Exploring the Association between Dermatolgyphic Patterns and occurrence of Periodontitis - A Case Control Study
Dr.Soumya Ojha1, Dr. Ananya Bhargava2*, Dr.Apoorva Bhargava3, Dr.Astha Bhargava4
1MDS (Public Health Dentistry ),Mumbai,Maharashtra,India
2* MDS ,Orthodontics and Dentofacial Orthopedics ,Senior Resident (Department of Dentistry), Ruxmaniben Deepchand Gardi Medical College,Ujjain (M.P), India
3 MDS,Conservative Dentistry and Endodontics,Senior Resident (Department of Dentistry),Netaji Subhash Chandra Bose Government Medical College,Jabalpur (M.P) , India
4Post Graduate Student (Department of Prosthodontics ) ,Hitkarini Dental College and Hospital,Jabalpur(M.P), India
*Author2@Dr.Ananya Bhargava,MDS ,Orthodontics and Dentofacial Orthopedics ,Senior Resident (Department of Dentistry), Ruxmaniben Deepchand Gardi Medical College,Ujjain (M.P), India
[email protected] ABSTRACT
Background and objectives: Dermatoglyphics is a newer science of forensic based study involving the fingertip and palmar prints. In the field of dentistry dermatoglyphics has been used to unveil various oral diseases like precancerous lesion, malocclusion, dental caries, cleft lip and palate etc. Hence with the help of dermatoglyphics we can explore the association between various dermatoglyphic patterns and occurrence periodontitis.
Methodology: A total of 100 participants (70 periodontitis patients and 30 healthy controls) were included in the study. Tobacco habits was recorded for all the participants. All the participants in the study were examined for intra oral findings.Dermatoglyphic patterns were also recorded.
Results: Among periodontitis and control group, there was significant increase in the whorl pattern among periodontitis group (55.8%), whereas in control group loop pattern (66.6%) was found to be significantly increased (p<0.05). Among periodontitis and control group significant difference noted for right hand and left hand palm ‘adt’
(p<0.05).
Conclusion: Whorl type of fingerprint pattern and adt angle found in our study would probably be served as a candidate screening marker for susceptibility to periodontitis in general population.
Keywords : Periodontitis, Dermatoglyphic patterns.
Introduction
Skin is a thin layer of tissue forming the natural outer covering of the body of a person or animal and considered as the largest and delicate organ of the human body and performs many vital functions in life. The most conspicuous are the creases of the skin1.Dermatoglyphics (Derma=skin, Glyph= Carving) is a newer science of forensic based study involving the fingertip and palmar prints. The term dermatoglyphics was coined in 1926 by Cummins and Midlo2.Cummins is considered to be the father of dermatoglyphics. Dermatoglyphic patterns are genetically determined and remain unchanged from birth to death and are therefore considered a stable marker that once formed remain same throughout a person life3. Studying different types of dermatoglyphic pattern can determine a number of parameters, which could be helpful in diagnosing and treatment of various diseases. Thus, it is considered to be an important tool in assessing the genetic trait, evaluation of children with suspected genetic disorders and also in forensics.
Dermal Ridges develop in relation to the fetal volar pads, the formation of these pads is first visible on the fingertips during 6th–7th week of embryonic development4 .Dermal ridges are influenced by blood vessel-nerve pairs at the border between the dermis and epidermis during prenatal development and factors such as inadequate oxygen supply, unusual distribution of sweat glands, and alterations of epithelial growths could influence the ridge patterns.The three
major patterns of fingerprint include Arch, Loop, Whorl pattern and ‘atd, dat, adt’ palmar angles.
Abnormalities in epidermal ridges are influenced by a combination of hereditary and environmental factors. Oral diseases also have various etiological factors like tobacco chewing, alcohol consumption, viral diseases, dietary and environmental factors, some oral diseases are also genetically determined especially the precancerous lesions, cancers, periodontal diseases, malocclusion and dental caries.5,6
Periodontitis is defined as an inflammatory disease of the supporting tissues of the teeth caused by specific microorganisms or groups of specific microorganisms, resulting in progressive destruction of the periodontal ligament and alveolar bone with pocket formation, recession, or both. Various studies show agreement of dermatoglyphic features in assessing various medical conditions. It serves as a useful tool in understanding basic question in biology, medicine and genetics and a tool to predict occurrences and risks for biomedicalevents. Dermatoglyphics has been a boon to study occurrences of a lot of hereditary diseases and disorders. Variation from the healthy normal type of fingerprint occurs in many human disorders and diseased condition.
