Jaw Bone Density in Chronic Areca Nut Chewers and Nonchewers Using Digital Panoramic Radiography Indices as a Screening Tool for Osteoporosis: Protocol for a Comparative Evaluation

Abstract

Background: Jaw bone density can be altered due to various factors including aging, bone pathologies, hormonal levels, medications affecting bone density, and undue stress posed by parafunctional and adverse habits. Of these factors, chronic areca nut chewing, which creates a heavy load on jaw bones, is a commonly encountered adverse habit in patients. Digital panoramic radiography (OPG) indices are an easy and cost-effective method to evaluate jaw bone density. Index values can also be used as a screening tool for osteoporosis.

Objective: This study aims to compare and evaluate jaw bone density in chronic areca nut chewers and nonchewers using OPG indices as a screening tool for osteoporosis.

Methods: Patients aged 20 years to 40 years reporting to the Department of Oral Medicine and Radiology with and without a history of chronic areca nut chewing will be recruited. OPG will be collected for all recruited patients. The mandibular cortical index, panoramic mandibular index, gonial index, antegonial index, antegoinal notch depth, and mental index will be calculated.

Results: The values of these indices will be used to assess and compare osteoporosis in chronic areca nut chewers and nonchewers. Data will be entered and displayed in a tabular format, and correlations between osteoporosis and OPG index values will be determined. The study did not receive any external funding. Recruitment is expected to begin in summer 2025, and publication of the results is expected to occur in late 2026.

Conclusions: Evaluation of jaw bone density in chronic areca nut chewers using OPG indices might prove to be a feasible and cost-effective technique for assessing osteoporotic bone changes. Although the gold standard modality is dual x-ray absorptiometry, its cost and availability create challenges for use in the general population. As osteoporosis of jaw bones does not usually present with symptoms, patients can be made aware of it using the findings from this evaluation. Hence, it will ultimately aid in early detection and prompt interventions, thereby halting disease progress.

International registered report identifier (irrid): PRR1-10.2196/72041.

Keywords: areca nut; bone mineral density; digital panoramic radiography; jaw bone density; osteoporosis.

Figure 1

Graphic and radiographic representation for the calculation of the (B) mandibular cortical index and (C) mental index.

Figure 2

Graphic and radiographic representation for calculations of the panoramic mandibular index (width B/width C) and gonial index (width D).

Figure 3

Radiographic representation of the determination of the antigonial index.

Figure 4

Graphic and radiographic representation for calculation of the gonial index: the length of “e” in mm.

Figure 5

Graphic and radiographic representation for the calculation of the antegonial notch depth, which is calculated by measuring the depth of the notch from the line drawn tangent to the inferior border of the mandible.