JAW BONE ATROPHY INDUCED BY EXPOSURE TO TOXIC ENVIRONMENT USING RADIOLOGICAL INTERPRETATION

Headnote

Abstract

Introduction: The main aim of the research is of analyzing the thickness of the jaw bone on orthopantomography radiographies at patients exposed to occupational risk factors such as cyanides. Therefore, the statistical interpretation of the changes occurring at jaw bone level in a group of workers from a galvanizing section of metal plating is important.Materials and methods: A two-year comparative radiological and statistical study between two research groups of 102 subjects each - one group, exposed to occupational hazards - and radiological analysis of the thickness of jaw bones in the six-year molar teeth position, along the median line, both in the maxilla and the mandible, were performed.Results and discussion: The novelty consists in identifying the specific effects of an external vicious environment on bone thickness, and in the statistical interpretation of results. A good and positive correlation measured the maxilla bone thinness and the right side mandible bone thickness using panoramic radiography, as well as between the left side maxilla bone thickness and left side mandible bone thickness. It was also observed that bone atrophy increases with the seniority in work, meaning that a person with 30-40 years of work has a greater atrophy and a less bone thickness than a younger worker. Conclusions: Bone atrophy detected in the upper jaw bone as well as in the mandible within the investigation group is significantly higher than that detected on the right side, on the median line, and also on the left one, within the witness group.

Keywords: radiologic investigation, occupational hazards, cyanides, jaw hone, atrophy.

1.INTRODUCTION

Panoramic radiography or orthopantomography is one of the complementary elective methods in the process of complementary diagnosis of any type of disorder of the stomatognathic system [1-6]. The effects of occupational risk factors, namely cyanides and acid vapors, on bone atrophy were considered. The study compares two study groups, one working in a galvanizing department, and the witness group from the same factory, but from another department. As known, a 1.6·10-3mg/m3 cyanide concentration may appear in welding industry [7].

Our hypothesis is that the systematic exposure of the human body to toxins during the working hours may be the cause of professional diseases, hving major implications on oral health, as evidenced in the literature of the field. The damaging effects of toxins on the jaw bone structure were observed on the panoramic radiographies taken to two distinct groups of patients, only one being exposed to risk factors, such as: copper cyanide, zinc cyanide, nickel cyanide, hydrochloric acid vapors, sulfuric acid vapors and their different combinations, toxins caused by the technological process of galvanization [7-10]. The present study evidences the possible differences between the two studied groups, and how they may manifest on bone thickness. An initial clinical investigation showed significant differences between the two groups regarding oral health, salivary PH changes, aggravation of the existing parodontopathies and the occurrence of specific erosive dental lesions. Beside this, we proceeded with X-ray investigations and observed that there are thickness differences, too. Therefore, the radiological investigations were continued for comparing the thickness of the jaw bone within both studied groups, which were analyzed under the same conditions, permitting to compare the results. An "Orthocep OC 200" on 1:1 scale film, standard exposure with the flexibility of exposure techniques starting from 57 KV to 85 KV and from 2 mA to 16 mA, was used. Once calibrated, the sensor will remain constant in all studied groups. The results obtained are discussed in the following. 2.MATERIALS AND METHODS

The study material used in the present research in order to assess the occupational exposure to specific professional hazards includes two distinct groups of workers, consisting of 204 equally divided subjects, with ages from 26 to 65 years, as follows:

* The investigation group is represented by 102 male subjects exposed to occupational risk factors. Despite the fact that the company has specific regulations regarding labor protection, health and work security, with explicit rules on wearing protective equipment like masks and goggles, workers do not comply with them and choose to protect their hands by wearing only gloves, thus risking daily exposure to various toxins, like cyanides and acid vapors.

* The witness group is formed of 102 male subjects working in the same factory, yet not exposed to specific risk factors.

The working method used in the research was clinical and radiological examination. Panoramic radiographies were made for all subjects included in the study, with the same apparatus, to allow efficient comparisons (Fig. 1).

The panoramic radiographies were minutely examined on the negatoscope. During examination, apart from the classical references mentioned in literature, thickness of jaw bones at the six-year molar teeth along the median line (Fig. 1) was analyzed, in both maxilla and mandible [11-17].

3.RESULTS

The SPSS (Statistic Program for Social Science) was used to complete the statistical analysis as well as the graphic representations [18-19]. Figure 2 comparatively plots the graphical results regarding jaw bone thickness at the right 6-year molar for each studied group (research group RG and witness group WG).

A significant and direct (positive) association measured on panoramic radiographies between the bone thickness of the maxilla on the right side and the bone thickness of the mandible on the right side, at the 6-year molar, was evidenced in both the investigation (r=0.697, p=0.000<0.05) and the witness group (r=0.636, p=0.000<0.05).

