By Dr. ANNAT VARGHESE Dissertation

i

“CORRELATION OF DERMATOGLYPHIC AND CHEILOSCOPIC PATTERNS,

ALONG WITH ASSESSMENT OF PREVALENCE OF DENTAL CARIES AND

SKELETAL MALOCCLUSION IN CHILDREN OF AGE GROUP 6-14 YEARS”

By

Dr. ANNAT VARGHESE

Dissertation

Submitted to the Rajiv Gandhi University of Health Sciences,

Karnataka, Bangalore

In partial fulfilment of the requirements for the degree of

MASTER OF DENTAL SURGERY

In

PEDIATRIC AND PREVENTIVE DENTISTRY

Under the guidance of

Dr. SHIVAPRAKASH.P.K.

Professor & Head

DEPARTMENT OF PEDIATRIC AND PREVENTIVE DENTISTRY,

P.M.N.M DENTAL COLLEGE AND HOSPITAL,

BAGALKOT-587103, KARNATAKA

2020

Scanned by CamScanner


iv

ACKNOWLEDGEMENT

This venture would not have been possible without God’s grace and spiritual

guidance. I bow before the Almighty who with his immense bountiful nature showered

blessings on me.

With profound sense of gratitude and respect, I express my most cordial and

humble thanks to my guide, Dr.Shivaprakash P.K., Prof. and Head, Department of

Pediatric & Preventive Dentistry, P.M.N.M. Dental College and Hospital, Bagalkot,

for his unparalleled and excellent guidance, constant inspiration, unlimited patience

and encouragement for which my mere expression of thanks likewise does nothing to

suffice.

It is my immense pleasure to thank my respected co-guide Dr. Mahantesha T.

for inspiring and encouraging me to achieve beyond my set limits and always being

supportive that showed me the path to success, for which I am extremely grateful.

Expressions are inadequate to convey my immense gratitude to Professor Dr.

Hina Noorani and senior lecturers Dr.Rashmi G. Chour, Dr.Prashant Jalannavar,

and Dr.Hiranmayi Brid for their keen interest, moral support and encouragement

throughout my studies.

I am extremely indebted to Prof. Dr.Shreenivas.S.Vanaki, Principal, P.M.N.M

Dental College and Hospital, Bagalkot for providing me the opportunity to utilize all

the facilities available in this institution for the completion of the study.

Above all, I would like to thank my family and friends…

Dr. ANNAT VARGHESE

v

LIST OF ABBREVIATIONS

ABBREVIATIONS FULL NAME

ANB angle A point, Nasion, B point angle

ANOVA Analysis of variance

CPITN Community Periodontal Index of Treatment Need

CVG+RG Complete vertical grooves + Reticular grooves

deft Decayed-Extracted-Filled Teeth

DMFT Decayed-Missing-Filled Teeth

IG+RG Intersecting grooves + Reticular grooves

PVG+RG Partial vertical grooves + Reticular grooves

SPSS Statistical Package for Social Sciences

WHO World Health Organisation

vi

LIST OF TABLES

SERIAL

NO.

TABLES PAGE

NO.

1. Sample size

25

2. Study parameters

25

3. Age and Gender distribution among study subjects

27

4. Comparison of different types of Lip Print Patterns among

study subjects between three skeletal malocclusions using

Chi Square Test

27

5. Comparison of different types of Finger Print Patterns

among study subjects between three skeletal malocclusions

using Chi Square Test

27

6. Comparison of mean DMFT / deft scores between different

types of Skeletal malocclusion using Kruskal Wallis Test

28

7. Multiple comparison of mean difference in the DMFT/deft

scores b/w different skeletal malocclusions using Mann

Whitney Post hoc Test

28

8. Comparison of prevalence of Skeletal Malocclusion based

on different age and gender of study subjects using Chi

Square Test

28

vii

9. Correlation between different Lip and Finger Print Patterns

in Skeletal Class I Malocclusion using Chi Square Test

29


in Skeletal Class II Malocclusion using Chi Square Test

29


in Skeletal Class III Malocclusion using Chi Square Test

30

LIST OF GRAPHS

SERIAL

NO.

GRAPHS PAGE

NO.

1. Age-wise distribution of study subjects 30

2. Gender-wise distribution of study subjects 31

3. Lip Print Patterns among study subjects between three

skeletal malocclusions

31

4. Finger Print Patterns among study subjects between three

skeletal malocclusions

32

5. Mean DMFT/deft scores between different types of Skeletal

malocclusions

32

viii

6. Age-wise Prevalence of different types of skeletal

malocclusions

33

7. Gender-wise Prevalence of different types of skeletal

malocclusions

33

8. Correlation between different lip and finger print patterns in

Skeletal Class I Malocclusion

34


Skeletal Class II Malocclusion

34


Skeletal Class III Malocclusion

35

ix

LIST OF FIGURES

SERIAL

NO.

FIGURES PAGE NO:

1. Suzuki and Tsuchihashi’s

classification system

23

2. in Dermatoglyphic patterns 24

3. Armamentarium 60

4. Obtaining informed consent 60

5. Applying child safe lipstick with

brush

61

6. Lip print being collected through

scotch tape

61

7. Lip print collected and transferred to

paper

62

8. Applying black duplicating ink with

cotton

62

9. Finger print being collected 63

10. Finger print collected on paper

63

xi

ABSTRACT

TITLE: “CORRELATION OF DERMATOGLYPHIC AND CHEILOSCOPIC

PATTERNS, ALONG WITH ASSESSMENT OF PREVALENCE OF DENTAL

CARIES AND SKELETAL MALOCCLUSION IN CHILDREN OF AGE

GROUP 6-14 YEARS.”

BACKGROUND & OBJECTIVES:

To record and compare lip prints and finger prints in children with skeletal

malocclusion (I, II, III) of age group 6-14 years.

To determine the prevalence of dental caries and type of skeletal malocclusion

in children of age group 6-14 years.

METHODS:

90 children of age group of 6 - 14 years reporting to the Department of

Pediatric and Preventive Dentistry, P.M.N.M. Dental College and Hospital, Bagalkot

were divided into 3 groups, by examining the lateral cephalograms obtained from

them, as:

Group A - consisting of 30 children with skeletal Class-I malocclusion.

Group B - consisting of 30 children with skeletal Class-II malocclusion.

Group C - consisting of 30 children with skeletal Class-III malocclusion.

xii

For the groups:

Lip-prints were taken using child safe lipstick-scotch tape method on the bond

paper and classified according to Suzuki and Tsuchihashi’s classification

system.

Finger prints (right and left) of the subjects were recorded using black

duplicating ink on the bond paper and classified as arch, whorl and loop

patterns.

Presence of dental caries were assessed by deft/DMFT index.

RESULTS:

Unique lip prints and finger prints were obtained for different skeletal

malocclusions.

Prevalence of dental caries were as follows: Class III>Class II>Class I.

INTERPRETATION AND CONCLUSION:

This study highlights the scope of early diagnosis of skeletal malocclusions

through the chelioscopic and dermatoglyphic patterns which are unique for each

individual and the prevalence of dental caries which also must be considered as an

entity to be sorted out with the preventive and therapeutic measures.

Key words: Malocclusion; Lip print; Finger print; Dental caries.

Introduction

P.M.N.M Dental College, Bagalkot 1

“CORRELATION OF DERMATOGLYPHIC AND

CHEILOSCOPIC PATTERNS, ALONG WITH ASSESSMENT OF

PREVALENCE OF DENTAL CARIES AND SKELETAL

MALOCCLUSION IN CHILDREN OF AGE GROUP 6-14

YEARS.”

INTRODUCTION

Malocclusion is defined as an irregularity of the teeth or a malrelationship

between the dental arches beyond the range of what is accepted as normal. It is one of

the most common dental problems like dental caries, periodontal disease, and dental

fluorosis. In addition, mal-occluded dentition can cause disturbances in oral function

and psychosocial problems due to impaired dento-facial esthetics. The etiology of

malocclusion is multifactorial and can be a combination of hereditary factors

including some stimulus during the formation and development of orofacial structures

and environmental factors such as oral habits, social characteristics, and diet1.

Malocclusion can be classified into skeletal malocclusion and dental

malocclusion. The occlusion in which there is a malrelationship between the arches in

any of the planes is skeletal malocclusion and in which there are anomalies in tooth

position beyond the normal limits is dental malocclusion2. Based on cephalometric

analyses, skeletal malocclusion can be classified as: Class I Skeletal Pattern, Class II

Skeletal Pattern and Class III Skeletal Pattern. Understanding the skeletal pattern is

essential for choosing the proper treatment mechanics.

The relationship between the skeletal malocclusions (Class I, II and III Skeletal

Patterns) and soft tissue facial morphology has been an arena of vast research in

Introduction


contemporary orthodontics. The lip prints are unique to an individual just like the

fingerprints and shows strong hereditary pattern3.

