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ORIGINAL RESEARCH Table of Contents   
Year : 2010  |  Volume : 21  |  Issue : 3  |  Page : 364-368
ABO blood groups and Rhesus factor: An exploring link to periodontal diseases


1 Department of Periodontics, PMNM Dental College and Hospital, Bagalkot, Karnataka, India
2 Department of Anaesthesia, SN Medical College and Hospital, Bagalkot, Karnataka, India

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Date of Submission25-Oct-2009
Date of Decision11-Nov-2009
Date of Acceptance21-May-2010
Date of Web Publication29-Sep-2010
 

   Abstract 

Background: The presence or absence of blood group antigens has been associated with various diseases, with antigens also acting as receptors for infectious agents. Scanty literature is available in assessing the relative liability of blood group phenotypes to periodontal diseases. This research was conducted to determine the association of the ABO blood group and Rhesus (Rh) factor to periodontal diseases to assess whether they could be the predictors of periodontal diseases.
Materials and Methods: A total of 1,220 subjects aged between 20 and 55 years were selected on a random basis. The study populations were segregated into three groups according to Ramfjord's periodontal disease index: Healthy, Gingivitis and Periodontitis. Blood samples were collected to identify the ABO blood groups and the Rh factor by the slide method.
Results: Blood group A showed a significantly higher percentage in the gingivitis group and blood group O showed a higher percentage in the periodontitis group. The blood group AB showed the least percentage of periodontal diseases. The distribution of Rh factor in all groups showed a significantly higher distribution of Rh-positive.
Conclusion: The genetic factors may alter the oral ecology and the process of periodontal disease. These data are suggestive of a broad correlation between periodontal diseases and blood groups, which may act as risk predictors for periodontal diseases. This will make it possible to better-understand the risk factors of diseases of the periodontal tissues and to predict the effective methods of prevention and treatment of periodontal diseases.

Keywords: ABO antigens, gingivitis, periodontitis, rhesus factor, risk predictors

How to cite this article:
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

How to cite this URL:
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 [serial online] 2010 [cited 2019 Sep 22];21:364-8. Available from: http://www.ijdr.in/text.asp?2010/21/3/364/70804
The history of investigations regarding the relation between blood groups, Rhesus (Rh) factor and dental diseases goes back to 1930. [1] At the turn of the century, Landsteiner first described the existence of serologic differences between individuals, allowing him to classify people into one of four groups depending on whether their red cells contained agglutinogen "A," agglutinogen "B," neither A nor B (O) or both A and B (AB). This discovery led to a series of serologic, genetic and immunochemical studies that are continuing even at the present time. The ABO system and the Rh system are the most commonly used blood grouping systems. The antigens of the ABO system are an integral part of the red cell membrane, which is also found in plasma and other body fluids. The presence or absence of certain antigens has been associated with various diseases and anomalies, with antigens also acting as receptors for infectious agents. [2],[3]

Immunohistochemical studies have demonstrated the presence of A/B antigens on spinous cells in the non-keratinized oral epithelium of blood group A and B persons, where basal cells express precursor structures and the more-differentiated spinous cells express the A or B antigens. Blood group O persons who do not have the A and B gene-coded glycosyltransferase express a fucosylated variant (Ley) of the precursor structure. [4] This study provides new insight into the role of the immune system in maintaining health and combating disease, not only in the periodontium but also in the other tissues.

The relative liability of some blood group phenotypes to certain diseases has been investigated. Blood group A individuals have been reported to be more susceptible to gall stones, cholitis [5] and tumors of salivary glands, [6] pancreas as well as ovary. [7] Cardiovascular diseases are more common in blood groups A, O and non-O. [8],[9],[10],[11] Diabetes mellitus might be higher in subjects of blood groups A and O. [12] For several decades, the ABO groups have been suspected of contributing to infertility and fetal loss, but reports have often been conflicting and speculative. [13] This has resulted in a large accumulation of literature and a high degree of controversy.

Periodontal disease is a chronic immunoinflammatory response associated with both the genetic makeup and the environmental influence. This results in destruction of soft and hard tissues of the periodontium. The extent of disease is predicted to be controlled by the quality and quantity of the host response that is modulated by systemic disease. [14],[15] Periodontitis may have influences on the occurrence, severity of systemic conditions and diseases that share common risk factors. For the past few decades, research has been focused on systemic conditions and its role in the pathogenesis of periodontitis. Most studies have shown a positive correlation between periodontal disease and systemic conditions, especially cardiovascular diseases such as myocardial infarction and atherosclerosis, respiratory infections such as chronic obstructive pulmonary diseases and pneumonia and diabetes. They act individually in an additive fashion or synergistically to contribute to periodontal disease. [16],[17],[18] Continued scientific exploration is required to determine which factors should be the primary target for the treatment of periodontitis and other complications.

