Abstract
Aim
To analyze and compare digital dermatoglyphic patterns in patients with oral leukoplakia and oral submucous fibrosis and their role as noninvasive diagnostic tool.
Materials and Methods
Two hundred patients were segregated into four groups of 50 patients each with oral leukoplakia, oral submucous fibrosis, and patients with habits but no lesions were included. They were compared with 50 subjects without habits and without lesions. The study was undertaken to investigate the association of palmar dermatoglyphics with leukoplakia and oral submucous fibrosis. Palm and fingerprints were taken using digital method which were analyzed qualitatively and quantitatively.
Results
The present study found increase in frequency of whorls, palmar patterns in I2–I3 area, total finger ridge count, total triradius count and decrease in atd angle with the absence a–b ridge count in patients with oral leukoplakia and OSMF.
Conclusion
Thus, with the study of peculiar changes in digital dermatoglyphic patterns in patients with oral leukoplakia and oral submucous fibrosis, early detection and preventive measures can be instituted in normal individuals having habit history without lesions to prevent the occurrence and progression of these potentially malignant disorders.
Keywords: Dermatoglyphics, Oral submucous fibrosis, Oral leukoplakia
Introduction
The word “Dermatoglyphics” is originated from Greek words “Dermato” meaning skin and “Glyphics” meaning carving [1]. The term was coined by Cummins and Midlo [2]. Dermatoglyphics is the scientific study of fingerprints from palms, fingers, soles and toes of humans and animals. Since it is unique for each person and is not same even in monozygotic twins, dermatoglyphics could turn out to be an adjunctive diagnostic tool. In addition to this, since it is noninvasive, it can be used as a diagnostic tool in assessing individuals with suspected genetic disorders and also in forensics [3–5]. Presently, many researches claim that the study of dermatoglyphics is an important diagnostic tool for diseases with uncertain etiology and obscure pathogenesis such as trisomy 18, Down’s syndrome, Klinefelter syndrome, congenital heart disease, leukemia, cat's cry syndrome, Turner’s syndrome [3, 6, 7].
In dentistry, dermatoglyphics has been studied to help predict disorders like cleft lip and cleft palate, dental caries, gingival fibromatosis, periodontitis, bruxism, malocclusion, congenital anomalies like ectodermal dysplasia, etc. Smoking, drinking and tobacco chewing have been positively associated with oral lesions such as oral lichen planus, oral leukoplakia, oral submucous fibrosis and have strong potential for malignant transformation [6–9].
Activation of oncogenes or deletion and injuries to suppressor genes and genes responsible for DNA repair will all contribute to a defective functioning of the genome that governs cell division. A genetic predisposition is also supported by association-specific human leukocyte antigen (HLA) molecules, such as HLA-A10, -B7 and -DR3 [8, 10]. So to rule out the factor of genetic susceptibility, dermatoglyphics can be used as noninvasive tool as fingerprints are genetically determined. The present study was carried out to analyze the dermatoglyphic patterns digitally in oral leukoplakia, oral submucous fibrosis, subjects with habits and without lesions and to compare with the control group.
Materials and methods
This case–control prospective clinical study is a multicentric, multidisciplinary study conducted on 200 patients from October 2014 to September 2017. All patients were segregated into four groups with each group consisting of 50 patients. All patients belonged to an age-group of 20–70 years of age. Group I included 50 patients who were diagnosed clinically with oral leukoplakia. Group II included 50 patients who were diagnosed clinically with oral submucous fibrosis. Group III included 50 patients who were healthy individuals with habits of tobacco chewing but did not present any clinical oral lesions. Group IV included 50 patients who are healthy individuals without habits and without any clinical oral lesions. The confirmation of leukoplakia/OSMF was arrived at with the aid of biopsy. Patients with any systemic disease or skin diseases, patients with any congenital or acquired deformities of palms and fingers or having any scar or wound on the palms and fingers were excluded. Institutional ethical clearance was obtained. Written informed consent from the patients was taken.
