|Year : 2015 | Volume
| Issue : 2 | Page : 207-212
Qualitative analysis of dermatoglyphics in oral submucous fibrosis
Parvathi Devi Munishwar, Bellona Thiyam, Ravindra Setru Veerabhadrappa, Dharamveer Singh, Kuber Tyagi, Sumeet Shah
Department of Oral Medicine and Radiology, Teerthanker Mahaveer Dental College and Research Centre, Moradabad, Uttar Pradesh, India
|Date of Submission||06-Sep-2014|
|Date of Acceptance||22-Jul-2015|
|Date of Web Publication||21-Nov-2015|
Department of Oral Medicine and Radiology, Teerthanker Mahaveer Dental College and Research Centre, N.H.-24, Delhi Road, Moradabad - 244 001, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Aim: The study was conducted to analyze the significance of dermatoglyphics in predicting the development of oral submucous fibrosis (OSMF) among gutkha chewers. Objective: To evaluate the finger tip patterns in OSMF patients. Materials and Methods: The study was conducted on 75 subjects selected randomly from the OPD of Oral medicine and Radiology, out of which 25 subjects were gutkha chewers with OSMF, 25 were gutkha chewers without OSMF, and 25 were healthy subjects who were used as controls. The fingertip patterns were recorded using duplicating ink on A3 size paper and analyzed for their configurations using a magnifying lens. Results: Statistical analysis showed significant increase in the percentage of loops among gutkha chewers with OSMF and controls, and significant increase in the whorl patterns among the control group. The distribution of finger tip patterns of all the digits showed statistically significant increase in whorl pattern in right index (RI) and right ring (RR) finger. Conclusion: The present study showed a significant increase in the loop pattern among gutkha chewers with OSMF in comparison to controls. Thus, it can be concluded that people with more number of loop patterns are more prone to develop OSMF as compared to those with other patterns. Hence, dermatoglyphics can be used in this modern era to forecast the future of gutkha chewers, without much intervention.
Keywords: Dermatoglyphics, finger tip pattern, gutkha, oral submucous fibrosis
|How to cite this article:|
Munishwar PD, Thiyam B, Veerabhadrappa RS, Singh D, Tyagi K, Shah S. Qualitative analysis of dermatoglyphics in oral submucous fibrosis. J Indian Acad Oral Med Radiol 2015;27:207-12
|How to cite this URL:|
Munishwar PD, Thiyam B, Veerabhadrappa RS, Singh D, Tyagi K, Shah S. Qualitative analysis of dermatoglyphics in oral submucous fibrosis. J Indian Acad Oral Med Radiol [serial online] 2015 [cited 2019 Dec 15];27:207-12. Available from: http://www.jiaomr.in/text.asp?2015/27/2/207/170139
| Introduction|| |
The study of the human hand has always been fascinating, not only to anthropologists and physicians, but also to psychologists, writers, painters, sages, and chiromancers.  It was in 1926 that Cummins introduced the term "Dermatolgyphics."  According to Pour Jafari H, dermatoglyphics is the study of the patterns of the ridged skin of palms and soles.  It was first used in India for personal identification by Herschel.  The pattern remains unchanged throughout life except for an increase in size with general growth.  Fingerprint is a multifactor trait. A large number of genes play their role, along with environmental influence in forming fingerprints.  Sir Francis Galton (1892) conducted extensive research on the significance of skin ridge patterns, not only to demonstrate their permanence but also their use as a means of identification. He demonstrated the hereditary significance of fingerprints and the biological variations of different fingerprint patterns among different racial groups. 
