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ORIGINAL ARTICLE
Year : 2013  |  Volume : 31  |  Issue : 4  |  Page : 260-264
 

Comparison of dermatoglyphic traits and dental anomalies associated with cleft lip or cleft lip and palate patients with normal healthy children


1 Department of Pedodontics and Preventive Dentistry, SGT Dental College, Hospital and Research Institute, Budhera, Gurgaon, Haryana, India
2 Department of Oral and Maxillofacial Surgery, SGT Dental College, Hospital and Research Institute, Budhera, Gurgaon, Haryana, India

Date of Web Publication21-Nov-2013

Correspondence Address:
Kalpana Bansal
Department of Pedodontics and Preventive Dentistry, SGT Dental College, Hospital and Research Institute, Farukhnagar Road, Budhera - 122 505, Gurgaon, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-4388.121829

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   Abstract 

Background: Dermatoglyphics are considered as a window of congenital abnormalities and is known to be one of the best available diagnostic tools in genetic disorders. Objective: The present study was conducted to observe and compare the differences in the dermatoglyphic patterns between cleft lip/palate (CL/P) and normal healthy children and evaluate their associated dental findings. Setting: This is a cross-sectional prevalence study in which dermatoglyphic patterns and dental anomalies of 90 (CL/P) and normal healthy children aged 0-15 years were recorded under standard conditions of seating and lighting. Materials and Methods: Dermatoglyphic traits were recorded using ink stamp pad method. Dental findings were recorded through clinical and radiographic examination. Results: The most frequently seen dermatoglyphic trait in the study and control group was loops followed by whorls and arches. A highly significant (P < 0.001) difference between loops in the study and control group and statistically significant difference in the whorls (P = 0.001) were found using Student's t-test. The comparison of dental anomalies was accomplished using Chi-square test and hypodontia (50%) was seen maximum in cleft patients. Conclusion: Any deviation in dermatoglyphics features indicates a genetic etiology.


Keywords: Cleft lip and palate, dental anomalies, dermatoglyphics


How to cite this article:
Maheshwari N, Bansal K, Rao DJ, Chopra R. Comparison of dermatoglyphic traits and dental anomalies associated with cleft lip or cleft lip and palate patients with normal healthy children. J Indian Soc Pedod Prev Dent 2013;31:260-4

How to cite this URL:
Maheshwari N, Bansal K, Rao DJ, Chopra R. Comparison of dermatoglyphic traits and dental anomalies associated with cleft lip or cleft lip and palate patients with normal healthy children. J Indian Soc Pedod Prev Dent [serial online] 2013 [cited 2019 Aug 25];31:260-4. Available from: http://www.jisppd.com/text.asp?2013/31/4/260/121829



   Introduction Top


Dermatoglyphics is the study of dermal ridge configurations on the fingers, palms and soles. [1] The term was coined by Harold Cummins and Midlo in 1926. [2] Dermatoglyphics is derived from the Greek word "Derma" meaning skin and "glyphic" meaning carvings. [3] Dermatoglyphics are considered as a window of congenital abnormalities and is a sensitive indicator of intrauterine abnormalities and is known to be one of the best available diagnostic tools in genetic disorders. [1] Several studies have associated altered dermatoglyphic patterns with congenital defects, syndromes and other types of developmental disorders. [4],[5],[6]

In humans, the development of the primary palate and lip is completed by the 7 th week of intrauterine life and that of the secondary palate by 12 th week. The dermal ridges are formed by the 6 th week of gestation and reach a maximum size between 12 th and 13 th weeks. The genetic message contained in the genome - normal or abnormal is deciphered during this period and also reflected by dermatoglyphics. [7] Disturbances at any stage during palate development, e.g., defective palatal shelf growth, failed or delayed elevation and blocked fusion can result in cleft palate (CP) with or without cleft lip (CP ± L). [7] Cleft lip/palate (CL/P) occurs in approximately 1/750 live births in the United States. [8] The birth prevalence of clefts is somewhere between 27,000 and 33,000 clefts/year in India. [9] Despite the high prevalence of cleft lip and palate (CLP), few studies investigating the relationship between CLP and dermatoglyphics have been reported. [7],[10] The present study was conducted to observe and compare the differences in the dermatoglyphic patterns between children with oral CL/P and normal children so as to ascertain the genetic etiology and evaluate their associated dental finding.