Procedure for obtaining finger and palm prints
After informing the patients in detail about the procedure, sweat, oil and dirt are removed from the skin by washing the ridged areas with soap and water followed by drying. The digital green bit 84c dactyscan device was used for finger- and palm prints. Alcohol swab was used to clean the machine after every patient use. Dermatoglyphics was done by the clinicians themselves. Prints of the fingers were taken in three steps with the digital green bit 84c dactyscan device: (1) first four left fingers, (2) right four fingers and (3) thumbs of left and right hands. The prints were taken by pressing firmly against the screen of the machine. The acquisition was viewed on screen of laptop using the bioscan 10 software as shown in Fig. 1. Data were stored digitally as shown in Fig. 2. An image indicating the markings of the parameters studied is shown in Fig. 3. All the digital data are analyzed and assessed by a single operator, and patient selection on the basis of clinical findings is done by another operator.
Fig. 1.
Acquisition of left-hand fingerprints
Fig. 2.
Screen shot of palm print
Fig. 3.
An image indicating the markings of the parameters studied
The following dermatoglyphic parameters were analyzed both qualitatively and quantitatively.
Qualitative Analysis
Fingertip patterns and palmar patterns were studied under qualitative analysis.
Fingertip patterns were studied as: (a) arches (A), (b) loops (L) and (c) whorls (W)
Palmar patterns were studied as: (a) hypothenar area, (b) thenar/first interdigital area and (c) I2, I3 and I4 interdigital area.
Quantitative Analysis
Quantitative analysis was done under the following headings.
a–b ridge count,
Finger ridge count
Total finger ridge count (TFRC).
atd angle.
Tri—radius.
Statistical Analysis
Groups were compared among by one-way analysis of variance (ANOVA), the significance of difference in mean between the groups was calculated by Tukey’s post hoc test after ascertaining normality by Shapiro–Wilk’s test and homogeneity of variance between groups was calculated by Levene’s test. Discrete (categorical) groups were compared by Chi-square (χ2) test. Analyses were performed on SPSS (Window version 17.0) software.
Results
Qualitative Analysis Results
Fingerprint Patterns
Comparison of fingerprint Patterns in Both Hands
In Study groups, OSMF showed higher frequency (69.2%) in loops followed by leukoplakia (54.4%), with habits and without lesions (46%) and control group (47.2%). The loop pattern was predominantly observed in all the four groups: group I (58%), group II (67.6%), group III (45.2%) and group IV (45.8%). The whorl pattern and arch pattern were predominantly observed in group III and control group (Table 1).
Table 1.
Comparison of fingerprint pattern of both hands
| Fingerprint pattern | Group I (N = 50) | Group II (N = 50) | Group III (N = 50) | Group IV (N = 50) | χ2 value | P value |
|---|---|---|---|---|---|---|
| Arches | 43 (8.6%) | 28 (5.6%) | 71 (14.2%) | 69 (13.8%) | 27.65 | < 0.0001* |
| Loops | 290 (58%) | 338 (67. (5%) | 226 (45.2%) | 229 (45.8%) | 69.59 | < 0.0001* |
| Whorls | 167 (33.4%) | 134 (26.8%) | 203 (40.6%) | 202 (40.4%) | 28.45 | < 0.0001* |
* denotes statistical significance
Comparison of Fingerprint Patterns in Digit
Loop pattern was predominantly seen in group II as compared to other groups in all the digits except D4, which showed higher frequency of whorls than loops. The second common pattern observed in all the groups except D5 was whorl pattern, and a least number of arch patterns were seen in all the groups (Table 1).
Comparison of Palmar Patterns of Both Hands
On comparing the distribution of palm patterns on the right and left palm among the four groups, the highest pattern was observed in I3–I4 area followed by I2–I3 area, hypothenar area I1–I2 and the least patterns were found on thenar area. The distribution of palm patterns showed high frequency in group II as compared to other groups. The palm patterns in I2–I3 area were found predominantly in group II (31), followed by group III (24), control group (17) and least in group I (6). The palm pattern in hypothenar area showed high distribution in group II (23) and group III (23) followed by control group (22) and least in group I (16) (Table 2).
