|Year : 2017 | Volume
| Issue : 2 | Page : 70-75
Correlation between blood group and early childhood caries in children of Vadodara City, Gujarat: A cross-sectional observational study
Sapna Ashokkumar Pardasani, Bhavna H Dave, Sahaj Rohitkumar Parekh, Princy S Thomas
Department of Paedodontics and Preventive Dentistry, Sumandeep Vidyapeeth University, Vadodara, Gujarat, India
|Date of Web Publication||25-Jan-2018|
Dr. Sapna Ashokkumar Pardasani
8, Shree Park Society, B/H Aavkar Hall, Karelibaug, Vadodara - 390 018, Gujarat
Source of Support: None, Conflict of Interest: None
Context: The dental caries is a result of localized demineralization on tooth surface caused by metabolic events that occur in the dental plaque. Overall prevalence of early childhood caries (ECC) in general population ranges up to 70%. There are various studies conducted to find the association of ECC with various factors, yet very few studies have been conducted to predict and prevent the ECC before its occurrence. Aims: To perceive whether there is any correlation between blood group and ECC in children of Vadodara city. Settings and Design: The cross-sectional observational study was conducted among 120 selected children in a preschool. The students were segregated into two groups, 60 children with caries and 60 children without caries between chronological age of 2–6 years. Subjects and Methods: Blood group of the children was recorded from the blood group card of the patient, and dental caries status was recorded as decayed-extracted-filled teeth status with the help of autoclaved diagnostic instruments (mouth mirror and No. 23 explorer). Statistical Analysis Used: Kruskal–Wallis test, Mann–Whitney test, independent t-test, and Pearson Chi-square test were used for analysis. Results: From the total participants included in the study, blood group O+ showed maximum occurrence of ECC among all other blood groups. Conclusions: Children belonging to Vadodara city with blood group O+ are at high risk of getting ECC.
Keywords: Blood group, decayed-extracted-filled, early childhood caries
|How to cite this article:|
Pardasani SA, Dave BH, Parekh SR, Thomas PS. Correlation between blood group and early childhood caries in children of Vadodara City, Gujarat: A cross-sectional observational study. Indian J Oral Health Res 2017;3:70-5
|How to cite this URL:|
Pardasani SA, Dave BH, Parekh SR, Thomas PS. Correlation between blood group and early childhood caries in children of Vadodara City, Gujarat: A cross-sectional observational study. Indian J Oral Health Res [serial online] 2017 [cited 2022 Jun 26];3:70-5. Available from: https://www.ijohr.org/text.asp?2017/3/2/70/223928
| Introduction|| |
Dental caries has become a major public health challenge. Infants  have been more epidemic toward dental caries. Tooth decay in infant is a multifactorial infection  termed as early childhood caries (ECC)., Regardless of the decline in the prevalence, ECC still remains a problem in countries like India.
To study the ECC epidemiology, we need to follow management measures along with risk-based caries prevention. Various studies have been previously conducted;,, however, there are very few studies which have focused on the association of ECC with genetic factors.
Hence, this study aimed to find whether there is any association between ECC and blood group type, a genetic marker for ECC.
| Subjects and Methods|| |
This study was approved and carried out at a preschool in 2016. This school was selected based on convenience that is on availability of school children with deciduous dentition or mixed dentition on the day of examination. Prior permission from the school was obtained before conduction of the study.
Study population selection
Minimum sample size as calculated by a statistician was 120 students. Subject selection and data collection were initiated after ethical approval. The inclusion criteria were children of age group 2–6 years, students coming from same socioeconomic status, and children with blood group card/any authentic document (school diary, previous blood examination report) presenting their blood group type. Subjects of those parents, who granted written informed consent and assent form; understood the nature of study; and were considered willing, able, and likely to comply with all the study procedures, were included in the study. Potential subjects were excluded if they reported mental disability, physically handicapping conditions which affect their motor coordination, and/or having developmental anomalies. The strength of the preschool was 270; of these, parents of nine children did not give the consent to participate and seven children were absent on the day of study. Hence, we assessed 254 students in total. Furthermore, to overcome bias, we included those individuals who belonged to the same socioeconomic status (Kuppuswamy classification of socioeconomic status–January 2015), which was ruled out while recording demographic details. The examiner was calibrated by a co-investigator for examination, and an assistant was there for recording the details. Before conduction of the study, the purpose and the nature of study were explained to the principal of the school, and parent information sheet was provided in both English/local languages (Gujarati) following which they signed consent form and assent form before examination. Informed written consent and assent were taken from parents/guardians in English/local language (Gujarati).
