Correlation between dermatoglyphics and dental caries in children: A case-control study.

BACKGROUND: Dental caries is a microbiological disease affecting teeth which has both genetic as well as environmental factors. Dermatoglyphics is the study of fingerprint patterns and is also genetically determined. This study is aimed to determine a correlation between dermatoglyphic patterns and caries susceptibility among children.
METHODS: A total of 250 children (125 each of case and control groups) were selected. Dental caries status was evaluated using the DMFT index while dermatoglyphic study was performed by recording impressions using stamp pad-ink method.
RESULTS: Higher frequency of all dermatoglyphic patterns was observed among female subjects with caries as compared to caries-free subjects as well as compared to male subjects.
CONCLUSION: Dermatoglyphics can be employed as a positive indicator of caries susceptibility among children and holds importance in the area as future caries predictor. Copyright:

Introduction

Dental caries is considered to bear a multi-etiological basis wherein both environment and genetics play an important part.[1] Cummins and Midlo in 1926 coined the term “Dermatoglyphics” (Gr. derma; skin, carve; carving). Failure of nerve shoots to grow into the epithelium is manifested as dermatoglyphic aplasia.[2]

Dermatoglyphics is the “study of dermal ridge patterns on volar surfaces of fingers, palms, and soles.” Formation of ridges initiates in 13th week of prenatal life, while the formation of patterns is completed by 19th weeks of development. The formation of ridge is influenced by neurovascular bundles present between epidermis and dermis during prenatal development while the ridge patterns are influenced by inadequate oxygenation, unusual sweat gland distribution, and epidermal growth alterations. These ridges are indicators of intrauterine dental abnormalities in sixth to seventh week of development. Individuals with plain loop, double loop, whorled arch, tented arch, and central pocket loop have demonstrated dental caries susceptibility. Any deviation in dermatoglyphic patterns is indicative of dental caries susceptibility.[3]

Gallon in 1892 classified ridge patterns of distal phalanges into three basic types: whorls, loops, and arches. A) Arch pattern: This constitutes the simplest form of pattern. Types of arch patterns include: i) Simple or plain arch pattern: This comprises of ridges crossing fingertips from one to another side without curving; ii) Tented arch pattern: This pattern is characterized by a point of confluence termed as “triradius” as the ridges radiate from this point to three directions. This triradius is localized near midline axis of distal phalanx; B) Loop pattern: It is the most common ridge pattern. In this, ridges enter on one side, undergo abrupt recurve, and leave on the same side. If the ridge opening is on ulnar side, the loop is called “ulnar loop”; if it opens on a radial side, it is called “radial loop.” The triradius is laterally located on one side where loop has closed end. These may vary in size and shape or may be plain or double loops; C) whorls: This pattern contains two or more triradii. Henry in 1973 used the “whorl” for ridged encircling core. He designated more complex patterns as “composites.” The “concentric whorl pattern” is arranged as succession of concentric elliptical rings. “Double or spiral whorl pattern” is seen as spirals around a core either in clockwise or anti-clockwise direction. Complex patterns comprised of triradii and whorls are termed as “Accidentals.” Sometimes, configurations composed of loop or whorl or triple loops can also be classified as “Arch with loop” and “Arch with whorl.”[2]

The dermatoglyphics also plays an important role in forensic sciences and is used to identify unknown fingerprints of individuals. Three types of fingerprints are technically studied in addition to morphological types such as plastic impressions (made in soft material like butter, soap, etc.), visible prints (prints made when fingers have been covered in blood, dirt, oil, paint, etc.), and latent prints (prints not visible to the human eye, hidden, unseen until treated). Automated fingerprint identification system scan is used in various setups. Fingerprints are put into a computer database, which transforms them into digital minutiae. This is then used to identify unknown prints with several possible matches. In the end, a technician still makes the final ID of the unknown to the known print.[4]

Data pertaining to dermatoglyphics can be used to study genetic predisposition of few diseases including dental caries.[1]

This study aimed toward determining a correlation between the dermatoglyphic patterns and dental caries prevalence in primary dentition bearing children.

