|Year : 2011 | Volume
| Issue : 2 | Page : 213-218
|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
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|Date of Submission||20-Jul-2010|
|Date of Decision||08-Apr-2010|
|Date of Acceptance||11-Oct-2010|
|Date of Web Publication||27-Aug-2011|
| Abstract|| |
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 3 rd digit, and also low total ridge count, especially in males.
Keywords: Dental caries, dermatoglyphics, genetics
|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
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". 
The dermal ridges take their origin from the fetal volar pads that appear in the 6 th -7 th 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 the genome (normal or abnormal) is deciphered during this period and is also reflected by dermatoglyphics.  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 12 th -14 th 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. 
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.  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".
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 More Details (EVC)  and in dental caries  and by Kargul et al.  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.
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.
| Materials and Methods|| |
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 (2Χ power)
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 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.
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.)
Children with special health care needs (e.g. cleft lip and palate syndromes,  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.
Recording of dental caries status
- The oral examination of all the children was done in natural light.
- Caries status was recorded using the df index given by Grubbel AO.
Recording of handprints
- 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 (2Χ) 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 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.
- 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 4 th digit till the thumb.
- Then, they were observed from the thumb of right hand till the 4 th digit.
It was done under a magnifying glass with 2Χ 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.
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.
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 3 rd digit than in males, who showed more whorls on their right-hand 3 rd digit.
Caries group showed decreased TRC [Figure 8], especially in males, than caries-free group.
| 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.  Dermatoglyphics is considered as a window of congenital abnormalities and is a sensitive indicator of intrauterine anomalies. 
The dermatoglyphic patterns have been used as an oral health marker, which can determine the genetic 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. 
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. 
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.  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, ,, 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  and Somani,  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 2 nd 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.
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. 
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 3 rd digit of right hand of females predicts high caries risk.
- Presence of whorls on the 3 rd digit of left hand of males predicts high caries risk.
- The TRC of caries immune children was significantly greater than susceptible children.
| References|| |
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|5.||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. |
|6.||Metin A. Dermatoglyphic findings in Dental caries: A Preliminary report. J Clin Pediatr Dent 1998;22:147-9. |
|7.||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. |
|8.||Blanka Schaumann, Milton, Alter. Dermatolglyphics in medical disorders. New York, Heidel berg, Berlin: Springer- Verlage; 1976. |
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Department of Pedodontics and Preventive Dentistry, K.L.E.S's Institute of Dental Sciences, Belgaum, Karnataka
Source of Support: None, Conflict of Interest: None
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]
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