Dental Caries
Content
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Original Research
Palmistry: A tool for dental caries prediction!
Nidhi Madan, Arun Rathnam, Neeti Bajaj
Department of Pedodontics and
Preventive Dentistry, K.L.E.S’s
Institute of Dental Sciences,
Belgaum, Karnataka, India
ABSTRACT
Received
: 20-07-10
Review completed : 08-04-10
Accepted
: 11-10-10
Background: Dermatoglyphics can prove to be an extremely useful tool for preliminary
investigations in conditions with a suspected genetic base. Since caries is a multifactorial disease
with the influence of genetic pattern, early prediction for high-risk children can help in using
effective and efficient caries preventive measures that are a part of the pedodontist arsenal.
Aims and Objectives: This study was done to determine the genetic aspect involved in the
occurrence of dental caries through a cost-effective means, which can be used in field studies.
Materials and Methods: 550 kindergarten school children in the age group 3–6 years were
examined during a school examination camp. Of these, only 336 children were included
in the study. They were divided into four groups as follows: caries-free males (df score=0),
caries-free females, caries males (df score≥10), caries females. The handprints of each child
were taken and the frequency of occurrence of type of dermatoglyphic pattern on fingertip of
each digit was noted. Separate df scores were recorded. SPSS software and test of proportions
were used for the analysis.
Results and Conclusion: Handprints of caries-free children, especially females, showed
maximum ulnar loops. The caries group showed maximum occurrence of whorls (r=2:1), which
were more prevalent in females on the left hand 3rd digit than in males where the whorls were
found on the right hand 3rd digit, and also low total ridge count, especially in males.
Key words: Dental caries, dermatoglyphics, genetics
Palmistry in scientific terms is called as “dermatoglyphics”
(“derma” means skin and “glyphic” means carvings).
Dermatoglyphics is a study of palmer and plantar dermal
ridge carvings on the hands and feet. Unlike the palmer
lines or creases which keep altering throughout life, these
patterns or configurations are genetically determined and
remain constant throughout one’s life. The terminology
was coined by Harold Cummins and Midlo in 1926, and
Cummins is regarded as the “Father of Dermatoglyphics”.[1]
The dermal ridges take their origin from the fetal volar pads
that appear in the 6th–7th week of embryonic life, i.e. at the
same time as that of tooth formation in intraembryonic
life. This means that the genetic message contained in
Address for correspondence:
Dr. Nidhi Madan
E-mail: [email protected]
Access this article online
Quick Response Code:
Website:
www.ijdr.in
PMID:
***
DOI:
10.4103/0970-9290.84289
213
the genome (normal or abnormal) is deciphered during
this period and is also reflected by dermatoglyphics. [2]
These volar pads occur as mound-shaped elevations of the
mesenchymal tissue situated above the proximal end of most
distal metacarpal bone on each finger, in each interdigital
area. The size and position of these volar pads, to a large
extent, are responsible for the type of configuration of ridge
patterns. The ridge patterns are completed by 12th–14th week
of gestation, i.e. at the same time as that of tooth formation
completion in intraembryonic life. Both primary genetic
determination and development secondary to flexion
function have been suggested as the mechanisms underlying
the crease development.[3]
Sir Francis Galton, in 1892, gave the basic nomenclature of
the types of fingerprint patterns. They are grouped as loops,
whorls and arches. The loops can be further subdivided
into ulnar loops and radial loops.[4] The identification of
these dermatoglyphic patterns can be done after knowing
the basic dermatoglyphic landmarks, which are core
(or “Center” of pattern, shown as red circle in Figure 1)
and triradii (or “Delta” of pattern, shown as green circle in
Figure 1). Ideally, a triradii is the point marked by the
confluence of three ridges that form angles of approximately
120° with one another. If these ridges fail to meet, triradial point
is represented by a very short, dot-like ridge called as “Island”.
Indian Journal of Dental Research, 22(2), 2011
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Madan, et al.
Palmistry and dental caries
A loop [Figure 2] is recognized as a series of ridges that enter
the pattern area on one side of digit, recurves abruptly and
leaves the pattern area on the same side. A single triradius
is present, which is located laterally on the fingertip, where
the loop is closed. If the ridge opens on ulnar side (away from
thumb), it is called as ulnar loop, and if it opens toward the
radial side (toward thumb), it is called as radial loop. A whorl
[Figure 3] differs from the loop in the aspect of concentric
arrangement of ridges, with two or more triradii in the latter.
