Pronounced Palatal and Mandibular Tori Observed in Patient With Chronic Phenytoin Therapy: A Case Report

Abstract

Phenytoin, an anticonvulsant drug for epileptic patients, has many adverse effects, including calvarial thickening and coarsening of the facial features. Previous studies have demonstrated that phenytoin has an anabolic action on bone cells. This report describes pronounced palatal and mandibular tori found in a 45-year-old Japanese man undergoing chronic phenytoin therapy. The tori were extremely large, lobular, and symmetrical. A palatal torus appeared along the middle of the hard palate and mandibular tori consisted of 2 pairs of nodular masses extensively filling the lingual floor of the oral cavity. Pronounced osseous outgrowth occurred for the duration of a dose-increase of phenytoin from 1985 to 1997. His parents did not have any palatal or mandibular tori. These facts suggest that these unusual tori may have been the result of chronic phenytoin therapy, rather than association with the familial background.

Torus Palatinus and Torus Mandibularis in Edentulous Patients

“…24 However, the present study did not show any significant difference in the prevalence of either palatal or mandibular tori between males and females implying the sex based factor has little influence on the prevalence of tori. This is in contrast to a Norwegian study 15 and other studies 2,5,12,16,18,20 , which demonstrated males had a higher ratio to females for tori. Haugen 30 suggested genetics as the responsible factor for the difference, while Alvesalo 31 suggested sexual dimorphism in the manifestation of torus mandibularis might result from the effect of Y chromosome on growth, occurrence, expression, and timing of development of mandibular tori.…”

Current status of the torus palatinus and torus mandibularis

“…(7,20) As for this section, among the studies reviewed, there is no consensus on how to classify the growth; each study classifies the growth differently.…”

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

“… 9 , 21 This research did not include any studies on significant clinical medical conditions or associated dental anomalies in relation to tori. Correlation between TP and TM and chronic phenytoin administration was reported by Sasaki et al 25 Tori were also known to be associated with other dental anomalies such as exostosis, unerupted and impacted tooth, mandibular canines, and sclerosteosis. 17 , 22 The prevalence and degree of expression of tori might be related to the masticatory demand that increases with increasing age, and possibly, subsides after the fifth decade of life due to reduction in the number of teeth.…”