A plethora of studies have been conducted in the field of medicine. Surprisingly, very few researches have been conducted to determine the relation between ABO blood group and the incidence of oral or dental diseases. Some researchers claimed that there was a relation whereas some others could not find any, which could be attributed to the geographical diversity in the population groups. This had led to a controversy in the earlier years. [19] Thus, this research was conducted to determine the association of the ABO blood group and the Rh factor with periodontitis, to know whether they can be predictors of periodontal diseases. It is expected that performing investigations in this research area will make it possible to better-understand the risk factors of periodontal diseases and to predict the effective methods of prevention and treatment of periodontal diseases.


   Materials and Methods Top


The subjects were selected from the Outpatient Department of Periodontics at the P.M.N.M. Dental College and Hospital, Bagalkot. This study comprised of 1,220 subjects, inclusive of both sexes, aged between 20 and 55 years, selected on a random basis. Subjects who had at least 20 teeth, excluding the third molars, were included in the study. Patients who were unable to perform routine oral hygiene, smokers, alcoholics, any previous history of antibiotic therapy and any periodontal treatment within 6 months prior to examination were excluded from the study. Subjects who were suffering from any systemic diseases or systemic conditions like pregnancy, etc. that could aggravate periodontal manifestations were also excluded.

A standard proforma consisting of details of each subject, such as name, age, sex, medical, past dental history, oral hygiene habits and periodontal index, were recorded. Detailed oral examination was carried out using mouth mirror and explorer. The Oral hygiene index-simplified (OHI-S index) was used to assess oral hygiene. Periodontal status was recorded using a mouth mirror and University of Michigan "O" periodontal probe under artificial light. Periodontal scoring was performed according to Ramfjord's periodontal disease index (PDI). Based on PDI scoring, the study population was segregated into three groups: Healthy (score 0), Gingivitis (score 1-3) and Periodontitis (score 4-6). [20]

Investigations

The venous blood samples were collected to identify the ABO blood groups and the Rh factor after obtaining informed consent from all subjects. Blood samples were collected by a sterile finger prick with a disposable needle. The blood grouping and Rh factor investigation was carried out by slide method. [21]

Statistical analysis

The number of subjects in each study groups and the ABO blood groups were tabulated. The percentage distribution was calculated in both. To determine the association between the study groups, ABO blood groups and Rh factor, the tabulated data were statistically analysed using the Chi-square test.


   Results Top


A total of 1,220 subjects were examined, of which 336 were healthy, 372 were gingivitis and 512 were periodontitis patients. Of the total subjects, 635 were female and 585 were male. The mean age in female subjects was 38.91±4.53 years and in males it was 41.62±3.69 years.

Blood groups A, B, AB and O consisted of a total of 28.6% (350), 23.6% (289), 22.5% (275) and 25.08% (306) subjects, respectively, in each group. A relatively high percentage of individuals with blood group A (32.7%) and a smaller percentage of blood group O (18.2%) patients was observed in the gingivitis group. Similarly, a high percentage distribution of blood group O (32.8%) and a smaller percentage of blood group AB (18.5%) in the periodontitis group was observed [Table 1]. Chi-square analysis resulted in a highly significant association between ABO blood groups and study groups (χ2 =35.963, P=0.000). This data depicts that blood groups O and A leaned toward disease status whereas blood group AB leaned toward health. Comparative distribution of blood groups in gingivitis and periodontitis was performed. Blood group A showed a higher percentage in the gingivitis group (32.7%) while blood group O showed a higher percentage in the periodontitis group (32.8%), which were statistically significant (P<0.05).
Table 1 :Percentage distribution of ABO blood groups in the study groups


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The distribution of Rh factor among the study groups was calculated [Table 2]. The distribution of Rh factor in the study subjects showed a significantly higher percentage of Rh-positive (95.16%) than Rh-negative (4.84%) factor. However, a non-significant difference was found regarding the distribution of rhesus factors in all three study groups (P=0.381). This observation depicted the unbiased nature of the study groups.
Table 2 :Percentage distribution of Rhesus factor in the study groups


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   Discussion Top


The paradigm of pathogenesis of periodontitis is shifting. The presence of microorganisms is a crucial factor in inflammatory periodontal disease, but the progression of disease is related to host-based risk factors. Indeed, the periodontal diseases are now recognized to be ecogenetic diseases, which highlights their multifactorial nature. [22] Genetic variations may act as protective or risk factors for certain conditions, including periodontitis. Epidemiological studies on the associations between ABO blood group antigens, secretor status and susceptibility to infectious agents are summarized. Evidence for association of non-secretion with some autoimmune diseases for which infectious etiologies have been proposed. [23] Periodontal diseases are considered as host-based infectious disease in which the individual host response determines the nature of disease susceptibility. Scanty literature is available to infer the association between blood groups and prevalence of periodontal diseases. To the best of our knowledge, this is the first study conducted in a south Indian population regarding the effect of non-modifiable risk factors, i.e. blood group phenotypes and Rh factor on periodontal tissues.