Dermatoglyphics is considered a window of congenital and intrauterine abnormalities. The importance of dermatoglyphic studies in clinical medicine is that, during development, maternal environment, gene deviants, and chromosomal aberrations affect ridge formation. Pal et al. (1982) observed the genetic component for various finger tip patterns.  Once formed, they are age and environment stable, becoming a reliable indicator of genetic damage.  At present, research claims the study of dermatoglyphics is an important diagnostic tool for some diseases especially with obscure etiology and mysterious pathogenesis. Diagnosis of many diseases which are genetically or non-genetically determined, such as diabetes mellitus, schizophrenia, hypertension, etc., can now be aided by dermatoglyphic analysis.  In dentistry, dermatoglyphics helps to predict disorders like cleft lip and cleft palate, dental caries, malocclusion, congenital anomalies like ectodermal dysplasia, gingival fibromatosis, periodontitis, bruxism, malignant and potentially malignant diseases. 
Oral submucous fibrosis (OSMF) is a chronic precancerous disease of the oral mucosa characterized by inflammation and progressive accumulation of collagen fibers in lamina propria and deeper connective tissue followed by stiffening of an otherwise yielding mucosa resulting in difficulty in opening the mouth. The available epidemiological evidences suggest that chewing of gutkha is an important risk factor for OSMF, but not all chewers develop the condition. Genetic predisposition explains such individual variability.  Dermatoglyphic investigation is absolutely cost effective and requires no hospitalization, and it can help in predicting the phenotype of a possible future illness.  Hence, the present study was carried out to qualitatively analyse the finger tip patterns among gutkha chewers with and without OSMF.
| Materials and Methods|| |
The present study was conducted in the Department of Oral Medicine and Radiology from April to July 2014 to evaluate the finger tip patterns among gutkha chewers with and without OSMF, after taking the required ethical clearance from the institutional ethics committee. The study comprised 75 subjects (52 males and 23 females) with age ranging from 18 to 67 years. A pilot study was conducted with four subjects in each group and 5% alpha and 80% power of test were obtained. Based on this, a sample size of 25 in each group was decided. The subjects were selected randomly from those who visited the outpatient Department of Oral Medicine and Radiology, and divided into three groups. Group 1 consisted of 25 gutkha chewers with OSMF, Group 2 consisted of 25 gutkha chewers without OSMF, and Group 3 consisted of 25 healthy subjects as controls. The following inclusion and exclusion criteria were considered: Gutkha chewers and patients diagnosed with OSMF based on the clinical criteria given by Lai et al. (1995) were included in the study and patients with external deformities of the fingers/hand or who have had/has trauma or injury to hand, congenital malformations, and patients with dental caries, malocclusion, red and white lesions, ulcerated lesions, and systemic diseases were excluded from the study. The controls were selected randomly from a group of healthy individuals who had no habit history of gutkha chewing or who did not have any of the defects as mentioned in the exclusion criteria. A detailed history taking with thorough clinical examination was done and the findings were recorded. Informed written consent was obtained after explaining the procedure of the study to the subjects. A small quantity of ink was applied over the palm and fingers with a gauze piece and smeared thoroughly in light strokes uniformly. The finger tip patterns were printed starting from thumb to little finger in the same order on an A3 size paper. The prints were analyzed by using magnifying lens and classified into whorls, loops, arches, and accidentals according to the standard guidelines for the classification of the patterns. The data recorded were entered in Microsoft Excel sheet and statistically analysed. Statistical analysis was done by using SPSS version 20.0 statistical software. Kruskal-Wallis analysis of variance (ANOVA) test was applied to compare the significance of each pattern between the three groups and Mann-Whitney U test was applied to find the significance within each group.
