|Year : 2020 | Volume
| Issue : 1 | Page : 4-10
Association of ABO blood group with crowding among patients with different malocclusions
Akshi Rathi, Sanjeev Datana, Shiv Shankar Agarwal, SK Bhandari
Department of Dental Surgery and Oral Health Sciences, AFMC, Pune, Maharashtra, India
|Date of Submission||17-Dec-2019|
|Date of Acceptance||19-Dec-2019|
|Date of Web Publication||31-Jan-2020|
Department of Dental Surgery and Oral Health Sciences, AFMC, Pune - 411 040, Maharashtra
Source of Support: None, Conflict of Interest: None
Introduction: This study correlated ABO blood groups and crowding in the lower anterior region and also to find an interrelationship between ABO blood grouping system and sagittal relation of the jaws.
Materials and Methods: The sample size consisted of 138 Maharashtrian patients (60 males and 78 females) age range from 12 to 30 years which were randomly selected. Each patient's records comprised: a lateral cephalometric head film, photographs, and dental casts as standard pretreatment records. Based on ANB angles, patients were divided into Group-1: ANB 1–3° (51 individuals with 27 males and 24 females), Group-2: ANB >3° (60 individuals with 24 males and 36 females), and Group-3: ANB <1° (27 individuals with 9 males and 18 females). These groups were further divided into five subgroups on the basis of lower incisor crowding.
Results: The mean ± standard deviation of age in Group 1, Group 2, and Group 3 was 16.53 ± 2.43 years, 17.60 ± 3.73 years, and 18.67 ± 3.28 years, respectively. The gender distribution of cases studied did not differ significantly across three study groups. The distribution of median ANB did not differ significantly across various blood groups in the study group. The blood group distribution of cases studied did not differ significantly across three study groups. The distribution of Little's index differs significantly across perfect alignment and minimal irregularity as well as between minimal irregularity and moderate irregularity. The distribution of Little's index did not differ significantly between perfect alignment and moderate irregularity.
Conclusions: The occurrence of blood group B+ was more in Class I and II skeletal patterns whereas in Class III skeletal pattern individuals have more prevalence of blood group A+. ABO blood groups and Little's Irregularity Index for crowding is found to be correlated between perfect alignment and minimal irregularity individuals as well as between minimal and moderate irregularity subjects.
Keywords: ABO blood groups, Little's Irregularity Index, sagittal jaw relationship
|How to cite this article:|
Rathi A, Datana S, Agarwal SS, Bhandari S K. Association of ABO blood group with crowding among patients with different malocclusions. J Dent Def Sect. 2020;14:4-10
|How to cite this URL:|
Rathi A, Datana S, Agarwal SS, Bhandari S K. Association of ABO blood group with crowding among patients with different malocclusions. J Dent Def Sect. [serial online] 2020 [cited 2020 Sep 25];14:4-10. Available from: http://www.journaldds.org/text.asp?2020/14/1/4/276407
| Introduction|| |
Functional contact during chewing or at rest or relationship of the maxillary and mandibular teeth together as they approximate each other is defined as normal occlusion, whereas the condition of any deviation from this normal or ideal occlusal state is termed as malocclusion. The incorrect relationship between the teeth when they contact each other as the jaws close or misalignment of the two different dental arches is defined as malocclusion, this deviation from the ideal occlusion which is regarded as esthetically unsatisfactory and unacceptable implies a state of disharmony and misbalance within the relative sizes and position of teeth, jaws, facial structure, and soft tissues enveloping the face and oral cavity (tongue, lip, and cheek).
Due to the consumption of soft diet, deficiency of growth induction or the lack of proximal attrition of teeth which can lead to well-aligned arches, are considered common enemies in modern society for the development of malocclusion. This morphologic deviation of the biophysical environment which has been derived from acceptable norms for humans is dental malocclusion. Genetic and environmental factors which relatively influence onto the etiology of malocclusion have been a topic of discussion, debate, and controversy in the orthodontic literature.