In all the dermatoglyphic patterns seen, arches [Figure 4]
show the simplest ridge pattern, which is formed by the
succession of one or more parallel ridges which cross the
finger from one side to the other without recurving. These
patterns usually do not show the presence of triradii, except
when the tented arch is present that will have a triradii
point near its midline.
This is a nascent science requiring more research work. Earlier
research work by M. Atasu on the dermatoglyphic patterns
observed in Ellis–van Creveld syndrome (EVC)[5] and in
dental caries[6] and by Kargul et al.[7] on the dermatoglyphic
patterns observed in hypohydrotic ectodermal dysplasia
patients are the landmark studies. These patterns have been,
since time immemorial, a basis of personal identity.
handprints will not be used for any purpose other than
the present study. After getting approval from the parents,
the children were included. Each child was designated
a sample number and that same number was written on
his/her handprint recording sheet and his/her df score
was written on a separate sheet against their respective
sample number.
Groups
Caries-free group: subdivided into males and females:
The children with df score “0”, i.e. with no caries.
Caries group: subdivided into males and females:
The children with df score more than or equal to “10”.
(Extremes were taken to get a significant correlation with
caries susceptibility. The children with intermediate scores
were not included.)
Exclusion criteria
Children with special health care needs (e.g. cleft lip and
palate syndromes,[2] medically and physically challenged)
were excluded as the literature suggests them to show a
peculiar pattern, and oral hygiene maintenance is variable
in them in comparison to normal healthy children.
In the present work, we studied the dermatoglyphic patterns
in caries-free children and children with dental caries to
determine the usefulness of dermatoglyphics in predicting
the genetic susceptibility of children to dental caries through
a cost-effective means which can be used in field studies.
Recording of dental caries status
MATERIALS AND METHODS
Recording of handprints
A cross-sectional study was performed on 550 kindergarten
school children of age group 3–6 years during a school
examination camp conducted by the Department of
Pedodontics and Preventive Dentistry, K.L.E.S’s Institute of
Dental Sciences, Belgaum, Karnataka, India. The materials
used in the study included basic diagnostic instruments
needed for recording df index and the materials needed for
recording handprints. They were as follows:
• Basic diagnostic instruments
• Gauze pads
• Duplicating printing ink
• Chart paper (white)
• Magnifying glass (2× power)
• Soap
Methodology
Out of the 550 children examined, 336 children were
included in the study. An informed consent from the
Principal of the school was taken before the onset of the
study. Two weeks prior, a letter was sent to the parents
to inform them regarding the study to be carried out
including their ward. They were assured that children’s
Indian Journal of Dental Research, 22(2), 2011
• The oral examination of all the children was done in
natural light.
• Caries status was recorded using the df index given by
Grubbel AO.
• The methodology of taking handprints was explained to
the children and they were cautioned not to smear the
dye on their body or clothing.
• The hands of the patient were scrubbed thoroughly and
blot dried.
• The duplicating ink was dispensed in a pea-sized
amount for each hand and spread to the entire area of
palm and fingers with the help of a gauze pack. It was
important that a very minimal amount of dye was taken
as this helped in getting clear handprints. The more
the amount of dye, darker were the prints and thus
unreadable. Various dyes were tried before settling for
black duplicating printing ink.
• Once even spread of the dye was ensured, the patient
was asked to place his/her hand with all fingers apart
on a sheet of paper. If the patient shook his/her hand
during the procedure, the recording got smudged. Light
pressure was applied over all the fingers to ensure proper
recording of prints.
• The handprints obtained were checked for their clarity
through a magnifying glass (2×) and a number was given
to it. The presence of core and the triradii of the pattern
were noted to include the handprint in the study. If these
214
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Madan, et al.
Palmistry and dental caries
Figure 1: Core and triradii
Figure 2: Dermatoglyphic pattern: Loops
Figure 3: Dermatoglyphic pattern: Whorls
Figure 4: Dermatoglyphic pattern: Arches
• Often, it was noted that the thumb did not provide
proper prints, which could be due to its spatial
orientation as compared to the rest of the fingers. So, a
separate impression of the thumb was taken.
Method of reading handprints
The handprints were observed in a sequential manner:
• The handprints were observed from the left hand 4th
digit till the thumb.
• Then, they were observed from the thumb of right hand
till the 4th digit.