| Results|| |
[Graph 1] shows the distribution of male and female subjects among the three groups, and the age of the study samples ranging from 18 to 67 years is shown in [Graph 2], with the mean age of the study subjects being 31.93 ± 11.21 years. There was increase in the percentage of loops (43.60%) in Group 1, whorl patterns (49.20%) in Group 2, and loop pattern (57.60%) in Group 3, which was statistically highly significant between all the three groups [Table 1]. The distribution of finger tip patterns of all the digits among the three groups has been summarized in [Table 2] which shows statistically significant increase in whorl pattern in right index (RI) and right ring (RR) finger, with P values of 0.0328 and 0.0368, respectively, among the gutkha chewers with and without OSMF as compared to the control group. Comparing the three groups with respect to the patterns, there were more number of loops, significantly increased in the control group, as compared to the other groups. The mean and SD value are shown in [Table 3] and [Table 4]. Comparison of the patterns among the three groups by Mann-Whitney U test showed significant difference between the control group and gutkha chewers with and without OSMF, whereas there was no significant difference between gutkha chewers without OSMF and with OSMF. The number of arches showed significant increase in case of OSMF group as compared to the controls. However, there was no statistical significance found between the accidental pattern and the groups; the mean and SD value are shown in [Table 5] and [Table 6].
|Table 1: Pattern-wise comparison of the study samples in all the three groups|
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|Table 2: Comparison of three groups with fingerprint patterns in all the fingers of both left and right hands|
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|Table 3: Comparison of three groups with respect to number of whorls as computed by Kruskal-Wallis ANOVA|
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|Table 4: Comparison of three groups with respect to number of loops as computed by Kruskal– Wallis ANOVA|
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|Table 5: Comparison of three groups with respect to number of arches as computed by Kruskal– Wallis ANOVA|
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|Table 6: Comparison of three groups with respect to number of accidental as computed by Kruskal– Wallis ANOVA|
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| Discussion|| |
The scientific basis of friction ridge identification has evolved over many years, or even centuries. William Herschel (1858) was the first to experiment with fingerprints in India. Fingerprint patterns are classified into three main patterns.  Loops constitute 60-65% of the patterns and are the most common pattern on the finger tip. If the ridge opens on the ulnar side, the resulting loop is termed as ulnar loop. If the ridge opens toward the radial margin, it is called a radial loop. Whorls make up 30-35% of the total pattern. Henry (1937) limited the designation of the term "whorl" to those configurations having ridges that actually encircle a core. The ridges in a simple whorl are commonly arranged as a succession of concentric rings or ellipses. Another configuration of spirals around the core in either a clockwise or a counterclockwise direction is called a double or a spiral whorl. Arch is the simplest pattern found on finger tips and constitutes 5% of the patterns. The arch pattern is subdivided into two types - Simple arch or plain arch, composed of ridges that cross the finger tip from one side to the other without recurving, and tented arch composed of ridges that meet at a point so that their smooth sweep is interrupted. 
Oral submucous fibrosis is also called as "diffuse oral submucous fibrosis," "idiopathic scleroderma of mouth," "idiopathic palatal fibrosis," "sclerosing stomatitis," "juxtaepithelial fibrosis," etc.  It is a potentially malignant disorder (PMD) and a crippling condition of the oral mucosa.  Although there are regional variations in the type of areca nut products used in India, the betel quid (BQ) is the most popular and OSMF is predominantly seen in India, Bangladesh, Sri Lanka, Pakistan, Taiwan, China, and among other Asiatics, with a reported prevalence ranging up to 0.4% in the Indian rural population (Murti et al., 1995).  Epidemiological and in vitro experimental studies have shown that chewing areca nut (Areca catechu) is the major aetiological factor for OSMF. This habit was prevalent in ancient Indian culture.  Although available epidemiological evidences suggest that chewing of gutkha is an important risk factor for OSMF, genetic etiology of OSMF had been studied since 1986 suggesting genetic predisposition.  The disease was also reported in some cases who do not practice betel nut chewing and familial occurrence of the disease was also reported from northern Kerala, India. 
