Oral Tori in Chronic Peritoneal Dialysis Patients.
BACKGROUND
The 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.


METHODS
In 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.


RESULTS
The 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).


CONCLUSIONS
Secondary hyperparathyroidism does not contribute to the formation of tori in peritoneal dialysis patients. Further studies are warranted.
Department of Pediatric Dentistry, Chang Gung Memorial Hospital, Linkou, Taiwan.
Chia-Lin
CL
Hsu
Department of Nephrology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan.
Ching-Wei
CW
Hsu
Department of Pediatric Dentistry, Chang Gung Memorial Hospital, Linkou, Taiwan.
Pei-Ching
PC
Chang
Department of Nephrology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan.|Kidney Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.
Wen-Hung
WH
Huang
Department of Nephrology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan.|Kidney Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.
Cheng-Hao
CH
Weng
Department of Nephrology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan.|Kidney Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.
Huang-Yu
HY
Yang
Department of Nephrology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan.|Kidney Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.
Shou-Hsuan
SH
Liu
Department of Nephrology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan.|Kidney Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.
Kuan-Hsing
KH
Chen
Department of Nephrology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan.
Shu-Man
SM
Weng
Department of Clinical Pathology, Far Eastern Memorial Hospital, New Taipei, Taiwan.
Chih-Chun
CC
Chang
Department of Nephrology, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan.
I-Kuan
IK
Wang
Department of Pediatric Dentistry, Chang Gung Memorial Hospital, Linkou, Taiwan.
Aileen I
AI
Tsai
Department of Nephrology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan.|Kidney Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.|Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, Taiwan.
Tzung-Hai
TH
Yen
D000328:Adult; D005096:Exostoses / Q000453:epidemiology / Q000209:etiology / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008334:Mandible / Q000002:abnormalities / Q000473:pathology; D008875:Middle Aged; D009059:Mouth Diseases / Q000453:epidemiology / Q000209:etiology / Q000473:pathology; D021362:Palate, Hard / Q000002:abnormalities / Q000473:pathology; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D015995:Prevalence