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ORIGINAL ARTICLE
Year : 2014  |  Volume : 41  |  Issue : 2  |  Page : 127-130

A comparative study of mandibular nutrient canals in healthy and hypertensive subjects


1 Department of Anatomy, Shamnur Shivashankarappa Institute of Medical Sciences and Research Centre, Davangere, Karnataka, India
2 Department of Dental Public Health, Surendra Dental College and Hospital, Sree Ganga Nagar, Rajasthan, India

Date of Web Publication20-May-2014

Correspondence Address:
Beleguppa Poornima
Department of Anatomy, Shamnur Shivashankarappa Institute of Medical Sciences and Research Centre, Davangere - 577 005, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-5009.132861

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  Abstract 

Objectives: The present study has been undertaken to find out any correlation with the prevalence of nutrient canals in hypertensive patients. Materials and Methods: A comparative study was done on patients with control group comprising of healthy individuals, and a study group of patients with a history of hypertension. An IOPAR of lower anterior region was done using bisecting angle technique and was interpreted for the presence or absence of nutrient canals. The results so obtained were subjected to statistical analysis. Results: We found that the incidence of nutrient canals was significantly higher in the study group as compared with the control group. The incidence of nutrient canals was also found to increase with age till 70 years. Conclusion: Hypertension being one of the most commonly encountered medical problems and many cases being undiagnosed, the presence of nutrient canals though not entirely indicative of hypertension, might increase the suspicion of the condition to be investigated further.

Keywords: Healthy individuals, hypertension, nutrient canals


How to cite this article:
Poornima B, Angadi AV, Sakri SB. A comparative study of mandibular nutrient canals in healthy and hypertensive subjects. J Sci Soc 2014;41:127-30

How to cite this URL:
Poornima B, Angadi AV, Sakri SB. A comparative study of mandibular nutrient canals in healthy and hypertensive subjects. J Sci Soc [serial online] 2014 [cited 2020 Aug 9];41:127-30. Available from: http://www.jscisociety.com/text.asp?2014/41/2/127/132861


  Introduction Top


The radiolucencies representing the spaces in bone which house the blood vessels and nerves supplying the surrounding structures are called nutrient canals way back in 1923, Hirschfield called them interdental channels. [1],[2] They are predominantly seen on the intraoral periapical radiograph of the mandibular anterior region, followed by the mandibular premolar region as well as the wall of maxillary sinus with the terminal points of these canals are seen as small nutrient foramina. In spite of the limitation of periapical dental radiography, it appears to be the best projection to identify the nutrient canals in the anterior mandible. However, they are not seen in radiograph of all patients and hence their utility is questioned by many researchers. Though they consider them normal structures, some investigators have correlated their radiographic appearance with myriad pathologic conditions such as periodontal disease, hypertension, diabetes, tuberculosis, rickets, calcium deficiency, and disuse atrophy among others.

Hypertension being one such condition is also called a silent killer. It is one of the most commonly encountered medical problems in dentistry. It is readily detectable, often asymptomatic, and easily manageable and can lead to lethal complications if left untreated.

The present study was undertaken to assess if any correlation in the appearance of nutrient canals with hypertension exists and to determine whether the presence of nutrient canals could be used as a clue for the detection of hypertensive patients.

Objectives

  • To determine if any correlation exists in the presence of nutrient canals in hypertensive patients and healthy individuals.



  Materials and methods Top


Source of data

Patients visiting the private clinics of Davangere and Harihara in Davangere district, Karnataka with age groups from 10 to 70 years were included in the study.

The study included 840 patients (450 hypertensive and 390 healthy individuals).

Inclusion criteria

  • Patients in the age group of 10-70 years.
  • Known hypertensive and normal healthy individuals.


Exclusion criteria

  • Patients who are less than 10 and more than 70 years of age.
  • Patient with a history of systemic disorders.
  • Patients who were smokers.


Methods

A total of 840 patients visiting the private clinics of Davangere and Harihara in Davangere district, Karnataka were included for this study. Detailed case history of both the case and control groups was recorded. Blood pressure was determined by auscultatory method in sitting posture and recorded in the proforma. [3],[4],[5] The study was carried out for a period of 6 months.

An IOPAR of lower anterior region was taken on an intraoral x-ray machine with exposure parameters of 70 kvp and 10 mA's. The radiographs were interpreted using a magnifying lens. Presence or absence of nutrient canals, their number and location were recorded in a sequential manner.

Statistical methods

Descriptive statistical analysis has been carried out in the present study.

Chi-square test has been used to find the significance of incidence of nutrient canals in hypertensive and nonhypertensive and the binomial probability distribution has been used to find the significance of incidence of nutrient canals according to study features. A total of 95% confidence interval has been computed in the present study.


  Results Top


A comparative study consisting of 450 hypertensive patients and 390 healthy individuals was undertaken to study the incidence of nutrient canals in each group. Out of 840 patients, 316 (37.56%) patients showed the presence of nutrient canals [Table 1].
Table 1: Overall prevalence of nutrient canals in the study

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In the study group, 206 (45.87%) patients showed the presence of nutrient canals and in the control group, 110 (28.13%) patients showed the presence of nutrient canals. The prevalence of nutrient canals was 2.19 times more in study group when compared with control group with a significant P value of 0.001 [Table 2].
Table 2: Comparison of prevalence of nutrient canals in the study and control group