Table 2.
Comparison of palmar pattern of both the hands
| Palmar pattern | Group I (N = 50) | Group II (N = 50) | Group m (N = 50) | Group IV (N = 50) | χ2 value | P value |
|---|---|---|---|---|---|---|
| Thenar/I1 | 1 | 7 | 2 | 6 | 6.77 | O.079 NS |
| I1–I2 | 7 | 3 | 7 | 6 | 1.98 | 0 58 NS |
| I2–I3 | 16 | 31 | 24 | 17 | 8.51 | 0.036* significant |
| I3–I4 | 27 | 43 | 43 | 39 | 7.30 | 0.062 NS |
| Hypothenar area | 16 | 22 | 23 | 23 | 2.05 | 0 56 NS |
* denotes statistical significance
Total Finger Ridge Count of Right and Left Hand
The mean ridge count in group I cases was insignificant on comparison with group II and control group but found moderately significant with group III (P < 0.01**) (Fig. 4).
Fig. 4.
Graph 1 showing the comparison of total mean finger ridge count in both the hands
Triradius Count of Right- and Left-Hand Fingers
The mean triradius count of right- and left-hand fingers in group II was 5.48 with a SD ± 3.14; in control group, 5.02 with a SD ± 2.97; in group I, 4.16 with a SD ± 2.66; and in group III, 3.34 with a SD ± 2.84. Testing with one-way ANOVA gave highly significant difference in mean (F—5.31, P—0.0015) (Fig. 5).
Fig. 5.
Graph 2 showing the comparison of triradius count of right- and left-hand fingers
Total Triradius Count
The mean total triradius count of both hands was predominantly high in control group as compared to other groups. The mean total triradius count of both hands in control group was 7.84 with a SD ± 3.48; in group III, 7.34 with a SD ± 3.66; group II, 7.26 with a SD ± 3.53; and group I, 5.42 with a SD ± 2.89. Testing with one-way ANOVA gave highly significant difference in mean (F—4.21, P—0.0075) (Fig. 6).
Fig. 6.
Graph 3 showing total triradius count
Atd ANGLE: The mean atd angle of right and left palm was predominantly high in control group as compared to other groups. Testing with one-way ANOVA gave highly significant difference in mean (F—4.36, P—0.0093—right palm; (F—7.22, P—0.0006—left palm) (Tables 3, 4).
Table 3.
Showing atd angle of right palm
| Groups | Atd angle of right palm | ‘F’ ratio | P value |
|---|---|---|---|
| Mean ± SD | |||
| Group I | 39.86 ± 6.67 | 4.36 | P = 0 0093 |
| Group II | 40.29 ± 6.97 | ||
| Group EH | 45.53 ± 3.38 | ||
| Group IV | 47.63 ± 6.75 |
Table 4.
Showing mean atd angle of left palm
| Groups | Atd angle of left palm | ‘F ratio’ | P value |
|---|---|---|---|
| Mean ± SD | |||
| Group I | 38.43 ± 6.21 | 7.22 | P = 0.0006 |
| Group II | 41.38 ± 6.82 | ||
| Group IE | 45.53 ± 3.38 | ||
| Group IV | 48.3 ± 3.33 |
Total a–b ridge count: The a–b ridge count was not prevalent in any of the groups.
Discussion
Dermatoglyphics is considered a window of congenital and intrauterine abnormalities. The importance of dermatoglyphic studies in clinical medicine is that, during development, maternal environment, gene deviants, and chromosomal aberrations affect ridge formation. Literature suggested that the study of dermatoglyphics is an important diagnostic tool in potentially malignant disorders for suspecting the genetic etiology [11–14]. Hence, preventive measures can be instituted to minimize premalignant lesions.
Millions of the people in India chew gutkha, tobacco, which initiates oral premalignant lesions like oral submucous fibrosis and leukoplakia [9]. As a biomarker to assess genetic susceptibility of such lesions, the present study was conducted to evaluate any association between oral submucous fibrosis and oral leukoplakia with palmar dermatoglyphics [1, 8, 15–18]. We found increase in frequency of whorls, palmar patterns in I2–I3 area, total finger ridge count, total triradius count and decrease in atd angle with the absence a–b ridge count in patients with oral leukoplakia and OSMF.
