Medication-related osteonecrosis in torus palatinus: Report of a case and literature review

BACKGROUND

Medication-related osteonecrosis of the jaw bones have been frequently reported. However, its occurrence in torus palatinus is very rare with only 10 cases published in the English-language literature.

CASE REPORT

We describe an additional case in a 79-year-old woman, who was referred for evaluation of a painful swelling with areas of suppuration on the hard palate.

CONCLUSION

Conservative treatment was performed and after spontaneous sequestrectomy, total healing was achieved.

LRP4 mutations, dental anomalies, and oral exostoses

BACKGROUND

In order to generate a normal set of teeth, fine-tuning of Wnt/β-catenin signaling is required, in which WNT ligands bind to their inhibitors or WNT inhibitors bind to their co-receptors. Lrp4 regulates the number of teeth and their morphology by modulating Wnt/β-catenin signaling as a Wnt/β-catenin activator or inhibitor, depending on its interactions with the partner proteins, such as Sostdc1 and Dkk1.

AIM

To investigate genetic etiologies of dental anomalies involving LRP4 in a Thai cohort of 250 children and adults with dental anomalies.

DESIGN

Oral and radiographic examinations and whole exome sequencing were performed for every patient.

RESULTS

Two novel (p.Leu1356Arg and p.Ala1702Gly) and three recurrent (p.Arg263His, p.Gly1314Ser, and p.Asn1385Ser) rare variants in low-density lipoprotein receptor-related protein 4 (LRP4: MIM 604270) were identified in 11 patients. Oral exostoses were observed in five patients.

CONCLUSION

Antagonism of Bmp signaling by Sostdc1 requires the presence of Lrp4. Mice lacking Lrp4 have been demonstrated to have alteration of Wnt-Bmp-Shh signaling and an abnormal number of incisors. Therefore, the LRP4 mutations found in our patients may disrupt Wnt-Bmp-Shh signaling, thereby resulting in dental anomalies and oral exostoses. Root maldevelopment in the patients suggests an important role of LRP4 in root morphogenesis.

Rare Variants in LRP4 Are Associated with Mesiodens, Root Maldevelopment, and Oral Exostoses in Humans

BACKGROUND

Low density lipoprotein receptor-related protein 4 (LRP4; MIM 604270) modulates WNT/β-catenin signaling, through its binding of WNT ligands, and to co-receptors LRP5/6, and WNT inhibitors DKK1, SOSTDC1, and SOST. LRP4 binds to SOSTDC1 and WNT proteins establishing a negative feedback loop between Wnt/β-catenin, Bmp, and Shh signaling during the bud and cap stages of tooth development. Consistent with a critical role for this complex in developing teeth, mice lacking Lrp4 or Sostdc1 have multiple dental anomalies including supernumerary incisors and molars. However, there is limited evidence supporting variants in LRP4 in human dental pathologies.

METHODS

We clinically, radiographically, and molecularly investigated 94 Thai patients with mesiodens. Lrp4 mutant mice were generated in order to study the effects of aberrant Lrp4 expression in mice.

RESULTS

Whole exome and Sanger sequencing identified three extremely rare variants (c.4154A>G, p.Asn1385Ser; c.3940G>A, p.Gly1314Ser; and c.448G>A, p.Asp150Asn) in LRP4 in seven patients with mesiodens. Two patients had oral exostoses and two patients had root maldevelopments. Supernumerary incisors were observed in Lrp4 mutant mice.

CONCLUSIONS

Our study implicates heterozygous genetic variants in LRP4 as contributing factors in the presentation of mesiodens, root maldevelopments, and oral exostoses, possibly as a result of altered WNT/β-catenin-BMP-SHH signaling.

Sucrose Is Not the Whole Story: Risk Factors and Oral Health at the Contact (Yakutia, Siberia-16th/19th)

Simple Summary

We have studied the dental epidemiology of 96 frozen bodies from north-eastern Siberia (Yakuts) before and after the contact—with an accurate chronology–between Autochthonous and European populations. The peculiarities of the Yakut population are the rarity of cavities and the relative frequency of dental pathologies leading to death. Dental health evolves only two centuries after the contact; assimilation into the Russian Orthodox culture has decreased tooth wear and increased tooth loss. A comparison with historical data suggests that this evolution is not linked to the increasing importance of sucrose, but to the combined action of the substitution of dendrophagia with cereal flour; a decrease in immunity associated with the development of chronic infectious diseases; smoking as well as the mandibular torus: a risk factor favoring apical cysts.

