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ORIGINAL RESEARCH Table of Contents   
Year : 2007  |  Volume : 18  |  Issue : 4  |  Page : 181-185
Incidence of mandibular nutrient canals in hypertensive patients: A radiographic study


Department of Oral Medicine and Radiology, Dr. DY Patil Dental College and Hospital, Mahesh Nagar, Pimpri, Pune - 18, India

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Date of Submission12-Oct-2006
Date of Decision05-Mar-2007
Date of Acceptance19-Mar-2007
 

   Abstract 

Hypertension, also called a 'silent killer,' is one of the most common medical problems seen in our profession. A prospective study was conducted in the Department of Oral Medicine and Radiology to determine the incidence of the appearance of nutrient canals in the periapical radiographs of the mandibular anterior region of patients with high blood pressure. A total of 100 patients, between 10-80 years, were examined. After taking a proper history, systemic and oral examinations were done and the findings were recorded under two categories, hypertensive patients and normotensive patients. They were further subdivided according to their periodontal status. Intraoral periapical radiographs of the lower anterior region were then taken. Radiographs were interpreted with a good X-ray viewer and the use of a magnifying glass. Findings were recorded on a prepared format.

Keywords: Hypertension, nutrient canals

How to cite this article:
Jaju PP, Suvarna PV, Parikh NJ. Incidence of mandibular nutrient canals in hypertensive patients: A radiographic study. Indian J Dent Res 2007;18:181-5

How to cite this URL:
Jaju PP, Suvarna PV, Parikh NJ. Incidence of mandibular nutrient canals in hypertensive patients: A radiographic study. Indian J Dent Res [serial online] 2007 [cited 2019 May 19];18:181-5. Available from: http://www.ijdr.in/text.asp?2007/18/4/181/35829
Hypertension, also called a 'silent killer,' is one of the most commonly encountered medical problems in dental practice. It is readily detectable, often asymptomatic, easily manageable, and can lead to lethal complications if left untreated. High blood pressure is a trait, as opposed to a specific disease, and represents a quantitative rather than a qualitative deviation from the norm. [1]

Radiolucencies that appear to represent spaces in bone through which blood vessels and nerves travel to supply surrounding structures have been termed as nutrient canals. Nutrient canals appear most frequently on the intraoral radiographs of the mandibular anterior region, followed by the mandibular premolar area, the maxillary premolar area, and the wall of the maxillary sinus. [2]

Some consider them as normal structures, whereas others have correlated the radiographic appearance of nutrient canals with hypertension, diabetes mellitus, periodontal disease, rickets, calcium deficiency, and disuse atrophy.[3] This study was undertaken to correlate the presence of mandibular nutrient canals in hypertensive patients with or without associated diseases.


   Materials and Methods Top


A small prospective study was conducted in the Department of Oral Medicine and Radiology, A total of 100 patients (55 hypertensive and 45 normotensive) between the ages of 20 years and 80 years were included in the study. There were 47 female patients and 53 male patients. After taking a proper history, a systemic and oral examination was done and the findings were recorded in a prepared proforma. Patients were classified as hypertensive based on the criteria recommended in the report of the sixth Joint National Committee for Prevention, Detection, Evaluation, and Treatment of high blood pressure. [4]

Patients were divided into three groups:

Group I

This group included 39 known cases of hypertension. The patients were divided into three subgroups:

Subgroup A: Included patients without hypertension, with good oral hygiene, and without any evidence of periodontal disease.

Subgroup B: Included 33 hypertensive patients with clinical evidence of periodontal disease such as calculus, gingivitis, periodontal pockets, traumatic occlusion, overhanging restorations, and gingival recession.

Subgroup C: Included 6 hypertensive patients who were partially or completely edentulous.

Group II

This group included 16 hypertensive patients with associated medical conditions like diabetes mellitus. This group was also divided into three subgroups:

Subgroup A: Included 1 patient with good oral hygiene and without periodontal disease.

Subgroup B: Included 12 patients with evidence of periodontal disease.

Subgroup C: Included 3 patients who were partially or completely edentulous.

Group III

This group comprised normotensive patients. There were three subgroups:

Subgroup A: Included 5 patients with good oral hygiene and without periodontal disease.

Subgroup B: Included 31 patients with evidence of periodontal disease.

Subgroup C: Included 9 patients who were partially or completely edentulous.

Radiographic study

The present study was restricted to radiographs of the mandibular anterior cuspid central incisor region, since nutrient canals are most commonly observed in this area. Written consent was taken from the patients before taking the radiograph. Radiographs were taken with Evolution X X-ray machine with settings of 70 kvP and 8 mA and an exposure time of 0.5 s. Bisecting angle technique with number 2 periapical film was used. The film was then processed by the manual method. After the radiographs were dried, they were mounted on a good X-ray viewer and the radiograph was interpreted with the use of a magnifying glass. Findings were recorded in the prepared format.


   Results Top


The incidence of nutrient canals in hypertensive and normotensive patients according to their oral hygiene status was evaluated [Table - 1],[Figure - 1],[Figure - 2].

The incidence of nutrient canals according to the age of patients was also evaluated [Table - 2] [Figure - 3].

The incidence of nutrient canals according to duration of hypertension was also checked [Table - 3].

The incidence of nutrient canals according to the severity of bone loss was then evaluated [Table - 4],[Figure - 4],[Figure - 5],[Figure - 6].