Figure 5: Method of ridge counting
landmarks cannot be demarcated clearly, then taking
another handprint was recommended. The handprints
taken were preserved with caution. A single-blinded
examiner observed all the handprints.
215
It was done under a magnifying glass with 2× power. Only
the occurrence of type of pattern on the finger tips of
10 digits was noted for each digit. The total ridge count
(TRC) was done.
1. Type of dermatoglyphic pattern: The frequency of true
patterns of loops [Figure 2], whorls [Figure 3] and arches
[Figure 4] was counted on the finger tips of all the 10
digits.
Indian Journal of Dental Research, 22(2), 2011
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Madan, et al.
Palmistry and dental caries
2. Total ridge counting:
• Mark the two landmarks as “core” (as red circle in
Figure 5) and “triradii” (as green circle in Figure 5)
of the pattern.
• A line (as blue line in Figure 5) is drawn joining
these two landmarks (this line should be as nearly as
possible at right angles to the ridge area).
• All the ridges that cross this line are counted, whereas
ridges terminating before touching the line are not
counted.
• Ridge containing the point of core and triradii is not
included in the count.
• If a ridge bifurcates before reaching the line, it is
counted as two ridges.
Statistical analysis
The data obtained was subjected to statistical analysis
using the SPSS (Statistical Package for Social Science,
Version 10.0) software and test of proportion was used
for the analysis.
RESULTS
A total of 336 children were included in the study of whom
168 (50%) were boys and 168 (50%) were girls. They
were further subdivided into two groups as “caries-free”
(96 boys and 78 girls) and “caries” (72 boys and 90 girls) groups.
Handprints of caries-free children [Figure 6], especially
females, showed maximum ulnar loops (P<0.05), followed
by whorls and arches and the least present were radial
loops. Caries-free males showed more occurrences of arches.
The caries group showed maximum occurrence of whorls
(r=2:1) than caries-free group and they were found to be
more prevalent in females [Figure 7] on their left hand
3rd digit than in males, who showed more whorls on their
right-hand 3rd digit.
Caries group showed decreased TRC [Figure 8], especially in
males, than caries-free group.
600
Ulnar loops (UL)
Whorls
Arches
Radial loops (RL)
500
400
300
200
100
0
CF Males
C males
CF Females C Females
Figure 6: Dermatoglyphic patterns in caries and caries-free children
Male left
Male right
Female left
Female right
4th DIGIT
3rd DIGIT
2nd DIGIT
1st DIGIT
THUMB
0
50
100
Figure 7: Whorls in all digits
23%
29%
Caries free male
Caries male
Caries free female
Caries female
DISCUSSION
For ages, the features of the hands have fascinated scholars,
sages, theologians, doctors and laymen alike. The modern
study of the hand is far removed from the popular image of
the traditional palmist uttering mysterious incantations in
an arcane language. Rather, through decades of scientific
research, the hand has come to be recognized as a powerful
tool in the diagnosis of psychological, medical and genetic
conditions.[8] Dermatoglyphics is considered as a window
of congenital abnormalities and is a sensitive indicator of
intrauterine anomalies.[2]
The dermatoglyphic patterns have been used as an
oral health marker, which can determine the genetic
Indian Journal of Dental Research, 22(2), 2011
27%
21%
Figure 8: Total ridge count
predisposition of children to dental caries. The children
and their parents are observed to show similar pattern of
occurrence of dental caries. This can be attributed to the
genetic inheritance of salivary pH, enzymes, salivary flow
and tooth morphology.[9]
216
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Madan, et al.
Palmistry and dental caries
The epidermal ridges of the fingers and palms as well as
the facial structures like the lip, alveolus, teeth and palate
are formed from the same embryonic tissues (ectoderm)
during the same embryonic period (6–9 weeks). Thus, the
genetic and environmental factors which are responsible
for causing dental caries may also cause peculiarities in the
dermatoglyphic patterns.[10]
The age group of 3–6 years was chosen to include the
primary dentition and also to have a larger children base
while examining kindergarten schools. The def index
given by Grubbel in 1944 is used for caries recording in
primary dentition. It was modified to the df index as the
“e” component of the index could not be recorded with
utmost certainity. The modification, “df” index, was used
in this study.