A multifactorial origin has been attributed to malocclusion and a single specific cause cannot be pinpointed. Factors leading to malocclusion can be general or local. Among the general factors, genetic and hereditary components, nutritional deficiencies, systemic diseases, and abnormal pressure habits have been identified. In case of local factors, the presence of supernumerary teeth delayed exfoliation or eruption of primary dentition, delayed eruption of permanent dentition, premature loss of primary teeth, and carious teeth have been considered. Indeed, a significant role of genetics has been seen in factors causing malocclusion.
In 2011, Ting et al. suggested an association for the genes EDA and XEDAR in dental crowding present in Class I patients that were significantly different in a genotype or allele frequency distribution in the Chinese population. Epidemiological studies have also revealed relationships between dental malocclusion and some genetic characteristics or accompanied diseases, which will help to identify and manage these conditions effectively. Considering genetic characteristics, the relationship between the ABO blood group system and some oral diseases such as malocclusions has been documented.
Landsteiner in 1901, was the first person to explain the presence of variation in serology between individuals (in 1930 he received a Nobel Prize and in 1940 along with Weiner; he discovered Rhesus system), and classified them into four groups depending on whether their RBC cell membrane composed of agglutinogen (antigens). One of the most important and commonly used blood-typing systems, the ABO system, consists of four blood variants: A, B, AB, and O. Blood group O erythrocytes bear no antigens, but blood serum has antibodies to both A and B antigens. Type A and B erythrocytes have A and B antigens, respectively, and produce antibodies against each other. Type AB erythrocytes do not produce antibodies to other blood types due to which they have both A and B antigens.
Epidemiology of the ABO system is complex worldwide. Variations may appear to happen in various regions within one small country. Racial variation in the blood group distribution also manifests. Studies done in Iraq have detected that the O blood type was more common followed by blood type B and A, and the least dominant was AB.,
On literature evaluation, Weber and Pastern. suggested the association of ABO blood group and periodontal disease. Kaslick et al. studied the correlation of aggressive periodontitis and ABO blood group. They observed a significantly reduced incidence in patients with blood group O and increased in patients with blood group B.
Keeping these factors in mind, this study was designed with the aim of studying the correlation between ABO blood groups and crowding in the lower anterior region and also to find an inter-relationship between ABO blood grouping system and sagittal relation of the jaws.
| Materials and Methods|| |
The data for this study were gathered from the archives of the Department of Orthodontics and Dentofacial Orthopaedics of a tertiary care hospital at Pune (Maharashtra). The data were collected from patients selected for orthodontic treatment. Sample size estimation was done using statistical analysis.
The sample size consisted of 138 Maharashtrian patients (60 males and 78 females) age range from 12 to 30 years, which were randomly selected. Each patient was examined, and the records comprised: a lateral cephalometric head film, photographs, and dental casts which were taken as standard pretreatment records for orthodontic treatment.
Patients who have or had any systemic disease, for example, acute or chronic inflammatory or autoimmune diseases were not included in the sample. Those who presented with a history of trauma to the primary or permanent dentition or any form of previous orthodontic treatment and also, patients with a history of smoking or steroidal and nonsteroidal anti-inflammatory drugs were excluded cases. Moreover, patients with oral mucosal lesions, periodontal diseases, root resorption, periapical lesions, or active caries, and missing molars or retained deciduous teeth were not considered in this study.
Information regarding the blood group was obtained from the medical case sheet of the patient.
Based on ANB angles, patients were divided into:
- Group-1: ANB 1–3° (51 individuals with 27 males and 24 females)
- Group-2: ANB >3° (60 individuals with 24 males and 36 females)
- Group-3: ANB <1° (27 individuals with 9 males and 18 females).