   Materials and Methods Top


The study was carried out at the Department of Pedodontics and Preventive Dentistry, SGT Dental College, Gurgaon, India. The participants were recruited from the Out-Patient Department of SGT Dental College, Gurgaon. A total of 90 study participants were divided into two groups for recording the dermatoglyphics - study group, which included 45 children with nonsyndromic CL/P without any other external manifestations and age, sex and socio economic status matched control group, which included 45 normal healthy children with no family history of CL/P in three generations. Children below the age of 4 years were excluded for studying the dental anomalies. Hence, the dental anomalies were studied in only 60 children, 30 in each group (study and control).

An informed consent was obtained from the parents of the children participating in the study. Approval to carry out the study was obtained from Institutional Review Board. For each child under study and control group bilateral finger prints were obtained on the royal executive bond paper using the ink stamp pad method. The hands were first cleaned to remove sweat, oil or dirt from the skin surface for enhancing the quality of dermatoglyphics. This was done by cleaning the hands firstly with soap and water and then wiping with ethyl alcohol soaked gauze. Whenever, the quality of prints was not suitable of interpretation, the prints of those participants were retaken. The obtained fingerprints on the distal phalanges were classified in to arches, loops and whorls with the help of a magnifying glass (×2) [Figure 1].
Figure 1: Finger print types showing arch, loop and whorl patterns

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The intra oral examination of all the patients was done under operating light of the dental chair with the help of mouth mirror and probe. The dental findings were noted on the basis of clinical findings and were confirmed with the help of radiographs. Panoramic radiographs, occlusal view and intra oral periapical X-rays were taken based on the requirement and need for precision. In children below the age of 5 years radiographs could not be done due to their lack of cooperation. Anomalies recorded were hypodontia, presence of supernumerary teeth and anomalies in shape and size, hypoplasia and malpositioning of teeth.

  1. Hypodontia - It was considered when at least one developmentally missing tooth was observed.
  2. Supernumerary teeth - A supernumerary tooth is one that is additional to the normal series and can be found in almost any region of the dental arch.
  3. Microdontia and macrodontia - An inherited condition that produces one or more disproportionately smaller or larger teeth.
  4. Hypoplasia - A hereditary condition in which the dental enamel shows either a break in continuity or surface loss, often because of insufficient calcification.
  5. Malpositioning - An improper position of teeth in relationship to the basal bone of the alveolar process, to adjacent teeth or to opposing teeth.


Statistical analysis

All the data was subjected to statistical analysis and compilation of the results was done. The statistical analysis was performed with the Statistical Package for Social Sciences (SPSS Inc. Released 2007. SPSS for Windows, Version 16.0. Chicago, SPSS Inc). All the data was recorded and observed by only one observer to avoid inter examiner differences. The mean values of the dermatoglyphic patterns in between the study and control groups, was done using Student's t-test. The comparison of dental anomalies between the study and control group was accomplished using Chi-square test. The significance value (P value) was <0.05, at 95% confidence level and if P value was <0.001 in that case the significance level will be at 99% confidence level, otherwise with P > 0.05 the mean difference was considered as non-significant.


   Results Top


The mean overall age of the sample children was 8.62 years with 8.38 ± 4.01 in the study group and 8.91 ± 3.26 in the control group. A total of 51 boys and 39 girls were enrolled in the study. On the basis of type of cleft, the study group was further subdivided into three sub-groups. The subgroup I included children with cleft lip with or without alveolus (CL ± A), subgroup II included children with CP alone and subgroup III included children with CLP. On the analysis of the dermatoglyphic patterns of the sample it was observed that the frequency of loops as compared to whorl and arch patterns was much higher in the study children. Further, it was found that the mean number of loop patterns in each child of the study group was found in 7.24 fingertips, followed by whorl patterns in 2.07 fingertips and arch patterns in 0.69 finger tips. On computing, the mean of each pattern, it was found that the mean number of loops in each child of the control group was found in 4.80 fingertips, whorl pattern in 3.80 fingertips and arch pattern in 1.40 fingertips. The statistical comparison of the three dermatoglyphic patterns between study and control group showed a highly significant difference between the loops in the study and control group (P < 0.001) and statistically significant difference in the whorls of study and control group (P = 0.001). The total numbers of arches were not significantly different when compared with the control group (P = 0.054) [Table 1].
Table 1: Statistical comparison of the three dermatoglyphic patterns between study and control group