In the field of dentistry dermatoglyphics has been used to unveil various oral diseaseslike precancerous lesion, malocclusion, dental caries, cleft lip and palate etc.1 Dermal ridges and craniofacial structures are both formed during 6- 7th week of intra-uterine life, therefore hereditary and environmental factors leading to dental and periodontal diseases may also cause peculiarities in fingerprints.7The purpose of our study was to explore the association between various dermatoglyphic patterns and occurrence of Periodontitis among cases and controls .
Methods
The study participants were examined in the Department of Public Health Dentistry, Peoples College of Dental Sciences and Research Centre and the observations were recorded in the pre designed proforma.
Study location: People’s College of Dental Sciences& Research Centre, Bhopal (M.P)..
Duration of the study:The study was conducted from 1st July 2017 to 30th September 2017.
Sample size :The prevalence of periodontal status in India (58.6%),8 and assuming a standard error of 10%, minimum sample size of 66 was calculated The final sample size comprised of 70 patients of periodontitis and 30 healthy controls. The total sample size was 100.
Study variables :
Tobacco habits was recorded for all the participants. All the participants in the study were examined for intra oral findings. CPI score, Loss of Attachment score was recorded. A predesigned questionnaire (ANNEXURE I) including questions on history of tobacco consumption, duration of tobacco consumption, form of tobacco intake, frequency of using smoking and smokeless form of tobacco, frequency of brushing, aids used to clean teeth and how the patients rate their overall oral health. Dermatoglyphic patterns were also recorded for Arch, whorl and loop finger print pattern [Figure I], ‘atd’ angle, ‘dat’ angle, ‘adt’ angle[Figure II].
Inclusion criteria :
2.Patients having periodontal clinical attachment loss more than 1mm 3.Patients willing to participate.
Exclusion criteria :
1.Patients with scars or any injury to digits.
2.Patients having any disability of the upper limb
3.Patients under any medication or having any systemic disease and contraindicated for oral examination.
Infection control :
The clinical examination was carried out using aseptic precautions. All the instruments were used once in a day and were autoclaved afterwards for the next time use. Disposable gloves and mouth mask were used for examination of all study participants.
Intervention :
A structured format was designed, for the collection of demographic data, detailed history of habits and medical history.[Annexure I] All the subjects had undergone clinical examination by a single calibrated examiner for presence of periodontitis lesion. Those having the lesions were allocated to the study group and those who did not have any signs and symptoms of periodontitis were allocated to the control group. This was followed by recording finger and palmar printing for all the patients.
Recording finger and palm print:
Palmar prints were taken by using standard ink method proposed by Strong AM23 , using blue duplicating ink (Kores India Limited, Mumbai), Thick bond paper (100 g/m2).[Figure III].
Apparatus and Materials:
Gloves, Mouth mask, Head cap, Kidney tray, Mouth mirror, Probe, CPITN probe, Tweezer, Cotton. Disinfectant, Koresindia ink pad, Thick white bond paper (100g/m2), Magnifying glass (6xs), divider, scale and compass.
Procedure:
The hands of the study participants were cleaned with soap and water and then scrubbed thoroughly with an antiseptic lotion and allowed to dry. This was done to enhance the quality of the dermatoglyphic prints, by removing sweat, oil or dirt from the skin surface. After this, right hand four digits were guided by the researcher to the ink stamp pad and pressed firmly against the bond paper (100 GSM). Then this was repeated for the thumb and palm of the same hand. The paper was stabilized on a hard smooth surface board. The same procedure was repeated for the left hand. The fingertip pattern configurations were categorized as arches, loops, whorls and palmar angles were categorized as ‘atd, dat, adt’. The dermatoglyphic patterns were analyzed with the help of a magnifying glass (6 xs). The finger and palmar prints were analyzed qualitatively and quantitatively for arches, loops, whorls finger print pattern and ‘atd, dat, adt’
palmar angles using explainCummins, Midlo and Penrose method.9,10
Data Analysis
Data was analyzed using IBM SPSS (statistical package for the social sciences) for windows, version 22.0 Armonk, NY: IBM corp. for the generation of descriptive and inferential statistics.
The statistically significant difference among groups was determined by the chi square test, students t test and the level of significance was set at p<0.05.
Figure- I finger print patterns
Figure-II Palmar ‘atd, dat,adt’ Angles
ANNEXURE I
Figure-III Recorded Finger and palm print of study participants by inkpad method
Results
Table- 1 Frequency Distribution of Tobacco usage among Control group and Periodontitis group
When we compared the frequencies of tobacco usage between the cases of periodontitis and controls significant difference was noted with respect to usage of tobacco, duration of tobacco use, frequency of smoking, form of tobacco intake, and form of smokeless tobacco intake (p<0.05).