Out of 550 school children, only 336 children were included
in the study as their df score was either 0 or equal to/above
10. This df score criteria was followed in accordance with
that suggested by Atasu.[6] The sample was divided equally
into males and females to notice any sexual predilection of
genetic pattern of caries.
We did not include the dermatoglyphics of children with
syndromes,[2,5,7] as the literature suggests them to show a
peculiar pattern, and oral hygiene maintenance is variable
in them in comparison to normal healthy children.
In the present study, dermatoglyphic data were collected in
accordance with the method used by Atasu[6] and Somani,[10]
using the ink method with the black duplicating printing
ink. The stamp pad or liquid dyes cause smudging and the
pattern of the prints are not properly distinguished. Another
option is to take the alginate impression of the hand and
pour it in dye stone, but obviously this method is cost
prohibitive. Other methods of recording handprints include
photography, scanners and biometric machines.
Blinding of the examiner was done by recording the df
score and handprint samples separately. A single examiner
carried out the reading of all the handprints to decrease
inter-examiner variability.
We infer the following from the findings of the study.
• Females showed ulnar loops, especially on the left-hand
thumb, and males had ulnar loop on the left-hand 2nd
digit (middle finger).
• Arches on thumb in males are considered to be less
susceptible to dental caries.
• Increased occurrence of whorls (or Chakras ) was
noted in the children showing comparatively higher
df score.
• Whorls in the third digit or ring finger (left hand of
males and right hand of females) [Figure 8] had higher
df score.
217
Children showing the dermatoglyphic markers for caries
can be kept at “customized” dental visits instead of
standard “6-month” recall and preventive measures like
pit and fissure sealants, frequent fluoride application can
be considered.
The data available from this study reveal that females
show more consistent patterns to predict dental caries
susceptibility through dermatoglyphic markers.
The quantitative analysis of the TRC in caries-free and
caries children showed the increased occurrence of TRC
[Figure 8] in caries-free children than caries group. These
findings are found to be consistent to that observed in a
study by Metin Atasu in 1998.[6]
Limitations of the study
• Schools in only Belgaum district were considered,
whereas a more stratified sample will show more
accurate results.
• Dermatoglyphic patterns of monozygotic twins or
parents/children should be compared with df scores for
better results.
• There is no way of finding out whether genetics or
environmental factors play a dominating role in the
occurrence of dental caries.
• Dental caries, being a multifactorial disease, cannot be
controlled in children just by knowing their genetic
susceptibility to the disease. If such patients do not have
any complaint regarding their dental problem, then
motivating parents and the child in such circumstances
is unconvincing and difficult.
CONCLUSIONS
To conclude, the following points can be considered to find
the genetic susceptibility of children to dental caries:
• Dermatoglyphic patterns show a strong correlation to
the prevalence of dental caries.
• Presence of whorls on the 3rd digit of right hand of
females predicts high caries risk.
• Presence of whorls on the 3rd digit of left hand of males
predicts high caries risk.
• The TRC of caries immune children was significantly
greater than susceptible children.
REFERENCES
1.
2.
3.
4.
5.
Mulvihill JJ, Smith DW. The genesis of dermatoglyphics. J Pediatr
1969;75:579-89.
Mathew L, Hegde AM, Rai K. Dermatoglyphic peculiarities in children
with oral clefts. J Indian Soc Pedod Prev Dent 2005;23:179-82.
Kimura S. Embryologic development of flexion creases. Birth Defects
Orig Artic Ser 1991;27:113-29.
Galton F. Finger prints. London: McMillan; 1982.
Atasu M, Biren S. Ellis-van Creveld syndrome: Dental, Clinical,
Genetic and Dermatoglyphic findings of a case. J Clin Pediatr Dent
2000;24:141-5.
Indian Journal of Dental Research, 22(2), 2011
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Madan, et al.
Palmistry and dental caries
6.
7.
8.
9.
Metin A. Dermatoglyphic findings in Dental caries: A Preliminary report.
J Clin Pediatr Dent 1998;22:147-9.
Kargul B, Alcan T, Kabalay U, Atasu M. Hypohydrotic ectodermal
dysplasia: Dental, Clinical, Genetic and Dermatoglyphic findings of
three cases. J Clin Pediatr Dent 2001;26:5-12.
Blanka Schaumann, Milton, Alter. Dermatolglyphics in medical
disorders. New York, Heidel berg, Berlin: Springer- Verlage; 1976.