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On comparison of occurrence of dental anomalies between the study and control group, it was found that the most frequent anomaly seen in the study group was hypodontia whereas, in the control group was supernumerary teeth. The teeth mostly found to be missing were maxillary lateral incisor and maxillary premolars. Supernumerary teeth were the second most commonly found dental anomaly in the study group. The rest of the dental anomalies namely anomalies of size and shape, hypoplasia and malpositioning were less frequently seen in both groups. All the dental anomalies seen were more in the study group than the control group. The anomaly seen in the maximum number of cases was hypodontia (P < 0.001) [Table 2].
Table 2: Comparison of occurrence of dental anomalies between the study and control children

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The greatest numbers of all the anomalies seen were present in subgroup III (CLP) and the least were in subgroup II (CP). The difference was statistically significant (P value <0.05) between the three subgroups in relation to the malpositioning of the tooth. The occurrence of other anomalies such as hypodontia, supernumerary teeth, anomalies of size and shape and hypoplasia were not found to be statistically significantly different (P > 0.05) [Table 3].
Table 3: Comparison of occurrence of dental anomalies between the three study subgroups

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   Discussion Top


The dermal ridges and furrows are formed early during fetal life and once formed they remain unchanged throughout life and vary between individuals. They are of considerable clinical interest because they not only serve as a means of identification but are also affected by certain abnormalities during early development including genetic disorder. [11] The epidermal ridges of the fingers and palms as well as facial structures such as lips, alveolus and palate form from the same embryonic tissue during the same embryonic period; thus these features may serve as proxy markers altering early development in CLP. [7]

In the present study, it was observed that children with oral clefts had an increased frequency of loops and decreased number of whorls on the distal phalanges of the ten fingers. On comparison of the frequency of whorl patterns between the study and control group, the control group had increased frequency of whorls than the study group. A statistically significant difference between the total number of loops and whorls in the study and control group has been seen in our study (P < 0.001). The arch pattern was found to be least frequent in both groups and the difference in two groups was not statistically significant (P = 0.054). Similar findings have been observed in various other studies. In a study increased frequency of loop patterns was observed in CLP children, whereas in the normal healthy children more number of whorl pattern were seen. [7] A significant difference between congenital cleft lip and CP patients and normal population indicate a genetic difference between them. [10] These results were supportive of a genetic etiology for cleft lip and CP anomalies. The CLP patients had an increased frequency of loops and decreased frequency of whorls in his sample of Indian CLP patients. Dermatoglyphic patterns were also compared in 95 nonsyndromic Filipino subjects with 90 unaffected relatives and found that ulnar loops and arches were significantly increased and whorls decreased in the affected group compared with unaffected group. [12]

CLP patients have shown to have more dental anomalies than in healthy patients. The dental anomalies in patients with clefts can be numerical and/or morphological change in teeth. [13] Common dental abnormalities found in cleft lip and CP patients include tooth agenesis, microdontia, ectopic eruption, transposition of the maxillary canines and pre molars, delayed tooth development, crown and root malformation. [14]

In the present study, among all the dental anomalies seen, hypodontia was observed in 50% of the study group children and this was also confirmed with radiographs. These results are in agreement with the findings of the study in which hypodontia was observed in 57.6% of cleft children. [13] The findings of our study were much higher than 5.5% found by Olin [15] and the 21% by Jiroutovα and Müllerovα. [16] The discrepancy may be attributable at least partially to the small number of cleft lip subjects in our study. The percentage of hypodontia seen in the control group was as low as 3.33%. In general, population also, the incidence of missing permanent teeth, excluding third molar was 3.4% in Swiss children, 4.4% in American children, 6.4% in Israeli children, 6.1% in Swedish children and 8% in Finnish children and 9.6% in Austrian children. [17] Statistically significant difference was found in the prevalence of hypodontia in the study and control group. The prevalence of hypodontia in isolated CP group was reported to be 4 times than of the non-cleft group and higher in the maxilla than in the mandible. [17] The increased incidence of hypodontia in children with clefts might be a result not only of the genetic factors directly affecting hypodontia, but also the factors causing cleft itself. [17] However, in children with only CL ± A (subgroup I), the prevalence of hypodontia was 31.25% whereas in the subgroup III 44.44% of children had hypodontia. These findings were similar with those seen in the study conducted by Boehn [18] and Ranta. [19] In our study, in children with isolated CP, i.e., subgroup II, hypodontia was reported in 18.18% of children The prevalence of hypodontia for the CP group was 32.1% reported by Boehn [18] for 31 Danish and Norwegian children and 31.5% by Ranta [19] for a group of 251 children.