Materials and Methods

This was a case-control study comprising of 250 primary dentition bearing children who were selected based upon the following exclusion criteria: 1) absence of digits, 2) genetic disorders, 3) subjects undergoing chemotherapy, 4) mentally or physically handicapped subjects, 5) subjects with skin disorders, 6) trauma to finger-tips, and 7) uncooperative children. The study protocol was approved from institutional ethical committee on 07/03/19. Of these, 125 subjects belonged to case study group (with dental caries) while control group (caries-free) also comprised of 125 subjects. Prior to data collection, informed written consent was obtained after explaining the study. Clinical oral examination was performed using mouth mirror and probe. The caries status was recorded as DMFT index score.

For recording fingerprints, the method employed by Sanghavi et al. (2016) was used.[5] Prior to recording fingerprint patterns, hands were washed using soap and water and allowed to air-dry. Following this, the fingers were pressed onto inked stamp-pad and uniform pressure was applied by using a roller. Print patterns were recorded on an A4-sized white paper.

Finger-prints of all five digits were made using a stamp paper and ink on an A4-sized white sheet. These prints were studied using magnifying lens. The fingerprints were analyzed as per standard classification. Fingerprint patterns were classified as: a) whorl pattern, b) loop pattern, subclassified into i) ulnar and ii) radial loops, and c) arch pattern, which was subdivided into i) plain and ii) tented arch patterns. Other patterns were double loop whorls, central pocket whorls, and accidental whorls [Figure 1].

Figure 1

Different fingerprint patterns

Data obtained was recorded in Microsoft Excel Worksheet and statistical analysis was performed using “T-test.” A P value of < 0.05 was considered to be significant.

Results

Distribution of dermatoglyphic patterns and dental caries was noted as a) dental caries and whorl patterns; b) dental caries and loop patterns; c) dental caries and arch patterns; d) dental caries and accidental pattern; e) dental caries and double loop whorls; and f) dental caries and central pocket whorl patterns [Graph 1]. All female subjects showed a higher distribution of fingerprint patterns among females than male subjects [Table 1].

Graph 1

Graph depicting dermatoglyphic pattern distribution among study and control groups

Table 1

Dermatoglyphic patterns’ distribution in carious and caries-free children

Fingerprint patterns	Caries-free (Control) group		Caries group
	Males	Females	Males	Females
Plain arch	01	02	02	14
Tented arch	05	07	05	16
Ulnar loop	25	30	05	16
Radial loop	17	25	25	35
Double loop whorls	02	05	05	55
Plain whorls	23	25	25	40
Central pocket whorl	10	20	08	12
Accidental	27	26	09	15
Total numbers	110	140	90	160

Discussion

Dental caries is a multi-factorial oral disease which is characterized by demineralization of inorganic and destruction of organic contents of teeth.[6]

Fingerprints are unique to an individual because they are genetic characteristics of growth and are tailored individually.[7] Genetically regulated processes that influence dental caries include enamel structure, eruption, morphology of teeth, salivary composition and flow, and immune response.[8] The genetic basis of dental caries has been proven by twin studies on caries susceptibility and studies on inherited enamel variations.[9]

The first appearance of epidermal ridges takes place at approximately 10th to 11th week of gestation which represents localized epithelial proliferations. This was first described by William J Babler in 1976. Characteristic ridge patterns’ formation takes place during primary ridge formation. At around 14 weeks, this primary ridge formation ceases while secondary ridges start to form at around 14 weeks of intrauterine development.[8] Secondary ridges are modified sebaceous glands on apex of primary ridges located at fixed intervals. Thus, dermatoglyphics is now considered to be an important tool in understanding diseases with genetic backdrop.[10] These fingerprint patterns after completion remain unaffected by environmental factors, thus establishing their role as an ideal identification marker. Genetic disorders with proven association with dermatoglyphics include cleft lip and/or palate, hereditary ectodermal dysplasia, malocclusion, bruxism, and Ellis–Van Creveld syndrome.[11] Dermatoglyphics has been considered to be “window of congenital abnormalities” and is an indicator of both dental and systemic intrauterine abnormalities.[12] Traditionally, dermatoglyphics plays a significant role in forensics by aiding in an individual's identification. Recently, it has found its usage in Dentistry due to association with diseases such as periodontitis, Down's syndrome, dental caries, malocclusion, etc.[1314]