Abstract

(1) Background: contact between indigenous and European populations has often resulted in changes in oral health attributed to the introduction of sucrose. Most studies are per tooth over considerable periods and with few ethnological references. (2) Aim: dental epidemiology of 96 autochthonous frozen bodies from Yakutia between the early 17th century and the late 19th century; comparisons with historical texts and ethnographic data. (3) Material and methods: we use descriptive statistics and discriminant factorial analyses to identify dominant variables in the dataset and compare periods and subjects, considering all variables. (4) Results: the peculiarities of the population are the rarity of cavities and the relative frequency of dental pathologies leading to death. Assimilation into the Russian Orthodox culture has led to decreased tooth wear and an increase in tooth loss. Dental health evolves only two centuries after the contact. (5) Conclusions: the confrontation with historical data suggests that changes are not related to the growing importance of sucrose but to a combined action: the substitution of dendrophagy by cereal flour; the decrease in immunity linked to the development of chronic infectious diseases; tobacco addiction and the mandibular torus: a risk factor promoting apical cysts.

Torus Palatinus in Taiwan Patients Receiving Peritoneal Dialysis and Hemodialysis: A Prospective Observational Study

Purpose

A consensus about the pathogenesis of torus palatinus (TP) in patients receiving dialysis still eludes the scientific community. This prospective observational study investigated the epidemiology of TP in peritoneal dialysis and hemodialysis patients and analyzed the influences of multiple pathogenic factors such as mineral and bone disorders, genetic, environmental or nutritional triggers, progression of age, heredity, climatologic or biomechanical causes, and hyperparathyroidism on the formation of TP.

Methods

Between 2013 and 2016, a total of 575 chronic dialysis patients (441 on hemodialysis and 134 on peritoneal dialysis) were recruited from Chang Gung Memorial Hospital, Taiwan. Patients were stratified into two groups based on the presence (n = 179) or absence (n = 396) of TP. Demographic, oral examination, laboratory, and dialysis data were collected for analysis. Student’s t-test was used to analyze the quantitative variables and Chi-square or Fisher’s exact test for categorical variables. Univariate binary logistic regression analysis was conducted to determine the predictors for TP and multivariate binary logistic regression analysis to identify significant associated factors.

Results

The prevalence of TP in dialysis patients in this study was 31.1% (28.3% for hemodialysis and 40.3% for peritoneal dialysis). Patients with TP were younger (54.6 ± 13.4 versus 58.9 ± 14.7 years, P = 0.001) and mostly female (60.3 versus 41.2%, P < 0.001). Most TP cases (55.3%) were small in size (<2 cm), with the flat shape (56.4%) being the most common followed by the spindle (17.9%), nodular (17.3%), and lobular (8.4%) shapes. A longer duration of dialysis was associated with TP ≥2 cm than with TP <2 cm (94.4 ± 85.9 versus 72.8 ± 59.1 months, P = 0.048). Multivariate logistic regression revealed that female gender (odds ratio 2.108, 95% confidence interval 1.455–3.055, P < 0.001) and younger age (odds ratio 0.982; 95% confidence interval 0.969–0.994, P = 0.005) were significant predictors for TP.

Conclusion

The prevalence of TP in chronic dialysis patients is 31.1%, higher in patients receiving peritoneal dialysis (40.3%) than hemodialysis (28.3%). Female gender and younger age are significant predictors associated with TP.

The relationship between oral tori and bite force

OBJECTIVE

The relationship between bite force and torus palatinus or mandibularis remains to be explained. The major aim of this study was to determine the correlation between bite force and oral tori.

METHODS

The bite force of 345 patients was measured with a bite force recorder; impressions of the shape and size of the oral tori were taken on plaster models prior to orthodontic treatments. Subsequently, the relationship between oral tori and bite force was analyzed.

RESULTS

The size, shape, and incidence of torus palatinus was not significantly correlated with bite force. However, the size of torus mandibularis increased significantly in proportion to the bite force (p = 0.020). The occurrence of different types of oral tori was not correlated with the bite force.

DISCUSSION

The size of torus mandibularis provides information about bite force and can thus be used to clinically assess occlusal stress.

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

Background

The 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.

Methods

The 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.

Results

Among 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.

Conclusion

No 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.

Prevalence and clinical characteristics of oral tori among outpatients in Northern Malaysia

OBJECTIVES

The objectives of this study were to determine the prevalence and clinical characteristics of torus palatinus (TP) and torus mandibularis (TM) in Malaysian dental patients.

METHODS

Thousand five hundred and thirty-two dental patients were examined for the presence of oral tori at the Faculty of Dentistry outpatient clinic, AIMST University. Factors such as race, age, sex, size, and shape of tori were studied.

RESULTS

The prevalence rates were 12% for TP and 2.8% for TM. A variation in the presence of tori among the three races in Malaysia-Chinese, Malays, and Indians-was noted, where the Chinese significantly had a higher prevalence of TP (17.9%) and TM (4.6%). Predominantly, tori were observed >40 years and older age group, and further both TP and TM were seen more commonly in women. Most TP were of smooth type (52.2%) and >2 cm (67.4%), while all TM were bilateral and nodular, plus most were <2 cm (67.4%).