Table-2 Comparison of Oral health behavior among Periodontitis group and Control group When we compared the frequencies of oral health behavior between the cases of periodontitis and controls significant differences was noted for brushing frequency and rating of overall oral health (p<0.05).
Table- 3 Comparison of CPI and LOA score among Periodontitis and Control group
When we compared the frequencies between the groups significant difference noted for CPI score healthy, presence of bleeding gums, presence of calculus presence of periodontal pocket of 4-5mm and 6mm or more and LOA 0f 0-3mm,4-5mm,6-8mm (p<0.05).
Table-4 Comparison of Finger print patterns among Periodontitis group and Control group When we compared the frequencies significant difference noted between the groups, there was significant increase in the whorl pattern among periodontitis group (55.8%), whereas in control group loop pattern (66.6%) was found to be significantly increased (p<0.05).
Table-5 Comparison of Palmar angles among Periodontitis group and Control group
When we compared the means significant difference noted between the groups for right hand and left hand palm ‘adt’ (p<0.05).
Table-1 Frequency of Tobacco usage Control group and Periodontitis group
Control group (N=30) N (%)
Periodontitis group (N=70) N (%)
Tobacco user Yes 24 (80) 31 (44.3)
No 6 (20) 39 (55.7)
Duration of 0-3 years 4 (13.3) 0 (0)
tobacco use 4-6 years 9 (30) 8 (11.4)
7-10 years 9 (30) 9 (12.9)
11-15 years 2 (6.7) 9 (12.9)
>15 years 0 (0) 5 (7.1)
Frequency of
smoking Non smoker 16 (53.3) 60 (85.7)
0-2/day 6 (20) 8 (11.4)
3-5/day 4 (13.3) 2 (2.9)
6-10/day 3 (10) 0 (0)
11-15/day 0(0) 0 (0)
>15/day 1 (3.3) 0 (0)
Form of tobacco intake
Chewing tobacco (smokeless)
9 (30) 21 (30)
Smoking 8 (26.7) 2 (2.9)
Both (smoked + smokeless)
6 (20) 8 (11.4)
None 7 (23.3) 39 (55.7)
Frequency of smokeless tobacco consumption
Not using 14 (46.7) 41 (58.6)
1-5 pouch 16 (53.3) 24 (34.3)
6-10 pouch 0 (0) 1 (1.4)
11-15 pouch 0 (0) 0 (0)
>15 pouch 0 (0) 4 (5.7)
Form of
smokeless tobacco intake
Not taking any 14 (46.7) 41 (58.6) Plain pan
masala
1 (3.3) 0 (0)
Arecanut 14 (46.7) 19 (27.1)
Tobacco 1 (3.3) 10 (14.3)
Table-2 Comparison of Oral health behavior among Periodontitis group and Control group
Periodontitis group N (%)
Control group N (%)
Chi square value
p Value
Frequency of
cleaning teeth Once a day 66 (94.3) 10 (33.3) 44.678 0.000*
Twice a day 4 (5.7) 11 (36.7)
2 or more
times a day 0 (0) 9 (30)
Aids used to
clean teeth Tooth brush 48 (68.6) 23 (76.7) 0.768 0.683
Finger 11 (15.7) 4 (13.3)
Chewstick 11 (15.7) 3 (10)
Any other 0 (0) 0 (0)
Use
toothpaste Yes 48 (68.6) 23 (76.7) 0.668 0.414
No 22 (31.4) 7 (23.3)
Rating of present oral health
Very poor 8 (11.4) 0 (0) 32.100 0.000*
Poor 27 (38.6) 2 (6.7)
Neither good nor bad
23 (32.9) 8 (26.7)
Good 12 (17.1) 14 (46.7)
Very good 0 (0) 6 (20)
Chi square value; p<0.05
Table-3 Comparison of CPI and LOA score among Periodontitis and Control group
Periodontitis group N (%)
Control group N (%)
Chi square value
p Value
CPI score
Healthy 23 (32.8) 26 (86.6) 40.247 0.000*
Bleeding 18 (25.7) 20 (66.6) 30.061 0.000*
Calculus 24 (34.2) 13 (43.3) 19.275 0.002*
Pocket 4-5mm 57 (81.4) 0 (0) 56.811 0.000*
Pocket 6mm or
more 47 (67.1) 0 (0) 100.00 0.000*
LOA score
LOA 0-3mm 63 (90) 30 (100) 100.00 0.000*
LOA 4-5mm 42 (60) 0 (0) 31.034 0.000*
LOA 6-8mm 70 (100) 0 (0) 100.00 0.000*
Chi square value; p<0.05
Table-4 Comparison of Finger print patterns among Periodontitis group and Control group
Periodontitis group N (%)
Control group N (%)
Chi square value
p Value
Total Arch pattern
29 (4.1) 17 (5.6) 8.317 0.081
Total Loop pattern
280 (40) 200 (66.6) 33.326 0.000*
Total Whorl pattern
391 (55.8) 83 (27.6) 32.755 0.000*
Chi square value; p<0.05
Table-5 Comparison of Palmar angles among Periodontitis group and Control group
Periodontitis group N (%)
Control group N (%)
p Value
MEAN+/-SD MEAN+/-SD
Right hand palm atd angle 43.61+/-5.54 45.33+/-3.71 0.124
Right hand palm dat angle 53.78+/-6.29 53.26+/-4.22 0.680
Right hand palm adt angle 78.38+/-5.45 81.20+/-4.96 0.017*
Left hand palm atd angle 42.31+/-5.54 45.00+/-3.87 0.127
Left hand palm dat angle 53.81+/-7.02 51.85+/-5.56 0.174
Left hand palm adt angle 78.94+/-6.20 81.46+/-4.36 0.046*
Students t-test; p<0.05
Discussions
The present case control study was carried out to explore the association and to assess the risk by dermatoglyphic patterns among patients of periodontitis visiting the Outpatient Department (OPD) of People’s College of Dental Sciences and Research Centre.