The scheduled days (Saturday and Sunday) were selected based on convenience of parents so that they can accompany their children on the day of study. Primarily, demographic details were collected and entered in a pro forma. Examination was carried out in natural light with children seated upright in chair with backrest. Autoclaved diagnostic instruments (mouth mirror and No. 23 explorer/Sickle probe/shepherd's hook probe [GDC Company]) were used for recording the index, and data were recorded by the trained assistants to help the principal investigator.
Caries diagnosing criteria
Criteria suggested by “Henry T. Klein, Carolle E. Palmer, and Knutson J. W. in 1938, modified in 1987” were used for the diagnosis of ECC which was done by the primary investigator only to avoid intraexaminer reliability. No child with permanent teeth was found during examination.
Sample distribution based on decayed-extracted-filled teeth status
After taking the records, we came up with the data which showed up that out of 254 participants, 64 were with caries and 190 without caries; however, four of the participants from caries group need to be excluded as two of them were not present with any document showing blood group type and the other two belonged to lower middle socioeconomic class. Moreover, we need to exclude seven subjects from caries-free group as they were not fulfilling the inclusion criteria.
Assessment for prevalence of early childhood caries to blood group type
Finally, we had 60 subjects belonging to caries group and 182 to caries-free group. Moreover, all of the above-presented subjects belonged only to higher middle socioeconomic class. As our aim was to correlate blood group type with ECC, we equally distributed subjects with caries and without caries. Hence, we randomly included 60 children without caries and 60 children with caries between chronological age of 2–6 years and then recorded blood group type. Only Rh+ blood groups were included in the study as we could not find Rh-blood group in the inspected preschool students.
We assessed all of the children present on the day of study and recorded the examination details in their diaries as well so that their parents can also know about the oral hygiene status of their child. In addition, we gave each of them complimentary toothpaste and taught them proper brushing technique (Floss Method) and recommend them to visit our hospital for treatment. Hence, this study came out to be beneficial for the targeted population.
After the collection of data, master chart was prepared on the computer using Microsoft Excel 2010 into which the collected data were entered. Statistical analysis was done using STATA/MP-Parallel Edition Version 13 for appropriate statistical test. Kruskal–Wallis test was used for comparison of the mean rank of decayed-extracted-filled (deft) with the blood group having ECC. Mann–Whitney test was used for interblood group comparison for assessing the significant difference towards prevalence of ECC. Independent t-test was used for intergroup comparison of mean age and Pearson Chi-square test was used to check the association between the groups.
| Results|| |
From total 270 subjects, 60 were selected with caries and 60 without caries (total 120) between age group of 24 and 72 months.
[Table 1] shows the prevalence of ECC among ABO blood group types among study subjects.
|Table 1: Prevalence of early childhood caries among ABO blood group types among study subjects|
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[Chart 1] shows the frequency of blood group distribution.
[Table 2] depicts the frequency distribution of demographic variables among study subjects with respect to presence or absence of caries.
|Table 2: Frequency distribution of demographic variables among study subjects with respect to presence or absence of caries|
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[Table 3] summarizes the prevalence of ECC in males and females with different blood group type.
|Table 3: Prevalence of early childhood caries in males and females with different blood group type|
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Box plot presentation shows the distribution of sample based on deft index score [Chart 2]. As the distribution was found to be not normal, we opted for non-parametric test (Kruskal-Wallis test) [Table 4].
Mean rank of deft when compared to blood group type revealed highest prevalence of ECC amongst children having blood group O+ (69.39) and lowest with AB+ blood group (43.03). Pearson Chi-square test value as calculated by Kruskal–Wallis test was found to be highly significant (df = 3, P = 0.039).
Comparison of the mean rank of deft with the blood group having ECC. When the mean rank of deft was compared among blood groups, it was found to be highest among children having O+ blood group (69.39) and lowest in blood group AB+ (43.03). Moreover, the P value, as calculated by Kruskal–Wallis test, was found to be highly significant (<0.05) [Graph 1].
