|Year : 2012 | Volume
| Issue : 4 | Page : 519-523
Correlation between "ABO" blood group phenotypes and periodontal disease: Prevalence in south Kanara district, Karnataka state, India
Gurpur Prakash Pai1, Mundoor Manjunath Dayakar1, Mulki Shaila2, Anitha Dayakar2
1 Department of Periodontics, K. V. G. Dental College and Hospital, Kurunjibag, Sullia, Karnataka, India
2 Department of Oral Pathology & Microbiology, K. V. G. Dental College and Hospital, Kurunjibag, Sullia, Karnataka, India
|Date of Submission||16-Nov-2011|
|Date of Acceptance||14-Sep-2012|
|Date of Web Publication||7-Feb-2013|
Gurpur Prakash Pai
Department of Periodontics, K. V. G. Dental College and Hospital, Kurunjibag, Sullia, Karnataka
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: The correlation between certain systemic diseases and ABO blood group is a well-documented fact. The association between periodontal disease and ABO blood group is not studied in relation to a specific geographic location. Here is a study conducted on a group of patients belonging to South Kanara district of Karnataka state. Materials and Methods: A total of 750 subjects aged between 30and 38 years belonging to South Kanara district were selected on random basis. The study subjects were segregated into healthy/mild gingivitis, moderate/severe gingivitis, and periodontitis group, based on Loe and Silness index and clinical attachment loss as criteria. The study group was further categorized and graded using Ramfjord's periodontal disease index. Blood samples were collected to identify ABO blood group. Results: Prevalence of blood group O was more in South Kanara district, followed by blood groups B and A, and the least prevalent was AB. The percentage distribution of subjects with blood groups O and AB was more in healthy/mild gingivitis group (group I) and moderate/severe gingivitis group (group II), while subjects with blood groups B and A were more in periodontitis group III. There was increased prevalence of subjects with blood groups O and AB with healthy periodontium, while subjects with blood groups B and A showed inclination toward diseased periodontium. Conclusion: There is a correlation existing between periodontal disease and ABO blood group in this geographic location. This association can be due to various blood group antigens acting as receptors for infectious agents associated with periodontal disease. This broad correlation between periodontal disease and ABO blood group also points toward susceptibility ofthe subjects with certain blood groups to periodontal disease.
Keywords: ABO antigen, ABO blood group, gingivitis, periodontitis South Kanara district
|How to cite this article:|
Pai GP, Dayakar MM, Shaila M, Dayakar A. Correlation between "ABO" blood group phenotypes and periodontal disease: Prevalence in south Kanara district, Karnataka state, India. J Indian Soc Periodontol 2012;16:519-23
|How to cite this URL:|
Pai GP, Dayakar MM, Shaila M, Dayakar A. Correlation between "ABO" blood group phenotypes and periodontal disease: Prevalence in south Kanara district, Karnataka state, India. J Indian Soc Periodontol [serial online] 2012 [cited 2018 Feb 23];16:519-23. Available from: http://www.jisponline.com/text.asp?2012/16/4/519/106892
| Introduction|| |
Periodontal disease is the most prevalent disease with a multifactorial etiology, affecting a large population worldwide. Plaque, being the primary etiologic agent, a constitutional factor, probably of genetic origin, may play a part. Hence, it is interesting to emphasize the significance of genetic factors in patients with periodontal disease and to find out whether any innate factor is also associated with it. However, if such a relationship between blood groups and periodontal disease can be established beyond a reasonable doubt, it can be concluded that the presence of particular blood group antigen has somehow increased the susceptibility to the disease. Karl Landsteiner  discovered the fundamental principles of blood grouping in 1900s. He described the blood groups according to "ABO" blood typing system. Since then, we have been able to categorize individuals based on their blood groups. The history of investigations regarding the relationship between blood groups and dental diseases goes back to 1930. 
Faser Roberts  discussed the relationship between ABO blood group and susceptibility to chronic disease as an example of genetic basis for family predisposition. In India and Western countries, many workers have tried to find out the relationship between ABO blood group and various systemic diseases, and the results showed that some diseases like dental caries,  salivary gland tumors,  chicken pox,  malaria,  oral cancer,  hematological malignancies,  ischemic heart disease,  cholera,  etc., had significant association.
The relative susceptibility of some blood group phenotypes to certain diseases has been investigated. Blood group A individuals have been reported to be more susceptible to gall stones, cholitis,  and tumors of pancreas as well as ovary.  As per a study among Bangladeshi people, blood group phenotype O was associated with a substantially increased risk for coronary artery disease (CAD).  Diabetes mellitus might be highly prevalent in subjects of blood groups A and O.  For several decades, the ABO blood group has been suspected of contributing to infertility and fetal loss, but reports have often been conflicting and speculative. This has resulted in a large accumulation of literature and a high degree of controversy. 