Further, these groups were divided based on the amount of lower incisor crowding into five subgroups. Little proposed the irregularity index as a quantitative method, which was used in this study for assessing lower anterior crowding. For the purpose of measuring, linear displacement of the anatomic contact points of the six anterior teeth was calculated. Index interprets:
- 0 – Perfect alignment (Sub Group 1)
- l-3 – Minimal irregularity (Sub Group 2)
- 4-6 – Moderate irregularity (Sub Group 3)
- 7-9 – Severe irregularity (Sub Group 4)
- 10 – Very severe irregularity (Sub Group 5).
The whole data were collected, compiled, and subjected to statistical analysis.
The data on normally distributed continuous variables are presented as Mean and Standard deviation (SD) and data on categorical variables are shown as n (% of cases) across three study groups. The data on nonnormally distributed continuous variables are presented as median along with min–max range. Chi-square test was used to statistically compare the variables across the study sample. Comparison among means of continuous variables was made using ANOVA with Bonferroni's correction when considering multiple group comparisons. Kruskal–Wallis H-test was used for comparing medians of continuous variables.
| Results|| |
The mean ± SD of age in Group 1, Group 2, and Group 3 was 16.53 ± 2.43 years, 17.60 ± 3.73 years, and 18.67 ± 3.28 years, respectively. The distribution of the mean age of cases studied did not differ significantly across three study groups (P > 0.05) [Table 1] and [Figure 1]. On compiling the data and segregating it into the desired subgroups, it was observed that there were no individuals pertaining to subgroups 4 and 5.
Of 51 cases in Group 1, 27 (52.9%) were male and 24 (47.1%) were female. Of 60 cases in Group 2, 24 (40.0%) were male and 36 (60.0%) were female. Of 27 cases in Group 3, 9 (33.3%) were male and 18 (66.7%) were female. The gender distribution of cases studied did not differ significantly across three study groups (P > 0.05) [Table 2] and [Figure 2].
The distribution of median Little's index did not differ significantly across three study groups (P > 0.05 for all). The distribution of median ANB differs is significantly across three study groups (P < 0.001 for all) [Table 3] and [Figure 3], [Figure 4].
|Table 3: Inter-group comparison of medians of several skeletal measurements studied|
Click here to view
The blood group distribution of cases studied did not differ significantly between the group of male and female cases studied (P > 0.05) [Table 4] and [Figure 5].
The distribution of median ANB did not differ significantly across various blood groups in the study group (P > 0.05) [Table 5] and [Figure 6].
Of 51 cases in Group 1, majority of cases had blood group B+ (18 cases, 35.3%). Of 60 cases in Group 2, majority of cases had blood group B+ (33 cases, 55.0%). Of 27 cases in Group 3, majority of cases had blood group A+ (12 cases, 44.4%). The blood group distribution of cases studied did not differ significantly across three study groups (P > 0.05) [Table 6] and [Figure 7].
Of 15 cases in perfect alignment group, majority of cases had blood group O+ (9 cases, 60%). Of 96 cases in minimal irregularity, majority of cases had blood group B+ (51 cases, 53%). Of 24 cases in moderate irregularity, majority of cases had blood group B+, AB+ (9 cases, 38%). The distribution of Little's index differs significantly across perfect alignment and minimal irregularity as well as between minimal irregularity and moderate irregularity (P < 0.05). The distribution of Little's index did not differ significantly between perfect alignment and moderate irregularity (P > 0.05) [Table 7].
|Table 7: Intergroup distribution of blood group with little's index of cases studied|
Click here to view
Distribution of the blood groups and Little's Irregularity Index in all the three groups show maximum distribution with respect to minimal irregularity subgroup [Table 8], [Table 9], [Table 10].
|Table 8: Inter-sub group distribution of blood group with little's index of cases studied|
Click here to view
|Table 9: Inter-sub group distribution of blood group with little's index of cases studied|
Click here to view
|Table 10: Inter-sub group distribution of blood group with little's index of cases studied|
Click here to view
| Discussion|| |
Dental anomalies in orthodontics can vary from a single tooth crossbite to scissors bite seen in between the arches. Such anomalies are either genetically or environmentally or functionally determined. Studies have been reported, suggesting the role of genes in causing dental malocclusions. Decrease in arch size in relation to teeth and increase of tooth size with respect to jaw size are attributed to be passed from both parents independently. In general, the characteristics of this nature can cause crowding in the individual.