To confirm the prevalence of blood group to ECC, we performed Mann–Whitney test [Table 5] to check the intergroup comparison and we found statistically significant difference between blood group O+ and AB+ only (Z = −1.056, P = 0.004) [Table 5].
| Discussion|| |
There are various diseases which are epidemic in India and ECC is one among them. Many studies have been conducted to correlate prevalence of numerous etiological factors and ECC; however, till date, to the best of our knowledge, no study has been conducted to know the prevalence of Vadodara population to ECC.
ECC is frequently associated with poor diet and bad oral habits. With the upgradation in research, it was understood that apart from environmental and etiological factors, certain unknown factors did play a consequential role in development of ECC. Hassel and Harris claimed that out of five distinct traits (expanded from Osborne (1963)) responsible for causing caries, density of the enamel and composition of salivary factors are the most likely candidates for direct genetic control; hence, we can consider genetic factor to play some role or major role in initiation of ECC.
The ABO blood type system comprises of four blood groups: O, A, B, and AB. Mondal et al. and Agrawal et al. have found the frequency of the distribution of blood group to occur as O > B > A > AB or O > A > B > AB., The O blood group 34.2% is the most prevalent blood group which is in accordance with our study [Chart 1] followed by A-positive blood group 26.7%, B-positive blood group 24.2%, and AB-positive blood group 15%.
When the distribution of ABO blood group among females were analyzed [Table 3], it was in agreement to the results found by Chandra and Gupta (2012),, which discovered that among Rh-positive female donors blood group type B was most common (35.29%) followed by group O (29.41%), A (20.58%), and AB (14.70%), which was almost alike to our results. However, the P value obtained in their study was highly insignificant. Again since the study population of our study was limited and we had not involved Rh-negative blood groups. Hence, such results should not be generalized to the whole population and warrant future studies.
Using a small population-based cross-sectional double-blinded study, we checked the prevalence of ECC with different blood groups types in population of Vadodara. The results revealed that blood Group O positive is more prevalent to ECC and Blood Group AB positive the least one. Very few studies have been conducted to assess the relationship between blood group and dental caries. Some studies concluded no association between deft status and blood group type while others showed the opposite results. However, each of the study's methodology showed some of the dissimilarity with other studies (including ours), for example, sample size distribution, subject selection and gender bias. In 2015, Singla et al. conducted study amongst 150 subjects (third and fourth decades) of Western Punjab populations, which were randomly selected based upon their deft status. Gender distribution was not equal. This study concluded that blood group A and B are more prevalent to ECC whereas blood group O and AB showed less prevalence. Contradictory results were obtained from a study performed by Kadhum and Diab  in 2015, in which they included equal female (aged 18 years) subjects belonging to each blood group. They revealed that blood group AB is more prevalent to ECC while blood group B is less. In our study, equal distribution of children was done based upon presence or absence of caries. Gender distribution was not equal. Results revealed that blood group O positive is more prevalent to caries.
To evaluate the prevalence of ECC with blood group types in a population, we encourage to conduct a study which includes a large population, with equal sample belonging to each blood group (Rh+ and Rh−) and gender, also to eliminate the other factors responsible for causing ECC such as presence of plaque, poor oral hygiene, gender, the frequency of consumption of sugar-containing drinks,,,, nocturnal breastfeeding, prolonged duration of breastfeeding,,, child's socioeconomic status, maternal knowledge of oral hygiene practices, maternal nutrition, and their mental health., This will eradicate the bias and focus only upon the association of blood group type to ECC.
In our study, we correlated blood group types of children along with their deft status, which revealed that blood group O positive with 65.9% is the most prevalent Blood Group type to ECC [Table 1] and blood group AB positive with 22.20% is the least one [Table 1]. The P value as calculated by Pearson Chi-square test was highly significant (0.019). The mean rank of deft was found to be highest among O-positive blood group (69.39) and least among AB-positive blood group (43.03) [Graph 1]. Moreover, the P value as calculated by Kruskal–Wallis test [Table 4] was highly significant. On the contrary, Dr. D'Adamo stated that blood group A may be less prone to dental caries than the other Blood Groups, especially if the blood group type A subjects are secretors., However, he also mentioned that blood group O subjects are more prone to caries especially if the subject is a nonsecretor. Further he has stated that individuals with high rates of caries have low rates of periodontal disease, and vice versa. This may be genuine for blood groups as well. Type O blood group has been known to have lower frequencies of periodontal disease;, hence, it can be postulated that blood group O can be more prevalent to ECC which was in agreement to our results obtained., At the same time, when Barros and Witkop conducted a study on a large group of Children, found no association between the deft score and ABO blood groups.