Lip prints consist of normal lines and fissures in the form of wrinkles and

grooves present in the zone of transition of human lip between the inner labial mucosa

and outer skin. The study of lip prints is referred to as Cheiloscopy. It can be defined

“as a method of identification of a person based on the characteristic arrangements of

lines appearing on the red part of lips or as a science dealing with lines appearing on

red part of the lips”.

Lips form an important component of the orofacial soft tissue profile. So they

play an important role in orthodontic diagnosis and treatment planning. Establishing a

correlation between sagittal jaw relation and lip prints would benefit the clinician by

predicting the type of malocclusion4. The pattern of wrinkles on the lips has

individual characteristics as fingerprints5. Similarly, in recent past several research

studies had established that lip prints can be used as evidence in personal

identification and criminal investigation in forensic dentistry3.

Dermatoglyphics as coined by Cummins and Midlo refers to the study of the

intricate dermal ridge configurations on the skin covering the palmar and plantar

surfaces of hands and feet and has been investigated extensively by many researchers.

Etymologically this term is a harmonious blend of two words derma, i.e., skin; and

glyphe, i.e., carve, giving the impression that something has been carved out of the

skin. The dermal patterns once formed remain constant throughout life6.

Through decades of scientific research, the hand has been recognized as a

powerful tool in the diagnosis of psychological, medical and genetic conditions6. The

use of finger prints in personal identification and in criminal investigation is accepted

Introduction


part of forensic science3. It has proved to be a helpful adjunct to other diagnostic

methods in identifying specific syndromes of genetic origin6.

Determining the relationship between the lip prints, finger prints and respective

skeletal malocclusions can facilitate early diagnosis of the developing jaw relation

and can also be helpful as a forensic tool. There exists a deficiency in studies carried

on samples of pediatric age groups.

Dental caries is the localized destruction of susceptible dental hard tissues by

acidic by-products from bacterial fermentation of dietary carbohydrates7. The

relationship between malocclusions and prevalence of dental caries is an important

concept. This association is due to the increased susceptibility to plaque retention

among the crowded teeth, which results in caries development8.

Dental caries has been compared with malocclusion and some authors reported

a positive association between them. Moreover, conflicting results have been obtained

in studies considering a possible relationship between malocclusion and various oral

hygiene measures9.

Considering the increasing frequency of poor oral health status in children

having malocclusion, it is required to conduct a study to investigate the

dermatoglyphics and cheiloscopic patterns, along with assessment of prevalence of

dental caries and type of skeletal malocclusion in boys and girls of age group 6-14

years.

Objectives


OBJECTIVES

1. To record and compare lip prints and finger prints in children with skeletal

malocclusion (I, II, III) of age group 6-14 years.

2. To determine the prevalence of dental caries in children with skeletal

malocclusion of age group 6-14 years.

3. To assess the prevalence of the type of skeletal malocclusion in boys and girls

of age group 6-14 years.

Review of Literature


REVIEW OF LITERATURE

A study was conducted by Shivani et al to find pre-dominant lip print pattern in

skeletal class-III malocclusion. A total of 30 patients were taken with skeletal class III

malocclusion. On the basis of ANB angle and wits appraisal patients were categorized

into skeletal class III malocclusion. Digital soft copies of their lateral cephalograms

were taken and lip prints were taken using lipstick-cellophane method on the bond

paper. Brand of Lipstick used was LAKME enrich satins 461. Descriptive statistical

analysis was used to find the prevalence of lip prints patterns among sagittal class III

skeletal malocclusions. CVG+RG, PVG+RG, IG+RG types of lip prints were

predominant in skeletal class III group of individuals10.

A study was conducted by Raghav et al to explore the possible association of

lip prints with skeletal malocclusion. A sample of 114 subjects in the age group of

18‑30 years, from North Indian adult population were selected on the basis of skeletal

class I, class II and class III malocclusion, each comprising of 38 subjects with equal

number of males and females. Lip prints of all the individuals were recorded and

digital soft copies of lateral cephalograms were taken. Lip prints were compared

between different skeletal malocclusions. It was found that branched lip pattern was

most common in North Indian adult population with no sexual dimorphism. The

Z‑test for proportion showed that the prevalence of vertical lip pattern was

significantly higher in subjects having skeletal class III malocclusion. A definite

co‑relation of vertical lip patterns with skeletal class III malocclusion was revealed3.

Kaushal et al conducted a study to explore the possible association of lip prints

with Skeletal Class I and Class II malocclusions with varying growth patterns. A

sample of 90 subjects in the age group of 18‑30 years, from District Solan (H.P.),

population were selected. Subjects were divided into two groups group I (Skeletal



Class I) and group II (Skeletal Class II). Lip prints of all the individuals were recorded

and compared between Skeletal Class I and Class II malocclusions with varying. It

was found that Branched lip pattern was most common in District Solan population

with no sexual dimorphism. No statistically significant association of lip prints with

Skeletal Class I and Class II malocclusion was revealed4.

A study was conducted by Sharma et al to determine whether there is any

association of lip print patterns with malocclusion. 300 subjects were recruited, out of

them 234 subjects including males and females were found to be fit for the study

having dental malocclusion with age range of 18-25 years. The subjects were

classified into three groups according to Angle’s classification of malocclusion into

Class-I, Class-II and Class-III malocclusions. A thin film of lipstick was applied onto

cleaned and dried lips and left for 3 minutes. The impressions of lips were taken on

the self-adhesive cellophane tape and then immediately transferred onto the bond

sheets. The analysis of these lip print patterns was done with the help of magnifying

lens. For analysis of lip prints, classification proposed by Tsuchihashi was used. Data

was then tabulated in various classes of lip print patterns and malocclusions and then

analyzed statistically. The statistical analysis with chi square test showed that lip print

patterns were found to have highly significant (p<0.001) association with

malocclusion11.

Ponnusamy et al conducted a study to assess the strength of association between

lip patterns and skeletal class I and II malocclusion. Lip prints of 25 subjects with

skeletal Class I and 25 with skeletal Class II malocclusion (age group of 18-35years)

were recorded. Statistically significant difference between the two malocclusions

were observed in the Vertical and Branched patterns while the intersected, reticular

and undermined patters showed no difference. This was evident in the female gender



while the male gender showed differences in the vertical pattern only. Since sagittal

jaw and dental relationships get established before lip prints, lip print assessment may

aid the clinical orthodontist by predicting the type of malocclusion12.

A study was conducted by Vignesh et al to assess the correlation between

different cheiloscopic patterns with the terminal planes in deciduous dentition. Three

hundred children who are 3–6 years old with complete primary dentition were

recruited, and the pattern of molar terminal plane was recorded in the proforma. Lip

prints of these children were recorded with lipstick‑cellophane method, and the

middle 10 mm of lower lip was analyzed for the lip print pattern as suggested by

Sivapathasundharam et al. The pattern was classified based on Tsuchihashi and

Suzuki classification. Type II (branched) pattern was the most predominant

cheiloscopic pattern. The predominant patterns which related to the terminal planes

were as follows: Type IV (reticular) and Type V (irregular) pattern for mesial step,

Type IV (reticular) pattern for distal step, and Type I (complete vertical) pattern for

flush terminal plane. No significant relationship was obtained on gender comparison.

Lip prints can provide an alternative to dermatoglyphics to predict the terminal plane

in primary dentition13.

A study was conducted by Tikare et al to assess the relationship between finger

prints and malocclusion. Six hundred and ninety six children aged twelve to sixteen

years were selected. Their fingerprints were recorded using duplicating ink and

malocclusion status was clinically assessed using Angle’s classification. A statistical

association was revealed between whorl patterns and classes 1 and 2 malocclusion.

Dermatoglyphics might be an appropriate marker for malocclusion and further studies

are required to elucidate an association between fingerprint patterns and

malocclusion14.



Sonika et al conducted a study to assess the relationship between fingerprint

patterns and skeletal malocclusion. Fingerprint patterns were collected using the ink

method from 90 subjects who were divided into skeletal class I, II, and III

malocclusion groups of 30 subjects each. The loop pattern was more frequent in

patients with skeletal class I and II malocclusion, and the whorl pattern was more

frequent in those with class III malocclusion. The present study attempted to assess

the relationship between dermatoglyphic patterns with skeletal malocclusion to use as

an indicator of developing malocclusion at an early age15.