There are three types of finger-print patterns: a) Visible prints: These are also known as “patent prints” as they are visible to naked eye; b) Latent prints: These are not apparent to the naked eye and are made visible by dusting or uses of fuming and chemical agents; and c) Plastic or impressed prints: These prints are indentations left upon soft and pliable surfaces like wax, clay, etc., These are visible to naked eye as well.[8] As per FBI identification division of 1957, fingerprints are of the following types:[15]

Arch pattern: It is found in approximately 5% of general population. It can be subclassified into a) Type 1: Plain arch and b) Tented arch.[15]

Loop pattern: It is found in approximately 70% of total population. This can be subclassified into a) Type 1: Ulnar and b) Type 2: Radial loop pattern.[15]

Whorl pattern: It is seen in 25% of population. It can be subclassified into a) Type 1: Double loop pattern; b) Type 2: Plain; c) Type 3: Central pocket; and d) Type 4: Accidental patterns.[15]

There are three landmarks in fingerprint patterns: a) Triradii, b) Cores, and c) Radiant.[2]

Triradii: This is formed by meeting of three ridge systems, the center of which is termed as “triradial point” with an approximate angulation of 120°.

Core: This forms the center of a pattern and is of two types: i) In loop pattern: The core is represented by straight ridge or two or more parallel ridges and b) In whorl pattern: The center looks like a lot or a circle or and ellipse.

Radiant: These are formed by ridges moving outwards from triradius.

Methods used in recording fingerprint patterns include[15]

Ink method: This is the most commonly used technique which uses an inking slab, paper, ink, and roller.

Farrot inkless method: In this method, a commercially available patented solution and a special paper are used.

Transparent adhesive tape method: Herein, a fingerprint is recorded by application of dry colored pigment and lifting the print using a transparent adhesive tape. These pigments may be carbon paper, carbon or India ink, powdered graphite, etc.[15]

Photographic technique: This technique is based upon utilization of total internal reflection obtained by pressing an object over prism surface. The image magnification is then photographed using a polarized camera.

Biometrics: This method uses automatic machines for scanning fingerprints and recording them.[16]

In addition, there are other special techniques such as radiodermatography (here, the correlation between print pattern and underlying bone is assessed) and hygrophotography (it is the study of pores).

There are certain limitations in studying fingerprint patterns, i.e. 1) Good quality ink has to be used for interpretation of prints, 2) Adequate quantity of ink should be dispensed for uniform ink recording, and 3) Malformations in fingers or extremities can affect proper print pattern recording.[16]

Metin Atasu in 1992 compared dermatoglyphic patterns between caries-free and caries affected students and found that those with caries had more whorl pattern as compared to caries-free students who had more of ulnar loop pattern.[1718] Ahmed et al. found ulnar loop patterns more frequently in caries-free group while the whorl pattern was most common in carious subjects.[19] Sharma and Somani also observed an increased frequency of ulnar loops in caries-free children.[20]

Sharma et al. demonstrated the prevalence of whorl pattern in caries subjects while the loop pattern was more seen in caries-free subjects. The whorl pattern showed a significant correlation with S. mutans (P = 0.4) and Lactobacilli (P = 0.015) counts in the caries group. It was also established by this study that more than four numbers of whorls were a moderate while less than six number of loops carried good caries prediction.[21]

Shetty et al. conducted a study on 168 students to evaluate the association between dermatoglyphics, dental caries, and oral hygiene status. A statistically significant association was seen between the dermatoglyphics and dental caries experience (P < 0.05). Loop pattern was associated with high DMFT score. Individuals with arch pattern were found to be caries-free. Association of dermatoglyphics with plaque index scores did not reveal statistically significant results.[22]