Bixler D. Genetic aspects of dental anomalies. Chapt. 6. In: Mc Donald
RE, Avery DR, editors. Dentistry for the child and adolescent. St Louis:
CV Mosby Co; 1988. p. 105-6.
10. Sharma A, Somani R. Dermatoglyphic interpretation of dental caries
and its correlation to salivary bacteria interactions: An in vivo study. J
Indian Soc Pedod Prev Dent 2009;27:17-21.
How to cite this article: Madan N, Rathnam A, Bajaj N. Palmistry: A tool for
dental caries prediction!. Indian J Dent Res 2011;22:213-8.
Source of Support: Nil, Conflict of Interest: None declared.
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Indian Journal of Dental Research, 22(2), 2011
218
Original Research
Palmistry: A tool for dental caries prediction!
Nidhi Madan, Arun Rathnam, Neeti Bajaj
Department of Pedodontics and
Preventive Dentistry, K.L.E.S’s
Institute of Dental Sciences,
Belgaum, Karnataka, India
ABSTRACT
Received
: 20-07-10
Review completed : 08-04-10
Accepted
: 11-10-10
Background: Dermatoglyphics can prove to be an extremely useful tool for preliminary
investigations in conditions with a suspected genetic base. Since caries is a multifactorial disease
with the influence of genetic pattern, early prediction for high-risk children can help in using
effective and efficient caries preventive measures that are a part of the pedodontist arsenal.
Aims and Objectives: This study was done to determine the genetic aspect involved in the
occurrence of dental caries through a cost-effective means, which can be used in field studies.
Materials and Methods: 550 kindergarten school children in the age group 3–6 years were
examined during a school examination camp. Of these, only 336 children were included
in the study. They were divided into four groups as follows: caries-free males (df score=0),
caries-free females, caries males (df score≥10), caries females. The handprints of each child
were taken and the frequency of occurrence of type of dermatoglyphic pattern on fingertip of
each digit was noted. Separate df scores were recorded. SPSS software and test of proportions
were used for the analysis.
Results and Conclusion: Handprints of caries-free children, especially females, showed
maximum ulnar loops. The caries group showed maximum occurrence of whorls (r=2:1), which
were more prevalent in females on the left hand 3rd digit than in males where the whorls were
found on the right hand 3rd digit, and also low total ridge count, especially in males.
Key words: Dental caries, dermatoglyphics, genetics
Palmistry in scientific terms is called as “dermatoglyphics”
(“derma” means skin and “glyphic” means carvings).
Dermatoglyphics is a study of palmer and plantar dermal
ridge carvings on the hands and feet. Unlike the palmer
lines or creases which keep altering throughout life, these
patterns or configurations are genetically determined and
remain constant throughout one’s life. The terminology
was coined by Harold Cummins and Midlo in 1926, and
Cummins is regarded as the “Father of Dermatoglyphics”.[1]
The dermal ridges take their origin from the fetal volar pads
that appear in the 6th–7th week of embryonic life, i.e. at the
same time as that of tooth formation in intraembryonic
life. This means that the genetic message contained in
Address for correspondence:
Dr. Nidhi Madan
E-mail: [email protected]
Access this article online
Quick Response Code:
Website:
www.ijdr.in
PMID:
***
DOI:
10.4103/0970-9290.84289
213
the genome (normal or abnormal) is deciphered during
this period and is also reflected by dermatoglyphics. [2]
These volar pads occur as mound-shaped elevations of the
mesenchymal tissue situated above the proximal end of most
distal metacarpal bone on each finger, in each interdigital
area. The size and position of these volar pads, to a large
extent, are responsible for the type of configuration of ridge
patterns. The ridge patterns are completed by 12th–14th week
of gestation, i.e. at the same time as that of tooth formation
completion in intraembryonic life. Both primary genetic
determination and development secondary to flexion
function have been suggested as the mechanisms underlying
the crease development.[3]
Sir Francis Galton, in 1892, gave the basic nomenclature of
the types of fingerprint patterns. They are grouped as loops,
whorls and arches. The loops can be further subdivided
into ulnar loops and radial loops.[4] The identification of
these dermatoglyphic patterns can be done after knowing
the basic dermatoglyphic landmarks, which are core
(or “Center” of pattern, shown as red circle in Figure 1)
and triradii (or “Delta” of pattern, shown as green circle in
Figure 1). Ideally, a triradii is the point marked by the
confluence of three ridges that form angles of approximately
120° with one another. If these ridges fail to meet, triradial point
is represented by a very short, dot-like ridge called as “Island”.