The percentage of supernumerary in the study group was 20% and in the control group was 16.66%. The number of supernumerary teeth in the study group was although more than in the control group, but no statistically significant difference was observed (P = 0.739). It was noted that 22% of children in the study subgroup III had supernumerary teeth followed by12.5% in subgroup I and nil in subgroup II. The difference between the study subgroups was not statistically significant (P = 0.189). In the study conducted by Wong et al., the prevalence of supernumerary teeth was 25% in the cleft lip group and was absent in the isolated CP group. [13] In CL children where the alveolus is apparently intact, the tooth germs of supernumeraries and lateral incisors could be expected to be less affected by clefting. This is the reason for the presence of more percentage of supernumeraries in the CL group in the study conducted by Wong et al. [13] However, in our study more percentage of supernumeraries were seen in the subgroup III, i.e., children having CLP. It has also been stated that the tendency for frequency of supernumeraries decreases with the severity of the cleft. [13]

Anomalies of size and shape were observed in 13.33% in the study group and 3% in the control group children. The difference between the two was not found to be statistically significant (P = 0.161). Shape anomalies of teeth in patients with clefts have been reported. [19],[20] However, none of the studies distinguish between cleft types. In our study, it was seen in 16.67% of children in the study subgroup III (CLP), 6.25% in the subgroup I (CL ± A) and nil in the subgroup II (CP). The difference between the study subgroups was not found to be statistically significant (P = 0.254). Akcam et al. found that microdontia was observed in 1.9-4.2% of children having unilateral right and left CLP. [20] Teeth in the region of an alveolar cleft have commonly been reported to be malformed, peg shaped, microformed or congenitally absent. [18],[19] Previous researches of the general population have shown the prevalence of microdontia to vary from 1.5% to 2%. These finding are consistent with the findings our study.

Hypoplasia was seen in 13.33% of children in the study group as compared to 3.33% in the control group. The difference between the study and control group was not statistically significant (P = 0.161). Hypoplasia was noted in 16.67% of children in the study subgroup III, 6.25% in the study subgroup I and nil in the study subgroup II. No statistically significant difference was seen among the three study subgroups (P = 0.254). The prevalence of hypoplasia in deciduous canines in patients with complete unilateral and bilateral CLP was 43.8% and 39% respectively. [21] The results of this study suggested that the cleft type does not affect the occurrence of hypoplasia of deciduous canines. [21] The prevalence of hypoplasia in deciduous canines in the general population ranges from 1% to 45%. [22],[23] The prevalence found in our study also falls in this range, but it was found only in permanent dentition. Hypoplasia affected permanent teeth in 38% of the 8-year-old children and 23% of the 12-year-old children while primary teeth were not affected. [24]

In the study group malpositioning was seen in 26.66% of children whereas in the control group it was seen in 10% of the children. The difference was not statistically significant between the study and control group (P = 0.009). It was present in 33.33% of children in the study subgroup III whereas in 12.5% of children in the study subgroup I and nil in subgroup II. The difference between these study subgroups was found to be statistically significant (P = 0.039). Tooth rotation was noticed only in the anterior region in various types of clefts. [20]

On overall analysis of dental anomalies among the three subgroups, maximum number of anomalies was seen in children having CLP and least number of anomalies were observed in children having isolated CP.


   Conclusion Top


A statistically significant difference in the dermatoglyphic pattern was found in the study group and control group. Hypodontia was significantly higher in the children with cleft than the normal healthy control group. Statistically significant difference was seen among the three study subgroups for the presence of malpositioning of teeth. Thus, a definite correlation was seen between dermatoglyphic pattern and the cleft deformity. The dermatoglyphics are genetically controlled characteristics, any deviation in dermatoglyphic features indicates a genetic difference between the controls and abnormal population, thus supporting a gene mediated etiology in cleft patients. Future studies with large sample including the parents and siblings of the cleft patients can be done for establishing a more definite correlation between the oral cleft and dermatoglyphic pattern.