A study was conducted by Neda et al to compare the dermatoglyphic

characteristics of different malocclusions. In this cross-sectional study, 323 patients

who were referred to Orthodontic Department of Mashhad Dental School were

recruited. The participants were classified into three groups according to Angle´s

classification, i.e., Skeletal Class 1 (n = 163), Skeletal Class 2 (n = 111), and Skeletal

Class 3 (n = 49). For all participants, they recorded the total ridge counts of each

finger (TRC), atd angles, a-b ridge counts, and types of fingerprint patterns. Right-

and left-hand asymmetry scores were calculated. The chi-squared test was used to

compare the dissimilarity of the types of patterns for each finger. Asymmetry of other

parameters was analyzed statistically using the ANOVA or Kruskal-Wallis tests. P-

values greater than 0.05 were considered to be significant. A significant difference

was determined between Class I and Class III patients in terms of left a-b ridge count

(p=0.049). Loop was the most frequent pattern in the three groups, whereas the arch

pattern occurred with the lowest frequency. No significant difference was found in the

other parameters that were studied. Although there were some slight differences in

dermatoglyphic peculiarities of different skeletal malocclusions, most of the palm and

fingerprint characteristics failed to indicate any significant differences16.



Baswaraj et al conducted a study on 60, 9-12 years old, healthy children, with

mixed dentition. Their left and right handprints were recorded on a paper, and the

fingerprints were studied to find the frequency of occurrence of different types of

patterns. Based on the dental aesthetic index, malocclusion was graded into four

groups and then was correlated with the patterns’ frequency. Loops were found to

increase and while the whorls decreased, with increasing severity of malocclusion. In

this study, loop pattern is a more common in the thumb and middle finger. Whorl

pattern is a more common in the ring finger and index finger17.

A study was conducted by Divyashree et al to determine the relation between

dermatoglyphics and malocclusion. 40 individuals cephalometrically confirmed as

Skeletal Class I and Skeletal Class II based on Downs and Steiner analysis between

the age group of 15 – 30 years were selected. Fingerprint patterns of the study

subjects were recorded using ink and paper method and the finger prints were studied

to find the frequency of occurrence of different types of patterns. The pattern

distribution is significantly different between both the groups. Increased frequency of

whorls were found both in right & left hands in Skeletal Class I pattern group.

Increased frequency of ulnar loops was found in the right hand of Skeletal Class II

pattern group18.

A study was conducted by George et al to assess the correlation between

dermatoglyphic patterns and sagittal skeletal discrepancies. A total of 180 patients,

aged 18-40 years, were selected from those who attended the outpatient clinic of the

Department of Orthodontics and Dentofacial Orthopedics, Mar Baselios Dental

College, Kothamangalam, Kerala, India. The fingerprints of both hands were taken by

ink and stamp method after proper hand washing. The patterns of arches, loops and

whorls in fingerprints were assessed. The total ridge count was also evaluated. Data



was also sent to the fingerprint experts for expert evaluation. The sagittal jaw relation

was determined from the patient’s lateral cephalogram. The collected data was then

statistically analyzed using Chi-square tests, ANOVA and Post-hoc tests and a

Multinomial regression prediction was also done. A significant association was

observed between the dermatoglyphic patterns exhibited by eight fingers and the

sagittal skeletal discrepancies (p<0.05). An increased distribution of whorl pattern

was observed in the skeletal Class II with maxillary excess group and skeletal Class II

with mandibular deficiency group while an increased distribution of loop pattern was

seen in the skeletal Class III with mandibular excess group and skeletal Class III with

maxillary deficiency group. Higher mean of total ridge count was also seen in the

groups of skeletal Class II with maxillary excess and skeletal Class II with mandibular

deficiency. Multinomial regression predicting skeletal pattern with respect to the

fingerprint pattern showed that the left thumb impression fits the best model for

predicting the skeletal pattern19.

A study was conducted by Charles et al to evaluate and compare the

dermatoglyphic patterns with various skeletal malocclusions. The study was carried

out on 40 outpatients reported with an age group of 18–20 years divided into four

groups as follows: Group: I – 10 (Class I occlusion), Group: II – 10 (skeletal Class I

malocclusion), Group: III – 10 (skeletal Class II malocclusion), and Group: IV – 10

(skeletal Class III malocclusion). The fingerprints were recorded using scanner

exclusively designed for diagnostic purpose of the study. The collected data were

analyzed using SPSS statistics software Version 23.0 to find which groups had

significant differences. Increased frequency of arch pattern was present in participants

with Class I malocclusion, and loop patterns were observed in those with Class I



occlusion and Class III malocclusion and whorl patterns in Class II malocclusion with

P < 0.0520.

Smitha et al conducted a study to explore an association if any, between the

dermatoglyphic patterns and type of malocclusion among the Malaysian dental and

medical students. A total of 104 Malaysian dental and medical students were included

in the study. The fingerprints and palm prints were recorded to analyze the type of

pattern. Occlusion status was clinically assessed using Angle’s classification of

malocclusion. Statistically significant association was seen between the left thumb

ridge pattern and type of malocclusion. Individuals with loop ridge pattern on their

left thumb showed high frequency of Class I normal occlusion and Class III

malocclusion, and those with whorl ridge pattern were witnessed to have Class I

malocclusion. Dermatoglyphics serves to strengthen the diagnostic impression of

malocclusion at an early age and hence can aid in predicting malocclusion and plan

preventive and interceptive orthodontics in pediatric patients21.

A study was conducted by Matilda et al to assess the prevalence of

malocclusion and its association with socio-demographic characteristics, caries

experience and level of oral hygiene in 12-14 year old school children residing in

Tanzania. A total of 1601 children attending 16 primary schools in Kinondoni and

Temeke districts. Chi-square and multiple logistic regression models were used.

Malocclusions were prevalent in Tanzanian children investigated and were associated

with environmental factors in terms of caries experience and residing in a less affluent

district9.

A study was conducted by Sajith et al to determine the association of

malocclusion with dental caries. This cross-sectional study included 243 children with

various mental disabilities with or without physical infirmities. The Dental Aesthetic



Index (DAI) and the dentition status were recorded using the World Health

Organization Oral Health Surveys – Basic Methods (1997) Pro-forma. The Decayed

(D), Missing (M) and Filled (F) components of the DMF index were calculated using

the Dentition Status and Treatment Need (DSTN). A Chi-square test, ANOVA, and t-

test were used to derive inferential statistics. The mean DAI score ± standard

deviation was 39.0 ± 12.3. A total of 123 (50.6%) participants (74 males and 49

females) had DAI scores of 36 and above, which indicated a handicapping

malocclusion requiring mandatory orthodontic treatment. Sixty-nine (28.4%)

adolescents (36 males and 33 females) had DAI scores between 31 and 35, which

indicated severe malocclusion, for which orthodontic intervention was desirable.

Incisal segment crowding (84.8%) was the most common aspect of the malocclusion.

The mean DMFT score was 4.36 ± 3.81, and 82.8% of the participants had a DMFT

score > 0. There was no statistically significant correlation between the mean DAI and

DMFT scores (r = 0.090, p = 0.15). Only 16 (6.6%) of the adolescents had minor or

no anomaly not needing orthodontic treatment. The prevalence of malocclusion and

dental caries was found to be high22.

Jennifer et al conducted a study to evaluate the relationship between caries and

malocclusion in the early and late mixed dentition in a population of children of

Chinese migrant workers in Shanghai. Dental charts were obtained for 646 children in

the mixed dentition, aged between 6 and 13 years old. The decayed, missing, and

filled teeth (DMFT) index and interproximal tooth structure lost due to caries (ITSLC)

were evaluated. In the early mixed dentition, overbite was more likely to be ideal in

subjects with DMFT > 0. In the late mixed dentition, crowding in both arches was

greater in subjects with DMFT > 0. In the total sample, crowding in the lower arch

only was greater in subjects with DMFT > 0. In the early mixed dentition, upper



crowding was lower in subjects with ITSLC in the upper arch and in both arches and

the rate of anterior cross-bite was higher in subjects with ITSLC in the upper arch. In

the late mixed dentition, overjet was more likely to be ideal in subjects with ITSLC in

the upper arch and upper crowding was greater in subjects with ITSLC in both arches.

In the total sample, overjet was more likely to be ideal in subjects with ITSLC in the

upper arch and lower crowding was greater in subjects with ITSLC in both arches. A

relationship exists between caries and malocclusion, and between ITSLC and

malocclusion, and some relationships may change with dental age23.

A study was conducted by Monika et al to associate the dental caries,

malocclusion and oral habits with the quality of life of preschool children. Cross-

sectional study with 93 children from three to five years of age who have or have not

been affected by untreated carious lesions were selected. Parents answered the

questionnaire on oral habits and quality of life instrument related to oral health

denominated Early Childhood Oral Health Impact Scale (B-ECOHIS). A pediatric

dentist assessed the severity of the carious lesions and the presence of occlusal

disorders. The level of significance used was 5%. The B-ECOHIS demonstrated

impact on quality of life with increasing age in the fields of symptoms, psychological

aspects, self-image and social interaction and family function. Dental caries were

shown to have an impact on the quality of life of children and their families,

especially in relation the domains of symptoms and limitations. There was no

association between malocclusion and quality of life related to oral health24.