The present study consisted of a total sample size of 100 patients. A total of 30 patients were examined for control group and 70 patients were examined in periodontitis group. History of tobacco consumption and oral health behavior characteristics was assessed using a pre designed questionnaire and compared between the groups. CPI score, Loss of Attachment score was assessed and compared between the groups. Finger and palm print patterns was also assessed and compared between the groups.
In the present study there was significant increase in the whorl pattern among periodontitis group 55.8%. In control group loop pattern 66.6% was found to be significantly increased.adt angle was significantly increased in periodontitis group.
Our study was in accordance with Astekar S et al 11 who did study to evaluate and compare the dermatoglyphic patterns in controls and periodontally compromised patients reported in control group, there was significant increase in the loop pattern 59%, whereas in chronic periodontitis patients whorl pattern 48.34% was found to be significantly increased.Our study was also in accordance with Reddy H et al4 who conducted a study on dermatoglyphics and periodontal diseases-a possible relation for early prediction.Results obtained showed an increased frequency of whorls and ulnar loops were found on all fingers of patients with chronic periodontitis. Our study was also in accordance with Thaker M et al12 who conducted a study to compare the fingerprint patterns in generalized chronic periodontitis and generalized chronic gingivitis patients.Results obtained showed an increased frequency of radial loop pattern (40%) were found in generalized chronic gingivitis subject, whereas in generalized chronic periodontitis subjects showed higher frequency of ulnar loop (36.36%) and central pocket whorl pattern (35.27%).
Our study was consistent with Devishree G et al13 who conducted a study to compare the palmar dermatoglyphic features in aggressive periodontitis patients and periodontally healthy individuals..Results obtained showed an increased frequency of ulnar loops found on all fingers of patients with aggressive periodontitis.Our study was inconsistent with kocchar et al14 who found decreased frequency of loop pattern in periodontally compromised patients.Our study was inconsistent with one of the findings of aster et al11 who found increase in mean dat angle among periodontitis patients whereas in present study adt angle was significantly increased among periodontitis group.
clusion
1. Tobacco usage was found more in periodontitis group than control group.
2. Brushing frequency and overall health rating was more in control group than in periodontitis group.
3. Presence of bleeding gums was noticed in periodontitis group.
4. Presence of Whorl type of fingerprint pattern and Increase in adt angle found in our study would probably be served as a candidate screening marker for susceptibility to periodontitis in general population.
Dermatoglyphic patterns can be utilized to study the genetic basis of various oral diseases like oral cancer, oral submucous fibrosis, dental caries, periodontitis, malocclusion etc.
Dermatoglyphic patterns may represent the genetic makeup of an individual and therefore can be used as screening tool. Dermatoglyphics serves to strengthen the diagnostic impression of the disease and hence preventive oral health measures can be undertaken. The population at risk can be appropriately counseled and motivated to change the lifestyle and the frequency of developing dreaded diseases in later life may also be prevented.
Limitations of the study
1.To establish an association with dermatoglyphic patterns and periodontitis , observations should be made on a larger sample which is representative of entire population.
2.The recording of fingerprints was also dependent on the pliable nature of application of fingerprint pressure and the amount of ink applied which could lead to improper fingerprints.
3.The amount of spreading of the fingers when the patterns are recorded can also affect the palmar angles.
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