The antigens of the ABO system are an integral part of the red cell membrane, which are also found in plasma and other body fluids. The presence or absence of certain antigens has been associated with various diseases and anomalies, with antigens also acting as receptors for infectious agents. Immunohistochemical studies have demonstrated the presence of A/B antigens on spinous cells in the non-keratinized oral epithelium of blood group A and B persons, where basal cells express precursor structures and the more-differentiated spinous cells express the A or B antigens. Blood group O persons who do not have the A and B gene-coded glycosyltransferase express a fucosylated variant (Ley) of the precursor structure. 
Weber and Pastern  were the first to study the association of ABO blood group with periodontal disease,. Kaslick et al.  studied the association of aggressive periodontitis and ABO blood group. They found significantly less patients with blood group O and more patients with blood group B.
Koregol et al.  in a study on 1220 subjects in South India concluded that blood group A formed a significantly higher percentage in the gingivitis group and blood group O formed a higher percentage in the periodontitis group. The blood group AB showed the least percentage of periodontal diseases. The distribution of Rh factor in all groups showed a significantly higher distribution of Rh-positive.
A plethora of studies have been conducted in the field of medicine. Surprisingly, very less number of studies have been conducted to determine the relationship between ABO blood group and incidence of oral and dental diseases. Some researchers claimed that there was a relationship, whereas some others could not find any, which could be attributed to the geographic diversity in the population groups. The purpose of the present study was to explore such a possibility to determine the prevalence of periodontal diseases among different blood groups using ABO system and to correlate periodontal disease severity with different blood groups in South Kanara district of Karnataka state. It is expected that performing investigations in this research area will make it possible to better understand the risk factors of periodontal diseases and to predict the effective methods of prevention and treatment of periodontal diseases.
| Materials and Methods|| |
A total of 750 subjects, in the age group between 30 and 38 years and of both the sexes with an equal percentage of males and females, were selected at random, with the following inclusion and exclusion criteria. The study subjects belonging to South Canara district with at least 20 teeth excluding the third molars were included, while subjects who were unable to perform routine oral hygiene, smokers, alcoholics, those with previous history of antibiotic therapy, those who have had periodontal treatment 6 months prior to examination, subjects suffering from systemic diseases and systemic conditions, pregnant women, and subjects with those conditions which could aggravate periodontal manifestations were excluded. Using a proforma, the details of each subject, such as name, age, sex, medical, past dental history, Plaque index (Silness and Loe), gingival index (Loe and Silness), and Ramfjord's periodontal index (PDI), were recorded using mouth mirror and Michigan "O" probe and a detailed oral examination was also carried out using mouth mirror and explorer. The PDI score for each individual was obtained by totaling the scores of each tooth examined and then dividing by the number of teeth examined. In the present study, all the cases were first segregated into groups based on Loe and Silness index as: group I (healthy/mild gingivitis), group II (moderate/severe gingivitis), and group III (periodontitis group; subjects with clinical attachment loss), and were further divided into four grades according to the following range of their severity of periodontal involvement based on Ramfjord's Periodontal Index as: grade 0 (0-0.16), grade I (0.17-0.5), grade II (0.6-1.5), grade III (1.6-3.0), and grade IV (3.1 and above).
Blood samples were collected using sterile disposable lancet and finger prick method. The blood grouping was done using slide agglutination method (visual method) after obtaining the consent form from each subject.
Percentage distribution of subjects with their ABO blood grouping was tabulated in each group and with various grades of periodontal involvement. A non-parametric test, Chi-square test, was used for statistical analysis.
| Results|| |
In this study performed on 750 subjects, the prevalence of subjects with blood groups A, B, AB, and O was 182 (24.27%), 228 (30.4%), 45 (6%), and 295 (39.3%), respectively as shown in [Figure 1]. This was in line with the distribution of ABO blood group data collected from 7027 subjects in a blood bank in the same geographic location, with a percentage distribution of 1778 (25.3%), 2073 (29.5%), 443 (6.3%), and 2733 (38.9%), respectively, as shown in [Table 1]. There was no statistically significant difference between the distribution of the study subjects in this study and that of the blood bank. (chi=0.608, P=0.895).
