# Norway,#Lofoten# 1181# 38.2%# Female#predilection# [36]# Ogunsalu#CU.#1994# Jamaica# 958# 6.6%# 0# [21]# Eggen#et#al.#1994# Norway,#Gudbrandsdalen# 829# 32.7%# Female#predilection# [36]# Nair#et#al.#1996# Vietnam# 550# 1.44%# Female#predilection# [37]# Gorsky#M#et#al.#1996# Israel# 1002# 21.0%# Female#predilection# [38]# Gorsky#M#et#al.#1998# Israel# 168# 38.7%# Female#predilection# [39]# Kerdpon#et#al.#1999# Southern#Thailand# 609# 61.7%# Female#predilection# [22]# Sonnier#et#al.1999# United#States#(African# American)# 328# 47.20%# Female#predilection# [40]# Sirirungrojying#et#al.1999# Thailand# 412# 27.8%# 0# [22]# Gozil#R#et#al.#1999# Turkish# 86# 45.4%# 0# [41]# Jainkittivong#et#al.#2000# Thailand# 960# 26.9%# 0# [42]# Al0Bayaty#et#al#in#2001# Trinidad#and#Tobago# 667# 12.3%# 0# [7]# Aphinhasmit#W#et#al.# 2002# Thailand# 1200# 58.1%# Female#predilection# [43]# Virgina#G#et#al.#2003# Spanish# 278# 20.3%# Female#predilection# [44]# Bruce#I#et#al.#2004# Ghana# 926# 14.6%# Female#predilection# [20]# Cagirankaya#LB#et#al.# 2004# Turkish# 253# 20.9%# Female#predilection# [45]# Yildiz#E#et#al.#2005# Turkish# 1943# 30.9%# Female#predilection# [46]# Al#Quran#FA#et#al.#2006# Jordan# 338# 29.8%# Female#predilection# [47]# Jainkittivong#A#et#al.#2007# Thailand# 1520# 60.5%# Female#predilection# [48]# Sisman#et#al.#2007# Turkish# 2660# 4.1%# Female#predilection# [49]# Hiremath#VK#et#al.#2011# Malay# 65# 55.4%# Female#predilection# [50]# Santosh#Patil#et#al.#2014# India# 3087# 6.9%# Male#predilection# [51]# Present#study# Jamaica# 335# 27.76%# Female#predilection# Present# study#!1! Prevalence  of  oral  tori  among  medical  and  dental  Students  at  the  University  of  the  West  Indies   Vol  4,  No  1  (2016)        DOI  10.5195/d3000.2016.55    http://dentistry3000.pitt.edu   6   types  TP  (40.74%),  TM  (37.03%),   both  TP  and  TM  (22.22%)).  Inter-­‐ estingly  similar  female  predilec-­‐ tion  was  also  observed  in  the  stud-­‐ ies  from  Jamaica,  Trinidad  and  To-­‐ bago,  Ghana  and  Thailand   [7,20,21,22].    Certain  prevalence   with  respect  to  age  has  also  been   observed.  Tori  tend  to  appear   more  frequent  during  middle  age   of  life  [4].  In  the  present  study,  we   could  not  conclude  on  age  fre-­‐ quency  of  tori,  due  to  population   involved  in  the  present  study  were   medical  and  dental  students  who   fall  in  the  age  range  of  19-­‐30   years.  The  onset  of  TP  appears  to   be  earlier  than  TM  and  the  cases   have  been  described  from  birth   and  the  first  decade  of  life.  In  con-­‐ trast,  appearance  of  TM  is  rare   before  the  first  decade  of  life   [4,42].  It  is  worth  noting  that  pre-­‐ sent  study  is  documenting  preva-­‐ lence  of  TM  as  37.03%  with  the   age  range  of  19-­‐30  years.  Most   published  reports  suggested  that   TP  appears  to  have  female  predi-­‐ lection  and  it  is  believed  that  there   may  be  dominant  type  linked  to   the  X  chromosome.  Although  most   studies  reported  female  predilec-­‐ tion  of  TP,  the  difference  was  not   statistically  significant.  On  other   hand  TM  was  also  reported  to   have  higher  predilection  in  males,   the  difference  had  no  statistical   significance.   Consistently,  epidemiologi-­‐ cal  studies  are  reported  from  1950   to  current  date  regarding  oral  tori   from  various  geographical  areas.   Comparing  prevalence  rates   among  our  literature  search  from   the  countries  Alaska,  Southern   Thailand,  Malaysia,  Yugoslavia,   Singapore,  United  States,  Turkey,   Israel,  Norway,  Jordan,  Jamaica,   Spain,  Iceland,  Ghana,  German,   Trinidad  and  Tobago,  India,  Vi-­‐ etnam  and  Saudi  Arabia  revealed  a   higher  prevalence  rate  of  oral  tori   in  Eskimos  and  the  least  in  Saudi   Arabians.                    (Table  5)  A  true   conclusion  about  a  country  having   a  high  or  low  prevalence  rate  of   oral  tori,  could  not  be  made  from   the  comparison  table  because  the   sample  size  between  each  study   shows  great  variation.  Interesting-­‐ ly,  most  countries  reported  a   higher  prevalence  of  oral  tori   among  females.  Hence,  it  can  be   concluded  that  oral  tori  is  a  com-­‐ mon  normal  anatomical  variant   that  can  be  seen  in  most  of  geo-­‐ graphical  areas  and  female  predi-­‐ lection  is  strongly  supported.  Fur-­‐ ther,  from  Caribbean  and  West   African  studies,  the  present  study   from  Jamaica  seems  to  have  high   prevalence  of  oral  tori.       Clinical  diagnosis  of  tori  is   usually  straight  forward  and  inves-­‐ tigations  are  generally  not  re-­‐ quired.  Dental  clinicians  should   note  that  tori  can  have  slow  and   continuous  growth  in  later  age.   However,  although  growth  is  slow   and  continuous,  it  may  stop  spon-­‐ taneously.  It  is  also  worth  to  note   that  differential  diagnosis  of  bony   and  unilateral  growing  lesion  in-­‐ cludes  tori,  peripheral  ossifying   firboma,  osteoma,  osteochon-­‐ droma,  osteoid  osteoma,  osteo-­‐ blastoma  and  osteosarcoma.  The   presence  of  pain  or  paresthesia  in   bony  unilateral  growing  should   prompt  further  investigation  [52].       Conclusion   The  prevalence  of  TP  and   TM  are  higher  in  our  observation.   Our  results  showed  a  female  pre-­‐ dilection  among  gender  and  simi-­‐ lar  interpretation  was  observed   from  previous  studies  from  vari-­‐ ous  geographic  locations.  The  pre-­‐ sent  study  supports  that  etiology   of  TP  and  TM  being  multifactorial,   specifically  genetic,  marine  diet,   and  well-­‐developed  masticatory   muscles.    Due  to  the  higher  preva-­‐ lence  of  TP  and  TM  in  the  present   study,  Jamaican  dentists  need  to   be  knowledgeable  about  the  high   prevalence  and  clinical  significance   of  TP  and  TM  on  dental  treatment.     References   1. 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