A similar observation can be made for the left region, where a significant and direct (positive) association, measured on panoramic radiographies, was observed between the bone thickness of the maxilla on the left side and the bone thickness of the mandible on the left side, at the 6-year molar, in both the investigation (r=0.712, p=0.000<0.05), and witness group (r=0.642, p=0.000<0.05).

As for bone thickness at the nasal spine and the mandible bone thickness at the median line (Fig. 3), a direct and significant correlation, measured on the panoramic radiographies, was revealed between the maxilla bone thickness at the nasal spine and the mandible bone thickness at the median line, in both the investigation (r=0.788, p=0.000<0.05) and witness group (r=0.480, p=0.000<0.05).

An interesting observation is to be made regarding the working time spent in the hazardous environment. Figure 4 presents comparatively bone thickness in the two studied groups, and a relation within the same group regarding the seniority in work. It is obvious that bone atrophy increases with the seniority in work, meaning that a person with 30-40 years of work has a greater atrophy and a less bone thickness than a younger worker.

4.DISCUSSION

There is a significant difference between the average maxilla bone thickness at the right 6-year molar within the investigation group and the average maxilla bone thickness at the right 6-year molar within the witness group, namley that the average thickness of the upper jaw bone at the 6-year molar in the investigation group (M=8.88, SD=3.77) is considerably lower (p=0.000<0.05) than that of the upper jaw bone at the 6-year molar within the witness group (M=17.86, SD=1.97).

There is a significant difference between the average thickness of the upper jaw bone at the nasal spine within the investigation batch and the average thickness of the upper jaw bone at the nasal spine within the witness group, in the sense that, in the investigation group (M=13.6, SD=3.52), the former is significantly lower (p=0.000<0.05) than the latter in the witness group (M=22.9, SD=1.73).

There is a significant difference between the average thickness of the upper jaw bone at the left 6-year molar in the investigation group and the average thickness of the upper jaw bone at the left 6-year molar in the witness group, namely the average thickness in the investigation group (M=9.04, SD=3.72) is significantly lower (p=0.000<0.05) than that of the upper jaw bone at the left 6-year molar with the witness molar (M=17.83, SD=1.94).

There is a significant difference between the average thickness of the mandible bone at the right 6-year molar in the investigation group, and that of the mandible bone at the right 6-year molar in the witness group, namley that the average thickness of the mandible bone with the investigation group (M=18.78, SD=5.59) is significantly lower (p=0.000<0.05) then that of the mandible bone at the 6-year molar in the witness group (M=36.48, SD=2.51).

There is a significant difference between the average thickness of the mandible bone on the median line in the investigation group and that of the mandible bone on the median line in the witness group, in the sense that the average thickness of the mandible bone on the median line in the investigation group (M=23.88, SD=5.68) is significantly lower (p=0.000<0.05) than that of the mandible bone on the median line in the witness group (M=40.77, SD=2.63).

There is a significant difference between the average thickness of the mandible bone at the left 6-year molar in the investigation group and the average thickness of the mandible bone at the left 6-year molar in the witness group, in the sense that the average thickness of the mandible bone at the left 6-year molar in the investigation group (M=19.1, SD=5.86) is considerably lower (p=0.000<0.05) than that of the mandible bone at the left 6-year molar in the witness group (M=36.7, SD=2.4).

5.CONCLUSIONS

Significant statistical differences can be noticed as to the average thickness of the upper jaw bone at the right 6-year molar (p=0.000<0.05), the average thickness of the upper jaw bone at the left 6-year molar (p=0.000<0.05), and that of the jaw bone at the nasal spine (p=0.000<0.05), the values with the investigation group being lower than in the witness group.

Significant statistical differences are noticed in the average thickness of the mandible at the right 6-year molar (p=0.000<0.05), average thickness of the maxilla at the left 6-year molar (p=0.000<0.05), and that of the bone thickness on the median mandibular line (p=0.000<0.05), the values being lower in the investigation group, compared to the witness one;

A higher thickness of the upper jaw bone on the right side corresponds to a higher dimension of the mandibular bone on the same side, in both the investigation (r=0.697, p=0.000<0.05) and witness group (r=0.636, p=0.000<0.05). In a similar way, a higher bone thickness of the upper jaw on the left side corresponds to a similar dimension of the mandibular bone on the same side, in both the investigation (r=0.712, p=0.000<0.05) and witness group (r=0.642, p=0.000<0.05);

A higher thickness of the upper jaw bone at the nasal spine corresponds to a similar dimension of the mandibular bone on the median line, in both the investigation (r=0.788, p=0.000<0.05) and witness group (r=0.480, p=0.000<0.05).

Bone atrophy detected after the examination of the panoramic radiographies in the upper jaw bone and the mandible within the investigation group is significantly higher (up to 50%) (p=0.000<0.05) than that detected on the right side, on the median line, as well as on the left one, within the witness group.