|Figure 1: Pi diagram showing the distribution of ABO blood group in the study group|
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|Table 1: Percentage and frequency distribution of ABO blood groups among blood donors (data collected from the blood bank) and subjects under study|
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A relatively high percentage of blood group O (34.58%) subjects and a smaller percentage of B blood group (15.35%) subjects were seen in healthy/mild gingivitis group, and a high percentage of subjects with blood groups B (64.84%) and A (64.84%) were seen in moderate/severe gingivitis group, while in periodontitis group there were less of O blood group (48.14%) subjects, as shown in [Table 2]. This data suggests that the patients with blood groups O and AB were more in healthy and gingivitis group (groups I and II, respectively), whereas subjects with blood groups B and A were more in periodontitis group (group III). The distribution was statistically significant (chi=30.211, P<0.001).
|Table 2: Percentage and frequency distribution of ABO blood group in Groups I-III|
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[Table 3] depicts the percentage distribution of blood groups in various grades of periodontal involvement. The results were statistically highly significant (chi=44.143, P<0.0010).
|Table 3: Percentage and frequency distribution of ABO blood group in various Grades (I, II, III, and IV) of periodontal involvement|
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[Table 4] and [Figure 2] show that 25.08% and 17.78% subjects belonged to blood groups O and AB, respectively, with grade 0 periodontal involvement, and when grades I, II, III, and IV were combined and studied, 90.11% and 89.04% of subjects belonged to blood groups A and B, respectively. The results were statistically highly significant (chi=26.45, P<0.0010).
|Figure 2: Component bar chart showing the percentage distribution of ABO blood group with various grades of periodontal involvement|
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|Table 4: Percentage and frequency distribution of ABO blood group with healthy periodontium (Grade 0) and with diseased periodontium (Grades I, II, III, and IV combined)|
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In [Table 5], percentage and frequency distribution of ABO blood group with mild (grade 0 and grade I) and moderate to severe periodontal involvement (grades II, III, and IV combined) were tabulated and studied. Combined grades (0 and I) of periodontal involvement was seen more commonly in blood groups AB (51.11%) and O (44.41%), whereas combined grades (II, III and IV) of periodontal involvement was seen commonly in subjects with blood group A (68.42%) and O (60.99%). The results were statistically highly significant (chi=33.129, P<0.0010).
|Table 5: Percentage and frequency distribution of ABO blood group with mild (Grade 0 and Grade I) and moderate to severe periodontal involvement (Grades II, III, and IV combined)|
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| Discussion|| |
The paradigm of pathogenesis of periodontitis is shifting. The presence of microorganisms is a crucial factor in inflammatory periodontal disease, but the progression of disease is related to host-based risk factors. Indeed, the periodontal diseases are now recognized to be ecogenetic diseases, which highlights their multifactorial nature. 
The tissue localization of the histo-blood group antigens has shown that the antigens in the tissues correspond to the erythrocyte blood group, but the tissue expression is dependent on the secretor status of the individual. Secretor status is secretion of blood group antigens ABO (H), which may be a factor influencing the development of systemic oral diseases in the stratified epithelium.  The expression of histo-blood group antigens depends on the state of cellular differentiation and maturation, and there is a sequential elongation of the terminal carbohydrate chain during the life span of the cell. Basal cells express short carbohydrate chains that are A/B precursors, whereas A or B antigens may be seen in the spinous cell layer. Variation in the differentiation patterns between keratinized versus non-keratinized epithelium influences the expression of blood group antigens. Keratinized squamous epithelium may express A or B antigens in only very few and highly differentiated cells, leaving the precursor H antigen expressed on most spinous cells. In contrast, in the non-keratinized epithelium of the buccal mucosa, the precursor H is expressed only on a few parabasal cells, whereas expression of A and B antigens is seen in most spinous cells. The expression of A/B antigens in oral tissues is thus regulated by the expression of the A/B transferases and the availability of a substrate for the transferase. 
New exciting data link the fringe genes to epithelial differentiation. Fringe genes are cell differentiation proteins that possess glycosyltransferase activity. These proteins initiate elongation of carbohydrate residues attached to notch receptors, which are transmembrane proteins that mediate communication associated with cell differentiation. The finding that fringe is expressed differently in mouse-stratified epithelium and that the gene product is glycosyltransferase is interesting in relation to the finding of a sequential expression of carbohydrates during epidermal differentiation, particularly as in mice, blood group antigen-related carbohydrates are found to be expressed in specific structures such as taste buds, tongue papillae, and gingival junctional epithelium. 
Demir et al. found that different ABO blood groups may show significant differences in the rates of colonization of a number of periodontal pathogens that are the main etiologic agents of periodontal diseases. 