 
   References Top

1.Ahmed I, Yasin J. Dermatoglyphic pattern study. APMC 2010;4:107-10.  Back to cited text no. 1
    
2.Madan N, Rathnam A, Bajaj N. Palmistry: A tool for dental caries prediction! Indian J Dent Res 2011;22:213-8.  Back to cited text no. 2
    
3.Seema, Mahajan A, Gandhi D, Singh M. Dermatoglyphics - Study & review of literature. Nov Sci Int J Med Sci 2012;1:191-8.  Back to cited text no. 3
    
4.Cummins H. Dermatoglyphic stigmata in mongoloid imbeciles. Anat Rec 1939;73:407-15.  Back to cited text no. 4
    
5.Reed T. Dermatoglyphics in medicine - Problems and use in suspected chromosome abnormalities. Am J Med Genet 1981;8:411-29.  Back to cited text no. 5
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6.Neiswanger K, Cooper ME, Weinberg SM, Flodman P, Keglovits AB, Liu Y, et al. Cleft lip with or without cleft palate and dermatoglyphic asymmetry: Evaluation of a Chinese population. Orthod Craniofac Res 2002;5:140-6.  Back to cited text no. 6
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7.Mathew L, Hegde AM, Rai K. Dermatoglyphic peculiarities in children with oral clefts. J Indian Soc Pedod Prev Dent 2005;23:179-82.  Back to cited text no. 7
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8.Yu W, Serrano M, Miguel SS, Ruest LB, Svoboda KK. Cleft lip and palate genetics and application in early embryological development. Indian J Plast Surg 2009;42 Suppl:S35-50.  Back to cited text no. 8
    
9.Mossey P, Little J. Addressing the challenges of cleft lip and palate research in India. Indian J Plast Surg 2009;42 Suppl:S9-18.  Back to cited text no. 9
    
10.Balgir RS. Dermatoglyphic features in congenital cleft lip and cleft palate anomalies. J Indian Med Assoc 1986;84:369-72.  Back to cited text no. 10
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11.Kiran K, Rai K, Hegde AM. Dermatoglyphics as a noninvasive diagnostic tool in predicting mental retardation. J Int Oral Health 2010;2:96-100.  Back to cited text no. 11
    
12.Scott NM, Weinberg SM, Neiswanger K, Brandon CA, Daack-Hirsch S, Murray JC, et al. Dermatoglyphic fingerprint heterogeneity among individuals with nonsyndromic cleft lip with or without cleft palate and their unaffected relatives in China and the Philippines. Hum Biol 2005;77:257-66.  Back to cited text no. 12
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13.Wong HM, Cheung L, King NM. Dental anomalies in Chinese children with cleft lip and palate. Dentistry 2012;2:1-8.  Back to cited text no. 13
    
14.Chen YH, Cheng NC, Wang YB, Yang CY. Prevalence of congenital dental anomalies in the primary dentition in Taiwan. Pediatr Dent 2010;32:525-9.  Back to cited text no. 14
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15.Olin WH. Dental anomalies in cleft lip and palate patients. Angle Orthod 1964;34:119-23.  Back to cited text no. 15
    
16.Jiroutová O, Müllerová Z. The occurrence of hypodontia in patients with cleft lip and/or palate. Acta Chir Plast 1994;36:53-6.  Back to cited text no. 16
    
17.Shapira Y, Lieberman MA. Abnormally-shaped supernumerary maxillary incisors. Angle Orthod 1974;44:322-5.  Back to cited text no. 17
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18.Boehn A. Dental anomalies in harelip and cleft palate. Acta Odontol Scand 1963;21 (Suppl 38):1-109.  Back to cited text no. 18
    
19.Ranta R. A review of tooth formation in children with cleft lip/palate. Am J Orthod Dentofacial Orthop 1986;90:11-8.  Back to cited text no. 19
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20.Akcam MO, Evirgen S, Uslu O, Memikoðlu UT. Dental anomalies in individuals with cleft lip and/or palate. Eur J Orthod 2010;32:207-13.  Back to cited text no. 20
    
21.Galante JM, Costa B, de Carvalho Carrara CF, Gomide MR. Prevalence of enamel hypoplasia in deciduous canines of patients with complete cleft lip and palate. Cleft Palate Craniofac J 2005;42:675-8.  Back to cited text no. 21
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22.Badger GR. Incidence of enamel hypoplasia in primary canines. ASDC J Dent Child 1985;52:57-8.  Back to cited text no. 22
[PUBMED]    
23.Jorgenson KD. The deciduous dentition. A descriptive and comparative anatomical study. Acta Odontol Scand 1956;14 Suppl 20:1-202.  Back to cited text no. 23
    
24.Chapple JR, Nunn JH. The oral health of children with clefts of the lip, palate, or both. Cleft Palate Craniofac J 2001;38:525-8.  Back to cited text no. 24
[PUBMED]    


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