The time exposure to the hazardous environment is more dangerous and has a direct influence on the thickness of the jaw bone.

Conflict of interest. All authors have equal contribution. The authors have nothing to disclose, there are no conflict of interest.

References

References

1. Srivastava K C, Shrivastava D, Hosni HA, Khan ZA, Al-Johani K, Alzoubi IA, Alam MK. Recommendations, practices and infrastructural model for the dental radiology set-up in clinical and academic institutions in the COVID-19 era. Biology. 2020;9(10):334.

2. Hung K, Montalvao C, Tanaka R, Kawai T, Bornstein MM. The use and performance of artificial intelligence applications in dental and maxillofacial radiology: A systematic review. Dentomaxillofac Radiol. 2020;49(1):20190107.

3. Tolstunov L. Maxillary tuberosity block bone graft: innovative technique and case report. J Oral Maxillofac Surg. 2009;67(8):1723-9.

4. Nackaerts O, Jacobs R, Horner K, Zhao F, Lindh C, Karayianni K, Devlin, H. Bone density measurements in intra-oral radiographs. Clin Oral Investig. 2007;11(3):225-9.

5. Woodward TM. Dental radiology. Top Companion Anim Med. 2009;24(1):20-36.

6. Stoica AM, Steţiu AA, Buruian M, Steţiu M, Monea M. A comparison study between cone-beam computed tomography (CBCT) and regular radiography in endodontics. J Optoelectron Adv Mater. 2016;18(5-6):562-6.

7. Welp EA, Weiderpass E, Boffetta P, Vainio H, Vasama-Neuvonen K, Petralia S, Partanen TJ. Environmental risk factors of breast cancer. Scand J Work Environ Health. 1998;24(1):3-7

8. Petersen PE, Henmar P. Oral conditions among workers in the Danish granite industry. Scand J Work Environ Health 1988;14(5):328-31.

9. Boffetta P, Collatuzzo G. Application of P4 (Predictive, Preventive, Personalized, Participatory) Approach to Occupational Medicine. Med Lav. 2022;113(1):e2022009.

10. Cristian A, Merdji A, Roy S, Stetiu AA, Aminallah L, Della N, Stetiu M, Benaissa A, Popa M. Influence of the galvanization environment on the oral health of the people working in such sections. International Journal of Medical Dentistry. 2021;25(2):63-8.

11. Nackaerts O, Jacobs R, Pillen M, Engelen L, Gijbels F, Devlin H, Lindh C, Nicopoulou-Karayianni K, van der Stelt P, Pavitt S, Horner K. Accuracy and precision of a densitometric tool for jaw bone. Dentomaxillofac Radiol. 2006;35(4):244-8.

12. Dutra V, Devlin H, Susin C, Yang J, Horner K, Fernandes ARC. Mandibular morphological changes in low bone mass edentulous females: evaluation of panoramic radiographs. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;102(5):663-8.

13. Drozdzowska B, Pluskiewicz W, Tarnawska B. Panoramic-based mandibular indices in relation to mandibular bone mineral density and skeletal status assessed by dual energy X-ray absorptiometry and quantitative ultrasound. Dentomaxillofac Radiol. 2002;31(6):361-7.

14. Gulsahi A, Paksoy CS, Yazıcıoglu N, Arpak N, Kucuk NO, Terzioglu H. Assessment of bone density differences between conventional and bonecondensing techniques using dual energy x-ray absorptiometry and radiography. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;104(5):692-8.

15. Taguchi A, Asano A, Ohtsuka M, Nakamoto T, Suei Y, Tsuda M, Kudo Y, Inagaki K, Noguchi T, Tanimoto K, Jacobs R, Klemetti E, White SC, Horner K. Observer performance in diagnosing osteoporosis by dental panoramic radiographs: results from the osteoporosis screening project in dentistry (OSPD). Bone. 2008;43(1):209-13.

16. Orhan BK, Yılmaz D, Ozemre MO, Kamburoǧlu K, Gulen O, Gulsahi A. Evaluation of Mandibular Third Molar Region in a Turkish Population Using Cone-Beam Computed Tomography. Curr Med Imaging. 2020;16(9):1105-10.

17. Secgin CK, Gulsahi A, Yavuz Y, Kamburoglu K. Comparison of mandibular index values determined from standard panoramic versus cone beam computed tomography reconstructed images. Oral Surg Oral Med Oral Pathol Oral Radiol. 2019;127(3):257-64.

18. Yang H. The case for being automatic: introducing the automatic linear modeling (LINEAR) procedure in SPSS statistics. Multiple Linear Regression Viewpoints. 2013;39(2):27-37.

19. Morgan GA, Barrett KC, Leech NL, Gloeckner GW. IBM SPSS for Introductory Statistics: Use and Interpretation: Use and Interpretation. London:Routledge;2019.