Periodontal disease is a multifactorial disease and the etiopathogenesis of the disease not been completely established yet, with a constitutional factor probably of genetic origin playing a part. The purpose of the study was to explore such a possibility and to correlate ABO blood group and periodontal status with severity of periodontal involvement in South Kanara district of Karnataka state. The distribution of ABO blood group in this study comprising 750 individuals was statistically similar to general distribution in 7027 subjects (data collected from the blood bank) of the same geographic location. Further, this distribution was similar to the observation made by Vijay Raghavan  in a study of 15,936 subjects in South Kanara district. This observation established the homogeneity and unbiased nature of the study, as well as points to the natural distribution that is likely to exist in the population where the study was carried out. Different geographic locations show variations in the prevalence of A, B, AB, and O blood groups, as observed by Pradhan et al.  in their study. There was a statistically significant relationship between percentage distribution of A, B, AB, and O blood groups and periodontal status (groups I, II, and III) in our study, as shown in [Table 2]. When the percentage distribution of A, B, AB, and O blood groups and various grades of periodontal involvement (Ramfjord's criteria of scoring) were studied [Table 3], it revealed interesting findings, which are that blood group O subjects followed by AB predominated in grade 0 periodontal involvement and blood group B followed by A predominated in grade III and IV periodontal involvement. This finding was in contrast to the observation made by Pradhan et al. where they reported that A blood group predominated in healthy periodontium and blood groups AB and O showed more inclination toward diseased periodontium. On comparing the percentage and frequency distribution of A, B, AB, and O blood group subjects with healthy periodontium (grade 0) and those with diseased periodontium (grades I, II, III, and IV combined), it was observed that subjects with O and AB blood groups had healthy periodontium. While blood group B followed by A predominated in the latter. This observation differed from that of Pradhan et al. who reported a higher frequency of blood groups A and B in subjects with healthy periodontium as compared to those with diseased periodontium who showed a higher frequency of blood groups O and AB. There was a statistically significant relationship between frequency distribution of A, B, AB, and O blood groups and different grades of periodontal involvement, as shown in [Table 3].
The comparative distribution of A, B, AB, and O blood groups in mild (grades 0 and I combined) and moderate to severe (grades II, III, and IV combined) periodontal involvement was studied. The results showed an increased percentage of subjects with blood group AB, followed by blood group O in grade 0 periodontal involvement. While blood group B, followed by blood group A predominated in moderate to severe periodontal involvement (grades II, III, and IV combined). There was a statistically significant relationship between frequency distribution of A, B, and AB blood groups and grades 0 and I combined and grades II, III, and IV combined, as shown in [Table 5]. This observation is different from the observation made by Pradhan et al.  wherein they found apparently higher frequency of blood groups A and B with mild periodontal involvement (grades 0 and I) and blood groups O and AB showed higher frequency in subjects with moderate to severe periodontal involvement (grades II, III, and IV combined). These variations in their results may be because the study subjects were medical students of younger age group (17-25 years), and were of higher socioeconomic status with awareness of oral hygiene habits and possibility of dental visits in the childhood or prior to the commencement of the study, while our study comprised randomly selected subjects of the age group 30-38 years and patients attending outpatient department of our college and these patients had no history of periodontal treatment in the past. In the present study and various other studies that reported on ABO blood group and periodontal disease, a difference is found in the percentage and frequency distribution of A, B, AB, and O blood group in different periodontal status and also in different grades of periodontal involvement. It is very difficult to elaborate a hypothesis on why subjects with particular blood group are found in increased frequency in healthy, gingivitis, and periodontitis groups, and also in various grades of periodontal involvement. However, occurrence of gingivitis and periodontitis is the result of many factors and the probable genetic influence demonstrates a small facet of multifactorial etiology of this disease. Since most of these studies are carried out on a small group of subjects, until universal figures are made available, the decision as to whether a particular blood group has a particular immunity or susceptibility should be put off. Until then, all reports of preponderances should be accepted with a pinch of salt.
| Conclusion|| |
There is a correlation existing between periodontal disease and ABO blood group in South Kanara district of Karnataka state. The prevalence of blood group O is more in this geographic location, followed by blood groups B and A, and the least prevalent was blood group AB. There was an increased prevalence of subjects with blood groups O and AB with healthy periodontium, while blood groups B and A showed inclination toward diseased periodontium. This association can be due to various blood group antigens acting as receptors for the infectious agents associated with periodontal disease. This broad correlation between periodontal disease and ABO blood group points toward susceptibility ofsubjects with certain blood groups - to periodontal disease.
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]