Blood grouping system has been found to be an important factor in determining what kind of disease we might come across during the diagnosis. Such predictions are more frequently done in medicine because of the vast research which has been done in this direction., A requirement for such research and studies in dentistry will help us in predicting certain anomalies or diseases and also help patients in preventing as well as treating them properly.
Certain studies have already associated ABO blood grouping with periodontitis, malocclusion prevalence and even with maxillofacial deformities.,,, A study done by Rahman et al. concluded that individuals with blood group O have more risk of developing oral squamous cell carcinoma. In 2018, Alam and Rahman suggested a genetic influence of dental anomalies like overbite, overjet to be associated with ABO blood groups. Kaslick et al. found the O+ blood group to be less associated with periodontitis than blood group B+ which showed a high prevalence. Roberts related chronic diseases as genetically determined when compared with ABO blood grouping system. Koregol concluded in his study that gingivitis was more prevalent in blood group A, whereas blood group O was more prevalent in the periodontitis group.
In orthodontics, a study done by Al-Khatieeb was concluded saying that the occurrence of malocclusion was seen more in O+ blood group and the AB-blood group was the least percentage found in individuals. They did not find any significant correlation of blood groups and the sagittal relationship of the jaws. The results of this study were in comparison to our study. We also could not find a significant association between blood groups and sagittal inter jaw relations. We had found blood group B+ to be more prevalent when considering groups 1 and 2, whereas A+ blood group was more in group 3. Furthermore, in correlating various blood groups, it was observed that blood group B was more associated with maxillofacial deformities as compared to blood group A as shown by a study done by Gheisari et al.
Even studies done on gender-wise association between ABO blood grouping system and malocclusion had inferred that there was the prevalence of genetic association among males and females and blood groups, but this is in contradiction with the results of our study which have revealed that gender distribution in all the three groups was not statistically significant when they are associated with ABO blood groups.
In our study, blood groups did not differ significantly between the three study groups. Even the little's index is not statistically significant within the groups but on correlating blood groups and Little's Irregularity Index for crowding we found statistical significant difference between perfect alignment and minimal irregularity group as well as between minimal and moderate irregularity group. We found that O+ blood group more associated with the perfect alignment group, also, the prevalence of B+ blood group with the highest percentage and B-blood group shows the least prevalence in individuals with minimal irregularity groups. On observing the moderate irregularity group, we could infer that B+ and AB+ blood group has the maximum prevalence. All these results do not comprehend with results concluded by Alam and Rahman, who had suggested that no correlation was found in crowding on associating it with blood groups.
| Conclusions|| |
In the present study, the occurrence of blood group B+ was more in Class I (35.3%) and II (55%) skeletal patterns individuals, whereas in class III skeletal pattern, individuals have more prevalence of blood group A+ (44.4%). However, no interrelationship between the ABO blood grouping system and the sagittal relationship of the jaws could be derived.
Individuals with O+ blood group has more or less perfect alignment, also, the B+ blood group is more prevalent in minimal irregularity cases. In the case of moderate irregularity in the lower arch, B+ and AB+ blood group has the maximum prevalence. ABO blood groups and Little's Irregularity Index for crowding is found to be correlated between perfect alignment and minimal irregularity individuals as well as between minimal and moderate irregularity subjects.
No gender differences could be observed in the study sample.
Studies with a larger sample size are required to validate the findings of this study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Daskalogiannakis J, editor. Glossary of Orthodontic Terms. Germany: Quintessence Books, 2000.
Houston, William JB. A Textbook of Orthodontics. Oxford, Boston: Butterworth-Heinemann, 1992.