In the present study, which was conducted to analyze the significance of dermatoglyphics in predicting the development of OSMF among gutkha chewers and to evaluate the fingerprint patterns in OSMF patients, there was increase in percentage of the loop pattern in OSMF group (43.60%) and control group (57.60%). The percentage of whorl pattern was increased in gutkha chewers without OSMF (49.20%); however, loop pattern was significantly increased in the control group. On digit-wise comparison, there was significant increase in whorl pattern in RR and RI among OSMF patients. The present study results are in accordance with the results of the study conducted by Gupta and Karjodkar  with respect to the increased percentage of loops in the OSMF group. But Tamgire et al.  reported that there was no statistically significant difference in all the patterns among gutkha chewers with and without OSMF and that on digit-wise comparison, there was significant increase of whorl pattern in the right and left thumbs of gutkha chewers with OSMF. The present study results are, however, not in accordance with the results of the study conducted by Ganvir and Gajbhiye  who found that whorl type of fingerprint pattern was predominant in significantly higher number of individuals of oral squamous cell carcinoma (OSCC) and OSMF groups than in control groups, whereas individuals of both the control groups showed loop as the predominant fingerprint pattern. Also, the study conducted by Kumar et al.  showed that there was a significant decrease of tented arch, ulnar loop, and radial loop and an increase of simple whorl in OSMF subjects in comparison with normal individuals.
Dermatoglypics has also been used to diagnose many diseases. In 2010, Kiran et al. conducted studies on mentally retarded children and found that the mentally challenged children showed a decreased frequency of arches and whorls and a corresponding marked increase in the presence of loops.  In 2011, Bhat et al. conducted a study on 100 deaf and mute children (6-16 years) and concluded that the frequency of whorls was found to be more in caries group and the frequency of loops was more in caries-free group.  In their study on diabetic patients, Sharma and Sharma found in 2012 that the highest distribution of the whorl, loop, and arch patterns was in the 4 th , 5 th , and 2 nd fingers, respectively, whereas they were present in the 4 th , 5 th , and 3 rd fingers in the controls, respectively. The whorl spiral (D-41%, C-52%) and whorl symmetrical (D-41%, C-57%) patterns were found to be highest in the 4 th finger, but a double loop whorl was seen in the 1 st finger (D- 23%, C-16%). The loop ulnar pattern was found to be the highest in the 5 th finger (D-80%, C-76%), but the loop radial was the highest in the 2 nd finger (D- 8%, C-7%). These differences between the two groups were statistically insignificant. Symmetrical (D-41%, C- 57%) was found to be highest in the 4 th finger, but a double loop whorl was seen in the 1 st finger (D-23%, C- 16%). The loop ulnar was highest in the 5 th finger (D- 80%, C- 76%), but the loop radial was highest in the 2 nd finger (D- 8%, C-7%). These differences between the two groups were statistically insignificant. 
The variation of the results in the present study compared to other studies may be due to the geographic variation, as the Indian subcontinent is known for its enormous linguistic, cultural, ethnic, religious, and geographic heterogeneity. Segura-Wang and Barrantes reported that there is interpopulation variation in dermatoglyphic patterns.  If OSMF can be predicted with the help of dermatoglyphics, then counselling and motivation of patients who are more prone to developing OSMF can be done at a much earlier stage. However, there is a need for more multicentric studies to be conducted in a larger population with age-, sex-, religion-, and race-matched controls, so as to segregate genetically predisposed individuals among the population at risk for developing OSMF.
| Conclusion|| |
Fingerprint analysis for personal identification is well known, as it is unique to all individuals and remains unchanged over lifetime. Dermatoglyphic analysis is now beginning to prove itself as an extremely useful tool for preliminary investigations in conditions with a suspected genetic basis. In many respects, it has been used as an adjunct to other disciplines, serving as a vehicle to resolve broader biomedical problems. Thus, in biology, anthropology, genetics, and medicine, dermatoglyphics serves as a tool to describe, compare, and contrast, and at times predict occurrences and risks for biomedical events studied by these major disciplinary areas. If the dermatoglyphic marker of OSMF is found, it will be of immense clinical importance in this era of gutkha chewing, so that people with a tendency to develop OSMF may be detected earlier among the gutkha chewers and the cost burden associated with genetic cytomarkers studies may also be prevented.
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Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]