On comparison of fingerprint patterns in both right and left hands, the frequency of loop pattern was highly significant in all the four groups: group I (58%), group II (67.6%), group III (45.2%) and group IV (45.8%). Patients with OSMF showed the highest frequency of loop pattern compared to other three groups. The whorl pattern and arch pattern were predominantly observed in group III and control group.
Previous studies revealed that in patients with oral leukoplakia and OSCC, there was a highly significant increased frequency of loops [2, 19, 20]. This is in accordance with the findings of our study in which OSMF showed the highest frequency of loop pattern compared to other three groups. Previous studies on qualitative analysis found finger ridge patterns among the four study groups to be statistically significant for arches which are in accordance with our study. Previous studies showed that arch pattern (60.7%) was predominant with a decrease in whorl pattern (29.3%) in study group when compared with the controls group [21]. However, their results were contradictory to our study.
Few studies observed predominant fingerprint pattern of whorls in OSCC and OSMF, whereas loops were predominant in control-group individuals, the results of which are not in accordance with our study where loop pattern was predominant in OSMF [22]. A recent study showed the percentage of loops was 30% in right and 38% in the left hand of subjects with OSMF. The whorl pattern among subjects having OSMF was 24% and 20% in right and left hands, and in the controls, it was 7% and 5%, respectively [23]. However, our study found the frequency of loop pattern of the right hand in OSMF group was higher when compared to the frequency on the left hand. Next, common pattern seen in our study was whorl pattern, which is in accordance with previous studies [24–26].
A recent study revealed that the ring fingers (D4) of both right and left hands had the highest percentage of whorl pattern at 35% and 30% respectively. This was followed by the right thumb (D1) and right index finger (D2), which had 25% of whorl pattern each. In control group, the highest percentage of whorl pattern was seen in the right ring finger (D4) with 15% and the arch pattern was highest in the left thumb (D1) with 15% [23]. These observations matched the findings of our results except for the OSMF group where loops were predominant in D4.
Another study found significant increase in pattern frequency in thenar/hypothenar area in both the hands in OSMF group as compared to other groups [24]. This contradicted our result where we found significance only in I2–I3 region.
A recent study compared total finger ridge counts in OSMF, OL, OSCC, and it was observed that there was an increase in the total finger ridge count (64.7%) in patients with OL, OSMF and OSCC (group A) [21]. Our results also showed significant increase in total finger ridge count in OSMF group compared to other groups. Venkatesh et al. compared total finger ridge count (TFRC) in all three study groups and observed that there was no significant difference in the mean TFRC among the three groups [2]. Our results revealed that mean total finger ridge count of OSMF group and leukoplakia group showed moderate significance with group III.
Gupta and Karjodkar analyzed frequency of total finger ridge counts (TFRC) and revealed that the mean value of TFRC in OSF group was lower than the other groups. But, the values were not found to be significant [19]. Conversely, our study showed higher mean value of TFRC in OSMF group compared to other groups and total finger ridge count of OSMF group and leukoplakia group showed moderate significance with group III. Our results showed that the mean atd angle of right palm and left palm was predominantly high in control group as compared to other groups. Previous studies show no significant difference in frequency of mean atd angles of both right and left hands in all three study groups.
Gupta and Karjodkar analyzed the number of accessory palmar triradii on right and left hands of the samples in each group and found statistically significant difference in frequency of palmar triradii [20]. Our study also showed high frequency of triradii count in both right and left palms among the study groups, highest in group III followed by control group, OSMF group and leukoplakia group. Our study also showed statistically significant difference in frequency of palmar triradii as per the literature [20, 25–27].