Goyal S, Goyal S. Pattern of dental malocclusion in orthodontic patients in Rwanda: A retrospective hospital-based study. Rwanda Med J 2012;69:13-8.
Flannery PM, Michael P. The ABO human blood groups and skeletal class III malocclusions. Loyola University, Master Thesis; 1969.
Mossey PA. The heritability of malocclusion: Part 2. The influence of genetics in malocclusion. Br J Orthod 1999;26:195-203.
Ting TY, Wong RW, Rabie AB. Analysis of genetic polymorphisms in skeletal class I crowding. Am J Orthod Dentofacial Orthop 2011;140:e9-15.
Sharma R. Association of ABO blood groups with malocclusion in population of Jaipur, India: A prospective study. Int J Sci Study 2015;2:45-51.
Landsteiner K. Uber agglutinationserscheinungen normalen menschlichen blutes. Wiener Klinische Wochenschrift 1901;14:1132-4.
Skripal IG. ABO system of blood groups in people and their resistance to certain infectious diseases (prognosis). Mikrobiol Z 1996;58:102-8.
Kolmakova GN, Kononova LL. The prevalence of ABO blood groups among persons of native nationality in Buryatia. Sud Med Ekspert 1999;42:15-6.
Halm S. Frequency distribution of ABO blood groups and Rh phenotypes of blood donors in Babylon Governorate-Iraq. University of Babylon, PhD Thesis; 2007.
Taha JY. Frequency of various Rh antigens in Basarah province, Iraq. Med J Basrah Univ 2005;23:53-5.
Weber R, Pastern W. Uber die Frage der konstitutionellen Bereitschaft zur sog Alveolar-pyorrhoe. Dtsch Mschr Zahnerlk 1927;45:704-9.
Kaslick RS, Chasens AI, Tuckman MA, Kaufman B. Investigation of periodontosis with periodontitis: Literature survey and findings based on ABO blood groups. J Periodontol 1971;42:420-7.
Steiner CC. Cephalometrics for you and me. Am J Orthod 1953;39:729-36.
Little RM. The irregularity index: A quantitative score of mandibular anterior alignment. Am J Orthod 1975;68:554-63.
Akhund IA, Alvi IA, Ansari AK, Mughal MA, Akhund AA. A study of relationship of ABO blood groups with myocardial infarction and angina pectoris. J Ayub Med Coll Abbottabad 2001;13:25-6.
Wolpin BM, Kraft P, Gross M, Helzlsouer K, Bueno-de-Mesquita HB, Steplowski E, et al
. Pancreatic cancer risk and ABO blood group alleles: Results from the pancreatic cancer cohort consortium. Cancer Res 2010;70:1015-23.
Rahman WS, Jalaludin NK, Ilyas N, Alam MK. The prevalence of ABO blood group in oral squamous cell carcinoma. Int Med J 2016;23:186-8.
Alam MK, Rahman WS. Dental anomalies with genetic influence of ABO blood group in Malaysian orthodontic patients. Int Med J 2018;25:9-14.
Roberts JA. Blood groups and susceptibility to disease: A review. Br J Prev Soc Med 1957;11:107-25.
Koregol AC, Raghavendra M, Nainegali S, Kalburgi N, Varma S. ABO blood groups and rhesus factor: An exploring link to periodontal diseases. Indian J Dent Res 2010;21:364-8.
] [Full text]
Al-Khatieeb MM, Al-Joubori SK, Taha SS. Association of ABO blood group and rhesus factor with dental malocclusion in a population of Baghdad Iraq. Int J Med Res Hea Sci 2018;7:165-9.
Gheisari R, Ghoreishian M, Movahedian B, Roozbehi A. The association between blood groups and maxillofacial deformities. Indian J Plast Surg 2008;41:138-40.
] [Full text]
Tariq B, Habib K, Riaz S, Ilyas M. Gender wise association between dental malocclusion classes and ABO blood group system. Dentistry 2019;9:4-8.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10]