Introduction

Torus Palatinus (TP) is a condition in which a bone growth appears on the palate, which is located at the mouth’s root.¹ The growths on the palate are referred to as tori, and the likelihood of these appearing in TP cases is largely thought to be due to factors such as genetics, alongside environmental factors.² This condition affects oral function and is particularly difficult for those older to deal with, due to dentures being affected. As well as this, tori can affect other regions close to the mouth, such as the sinuses and anything connected to the ear, nose, and throat (ENT) regions of the body.³ There have been studies in many different regions that have produced different results regarding the effect of gender on TP presentation; in some countries, this is much more prevalent in males, while in others, we see the opposite.⁴

Additionally, studies regarding how age affects the presentation differ in conclusions, with some not showing a significant effect due to age, whilst others demonstrate a link between age and TP.⁵ It is important to understand these two factors to elucidate whether they affect TP prevalence and can be used as predictors when studying this disease. This article investigates the role of age and gender in TP development; future implications will also be discussed.

General characteristics of torus palatinus

Torus palatinus occurs when tori are situated at the hard palate. The specific area is referred to as the palatine raphe, which is a line located in the middle of the palate. This area is at the centre of the palatine longitudinal ridge. TP comes in different shapes, the typical configurations are flat and spindle-shaped, as well as unilobular and polylobulated. It is important to note that the tori are covered by vascular membranes known as the mucosa.⁶ The prevalence of TP varies between countries. In India, for example, 1.3% of payments analysed in a study had TP, which was common in the 30-40 age range. Older patients had torus mandibularis (TM), which was the most prevalent condition in this study. This condition occurs when tori appear on the mandible, which is an area within the lower jaw region.⁷

In other countries, like Malaysia, TP is more common; interestingly, in this study, however, TP was significantly more prevalent in males than females, whereas this was not the case for TM. This implies that gender is a factor as well as age, dictating the prevalence of TP in populations.⁸ The presentation of tori is thought to be caused by different factors. Firstly, genetics is thought to have a role, and these injuries and muscle function influence the prevalence of TP. Diet is also a possible cause, with those with vitamin deficiencies generally being more susceptible to developing tori. As aforementioned, some evidence suggests that age and gender also influence the likelihood of TP.⁶

Influence of age on torus palatinus development

Age affects the likelihood of TP development. On average, tori shows up around the age of 34, with 30.7 being the average age for TP onset. As mentioned previously, TM presents itself in later years. Although most studies suggest that TP onset occurs in the thirties,  Other studies suggest that TP is also common in the 11-20 age group. Studies have also indicated that many people experience the onset much later in life. It is theorised that there is no definitive answer due to TP possibly beginning during puberty and growing at a very slow rate for many years till the tori are more pronounced. However, it can be concluded that for the most part, TP develops after 10 years of life.⁹

The prevalence of tori is higher in those who are older. Some studies have suggested that this is insignificant. There are, however, more TP and TM cases in older individuals. Therefore, the likelihood of TP increases as you age.¹⁰ Tori tend to grow slowly up to the age of 30, and then between the third and fourth decade of life, tori appear to grow at a higher rate before the growth rate begins to stagnate. This means that although older people would have TP due to growth, the peak age at which TP starts to become prevalent is at 30, thus, the onset is thought to be at this age. It may be earlier, however, that tori growth patterns lead to these reported results.³

Influence of gender on torus palatinus development

Gender is another factor that affects TP prevalence in individuals. Some studies, such as in Turkey, show that TP is more prevalent in females than in males.¹¹ Other studies, such as studies in Japan, have also indicated that there is a significant difference in TP prevalence between men and women, with women being more likely to present with TP. These results emphasise that there is more of a genetic predisposition to TP than suggested by other studies that stress the importance of environmental factors.¹²

Female hormones are likely to be a factor that causes this gender differential, as studies have suggested that the likelihood of this disease increases post-menopause, as bone density is higher.¹³ Although hormones are linked to females generally being more susceptible to TP, it is also important to acknowledge that there are genetic factors influencing this, with many of these thought to be related to the X chromosome.¹⁴

There is interplay between genetic and environmental factors, such as diet, as this can influence factors such as bone density, which is particularly important to consider in women during menopause, for example. The general consensus is that TP is more likely to occur in females, whereas TM is more clear regarding the link to gender.¹⁵

Interaction between age and gender

There are links between age and gender regarding TP prevalence. Studies have demonstrated that women tend to present with tori more frequently than men in the 20-29 age range and that there is a decrease over time, with some women still having tori after 70 years old. Men, on average, have fewer cases of tori presentation and TP and the number of cases drops less sharply as men age. Men also tend not to have TP passed 60.¹⁶

This is likely to be he case due to the aforementioned phenomenon of female hormones and menopause greatly decreasing TP cases over time due to bone density, whilst in men, this is not a factor.¹³

Post-menopausal women tend to present with large tori due to higher bone density, so age and gender are interlinked regarding female tori growth and presentation.¹³ Tori are known to grow over time, but this is not generally as significant in men when compared to women.¹⁷ Comparative studies focusing on age and gender have concluded that women present with more TP cases than men and that most people with TP are within the 31-41 age range; therefore, age is important in dictating TP onset. Whereas gender largely impacts TP prevalence.¹⁸

Clinical significance and implications

Instances of TP have impacted global healthcare systems. As mentioned previously, the mucosa around the tori makes it harder to design dentures for those who are typically of an older age.¹⁹ Treating TP cases, surgical interventions are typically required, which could lead to complications.²⁰ TP can also affect basic functions such as speech and lead to lower dental hygiene; thus, they must be treated before becoming a major inconvenience. This condition is also rare, and not all clinicians are fully aware of this condition. Diagnosis can be difficult, as it does resemble other oral issues, making diagnosis a challenge overall.²¹ Increased awareness amongst clinicians and dental professionals will be largely beneficial for diagnosing and treating this condition and will result in a lower TP prevalence.

Summary

In summary, age and gender affect the prevalence of Torus palatinus. Women are more likely to be affected by TP than men; they generally present with this condition later on in life when compared to men, who are less likely to have TP past a certain age. Many of the characteristics that led to this gender differential are thought to be due to sex-linked chromosomes. It has been established that age is linked to TP prevalence and that onset and presentation typically occur in the 30-40 age range; however, there needs to be better diagnosis as onset and presentation may be a very gradual process.

It is crucial to establish the reasoning as to why women tend to be affected by TP more than men, as although there are theories explaining why this is the case, there is not yet a complete, definitive causal mechanism. It is key for dental professionals to be increasingly aware of this condition, as it is rare and not always easy to diagnose; better diagnosis will lead to more adequate treatment and fewer complications. Overall, the link between age, gender and TP development is understood to an extent, but more research and understanding are required in the near future to lower the global prevalence of this condition.