A study was conducted by Roshan et al to assess the malocclusion status,

dentition status, and treatment needs of 15‑year‑old school children of Mangalore. A

cross‑sectional study of 1001 school children aged 15‑year‑old was conducted in

Mangalore. Their malocclusion status, dentition status, and treatment needs were



recorded using the WHO oral health assessment pro-forma. Statistical analysis was

done using Statistical Package for Social Sciences version 17. Descriptive statistics

was obtained and Chi‑square test was used. The level of significance was set at 0.05.

Decayed teeth were prevalent in 45.5% of the study subjects. Malocclusion was

present in 30% of the study subjects. Teeth missing due to caries and those requiring

extraction and prosthetic rehabilitation were significantly higher in government

schools (P < 0.05). Malocclusion and treatment need was significantly higher in

government schools (P < 0.05)25.

A study was conducted by Saurabh et al to find the relationship of orthodontic

malocclusion with periodontal status, dental caries, and sociodemographic factors.

The study population comprised 400 school‑going children of age 11–14 years. The

severity of malocclusion was determined by Treatment Priority Index. The

sociodemographic factors were evaluated using a questionnaire that enquired about

age, gender, parents’ monthly income, and their educational status. Periodontal status

was assessed using Community Periodontal Index of Treatment Need (CPITN) index.

To know about dental caries, decayed, missing, filled teeth (DMFT) index was used in

this study. Spearman’s rank correlation coefficients were used to find an association

between variables. The effect of sociodemographic factors on treatment priority index

(TPI) scores was examined using Chi‑square test. Student’s t‑test (to compare TPI

scores of different genders) and analysis of variance (to compare TPI scores among

different age groups) were used in this study. Out of a total of 400 children included

in the study, 19.5% students had normal occlusion whereas a majority of them

(80.5%) showed some sort of malocclusion. CPITN scores revealed that 3.1% pupils

had no sign of the disease, 57.5% showed gingival bleeding after gentle probing, and



39.4% had supra or subgingival calculus. No statistically significant correlation was

found between the orthodontic treatment need, periodontal status, and

sociodemographic factors while a significant relation is observed of TPI with

DMFT26.

Disha et al conducted a study to establish the prevalence of malocclusion and

its association with caries experience in 8–9‑year‑old children of Davangere city,

South Indian region. The study design was a cross‑sectional survey. A total of 800

children from 350 schools (both males and females) were randomly selected for the

study. t‑test and Chi‑square test were used for statistical analysis. The overall

prevalence of malocclusion among 8–9‑year‑old children was 40.9%. The most

prevalent malocclusion was crowding (11.5%), followed by excessive overjet (9.4%),

deep bite (6.8%), spacing (6.5%), crossbite (4.5%), and open bite (3.2%). Class I

molar relationship prevailed in 95.5% of children. The prevalence of malocclusion in

our study was in accordance with the other studies reported in India, which ranged

from 19.6% to 90%. Furthermore, correlation of malocclusion and dental caries in the

primary dentition, although nonsignificant, presented children with malocclusion to

have a higher caries experience than children without malocclusion27.

A study was conducted by Assad et al to assess the prevalence of malocclusion

and dental caries in school children, using Index of Orthodontic Treatment Need

(Dental Health Component) IOTN (DHC) and Decayed, Missing, Filled, Teeth

(DMFT) score. Also to evaluate any relationship between malocclusion/ orthodontic

treatment need and dental caries. This study was carried out on 574 school children

aged 11 to 16 years having permanent dentition, no history of orthodontic treatment

and no dental anomalies. Each student’s number of DMFT was computed and the

IOTN (DHC) was recorded based on contact point displacement only. Results of the



current study which comprised of 574 school children, with 320 males and 254

females, exhibited a mean IOTN grade of 2.4 ± 1.016 and a mean DMFT score of

2.57 ± 2.7. The prevalence of malocclusion was found to be 75.6% while the

prevalence of dental caries was 64.6%. The Pearson correlation coefficient found a

significant correlation between IOTN and DMFT scores. The brushing frequency and

gender did not correlate with DMFT scores, while sugar intake, age and SES had a

significant correlation with DMFT. Taking IOTN into consideration, age and diet

showed no correlation with it, whereas gender and Socio Economic Status (SES)

status displayed a significant correlation with IOTN grades28.

A study was conducted by Roopa et al to assess the prevalence of malocclusion

and its gender distribution among Indian school children. A cross-sectional

epidemiological survey was conducted in all the 30 districts of Karnataka, India.

School children in the age group of 10-16 years were the target population. Population

proportionate technique was employed for the sample size estimation. A total sample

of 9505 was randomly selected from 102 schools all over Karnataka, India.

Ackermann-Proffit classification of malocclusion was used to record the

malocclusion. Statistical analysis used was simple descriptive statistics. Results

obtained were: prevalence of crowding is 50.4% in boys and 51.4% in girls. Cross-

bite was reported in 17.8% and 18.3% in boys and girls, respectively. Angle’s class I

malocclusion was reported in 78.4% of boys and 80.2% of girls. Angle’s class II

malocclusion was reported in 21.5% of boys and 19.8% of girls and class III

malocclusion was observed in 0.1% of boys29.

Ciuffolo et al conducted a study to describe the prevalence and distribution, by

gender, of occlusal traits in a sample of Italian students aged 11–14 years (mean 13 ±

1 years). Using standardized and validated recording criteria, a single operator



measured the overjet, overbite, open bite, anterior and posterior crossbites, crowding,

coincidence of the upper and lower midlines, and diastema, in 810 secondary school

students (53.6 per cent males). Chi-square, t-test statistics, and odds ratios (ORs) with

95 per cent confidence intervals (CI) were used to investigate the relationship between

gender and malocclusion characteristic. Logistic regression was used to further

analyse the independent association between gender and each outcome measure.

Ninety-three per cent of the subjects showed at least one occlusal trait, with one or

two anomalies recorded in 63 per cent of children. The prevalence of occlusal traits

ranged from 1.1 (negative overjet) to 54 per cent (upper and lower midlines not

coincident). Males were more likely than females to show both an increased overbite

and an increased overjet, although the latter result was not confirmed by logistic

regression (P = 0.05). Multivariate analysis showed a negative association between

overbite and misalignment of the lower incisors and lack of coincidence of the upper

and lower midlines, whereas subjects with an increased overbite were more likely to

have an increased overjet (all P < 0.01)30.

Tiziano et al conducted a study which evaluated gender differences in the

cephalometric records of a large-scale cross-sectional sample of Caucasian subjects

with Class III malocclusion at different developmental ages. The purpose also was to

provide average age-related and sex-related data for craniofacial measures in

untreated Class III subjects that are used as reference in the diagnostic appraisal of the

patient with Class III disharmony. The sample examined consisted of 1094

pretreatment lateral cephalometric records (557 female subjects and 537 male

subjects) of Caucasian Class III individuals. The age range for female subjects was

between 3 years six months and 57 years seven months. The male subject group

ranged from 3 years three months to 48 years five months. Twelve age groups were



identified. Skeletal maturity at different age periods also was determined using the

stage of cervical vertebral maturation. Gender differences for all cephalometric

variables were analyzed using parametric statistics. The findings of the study

indicated that Class III malocclusion is associated with a significant degree of sexual

dimorphism in craniofacial parameters, especially from the age of 13 onward. Male

subjects with Class III malocclusion present with significantly larger linear

dimensions of the maxilla, mandible, and anterior facial heights when compared with

female subjects during the circum-pubertal and post-pubertal periods31.

A study was conducted by Ibrahim et al to describe the prevalence of

malocclusion in a population of Central Anatolian adolescents in relation to gender.

The sample comprised 2329 teenagers (1125 boys and 1204 girls), aged between 12

and 17 years (mean age: 14.6 yrs). Occlusal anteroposterior relationships were

assessed using the Angle classification. Other variables examined were overjet,

overbite, crowding, midline diastema, posterior crossbite, and scissors bite. The

results showed that about 10.1% of the subjects had normal occlusions, 34.9% of the

subjects had Class I malocclusions, 40.0% had Class II Division 1 malocclusions,

4.7% had Class II Division 2 malocclusions and 10.3% had Class III malocclusions.

Over 53.5% had normal overbites, and 18.3%, 14.4%, 5.6%, and 8.2% had increased,

reduced, edge-to-edge or anterior open bite values, respectively. Overjet relationship

was normal in 58.9%, increased in 25.1%, reversed in 10.4%, and edge-to-edge in

5.6%. A posterior crossbite registered in 9.5% and scissors bite in 0.3%. Anterior

crowding was present in 65.2% of the sample and midline diastema in 7.0%. No clear

gender differences were noted, except for normal overbite (most frequent in girls,

P<.001) and increased overbite (most frequent in boys, P<.05). Class II Division 1



malocclusion is the most prevalent occlusal pattern among the Central Anatolian

adolescents and the high values (25.1% and 18.3%) of increased overjet and overbite

were a reflection of the high prevalence of Class II malocclusion32.