The relative liability of some blood group phenotypes to certain oral diseases has been investigated earlier. It is suggested that particular blood group and a tendency toward caries might be constitutional characters that were not particularly related to race, although the blood group O and good teeth were less common in civilized people than in primitive races. [24] A high percentage of blood group O and low percentage of blood group A in caries immune group. [25],[26] In addition, denture wearers of blood group O were also found to be more susceptible to denture stomatitis. Maxillofacial deformities were the least with blood group A and were greater with blood group B, suggestive of ABO blood groups as one of the etiologic factors for these deformities. [27],[28]

The available literature suggested a preliminary data in the quest for an association between ABO blood group, Rh factor and periodontal diseases. In a study of ABO blood typing and HLA antigens, the gingivitis subjects had a larger percentage of AB types and a smaller percentage of O types. Similarly, greater severity of periodontal diseases was noted in blood group O, but no association was found between secretor status and Localized Juvenile Periodontitis (LJP). [29],[30] On the contrary, the aggressive periodontitis group showed a trend toward more blood groups A, B and a smaller percentage of O groups than the controls. [31] In this study, blood group A showed a highly significant distribution in gingivitis and group O in the periodontitis group. These findings points toward a possible genetic basis. [24]

The tissue localization of the histo-blood group antigens has shown that the antigens in the tissues correspond to the erythrocyte blood group, but the tissue expression is dependent on the secretor status of the individual. Secretor status is secretion of blood group antigens ABO (H), which may be a factor influencing the development of systemic oral diseases. [4] In the stratified epithelium, the expression of histo-blood group antigens depends on the state of cellular differentiation and maturation, and there is a sequential elongation of the terminal carbohydrate chain during the life span of the cell. Basal cells express short carbohydrate chains that are A/B precursors, whereas A or B antigens may be seen in the spinous cell layer. Variation in the differentiation patterns between keratinized vs. non-keratinized epithelium influences the expression of blood group antigens. Keratinized squamous epithelium may express A or B antigens in only very few and highly differentiated cells, leaving the precursor H antigen expressed on most spinous cells. In contrast, in the non-keratinized epithelium of the buccal mucosa, the precursor H is expressed only on a few parabasal cells, whereas expression of A and B antigens is seen in most spinous cells. The expression of A/B antigens in oral tissues is thus regulated by the expression of the A/B transferases and the availability of a substrate for the transferase. [4]

New exciting data link the fringe genes to epithelial differentiation. Fringe genes are cell-differentiation proteins that possess glycosyltranseferase activity. These proteins initiate elongation of carbohydrate residues attached to notch receptors, which are transmembrane proteins that mediate communication associated with cell differentiation. The finding that fringe expressed differently in mouse-stratified epithelium and that the gene product is glycosyltransferase is interesting in relation to the finding of a sequential expression of carbohydrates during epidermal differentiation, particularly as in mice, blood group antigen-related carbohydrates are found to be expressed in specific structures such as taste buds, tongue papillae and gingival junctional epithelium. [32] Conceptual and technical advances have provided us with further insights into the infectious agents, the characteristics of the host immune response in periodontal disease. Demir et al. found that different ABO blood groups may show significant differences in the rates of colonization of numbers of periodontal pathogens that are the main etiologic agents of periodontal diseases. [33] The murine genomic and complementary DNA that is equivalent to the human ABO gene has been cloned (Yamamoto et al., 2001). This may help to establish a mouse model system to assess the functionality of the ABO genes in the future. [34]

Rh systems have a major clinical significance and they are determined by the nature of different amino acid substitutes present on the surface of red blood cells. On comparison of percentage distribution of Rh factor in all study groups, it was determined that the Rh-positive factor showed a significantly higher distribution than the Rh-negative factor. This may be due to variation in substitutes of cell membrane proteins, which is determined by a series of allelic genes at a single locus. [2]


   Conclusion Top


The genetic factors may alter oral ecology and the process of periodontal diseases. In this study, there was a greater prevalence of gingivitis in blood group A and periodontitis in blood group O. The blood group AB showed the least prevalence of periodontal diseases. These data are suggestive of a correlation between periodontal diseases and blood groups, which may act as risk predictors for periodontal diseases. Genetic differences in immune cell development and antigen presentation may contribute to the susceptibility to infectious diseases. For definitive establishment of such an etiogenic role, multicenter collaborative studies including diverse population groups with exploration toward genetic basis are required to further elucidate this relation globally. The detailed characteristics on the function of gingival epithelium, particularly junctional epithelium, and their interaction with the surface antigens on red blood cells may provide new insights into periodontal diseases.


   Acknowledgment Top


Authors here by acknowledge Prof. L.S. Patil, Professor and Head, Department of Statistics, B.V.V.S. Science College, Bagalkot, Karnataka, India., for his valuable guidance.

 
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Correspondence Address:
Arati C Koregol
Department of Periodontics, PMNM Dental College and Hospital, Bagalkot, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.70804

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