Finally, the incidence of nutrient canals according to the sex of the patient was evaluated [Table - 5]


   Discussion Top


Hirschfeld first described nutrient canals and foramina on radiographs in 1923, when he called them 'interdental channels. They have been since referred to as 'circulatory canals', 'medullary canals', and 'nutrient canals'. [3]

Ennis and associates described the anatomy of nutrient canals, stating that they are derived from the incisive branch of the mandibular artery supplying the region anterior to the mental foramen and that terminal points of these canals are seen as small nutrient foramina on the superior labial surface of the anterior mandibular area. [5]

Bhaskar stated that nutrient canals are a normal anatomic structure. Worth described nutrient canals as channels or grooves which contain blood vessels and traverse the mandible and maxilla to supply teeth and gingival tissues. [2]

Hirschfeld, in 1923, suggested that nutrient canals could be a diagnostic sign of calcium deficiency but later, in 1927, said that it was a normal entity. [3]

Ryder, in 1942, correlated nutrient canals with thin alveolar ridges and the lack of trabacular spaces. [5] Wuehrmann and Manson Hing, in 1927, stated that nutrient canals tend to be related to advanced age, chronic illness, osteosclerosis, and periodontal disease. [5] In 1927, Kuroyanagi et al., Weinberger, and Greer and associates reported that the nutrient canals tend to be associated with periodontal disease. [5]

Higher incidence of nutrient canals in edentulous persons may be associated with resorption of the alveolar bone following tooth loss and the diminished thickness of the remaining alveolar bone.

Weinberger, in 1953, gave an explanation for the predominance of nutrient canals in the mandibular anterior region. According to him, this area is comparatively more subjected to irritation from calculus and trauma. Secondly, these teeth do not have the bony support, both cancellous and cortical, that exists for the other teeth. [3] In 1976, Patel and Wuehrmann and Patni and associates, in their respective studies, showed an increased incidence of nutrient canals in hypertensive patients. [3]

According to Patni et al., increased incidence of nutrient canals in hypertensive patients was due to dilatation of arterioles, hypertrophy and hyperplasia of the vessel wall, and arteriosclerosis, along with thickening of the arterial wall. There is narrowing of the lumen which may lead to the opening of more collateral blood vessels to compensate for the diminishing blood supply. All these changes contribute to the increased presence of nutrient canals in hypertensive patients. [3]

Donta et al. stated that the incidence of nutrient canals is much greater in hypertensive patients with alveolar bone loss when compared with normotensive patients with no bone loss. The present study supported this finding. They also stated that the nutrient canals were more in females and incidence of nutrient canals increased with increase in severity of alveolar bone loss. [6]

Bilge and associates said that occurrence of nutrient canals is related to age, edentulous mandible, periodontal problems, and high blood pressure. [7] But the study conducted by Yilmaz and associates in 2003 stated that there was no correlation between hypertension and nutrient canals. [8]


   Conclusion Top


The results of the present study showed that:

  1. The incidence of nutrient canals was more in patients who had hypertension associated with other conditions like diabetes mellitus, periodontal conditions, or disuse atrophy.
  2. The incidence of nutrient canals in hypertensive and normotensive patients was almost the same.


Thus, it can be concluded that nutrient canals alone cannot be used as a diagnostic criterion for the detection of hypertensive patients radiographically. The role of the possible cofactors needs to be studied further.

 
   References Top

1.Macleaod J. Davidson's principles and practice of medicine, 18 th ed. Churchill Livingstone: Edingburg; p. 216-22.  Back to cited text no. 1      
2.Britt GN. A study of human mandibular nutrient canals. Oral Surg Oral Med Oral Pathol 1977;44:635-45.  Back to cited text no. 2  [PUBMED]    
3.Patni VM, Merchant GJ, Dhooria HS. Incidence of nutrient canals in hypertensive patients: A radiographic study. Oral Surg Oral Med Oral Pathol 1985;59:206-11.  Back to cited text no. 3  [PUBMED]    
4.Riley CK, Terezhalmy GT. The patient with hypertension. Quintessence Int 2001;32:671-90.  Back to cited text no. 4  [PUBMED]    
5.Kishi K, Nagaoka T, Gotoh T, Imai K, Fujiki Y. Radiographic study of mandibular nutrient canals. Oral Surg Oral Med Oral Pathol 1982;54:118-22.  Back to cited text no. 5  [PUBMED]    
6.Donta CN, Pierrakou ED, Patsakas AJ. Incidence of nutrient canals in hypertensive patients with alveolar bone loss. A radiographic study. Hell Period Stomat Gnathopathoprosopike Cheir 1989;4:149-52.  Back to cited text no. 6      
7.Bilge OM, Harorli AB, Yilmaz AB. Radiographic study of mandibular nutrient canals. Ann Dent 1992;51:17-21.  Back to cited text no. 7  [PUBMED]    
8.Yilmaz AB, Akgul N, Akgul HM, Dagistanli S, Cakur B. Relationship between nutrient canals and hypertension. J Int Med Res 2003;31:123-5.  Back to cited text no. 8      

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Correspondence Address:
Prashant P Jaju
Department of Oral Medicine and Radiology, Dr. DY Patil Dental College and Hospital, Mahesh Nagar, Pimpri, Pune - 18
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.35829

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    Figures

  [Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5], [Figure - 6]
 
 
    Tables

  [Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5]

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