A study was conducted by Yuko et al to describe the prevalence and perform a

gender comparison of malocclusion requiring orthodontic treatment in Japan. On the

basis of the index of orthodontic treatment need, occlusal characteristics of a

population-based sample of adolescents (ages 12-15 years) were evaluated by

orthodontists. A total of 821 adolescents participated in this study. The prevalence of

malocclusion was 46.5%. Multivariate logistic regression indicated that girls were

1.56 times more likely than boys to develop malocclusion, particularly with anterior

crossbite and upper and lower crowding33.

Mridula et al conducted a study to assess the prevalence of malocclusion and

orthodontic treatment needs among 12‑15 years old school children of Udaipur, India.

A cross‑sectional descriptive survey was conducted among 887 subjects aged 12‑15

years. The prevalence of malocclusion and orthodontic treatment needs was assessed

using dental aesthetic index (World Health Organization, 1997). General information

on demographic data was also recorded. Chi‑square test, analysis of variance and

Scheffe’s test were employed for statistical analysis. Malocclusion and orthodontic

treatment need was reported among 33.3% of the study subjects. A significant age and

gender difference depicting preponderance among younger age group and a male

proclivity was experiential. A significant improvement in anterior crowding and

largest anterior maxillary irregularity with age was documented. Males had a

significantly higher prevalence of anterior crowding, midline diastema and largest

anterior maxillary irregularity than females. The prevalence of malocclusion and



orthodontic treatment needs among school children of Udaipur city, Rajasthan, India

was found to be 33.3%34.

A study was conducted by Bushra et al to explore the relationship of ABO

blood groups with classes of malocclusion and relative prevalence of these characters

in males and females of a defined population. The current study was performed on

500 individuals with an age range of 15 to 45 years, along with permanent dentition

only, reporting to the department of orthodontics of Punjab dental hospital, Lahore.

Complete details about the classes of malocclusion and blood group of the subjects

were noted in accordance with the ABO blood group system. The sample was divided

into three groups, i.e., Class I, Class II, and Class III. Data were analyzed statistically

by using SPSS 21.0. Pearson Chi-square was used as statistical analysis to get the

association of classes of malocclusion with blood group type. A significant difference

between the prevalence of classes of dental malocclusion in relation to blood group

types was found among both genders. There was gender wise association difference

between the classes of dental malocclusion and blood group types. The study also

covered the gender wise prevalence of dental malocclusion in all the four blood

groups which are A, B, AB and O35.

Methodology


METHODOLOGY

SOURCE OF THE DATA

Data regarding 90 children of both sexes, of the age group 6 to 14 years, those

who reported to the Department of Pedodontics and Preventive dentistry, P.M.N.M

Dental College, Bagalkot was taken after obtaining written consent from parents.

GENERAL INCLUSION AND EXCLUSION CRITERIA

Inclusion criteria:

1. Children willing to participate in the study.

2. Normal healthy children visiting for routine dental treatment.

3. Written consent was obtained from the Parents/ Guardians

4. Children of the age group 6 to 14 years.

5. Children without history of any systemic disorder, infectious diseases.

Exclusion criteria:

1. Children who were not willing to participate in the study.

2. Children suffering from any systemic disease or with any history of illness.

3. Children whose parents were not willing to give the written consent.

Methodology


MATERIALS:

Mouth mirror and probe

Lipstick

Child safe lipstick-scotch tape

Black duplicating ink

Cotton swab

White bond paper

Clipping board

Magnifying glass lens

METHODS OF COLLECTING DATA:

Ninety children of age group of 6 - 14 years reporting to the Department of


for routine dental check-up and treatment were considered for the study. After

obtaining the consent from the parents, these children were grouped based on

examining lateral cephalograms obtained from them. ANB angle, WITS appraisal and

Beta angle were calculated for each cephalograms to assess the anteroposterior jaw

position. Keeping the norms into consideration, the children were grouped as:




Methodology


Lip prints in each group were taken using child safe lipstick-scotch tape

method. Magnifying glass lens was used for the analysis of lip prints. The field of

observation was restricted to middle thirds of both upper and lower lips. All lip print

analyses were done by an observer who was blinded in relation to clinical

examination and cephalometric analysis of the patient. The lip print patterns were

classified according to the Suzuki and Tsuchihashi’s classification system10, 36. The lip

print pattern was determined by counting highest number of lines in the study area

having similarity to the Suzuki Tsuchihashi classification.

Figure 1: Suzuki and Tsuchihashi’s classification system


duplicating ink, which was applied on the fingers with cotton swab. First, the

subjects’ hands were cleaned with soap and water prior to recording their fingerprints

to remove dirt, oily secretions, and sweat and then dried with a towel. In taking the

rolled impressions of the individual fingers, the fingertip was placed at right angles to

the surface of the plate. Next, the finger was rolled or turned until the tip faced the

opposite direction. The finger was then placed on white paper and rolled in the same

manner to obtain a clean rolled impression of the finger pattern. The finger print

Methodology


patterns were analyzed for various dermatoglyphic patterns including the arch, loop,

and whorl patterns.

Figure 2: Dermatoglyphic patterns

Prevalence of dental caries was measured by DMF teeth index (DMFT) which

was introduced by Klein, Palmer and Knutson in 193837.

The criteria for DMFT score included 3 components:

1) D component: Used to describe Decayed teeth

2) M component: Used to describe Missing teeth due to caries

3) F component: Used to describe Filled teeth due to caries

Then DMFT score of an individual will be calculated by a formula:

DMFT = D + M + F

Maximum score: DMFT = 32; Minimum score = Zero

Prevalence of the type of skeletal malocclusion in boys and girls were evaluated

and compared.

Sample size estimation


SAMPLE SIZE ESTIMATION

Analysis: Descriptive and analytical statistics will be done. The normality of data will

be tested by Shapiro-Wilk test. If the data followed normal distribution parametric

tests (one-way ANOVA) will be used and if the data does not follow normal

distribution non-parametric test (Kruskal-Wallis) will be used. The chi-square test

will be used to check differences in proportions.

Statistical Software: SPSS (Statistical Package for Social Sciences) Version 20.1

(IBM Corporation, Chicago, USA)

Sample Size Calculation Software: N Master, V.2.0, CMC Vellor, India

Sample Size Calculation:

Minimum sample size calculated for your study is 23 in each of the three groups –

Class I, II and III. You can take sample size of 30 in each group considering loss of

data or follow up. The sample size calculations according to Divyashree et al (2016)

are as follows:

Table-1: Sample size

Sample size

Group I 23

Group II 23

Total 46

Table-2: Study parameters

Study parameters

Mean, Group I 107.85

Mean, Group II 138.8

Alpha 0.05

Beta 0.2

Power 0.8

Sample size estimation


Results


RESULTS

Table 3: Age and Gender distribution among study subjects

Table 4: Comparison of different types of Lip Print Patterns among study

subjects between three skeletal malocclusions using Chi Square Test

Comparison of different types of Lip Print Patterns among study subjects between 03 skeletal

malocclusions using Chi Square Test

Lip Print Patterns

Class I Class II Class III

c2 Value P-Value n % n % n %

Type I 10 33.3% 1 3.3% 1 3.3%

26.400 0.009*

Type II 14 46.7% 21 70.0% 25 83.4%

Type III 0 0.0% 2 6.7% 1 3.3%

Type I & II 3 10.0% 2 6.7% 0 0.0%

Type I & III 0 0.0% 1 3.3% 2 6.7%

Type II & III 2 6.7% 3 10.0% 1 3.3%

Type I, II, III & IV 1 3.3% 0 0.0% 0 0.0%

Note: Multiple Lip patterns have been distributed in Upper and Lower Lips

*-Statistically Significant

Table 5: Comparison of different types of Finger Print Patterns among study

subjects between three skeletal malocclusions using Chi Square Test

Comparison of different types of Finger Print Patterns among study subjects between 03 skeletal

malocclusions using Chi Square Test

Finger Print Patterns



Arch 0 0.0% 0 0.0% 1 3.3%

26.781 0.003*

Loop 9 30.0% 3 10.0% 16 53.5%

Whorl 11 36.7% 18 60.0% 4 13.3%

Arch & Loop 1 3.3% 0 0.0% 4 13.3%

Loop & Whorl 8 26.7% 8 26.7% 4 13.3%

Arch, Loop & Whorl 1 3.3% 1 3.3% 1 3.3%


Age and Gender distribution among study

subjects

Variables Category n %

Age 6-9 yrs 16 17.8%

10-13 yrs 74 82.2%

Mean SD

Mean & SD 10.9 1.7

Range 6 - 13

Sex Males 57 63.3%

Females 33 36.7%

Results


Table 6: Comparison of mean DMFT / deft scores between different types of

Skeletal malocclusion using Kruskal Wallis Test


Table 7: Multiple comparison of mean difference in the DMFT/deft scores b/w

different skeletal malocclusions using Mann Whitney Post hoc Test

Multiple comparison of mean difference in the DMFT/deft scores b/w

different skeletal malocclusions using Mann Whitney Post hoc Test

(I) Groups (J) Groups

Mean Diff.