Indian Journal of Dental Research, 22(2), 2011
[Downloaded free from http://www.ijdr.in on Tuesday, July 31, 2012, IP: 125.16.60.178] || Click here to download free Android application for this journal
Madan, et al.
Palmistry and dental caries
A loop [Figure 2] is recognized as a series of ridges that enter
the pattern area on one side of digit, recurves abruptly and
leaves the pattern area on the same side. A single triradius
is present, which is located laterally on the fingertip, where
the loop is closed. If the ridge opens on ulnar side (away from
thumb), it is called as ulnar loop, and if it opens toward the
radial side (toward thumb), it is called as radial loop. A whorl
[Figure 3] differs from the loop in the aspect of concentric
arrangement of ridges, with two or more triradii in the latter.
In all the dermatoglyphic patterns seen, arches [Figure 4]
show the simplest ridge pattern, which is formed by the
succession of one or more parallel ridges which cross the
finger from one side to the other without recurving. These
patterns usually do not show the presence of triradii, except
when the tented arch is present that will have a triradii
point near its midline.
This is a nascent science requiring more research work. Earlier
research work by M. Atasu on the dermatoglyphic patterns
observed in Ellis–van Creveld syndrome (EVC)[5] and in
dental caries[6] and by Kargul et al.[7] on the dermatoglyphic
patterns observed in hypohydrotic ectodermal dysplasia
patients are the landmark studies. These patterns have been,
since time immemorial, a basis of personal identity.
handprints will not be used for any purpose other than
the present study. After getting approval from the parents,
the children were included. Each child was designated
a sample number and that same number was written on
his/her handprint recording sheet and his/her df score
was written on a separate sheet against their respective
sample number.
Groups
Caries-free group: subdivided into males and females:
The children with df score “0”, i.e. with no caries.
Caries group: subdivided into males and females:
The children with df score more than or equal to “10”.
(Extremes were taken to get a significant correlation with
caries susceptibility. The children with intermediate scores
were not included.)
Exclusion criteria
Children with special health care needs (e.g. cleft lip and
palate syndromes,[2] medically and physically challenged)
were excluded as the literature suggests them to show a
peculiar pattern, and oral hygiene maintenance is variable
in them in comparison to normal healthy children.
In the present work, we studied the dermatoglyphic patterns
in caries-free children and children with dental caries to
determine the usefulness of dermatoglyphics in predicting
the genetic susceptibility of children to dental caries through
a cost-effective means which can be used in field studies.
Recording of dental caries status
MATERIALS AND METHODS
Recording of handprints
A cross-sectional study was performed on 550 kindergarten
school children of age group 3–6 years during a school
examination camp conducted by the Department of
Pedodontics and Preventive Dentistry, K.L.E.S’s Institute of
Dental Sciences, Belgaum, Karnataka, India. The materials
used in the study included basic diagnostic instruments
needed for recording df index and the materials needed for
recording handprints. They were as follows:
• Basic diagnostic instruments
• Gauze pads
• Duplicating printing ink
• Chart paper (white)
• Magnifying glass (2× power)
• Soap
Methodology
Out of the 550 children examined, 336 children were
included in the study. An informed consent from the
Principal of the school was taken before the onset of the
study. Two weeks prior, a letter was sent to the parents
to inform them regarding the study to be carried out
including their ward. They were assured that children’s
Indian Journal of Dental Research, 22(2), 2011
• The oral examination of all the children was done in
natural light.
• Caries status was recorded using the df index given by
Grubbel AO.
• The methodology of taking handprints was explained to
the children and they were cautioned not to smear the
dye on their body or clothing.
• The hands of the patient were scrubbed thoroughly and
blot dried.
• The duplicating ink was dispensed in a pea-sized
amount for each hand and spread to the entire area of
palm and fingers with the help of a gauze pack. It was
important that a very minimal amount of dye was taken
as this helped in getting clear handprints. The more
the amount of dye, darker were the prints and thus
unreadable. Various dyes were tried before settling for
black duplicating printing ink.
• Once even spread of the dye was ensured, the patient
was asked to place his/her hand with all fingers apart
on a sheet of paper. If the patient shook his/her hand
during the procedure, the recording got smudged. Light
pressure was applied over all the fingers to ensure proper
recording of prints.