A study conducted by Ligtenberg et al. concluded that the average aggregation of blood group O or A was much higher than blood group B. This result is in congruity with the findings of our study. However, in our study AB+ blood group is the least prevalent with lowest deft score for caries. Furthermore, Mann–Whitney test was conducted among all the pairs; only intergroup comparison between blood group O-positive with blood group AB-positive showed a significant difference, Z = −2.880, <0.05, with blood group O positive showing high prevalence as compared to other blood groups.
Considering the association of gender with ECC, still there is a debate going on whether sex can be considered as a risk factor for dental caries!! In 2015, Khan et al. (2015) concluded that child's feeding habit, oral hygiene practice, sugar intake, and parental education were found to be highly associated with ECC while gender did not play any significant role in the prevalence of ECC. Moreover, Saleem et al., Inayat et al. (2016), and Kurian et al. (2010) also found the same results in their study. This may be because at this early age dietary and oral hygiene practices related to ECC are mostly controlled by parents/caregivers. However, one of the studies conducted by Prakasha Shrutha et al. concluded that boys are highly prevalent to ECC as compared to females. Further, Bhardwaj et al. came up with positive correlation with gender and ECC, with males being more prone to caries as compared to females. The same results were concluded by Infante and Gillespie, Zerfowski et al., and Saravanan et al. These results are in true accordance with the ones obtained in our study [Table 2], males being highly prone to ECC 59.2% as compared to females 34.1% with P value highly significant (0.008). Koya et al. have explained the reason males being more prevalent to ECC may be due to gender bias in the Indian Society regardless of the socioeconomic status. Males might be feed for longer times as compared to females. However, the probability of biological factor like gender being risk factor for ECC is difficult to understand and may require further studies to investigate gender differences in caries risk practices.
Secretor status of an individual is thought to be associated with various anomalies and diseases such as ECC. Most people (between 80% and 85%) have blood group type antigens that float around freely in their body secretions such as saliva, semen, and sweat. These people are called secretors whereas people who do not secrete their blood type antigens in other fluids besides blood are nonsecretors. The amount of the blood antigens secreted in the saliva depends upon the quantity of saliva secreted in patients. D'Adamo states that secretors are less prevalent to ECC as compared to nonsecretors. In most of the studies that we had reviewed, there is no involvement of secretor status (including ours). For example, in 2014, Mazumdar et al. concluded that there is no correlation of dental caries with blood group type. However, as previously mentioned, the study conducted by Singla et al. has involved secretor status along with blood group type stated totally opposite results.
Hence, we also motivate the further studies to include secretor status along with an assessment of blood group type.
Limitations of our study
Rh-negative blood group was not involved since they were very less in number; therefore, Rh system was not taken into consideration. Based on the present findings, it can be inferred that children with blood group O positive appear to be more prevalent to ECC while the least prevalent blood group type is AB positive. However, we would encourage further studies with larger sample size along with the secretor status of individual, S-IgA level, and Rh blood group system for better understanding of association of blood group type and ECC.
Moreover, so just like the similar adage, “an ounce of prevention is worth a pound of cure,” dentist should make aware parents about the factors which may be risk factor for ECC and prevent it for the better future of the child.
| Conclusion|| |
The present study showed high prevalence of ECC among individuals possessing blood group O positive while individuals with the blood group AB positive were found to be less prone to ECC. The results obtained were highly significant. Although preventive measures and treatment measures are solutions to it, if the cause is not identified, it will lead to failure in prevention which leads to consequential and costly long-term adverse effects. To overcome the above situation, the ECC should be predicted before its occurrence.
We would like to acknowledge Dr. Sinha Soumya for playing a supportive role during synopsis preparation of this study and Mrs. Pardasani Jyoti - Principal of Joy Kids Care Preschool - for general support.
Financial support and sponsorship
Joy Kids Care Preschool supported the study.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]