(I-J)

95% CI for the

Diff.

P-Value Lower Upper

Class I Class II -0.27 -1.25 0.71 0.79

Class III -1.80 -2.78 -0.82 <0.001*

Class II Class III -1.53 -2.51 -0.55 0.001*


Table 8: Comparison of prevalence of Skeletal Malocclusion based on different

age and gender of study subjects using Chi Square Test

Comparison of prevalence of Skeletal Malocclusion based on different age and gender of study subjects using

Chi Square Test

Variables Categories



Age Group 6-9 yrs 8 50.0% 2 12.5% 6 37.5% 4.257 0.12

10-13 yrs 22 29.7% 28 37.9% 24 32.4%

Sex Males 15 26.3% 19 33.3% 23 40.4% 4.593 0.10

Females 15 45.5% 11 33.3% 7 21.2%

Comparison of mean DMFT / deft scores between different types of Skeletal

malocclusion using Kruskal Wallis Test

Sk. Malocclusions N Mean SD Min Max P-Value

Class I 30 1.80 1.27 0 5

<0.001* Class II 30 2.07 1.36 0 5

Class III 30 3.60 2.03 0 10

Results


Table 9: Correlation between different Lip and Finger Print Patterns in Skeletal

Class I Malocclusion using Chi Square Test

Correlation between different Lip and Finger Print Patterns in Skeletal Class I Malocclusion

using Chi Square Test

Lip Print Patterns Arch Loop Whorl

Arch &

Loop

Loop &

Whorl

Arch, Loop &

Whorl

Type I 0 5 2 0 3 0

Type II 0 3 7 1 2 1

Type III 0 0 0 0 0 0

Type I & II 0 0 1 0 2 0

Type I & III 0 0 0 0 0 0

Type II & III 0 0 1 0 1 0

Type I, II, III & IV 0 1 0 0 0 0

Χ2 Value - 12.326; P-Value - 0.72

Table 10: Correlation between different Lip and Finger Print Patterns in

Skeletal Class II Malocclusion using Chi Square Test

Correlation between different Lip and Finger Print Patterns in Skeletal Class II

Malocclusion using Chi Square Test


Arch &

Loop

Loop &

Whorl

Arch, Loop &

Whorl

Type I 0 0 1 0 0 0

Type II 0 3 13 0 4 1

Type III 0 0 1 0 1 0

Type I & II 0 0 0 0 2 0

Type I & III 0 0 1 0 0 0

Type II & III 0 0 2 0 1 0

Type I, II, III & IV 0 0 0 0 0 0

X2 Value - 8.998; P-Value - 0.88

Results


Table 11: Correlation between different Lip and Finger Print Patterns in

Skeletal Class III Malocclusion using Chi Square Test

Correlation between different Lip and Finger Print Patterns in Skeletal Class III

Malocclusion using Chi Square Test


Arch &

Loop

Loop &

Whorl

Arch, Loop &

Whorl

Type I 0 1 0 0 0 0

Type II 1 13 3 3 4 1

Type III 0 1 0 0 0 0

Type I & II 0 0 0 0 0 0

Type I & III 0 0 1 1 0 0

Type II & III 0 1 0 0 0 0

Type I, II, III & IV 0 0 0 0 0 0

X2 Value - 8.400; P-Value - 0.98

Graph 1: Age-wise distribution of study subjects

Results


Graph 2: Gender-wise distribution of study subjects

Graph 3: Lip Print Patterns among study subjects between three skeletal malocclusions

Results


Graph 4: Finger Print Patterns among study subjects between three skeletal

malocclusions

Graph 5: Mean DMFT/deft scores between different types of Skeletal

malocclusions

Results


Graph 6: Age-wise Prevalence of different types of skeletal malocclusions

Graph 7: Gender-wise Prevalence of different types of skeletal malocclusions

Results


Graph 8: Correlation between different lip and finger print patterns in Skeletal

Class I Malocclusion


Class II Malocclusion

Results



Class III Malocclusion

1. Distribution and Comparison of age and gender among various study subjects

(Table 3, Graph 1 & 2)

A total of 90 children were taken for the study and they were divided into 3 groups of

30 members each. Age of the children were categorized into 6-9 years and 10-13

years, respectively. The number of children in 6-9 years group was 16 and the number

of children in 10-13 years group was 74. This was due to the inclusion of children

who visited the department for the treatment. The mean age of children considered for

the study was 10.9 with a standard deviation of 1.7, of which 57 were males i.e.

63.3% and 33 were females i.e. 36.7%.

Results


2. Comparison of different types of Lip Print Patterns among study subjects

between three skeletal malocclusions using Chi Square Test (Table 4, Graph 3)

Among 30 children grouped under Class I malocclusion: Type I lip pattern was shown

by 10 (33.3%), Type II lip pattern was shown by 14 (46.7%), Type I & II lip pattern

was shown by 3 (10%), Type II & III was shown by 2 (6.7%) and Type I,II,III & IV

was shown by 1 (3.3%).

Among 30 children grouped under Class II malocclusion: Type I lip pattern was

shown by 1 (3.3%), Type II lip pattern was shown by 21 (70%), Type III lip pattern

was shown by 2 (6.7%), Type I & II lip pattern was shown by 2 (6.7%), Type I & III

lip pattern was shown by 1 (3.3%) and Type II & III was shown by 3 (10%).

Among 30 children grouped under Class III malocclusion: Type I lip pattern was

shown by 1 (3.3%), Type II lip pattern was shown by 25 (83.4%), Type III lip pattern

was shown by 1 (3.3%), Type I & III lip pattern was shown by 2 (6.7%) and Type II

& III was shown by 1 (3.3%).

Multiple lip print patterns have been distributed in upper and lower lips with a p-value

of 0.009 showing statistical significance.

3. Comparison of different types of Finger Print Patterns among study subjects

between three skeletal malocclusions using Chi Square Test (Table 5, Graph 4)

Among 30 children grouped under Class I malocclusion: 9 (30%) showed loop

pattern, 11 (36.7%) showed whorl pattern, 1 (3.3%) showed arch and loop pattern, 8

(26.7%) showed loop and whorl pattern and 1 (3.3%) showed arch, loop and whorl

pattern.

Results


Among 30 children grouped under Class II malocclusion: 3 (10%) showed loop

pattern, 18 (60%) showed whorl pattern, 8 (26.7%) showed loop and whorl pattern

and 1 (3.3%) showed arch, loop and whorl pattern.

Among 30 children grouped under Class III malocclusion: 1 (3.3%) showed arch

pattern, 16 (53.5%) showed loop pattern, 4 (13.3%) showed whorl pattern, 4 (13.3%)

showed arch and loop pattern, 4 (13.3%) showed loop and whorl pattern and 1 (3.3%)

showed arch, loop and whorl pattern.

The p-value obtained was 0.003 showing statistical significance.

4. Comparison of mean DMFT / deft scores between different types of Skeletal

malocclusion using Kruskal Wallis Test (Table 6 & 7, Graph 5)

Thirty children grouped under Class I malocclusion showed a mean DMFT/deft score of 1.8

with a standard deviation of 1.27, 30 children grouped under Class II malocclusion showed a

mean DMFT/deft score of 2.07 with a standard deviation of 1.36 and 30 children grouped

under Class III malocclusion showed a mean DMFT/deft score of 3.6 with a standard

deviation of 2.03.

The P-value obtained was <0.001 showing statistical significance.

5. Comparison of prevalence of Skeletal Malocclusion based on different age and

gender of study subjects using Chi Square Test (Table 8, Graph 6 & 7)

Among children grouped under 6-9 years: 8 (50%) showed Class I malocclusion, 2

(12.5%) showed Class II malocclusion and 6 (37.5%) showed Class III malocclusion.

Among children grouped under 10-13 years: 22 (29.7%) showed Class I

malocclusion, 28 (37.9%) showed Class II malocclusion and 24 (32.4%) showed

Class III malocclusion. P-value obtained was 0.12, showing statistical insignificance.

Results


Among 90 children: 15 (26.3%) males; 15 (45.5%) females showed Class I

malocclusion, 19 (33.3%) males; 11 (33.3%) females showed Class II malocclusion

and 23 (40.4%) males; 7 (21.2%) females showed Class III malocclusion. P-value

obtained was 0.10, showing statistical insignificance.

6. Correlation between different lip and finger print patterns in Skeletal Class I

Malocclusion (Table 9, Graph 8)

Among 10 children having Type I lip print pattern, the finger print pattern was: 5 had loop

pattern, 2 had whorl pattern and 3 had loop and whorl pattern.

Among 13 children having Type II lip print pattern, the finger print pattern was: 3 had loop

pattern, 7 had whorl pattern, 1 had arch and loop pattern, 2 had loop and whorl pattern and 1

had arch, loop and whorl pattern.