CONCLUSION

Presence of tori (TP and TM) was detected in 12.5% of the participants. The variations noted in the prevalence and clinical characteristics of tori among people of different races living in the same country reflect its multifactorial etiology. Both genetic and environmental factors are responsible for its occurrence, and particular races are more prone genetically where its expression is enhanced by environmental factors.

Prevalence of Palatal Exostoses in Patients Who Have Received Periodontal Surgery in the Posterior Maxilla

INTRODUCTION

Removal of torus palatinus and palatal exostoses has been advocated for preprosthetic reasons and to avoid adverse surgical sequelae in the treatment of periodontal disease. Although multiple studies have documented the prevalence of palatal exostoses in skull examinations, to the authors' knowledge, none have reported on the prevalence of these bony protuberances during actual periodontal surgeries. The goal of this retrospective observational case series is to report on the prevalence of palatal exostoses seen during surgeries for the treatment of periodontal disease in the posterior maxilla.

CASE SERIES

All records from a 30-month period (July 2010 to December 2012) in a single private periodontal practice were reviewed to identify patients who had received guided tissue regeneration, bone grafting, osseous recontouring, or a combination thereof in the posterior maxilla. A total of 168 patients met the inclusion criteria, and 131 of these patients had palatal exostoses removed during surgery.

CONCLUSION

The 77.97% prevalence of palatal exostoses found during periodontal surgeries in the posterior maxilla in this case series is significantly higher than that reported in previously documented skull examinations.

Prevalence of torus palatinus and torus mandibularis among Malay population

The aims of this study were to determine the prevalence, size, shape, and location of torus palatinus (TP) and torus mandibularis (TM), and to assess their sex-related and age-related differences in the Malay population. Sixty-five subjects were assessed for the presence of both tori at the School of Dental Sciences University Sains Malaysia. The prevalence of TP was 38–63% and that of TM was 1–10%. TP was frequently more common in females than males (90.9% versus 9.1%; P < 0.05) and was frequently found in medium sizes, spindle shaped, and was often located at the combined premolar to molar areas. The prevalence of TM was not significantly different in males and females (33.3% versus 66.7%; P = 0.523), occurred most commonly in bilateral multiple form, and was often located at the canine to premolar area.

Camurati-Engelmann disease: unique variant featuring a novel mutation in TGFβ1 encoding transforming growth factor beta 1 and a missense change in TNFSF11 encoding RANK ligand

We report a 32-year-old man and his 59-year-old mother with a unique and extensive variant of Camurati-Engelmann disease (CED) featuring histopathological changes of osteomalacia and alterations within TGFβ1 and TNFSF11 encoding TGFβ1 and RANKL, respectively. He suffered leg pain and weakness since childhood and reportedly grew until his late 20s, reaching 7 feet in height. He had deafness, perforated nasal septum, torus palatinus, disproportionately long limbs with knock-knees, low muscle mass, and pseudoclubbing. Radiographs revealed generalized skeletal abnormalities, including wide bones and cortical and trabecular bone thickening in keeping with CED, except that long bone ends were also affected. Lumbar spine and hip BMD Z-scores were + 7.7 and + 4.4, respectively. Biochemical markers of bone turnover were elevated. Hypocalciuria accompanied low serum 25-hydroxyvitamin D (25[OH]D) levels. Pituitary hypogonadism and low serum insulin-like growth factor (IGF)-1 were present. Karyotype was normal. Despite vitamin D repletion, iliac crest histology revealed severe osteomalacia. Exon 1 of TNFRSF11A (RANK), exons 2, 3, and 4 of LRP5, and all coding exons and adjacent mRNA splice junctions of TNFRSF11B (OPG), SQSTM1 (sequestosome 1), and TNSALP (tissue nonspecific alkaline phosphatase) were intact. His asymptomatic and less dysmorphic 5'11″ mother, also with low serum 25(OH)D, had milder clinical, radiological, biochemical, and histopathological findings. Both individuals were heterozygous for a novel 12-bp duplication (c.27_38dup, p.L10_L13dup) in exon 1 of TGFβ1, predicting four additional leucine residues in the latency-associated-peptide segment of TGFβ1, consistent with CED. The son was also homozygous for a single base transversion in TNFSF11, predicting a nonconservative amino acid change (c.107C > G, p.Pro36Arg) in the intracellular domain of RANKL that was heterozygous in his nonconsanguineous parents. This TNFSF11 variant was not found in the SNP Database, nor in published TNFSF11 association studies, but it occurred in four of the 134 TNFSF11 alleles (3.0%) we tested randomly among individuals without CED. Perhaps the unique phenotype of this CED family is conditioned by altered RANKL activity.