Conclusion
The results of the present study suggest peculiar changes in digital dermatoglyphic patterns in patients with oral leukoplakia and oral submucous fibrosis. Hence, dermatoglyphics can be used as a diagnostic tool for early detection. This helps in institution of preventive measures in normal individuals having habit history but without clinical lesions to prevent the occurrence and progression of these potentially malignant conditions.
Authors' Contribution
RS was the operating surgeon and involved in design of the study, data acquisition, data analysis and drafting of the article. HM contributed to data acquisition and data analysis. RW designed the study and analyzed the data. PT was the operating surgeon and designed the study. RVCT was involved in data acquisition, data analysis and drafting of the article. SB contributed to data acquisition and data analysis.
Funding
This study is self-funded.
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflict of interest.
Informed Consent
Written informed consent from the patients was taken.
Ethical Standard
Institutional ethical clearance was taken.
Footnotes
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
References
- 1.Sengupta AB, et al. A cross-sectional study of dermatoglyphics and dental caries in Bengalee children. J Indian Soc Pedod Prevent Dent. 2013;31(4):245–248. doi: 10.4103/0970-4388.121823. [DOI] [PubMed] [Google Scholar]
- 2.Venkatesh E, Bagewadi A, Vaishali K, Palmar Arvind S. Dermatoglyphics in oral leukoplakia and oral squamous cell carcinoma patients. J Indian Acad Oral Med Radiol. 2008;20:94–99. doi: 10.4103/0972-1363.52774. [DOI] [Google Scholar]
- 3.Lakshmi Prabha J, Thenmozhi R. A short review on dermatoglypics. J Pharm Sci Res. 2014;6(4):200–202. [Google Scholar]
- 4.Priya NS, Sharada P, Chaitanya Babu N, Girish HC. Dermatoglyphics in dentistry: an insight. World J Dent. 2013;4(2):144–147. doi: 10.5005/jp-journals-10015-1221. [DOI] [Google Scholar]
- 5.Ceena Denny E, Junaid A, Nandita S, Almas B. Dermatoglyphics in dentistry—a review. Int J Curr Res. 2013;5(21):30–33. [Google Scholar]
- 6.Cummins H, Midlo C. Fingerprints palms and soles—an introduction to dermatoglyphics. New York: The Blakistan Co., Inc; 1961. [Google Scholar]
- 7.Vijayaraghavan A, Aswath N. Qualitative and quantitative analysis of palmar dermatoglyphics among smokeless tobacco users. Indian J Dental Res. 2015;26(5):484–487. doi: 10.4103/0970-9290.172042. [DOI] [PubMed] [Google Scholar]
- 8.Liao HP, Yang WH, Huang YF. Genetic expression signature of oral submucous fibrosis and oral cancer—a preliminary microarray report. J Dent Sci. 2013;20:1–6. doi: 10.1016/j.jds.2013.02.017. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Tilakaratne WM, Klinikowski MF, Saku T, Peter TJ, Warnakulasuriya S. Oral submucous fibrosis: review on aetiology and pathogenesis. J Oral Oncol. 2006;42:561–568. doi: 10.1016/j.oraloncology.2005.08.005. [DOI] [PubMed] [Google Scholar]
- 10.Kumar K, Sarasvvathi TR, Rangnathan K, Devi M, Elizabeth J. Oral submucous fibrosis: a clinico-histopathological study in Chennai. Indian J Denial Res. 2007;18(3):106–111. doi: 10.4103/0970-9290.33785. [DOI] [PubMed] [Google Scholar]
- 11.Pundir S, Saxena S, Aggrawal P. Oral submucous fibrosis a disease with malignant potential—report of two cases. J Clin Exp Dent. 2010;2(4):215–218. doi: 10.4317/jced.2.e215. [DOI] [Google Scholar]