Among 3 children having Type I & II lip print pattern, the finger print pattern was: 1 had

whorl pattern and 2 had loop and whorl pattern.

Among 2 children having Type II & III lip print pattern, the finger print pattern was: 1 had


1 child having Type I,II,III & IV lip print pattern, showed loop finger print pattern.

P-value obtained was 0.72, showing statistical insignificance.

7. Correlation between different lip and finger print patterns in Skeletal Class II

Malocclusion (Table 10, Graph 9)

1 child having Type I lip print pattern, showed whorl finger print pattern.

Among 21 children having Type II lip print pattern, the finger print pattern was: 3 had loop

pattern, 13 had whorl pattern, 4 had loop and whorl pattern and 1 had arch, loop and whorl

pattern.

Results


Among 2 children having Type III lip print pattern, the finger print pattern was: 1 had whorl

pattern and 1 had loop and whorl pattern.

Among 2 children having Type I & II lip print pattern, the finger print pattern was loop and

whorl pattern.

1 child having Type I & III lip print pattern, showed whorl finger print pattern.

Among 3 children having Type II & III lip print pattern, the finger print pattern was: 2 had



8. Correlation between different lip and finger print patterns in Skeletal Class

III Malocclusion (Table 11, Graph 10)

1 child having Type I lip print pattern, showed loop finger print pattern.

Among 25 children having Type II lip print pattern, the finger print pattern was: 1 had arch

pattern, 13 had loop pattern, 3 had whorl pattern, 3 had arch and loop pattern, 4 had loop and

whorl pattern and 1 had arch, loop and whorl pattern.

1 child having Type III lip print pattern, showed loop finger print pattern.

Among 2 children having Type I & III lip print pattern, the finger print pattern was: 1 had

whorl pattern and 1 had arch and loop pattern.

1 child having Type II & III lip print pattern, showed loop finger print pattern.


Discussion


DISCUSSION

Malocclusion is one of the most common dental problems like dental caries,

periodontal disease, and dental fluorosis9. If a malocclusion is identified early, simple,

preventive and interceptive measures can alleviate a developing malocclusion. The

incidence of various categories of malocclusion in a particular population is necessary

to provide a basis for planning preventive and interceptive orthodontics29.

In 1950, Synder reported in his book Homicide Investigation that the

characteristics of the lips formed by lip grooves are as individually distinctive as the

ridge characteristics of finger prints38. Suzuki, in 1967, made detailed investigations

of the measurement of the lips, the use and color of rugae, and the method for its

extraction to obtain useful data for practical forensic application39. McDonell in 1972

conducted a study on lip prints between two identical twins and reported that two

identical twins seemed to be indistinguishable by every other means but their lip

prints were different40. Lip prints are established at a very early period in comparison

to sagittal jaw relation and dental relation41, 42. Establishing a correlation between

sagittal jaw relation and lip prints would benefit the clinician by predicting the type of

malocclusion and can also provide additional information on individual personal

identity12.

Cummins and Midlo (1929) defined dermatoglyphics as the study of the

intricate dermal ridge configuration on the skin covering the palmar and plantar

surfaces of the hands and feet43. Dermal configurations appear during the 12th week

of intrauterine life and are completely established by the 24th week and remain

constant throughout life, except for overall size44, 45. Finger and palm prints and facial

structures such as the lip, alveolus, and palate develop during the same embryonic

period. Therefore, any factor causing changes in the lip, alveolus, and palate may also

Discussion


cause different patterns in the appearance of finger and palm prints. Fingerprint

patterns and other characteristics of dermal ridges offer distinct advantages and may

be used as a screening tool to detect early malocclusion15.

Dental caries is an important dental public health problem, and it is the most

prevalent oral disease among children in the world. The prevalence pattern of dental

caries not only varies with age, sex, socioeconomic status, race, geographical location,

food habits, and oral hygiene practices but also within the oral cavity46. Dental caries

is the most prevalent dental affliction of childhood. Despite credible scientific

advances and the fact that caries is preventable, the disease continues to be a major

public health problem47. The relationship between caries and malocclusion has been

debated for decades. Despite ongoing research, no definitive studies have been

performed48, 49. The relationship between caries and specific types of malocclusion is

even more poorly defined. A better understanding of this potential relationship would

be beneficial to orthodontists, pediatric dentists and general dentists which would aid

in the diagnosis and treatment of malocclusion23.

Malocclusions are the result of orofacial adaptability to various etiological

factors50, which result in various implications such as psychosocial problems related

to impaired dento-facial aesthetics, disturbances of oral function, such as mastication,

swallowing and speech and greater susceptibility to trauma and periodontal disease9.

A number of studies have demonstrated its impact on quality‑of‑life51, 52. Since the

public equates good dental appearance with success in many pursuits and societal

forces define the norms for acceptable, normal and attractive physical appearance, an

individual with malocclusion might develop a feeling of shame about their dental

appearance and may feel shy in social situations or lose career opportunities.

According to World Health Organization (WHO), the main oral diseases should be

Discussion


subjected to periodic epidemiological surveys. The epidemiological data on

orthodontic treatment need is of interest for dental public health programs, clinical

treatment, screening for treatment priority, resource planning and third party

funding50. Appraisal of gender-wise distribution of malocclusion in childhood can

facilitate efforts to prevent such a disorder and its consequences and make it possible

to reduce the complexity of costly orthodontic treatment. Furthermore, this knowledge

might help to minimize or eliminate future treatment need34.

The mixed dentition is the time of greatest opportunity for occlusal guidance,

especially in cases of malocclusion. As uninterrupted growth might further complicate

the condition in the permanent dentition, an appropriate diagnosis at an early stage

becomes necessary. Any relation between the dermatoglyphic, cheiloscopic patterns

and skeletal jaw relation might aid in the early diagnosis and interception of the

condition and also might be helpful in future forensic research. There exists a

deficiency in studies carried on samples of pediatric age group, hence it is necessary

to conduct a study to investigate the dermatoglyphic and cheiloscopic patterns, along

with assessment of prevalence of dental caries and type of skeletal malocclusion in

boys and girls of age group 6-14 years.

In this study, 90 children of age group of 6 - 14 years reporting to the

Department of Pediatric and Preventive Dentistry, P.M.N.M. Dental College and

Hospital, Bagalkot for routine dental check-up and treatment were selected and

divided into 3 groups, by examining the lateral cephalograms obtained from them, as:




Discussion


For the groups:


paper, without any distortion.


duplicating ink, which were applied on the fingers with cotton swab. The

digits were guided and pressed firmly against the white bond paper clipped on

to a board.

The lip print patterns were classified according to Suzuki and Tsuchihashi’s

classification system10, 36 and finger print patterns were classified into arch,

whorl and loop patterns.


Prevalence of the type of skeletal malocclusion in boys and girls were

evaluated.

In the course of the present study it was observed that the full thickness of the

lips could not always be recorded in patients with various malocclusions due to the

skeletal prognathism or retrognathism. Therefore, both upper and lower lips were

studied for each patient. This is in contrast with the study conducted by

Sivapathasundharam et al., (2001) in which they suggested to study the lip print

pattern in the middle part of lower lip up to 10 mm wide53. Mamandras A. H et al.,

(1988) observed the lips reach their maturity in late adolescence54. Therefore in the

present study the field of observation was restricted to middle thirds of both upper and

lower lips.

In this study, Type II (branched) pattern was the most predominant lip print

pattern and multiple lip print patterns have been distributed in upper and lower lips

Discussion


with a p-value of 0.009 showing statistical significance (Table 4, Graph 3). This was

in accordance with the studies conducted by Pradeep Raghav et al3 and Vignesh et

al13. This was in contrast with the study conducted by Sujatha Ponnusamy et al12

which showed that vertical pattern was the most prevalent lip print pattern among

Class-I and Class-II skeletal malocclusions. This might be due to the reason that the

parameters considered in the present study were different from the above mentioned

contrast study.

In the present study, predominant lip print patterns which related to the

skeletal malocclusions were as follows: Type I (vertical) pattern for Class-I

malocclusion, Type II (branched) and Type III (intersected) pattern for Class-II

malocclusion and Type I (vertical) and Type III (intersected) pattern for Class-III

malocclusion (Table 4, Graph 3). This was in accordance with the study conducted

by Pradeep Raghav et al3. This was in contrast with the study conducted by Shivani et

al10 who concluded that combination of lip print patterns were predominant in skeletal

class III group of individuals. This contrast might be due to the reason that the above

mentioned study had only considered the Class-III skeletal malocclusion and

compared its correlation with lip print patterns.

In this study, whorl pattern was the most predominant lip print pattern among

Class I and Class II malocclusion and loop pattern among Class-III malocclusion with

a p-value of 0.003 showing statistical significance (Table 5, Graph 4). This was in

accordance with the studies conducted by Susha et al19 and Smitha et al21.