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In the study, the incidence of nutrient canals was studied in different age groups. In 10-20 years category, all 20 patients belonged to control group and 6 (5.45%) of them had nutrient canals. In 21-30 years category, 1 patient belonged to study group and none of them had nutrient canals, 45 belonged to control group, 9 (8.17%) had nutrient canals. In 31-40 years category, 50 belonged to study group and 107 belonged to control group, among them 6 (3.15%) and 19 (17.25%) in study and control group respectively had nutrient canals. In 41-50 years category, 120 and 102 belonged to study and control group respectively, among them 64 (31.02%) in the study group and 24 (21.60%) in the control group showed the prevalence of nutrient canals. In the 51-60 years category, among 155 in the study group 104 (50.19%) and among 61 in the control group 30 (27.27%) showed the incidence of nutrient canals and in the last age group of 61-70 years, among 124 in the study group 32 (15.64%) and among 55 in the control group 22 (20%) showed the incidence of nutrient canals [Table 3].
Table 3: Prevalence of nutrient canals in diff erent age groups

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Severity of hypertension was categorized as given by British Hypertension Society depending on systemic and diastolic blood pressure. Among 302 patients with mild hypertension, 137 (66.50%) had nutrient canals. Out of 110 patients with moderate hypertension, 51 (24.75%) had nutrient canals and out of 38 patients with severe hypertension, 18 (8.75%) had nutrient canals [Table 4].
Table 4: Prevalence of nutrient canals in study group based on the severity of hypertension

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  Discussion Top


Nutrient canals are frequently observed in the dental periapical radiographs, and they are considered to serve as conduits for blood vessels and nerves. 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. The present study was undertaken to determine the correlation between the radiographic appearance of nutrient canals and hypertension.

In this study, the lower anterior IOPARS of 450 hypertensive patients in study group and 390 normal healthy individuals in control group were taken to compare the presence of nutrient canals.

The studies on the incidence of nutrient canals in the past have showed varied results ranging from as high as 88% to as low as 5%. [6],[7] In our study, which included 840 patients, the incidence was 37.56%.

The efforts to study the correlation of the presence of nutrient canals with hypertension in the various other studies have yielded both positive and negative results. [8],[9],[10],[11] Our results showed the higher incidence of nutrient canals in the study group (45.87%) when compared with control group (28.13%) which was similar to the previous studies reported. [8],[9] The principal effects of hypertension are dilatation of arterioles, hypertrophy, and hyperplasia of the vessel wall and arteriosclerosis. In arteriosclerosis, along with thickening of the arterial wall, there is narrowing of the lumen, which may lead to the opening of more collateral, or both of these changes may be responsible for the increased incidence of nutrient canals in hypertensive patients. [8]

There was also significant difference in the incidence of nutrient canals within the same age group and especially within the age groups of above 40 years of age, but there was decreased incidence in the patients above 70 years and below 30 years of age, which was also observed in previous studies. [8],[12] There were few patients in the study group below 30 years to compare with the control group. The reason postulated for sudden decrease in incidence of nutrient canals in aged patients is calcification of blood vessels as a process of aging. [8],[13]

In the present study, the incidence of nutrient canals did not show any correlation with the severity and the duration of hypertension, but an interestingly significant reduction in the incidence of nutrient canals was seen in patients suffering from hypertension for more than 10 years. Similar findings were also reported in the previous study except for the fact that the incidence of nutrient canals increased with the duration of hypertension until 10 years. [8],[10] The cause for this reduction in the incidence may be due to calcification of the blood vessels, which is the terminal stage of arteriosclerosis in patients with longstanding hypertension leading to the disappearance of nutrient canals. [8],[10],[11]

The overall observation of the study reveals that there was statistically significantly increased incidence of nutrient canals in the study group when compared to control group.


  Conclusion Top


The present study throws light on the presence of nutrient canals in hypertensive and normal individuals. An understanding of the appearances of nutrient canals in the mandibular region is very helpful in arriving at a radiological diagnosis with reference to systemic conditions. That the nutrient canals are significantly higher among hypertensive patient would pave way in establishing the role of radiographs in systemic diseases.

 
  References Top

1.Hirschfield I. A study of skulls in the American museum of natural history in relation to periodontal disease. J Dent Res 1923;5:241.  Back to cited text no. 1
    
2.Hirschfield I. Interdental canals. J Am Dent Assoc 1927;14:617.  Back to cited text no. 2
    
3.Guyton AC, Hall JE. Text book of Medical Physiology. 10 th ed. p. 161-76.  Back to cited text no. 3
    
4.Chaudhary. Text book of Medical Physiology. p. 243-8.  Back to cited text no. 4
    
5.Macleod J. Macleod′s Clinical Examination. 11 th ed. p. 93-5.  Back to cited text no. 5
    
6.Lovett DW. Nutrient canals: A roentgenographic study. J Am Dent Assoc 1948;37:671-5.  Back to cited text no. 6
[PUBMED]    
7.Greer DF, Wege WR, Wuehrmann AH. The significance of nutrient canals appearing on IOPAR, International Association of Dental Research, Programs and Abstracts of Papers. 1968;162.  Back to cited text no. 7
    
8.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. 8
[PUBMED]    
9.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. 9
[PUBMED]    
10.Yilmaz AB, Akgül N, Akgül HM, Dagistanli S, Cakur B. Relationship between mandibular nutrient canals and hypertension. J Int Med Res 2003;31:123-5.  Back to cited text no. 10
    
11.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.  Back to cited text no. 11
[PUBMED]  Medknow Journal  
12.Patel JR, Wuehrmann AH. A radiographic study of nutrient canals. Oral Surg Oral Med Oral Pathol 1976;42:693-701.  Back to cited text no. 12
[PUBMED]    
13.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. 13
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    Tables

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



 

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Abstract
Introduction
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