• The handprints obtained were checked for their clarity
through a magnifying glass (2×) and a number was given
to it. The presence of core and the triradii of the pattern
were noted to include the handprint in the study. If these
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Madan, et al.
Palmistry and dental caries
Figure 1: Core and triradii
Figure 2: Dermatoglyphic pattern: Loops
Figure 3: Dermatoglyphic pattern: Whorls
Figure 4: Dermatoglyphic pattern: Arches
• Often, it was noted that the thumb did not provide
proper prints, which could be due to its spatial
orientation as compared to the rest of the fingers. So, a
separate impression of the thumb was taken.
Method of reading handprints
The handprints were observed in a sequential manner:
• The handprints were observed from the left hand 4th
digit till the thumb.
• Then, they were observed from the thumb of right hand
till the 4th digit.
Figure 5: Method of ridge counting
landmarks cannot be demarcated clearly, then taking
another handprint was recommended. The handprints
taken were preserved with caution. A single-blinded
examiner observed all the handprints.
215
It was done under a magnifying glass with 2× power. Only
the occurrence of type of pattern on the finger tips of
10 digits was noted for each digit. The total ridge count
(TRC) was done.
1. Type of dermatoglyphic pattern: The frequency of true
patterns of loops [Figure 2], whorls [Figure 3] and arches
[Figure 4] was counted on the finger tips of all the 10
digits.
Indian Journal of Dental Research, 22(2), 2011
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Madan, et al.
Palmistry and dental caries
2. Total ridge counting:
• Mark the two landmarks as “core” (as red circle in
Figure 5) and “triradii” (as green circle in Figure 5)
of the pattern.
• A line (as blue line in Figure 5) is drawn joining
these two landmarks (this line should be as nearly as
possible at right angles to the ridge area).
• All the ridges that cross this line are counted, whereas
ridges terminating before touching the line are not
counted.
• Ridge containing the point of core and triradii is not
included in the count.
• If a ridge bifurcates before reaching the line, it is
counted as two ridges.
Statistical analysis
The data obtained was subjected to statistical analysis
using the SPSS (Statistical Package for Social Science,
Version 10.0) software and test of proportion was used
for the analysis.
RESULTS
A total of 336 children were included in the study of whom
168 (50%) were boys and 168 (50%) were girls. They
were further subdivided into two groups as “caries-free”
(96 boys and 78 girls) and “caries” (72 boys and 90 girls) groups.
Handprints of caries-free children [Figure 6], especially
females, showed maximum ulnar loops (P<0.05), followed
by whorls and arches and the least present were radial
loops. Caries-free males showed more occurrences of arches.
The caries group showed maximum occurrence of whorls
(r=2:1) than caries-free group and they were found to be
more prevalent in females [Figure 7] on their left hand
3rd digit than in males, who showed more whorls on their
right-hand 3rd digit.
Caries group showed decreased TRC [Figure 8], especially in
males, than caries-free group.
600
Ulnar loops (UL)
Whorls
Arches
Radial loops (RL)
500
400
300
200
100
0
CF Males
C males
CF Females C Females
Figure 6: Dermatoglyphic patterns in caries and caries-free children
Male left
Male right
Female left
Female right
4th DIGIT
3rd DIGIT
2nd DIGIT
1st DIGIT
THUMB
0
50
100
Figure 7: Whorls in all digits
23%
29%
Caries free male
Caries male
Caries free female
Caries female
DISCUSSION
For ages, the features of the hands have fascinated scholars,
sages, theologians, doctors and laymen alike. The modern
study of the hand is far removed from the popular image of
the traditional palmist uttering mysterious incantations in
an arcane language. Rather, through decades of scientific
research, the hand has come to be recognized as a powerful
tool in the diagnosis of psychological, medical and genetic
conditions.[8] Dermatoglyphics is considered as a window
of congenital abnormalities and is a sensitive indicator of
intrauterine anomalies.[2]
The dermatoglyphic patterns have been used as an
oral health marker, which can determine the genetic
Indian Journal of Dental Research, 22(2), 2011
27%
21%
Figure 8: Total ridge count
predisposition of children to dental caries. The children
and their parents are observed to show similar pattern of
occurrence of dental caries. This can be attributed to the
genetic inheritance of salivary pH, enzymes, salivary flow
and tooth morphology.[9]
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The epidermal ridges of the fingers and palms as well as
the facial structures like the lip, alveolus, teeth and palate
are formed from the same embryonic tissues (ectoderm)
during the same embryonic period (6–9 weeks). Thus, the
genetic and environmental factors which are responsible
for causing dental caries may also cause peculiarities in the
dermatoglyphic patterns.[10]
The age group of 3–6 years was chosen to include the
primary dentition and also to have a larger children base
while examining kindergarten schools. The def index
given by Grubbel in 1944 is used for caries recording in
primary dentition. It was modified to the df index as the
“e” component of the index could not be recorded with
utmost certainity. The modification, “df” index, was used
in this study.