In the present study, predominant finger print patterns which related to the

skeletal malocclusions were as follows: Loop pattern for Class-I malocclusion, Loop

and Whorl pattern for Class-II malocclusion and Whorl pattern for Class-III

Discussion


malocclusion (Table 5, Graph 4). This was in contrast with the studies conducted by

Sonika et al15, who concluded that loop pattern was more frequent in patients with

skeletal Class I and II malocclusion, and the whorl pattern was more frequent in those

with Class-III malocclusion. This might be because the previous study was based on

Angle’s classification of malocclusion and in the current study skeletal malocclusion

was considered.

In the present study it was also noticed that the correlation of cheiloscopic

patterns with the skeletal malocclusion is more comparable than the dermatoglyphic

patterns obtained among the study groups (Table 9,10,11; Graph 8,9,10). Hence, by

obtaining these patterns, it is easier to predict the type of skeletal malocclusions and

an early intervention can be achieved. Collection of the data containing cheiloscopic

and dermatoglyphic patterns can be also used in forensics in the future.

In this study, DMFT scores and standard deviations obtained for each group

are as follows: 1.8 and 1.27 for Class-I malocclusion; 2.07 and 1.36 for Class-II

malocclusion; 3.6 and 2.03 for Class-III malocclusion. P-value obtained was <0.001,

which was statistically significant (Table 6 & 7, Graph 5). This proves that as the

malocclusion becomes severe, there is increased prevalence of dental caries. This was

in accordance with the studies conducted by Assad et al28 and Patil et al27, who

concluded that children with malocclusion, have a higher caries experience than

children without malocclusion. This is due to the occlusal mishaps caused by the

skeletal malocclusions. Hence maintaining of oral hygiene becomes more

cumbersome, leading to increased susceptibility to dental caries.

In the present study, age of the children were categorized into 6-9 years and

10-13 years, respectively. Among these two age ranges, 6-9 years showed increased

Discussion


prevalence of Class-I malocclusion followed by Class III and II malocclusions,

whereas 10-13 years showed increased prevalence of Class-II malocclusion followed

by Class III and I malocclusions. P-value obtained was 0.12 (Table 8, Graph 6). This

showed that, only as the age increases the skeletal pattern becomes more evident.

Hence an early diagnosis with the specific chelioscopic and dermatoglyphic patterns

of skeletal malocclusion can allow the clinician to plan the treatment at an early stage.

This was in accordance with the study conducted by Tiziano et al31, who concluded

that malocclusion is associated with a significant degree of sexual dimorphism in

craniofacial parameters, especially from the age of 13 onwards. The results obtained

in this present study was in contrast with the study conducted by Mridula et al34, who

concluded that a significant improvement in anterior crowding and largest anterior

maxillary irregularity is seen with increase in age. This might be because the previous

study considered more parameters like crowding, spacing, etc. compared to the

present study which only focused on skeletal malocclusion.

In the current study gender prevalence of skeletal malocclusion was also taken

as a parameter and the results showed that males had an increased prevalence of Class

II and III malocclusions compared to females (Table 8, Graph 7). This was in

accordance with the study conducted by Fabio et al30. This was in contrast with the

study conducted by Komazaki et al33, who concluded that Multivariate logistic

regression indicated that girls were 1.56 times more likely than boys to develop

malocclusion. This might be because the previous study considered parameters like

anterior crossbite, upper and lower crowding, etc. which were not considered in the

present study.

This study highlights the scope of early diagnosis of skeletal malocclusions

through the chelioscopic and dermatoglyphic patterns which are unique for each

Discussion


individual and the prevalence of dental caries which also must be considered as an

entity to be sorted out with the preventive and therapeutic measures. This study also

brought out the prevalent patterns observed among each group of skeletal

malocclusions which can group out children at an earlier stage, even before the

clinical manifestations arise. Hence, early diagnosis and treatment planning can give a

clinician with ways of treating such malocclusions at a faster rate.

The limitations of the study was smaller sample size which can be rectified by

further research with a larger sample size and taking into consideration the varied

ethnic background for conclusive results regarding association of chelioscopic and

dermatoglyphic patterns with different skeletal malocclusions.

Conclusion


CONCLUSION











For the groups:






to a board.





Conclusion



evaluated.

The results obtained were grouped, tabulated, compared and subjected to

appropriate statistical evaluation.

Within the limitations of this study, the following conclusions were drawn:

1. Predominant lip print patterns which related to the skeletal malocclusions were

as follows: Type I (vertical) pattern for Class-I malocclusion, Type II

(branched) and Type III (intersected) pattern for Class-II malocclusion and

Type I (vertical) and Type III (intersected) pattern for Class-III malocclusion.

2. Predominant finger print patterns which related to the skeletal malocclusions

were as follows: Loop pattern for Class-I malocclusion, Loop and Whorl

pattern for Class-II malocclusion and Whorl pattern for Class-III malocclusion.

3. The caries experience was significantly more in children having severe

malocclusions (Class-III>Class-II>Class-I).

4. Males had an increased prevalence of Class II and III malocclusions compared

to females and as the age increases the skeletal pattern becomes more evident.

Summary


SUMMARY

The mixed dentition is the time of greatest opportunity for occlusal guidance,

especially in cases of malocclusion. As uninterrupted growth might further complicate

the condition in the permanent dentition, an appropriate diagnosis at an early stage

becomes necessary. Any relation between the dermatoglyphic, cheiloscopic patterns

and skeletal jaw relation might aid in the early diagnosis and interception of the

condition and also might be helpful in future forensic research. There exists a

deficiency in studies carried on samples of pediatric age group, hence it is necessary

to conduct a study to investigate the dermatoglyphic and cheiloscopic patterns, along

with assessment of prevalence of dental caries and type of skeletal malocclusion in

boys and girls of age group 6-14 years.











Summary


For the groups:






to a board.






evaluated.

The results obtained were grouped, tabulated, compared and subjected to

appropriate statistical evaluation.

Within the limitations of this study, the following conclusions were drawn:

1. Predominant lip print patterns which related to the skeletal malocclusions were

as follows: Type I (vertical) pattern for Class-I malocclusion, Type II

(branched) and Type III (intersected) pattern for Class-II malocclusion and

Type I (vertical) and Type III (intersected) pattern for Class-III malocclusion.

Summary


2. Predominant finger print patterns which related to the skeletal malocclusions

were as follows: Loop pattern for Class-I malocclusion, Loop and Whorl

pattern for Class-II malocclusion and Whorl pattern for Class-III malocclusion.

3. The caries experience was significantly more in children having severe

malocclusions (Class-III>Class-II>Class-I).

4. Males had an increased prevalence of Class II and III malocclusions compared

to females and as the age increases the skeletal pattern becomes more evident.

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DEPARTMENT OF PEDIATRIC AND PREVENTIVE DENTISTRY,

P.M.N.M DENTAL COLLEGE AND HOSPITAL,

BAGALKOT-587103, KARNATAKA

INFORMED CONSENT FOR DISSERTATION

Name:

Age/sex:

Address:

Phone no. :

I, , the undersigned, as the legally responsible

parent/guardian/care-taker of have been explained the whole

procedure of the dental examination to be performed by Dr. Annat Varghese, (Post graduate

student ,Department of Pediatric and Preventive Dentistry, P.M.N.M Dental College &

Hospital, Bagalkot) on my child which includes dental examination, radiographic

examination, dactylographic and cheiloscopic examination.

I, hereby grant my consent for the above procedures being performed on my child.

Place:

Date:

Signature

(Parent / legal guardian)


DEPARTMENT OF PEDIATRIC & PREVENTIVE DENTISTRY

B.V.V.S P.M.N.M DENTAL COLLEGE & HOSPITAL, BAGALKOT – 587103,

KARNATAKA

1. Suzuki and Tsuchihashi’s classification system

2. Dermatoglyphic patterns

3. deft / DMFT Scoring Index:

Name:

Age:

Sex:

Type of skeletal malocclusion:

55 54 53 52 51 61 62 63 64 65

17 16 15 14 13 12 11 21 22 23 24 25 26 27

47 46 45 44 43 42 41 31 32 33 34 35 36 37

85 84 83 82 81 71 72 73 74 75

DMFT Score = deft Score =




Annexure


ANNEXURE

FIGURE 3: ARMAMENTARIUM

FIGURE 4: OBTAINING INFORMED CONSENT

Annexure


FIGURE 5: APPLYING CHILD SAFE LIPSTICK WITH BRUSH

FIGURE 6: LIP PRINT BEING COLLECTED THROUGH SCOTCH TAPE

Annexure


FIGURE 7: LIP PRINT COLLECTED AND TRANSFERRED TO PAPER

FIGURE 8: APPLYING BLACK DUPLICATING INK WITH COTTON

Annexure


FIGURE 9: FINGER PRINT BEING COLLECTED

FIGURE 10: FINGER PRINT COLLECTED ON PAPER

Documents

By Dr. ANNAT VARGHESE Dissertation