- 12.Nelson BS, Heischober B. Betel nut: a common drug used by naturalized citizens from India, Far East Asia, and the South Pacific Islands. Ann Emerg Med. 1999;34(2):238–243. doi: 10.1016/S0196-0644(99)70239-8. [DOI] [PubMed] [Google Scholar]
- 13.Wollina U, Shyam BV, Fareedi MA, Kishor P. Oral submucous fibrosis: an update. Clin Cosmet Investig Dermatol. 2015;8:193–204. doi: 10.2147/CCID.S80576. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Gupta M, Mishra P, Shrivastava K, Singh N, Singh P. Oral submucous fibrosis—current concepts of aetiology & its management. J Appl Dent Med Sci. 2015;1(1):29–39. [Google Scholar]
- 15.Chaturvedi P, Nair DR, Pawar U. Oral cancer: premalignant conditions and screening—an update. J Cancer Res Ther. 2012;8(6):57–66. doi: 10.4103/0973-1482.92217. [DOI] [PubMed] [Google Scholar]
- 16.Parlatescua I, Carmen G, Elena C, Serban T. Oral leukoplakia—an update. Maedica A J Clin Med. 2014;9(1):88–93. [PMC free article] [PubMed] [Google Scholar]
- 17.Mithani SK, Mydlarz WK, Grumbine Fl, Smith IM, Califano Ja. Molecular genetics of premalignant oral lesions. Oral Dis. 2007;13:126–133. doi: 10.1111/j.1601-0825.2006.01349.x. [DOI] [PubMed] [Google Scholar]
- 18.Sikdar N, Paul RR, Roy B. Glutathione S-transferase M3 (A/A) genotype as a risk factor for oral cancer and leukoplakia among Indian tobacco smokers. Int J Cancer. 2014;109:95–101. doi: 10.1002/ijc.11610. [DOI] [PubMed] [Google Scholar]
- 19.Gupta A, Karjodkar FR. Role of dermatoglyphics as an indicator of precancerous and cancerous lesions of the oral cavity. Contemp Clin Dent. 2013;4(4):448–453. doi: 10.4103/0976-237X.123039. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.David MP, Sinha P. Dermatoglyphic patterns in subjects with potentially malignant disorders and oral carcinoma. J Adv Clin Res Insights. 2015;2:7–11. doi: 10.15713/ins.jcri.33. [DOI] [Google Scholar]
- 21.Jatti D, Kantraj YDB, Nagaraju R. Role of dermatoglyphics in malignant and potentially malignant disorders of the oral cavity: a cross-sectional study. J Indian Acad Oral Med Radiol. 2014;26(4):370–384. doi: 10.4103/0972-1363.155674. [DOI] [Google Scholar]
- 22.Ganvir SM, Gajbhiye NY. Detection of genetic predisposition in oral squamous cell carcinoma (OSCC) and oral submucous fibrosis patients by qualitative analysis of finger and palm-print patterns: a dermatoglyphic study. Clin Cancer Investig J. 2014;3(5):377–380. doi: 10.4103/2278-0513.138054. [DOI] [Google Scholar]
- 23.Shetty P, Shamala R Murali, Yalamalli M, Kumar VA. Dermatoglyphics as a genetic marker for oral submucous fibrosis: a cross-sectional study. J Indian Assoc Public Health Dent. 2016;14:41–45. doi: 10.4103/2319-5932.178730. [DOI] [Google Scholar]
- 24.Kulkarni V. Palmar dermatoglyphics among gutkha chewers with and without oral submucous fibrosis. Med Innov. 2014;3(1):15–21. [Google Scholar]
- 25.Munishwar PD, et al. Qualitative analysis of dermatoglyphics in oral submucous fibrosis. J Indian Acad Oral Med Radiol. 2015;27(2):207–212. doi: 10.4103/0972-1363.170139. [DOI] [Google Scholar]
- 26.Dutta N, Shetty R, Pandey V, Kumar S, Rathore N. Comparison of finger print patterns in patients with and without oral submucosis fibrosis—a dermatoglyphics study. Int J Contemp Med Res. 2016;3(4):1172–1173. [Google Scholar]
- 27.Kumar S, Kandakurti S, Saxena VS, Sachdev AS, Gupta J. A dermatoglyphic study in oral submucous fibrosis patients. J Indian Acad Oral Med Radiol. 2014;26(3):269–273. doi: 10.4103/0972-1363.145002. [DOI] [Google Scholar]