Asif et al. evaluated dermatoglyphics in 400 deaf and mute children with or without caries. They found that the arch pattern was most commonly found though it was statistically nonsignificant. Among females of both study groups, arch pattern was the most common followed by loop while among males, arch pattern was more frequent in caries-free group while in caries group, arch pattern was most commonly reported followed by loop pattern.[23]

Veeresh recorded the DMFT (decayed, missing, filled teeth) score of 300 female subjects within the age group of 18–25 years and accordingly divided into 3 groups of 100 each: group 1 (DMFT score = 0), group 2 (DMFT score <5), and group 3 (DMFT score ≥5). The mean salivary pH was least in group 3. It was evaluated that the predominant dermatoglyphic pattern observed in groups 1 and 2 was loop pattern, whereas, in group 3, whorl pattern was predominant.[24]

A study conducted by Navit et al. in early childhood caries showed that the “whorl” finger-print pattern was more prevalent in caries-free children and the subjects with early childhood caries did not demonstrate a significant predilection for any one of the ridge patterns.[6] Thakker et al. showed a statistically significant increase in whorl frequency in children with dental caries experience.[25] Anitha et al. concluded that an increase in ulnar loops in caries-free and whorls in children with dental caries.[26]

Sengupta et al. in their study on 200 children diagnosed with dental caries and 100 without dental caries showed that among male subjects, a significant decrease in whorl pattern was seen in non-carious; however, opposite was observed among female subjects. In females, significantly less numbers of ulnar loops were seen in caries group, while no statistically significant observation was seen among male subjects.[27]

Archana et al. reported whorl pattern in 50.8%, ulnar loop in 45.2%, radial loop in 3.2%, and arch pattern in 0.8% in dentulous subjects, while in edentulous subjects, an overall reduction in ridge pattern was seen as whorl (49.8%), ulnar loops (37.4%), and radial loops (2.8%) while arch pattern increased to 10%.[28]

Srilatha et al. showed significant as well as a positive correlation of dental caries with S. mutans, while ulnar loops and total ridge count demonstrated negative correlation.[29]

Chinmaya et al. showed a higher prevalence of dental caries in subjects with whorl pattern with comparison to other patterns, while subjects with loop pattern demonstrated lowest dental caries prevalence. This was found to be statistically significant (P < 0.05). The whorl pattern subtypes of central pocket whorl along with terminal loop showed maximum caries prevalence.[30]

Erkwatehy and Sheta reported an increase in whorl frequency and reduction in loop frequency in caries group on comparison with caries-free group.[31]

Sanghavi et al. also observed high whorl pattern numbers in carious subjects, while a greater numbers of loop pattern was seen in caries-free subjects.[5]

Nallanchakrava et al. in their dermatoglyphic analysis in specially-abled subjects with dental caries found a higher number of “loop patterns” when compared to control group.[32]

Upadhyaya et al. concluded in their study more frequency of whorls in caries group than in caries-free group. The loop and arch patterns were more frequent in caries-free subjects than in control group.[33] Deepti et al. reported that the loop pattern was most prevalent in subjects with dental caries followed by whorl pattern, while the ulnar loop pattern was common in both caries—positive as well as control subjects.[34] In addition, Sharma and Somani demonstrated a higher prevalence of loop pattern in caries-free subjects than in subjects with dental caries.[35]

Implications for Clinical Practice

Dermatoglyphics has proven to be a very useful, noninvasive, and economical tool for the preliminary diagnosis of diseases of suspected genetic origin like dental caries. An association of dermatoglyphics and dental caries may be helpful in identifying the possible genetic predisposition and early prediction of dental caries in children, so as to initiate oral health measures at an early stage.[36] Both dermatoglyphics and dental caries are genetically determined diseases; hence, studies on their correlation have been focused upon so as to ascertain it as a positive indicator of disease. This paper adds data on dental caries prevalence and dermatoglyphic pattern among pediatric subjects. Although there is some contradictory data available, the evidence of such makes it more the reason why such studies should be carried out.[37]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patients have given their consent for their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.