Out of 550 school children, only 336 children were included
in the study as their df score was either 0 or equal to/above
10. This df score criteria was followed in accordance with
that suggested by Atasu.[6] The sample was divided equally
into males and females to notice any sexual predilection of
genetic pattern of caries.
We did not include the dermatoglyphics of children with
syndromes,[2,5,7] as the literature suggests them to show a
peculiar pattern, and oral hygiene maintenance is variable
in them in comparison to normal healthy children.
In the present study, dermatoglyphic data were collected in
accordance with the method used by Atasu[6] and Somani,[10]
using the ink method with the black duplicating printing
ink. The stamp pad or liquid dyes cause smudging and the
pattern of the prints are not properly distinguished. Another
option is to take the alginate impression of the hand and
pour it in dye stone, but obviously this method is cost
prohibitive. Other methods of recording handprints include
photography, scanners and biometric machines.
Blinding of the examiner was done by recording the df
score and handprint samples separately. A single examiner
carried out the reading of all the handprints to decrease
inter-examiner variability.
We infer the following from the findings of the study.
• Females showed ulnar loops, especially on the left-hand
thumb, and males had ulnar loop on the left-hand 2nd
digit (middle finger).
• Arches on thumb in males are considered to be less
susceptible to dental caries.
• Increased occurrence of whorls (or Chakras ) was
noted in the children showing comparatively higher
df score.
• Whorls in the third digit or ring finger (left hand of
males and right hand of females) [Figure 8] had higher
df score.
217
Children showing the dermatoglyphic markers for caries
can be kept at “customized” dental visits instead of
standard “6-month” recall and preventive measures like
pit and fissure sealants, frequent fluoride application can
be considered.
The data available from this study reveal that females
show more consistent patterns to predict dental caries
susceptibility through dermatoglyphic markers.
The quantitative analysis of the TRC in caries-free and
caries children showed the increased occurrence of TRC
[Figure 8] in caries-free children than caries group. These
findings are found to be consistent to that observed in a
study by Metin Atasu in 1998.[6]
Limitations of the study
• Schools in only Belgaum district were considered,
whereas a more stratified sample will show more
accurate results.
• Dermatoglyphic patterns of monozygotic twins or
parents/children should be compared with df scores for
better results.
• There is no way of finding out whether genetics or
environmental factors play a dominating role in the
occurrence of dental caries.
• Dental caries, being a multifactorial disease, cannot be
controlled in children just by knowing their genetic
susceptibility to the disease. If such patients do not have
any complaint regarding their dental problem, then
motivating parents and the child in such circumstances
is unconvincing and difficult.
CONCLUSIONS
To conclude, the following points can be considered to find
the genetic susceptibility of children to dental caries:
• Dermatoglyphic patterns show a strong correlation to
the prevalence of dental caries.
• Presence of whorls on the 3rd digit of right hand of
females predicts high caries risk.
• Presence of whorls on the 3rd digit of left hand of males
predicts high caries risk.
• The TRC of caries immune children was significantly
greater than susceptible children.
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5.
Mulvihill JJ, Smith DW. The genesis of dermatoglyphics. J Pediatr
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Kimura S. Embryologic development of flexion creases. Birth Defects
Orig Artic Ser 1991;27:113-29.
Galton F. Finger prints. London: McMillan; 1982.
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Palmistry and dental caries
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Bixler D. Genetic aspects of dental anomalies. Chapt. 6. In: Mc Donald
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10. Sharma A, Somani R. Dermatoglyphic interpretation of dental caries
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How to cite this article: Madan N, Rathnam A, Bajaj N. Palmistry: A tool for
dental caries prediction!. Indian J Dent Res 2011;22:213-8.
Source of Support: Nil, Conflict of Interest: None declared.
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