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Evaluation of Association Between the Prevalence and Severity of Periodontal

Diseases and ABO Blood Groups Among Nepalese Adults

Article  in  Indian Journal of Science and Technology · January 2014

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Manoj Humagain Dinesh Rokaya

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Ind. J. Sci. Res. and Tech. 2014 2(3):66-70/Humagain & Rokaya ISSN:-2321-9262 (Online)
Online Available at: http://www.indjsrt.com
Research Article

EVALUATION OF ASSOCIATION BETWEEN THE PREVALENCE AND SEVERITY

OF PERIODONTAL DISEASES AND ABO BLOOD GROUPS AMONG NEPALESE
ADULTS
*
Manoj Humagain and Dinesh Rokaya
Department of Periodontology, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
*Author for Correspondence

ABSTRACTS
Background: Periodontal disease is one of the two major dental diseases that affect human populations worldwide at
high prevalence rates. Although it is primarily caused by bacterial plaque, its incidence and severity is modified by
an individual’s inflammatory response, systemic health, and various local factors that predispose to plaque
accumulation. The correlation between some systemic disease and ABO blood group is well documented in the
literature, little investigations has been made to explore the relationships between ABO blood groups and the
incidence of oral and dental diseases. The aim of this study was to investigate the association between ABO blood
group and periodontal disease prevalence and severity among Nepalese adults. Materials and Methods: A total of
553 systemically healthy patients aged between 20 to 65 years were selected. Details of medical history, probing
pocket depth (PD), loss of clinical attachment level (CAL) and number of missing teeth were recorded. Results: A
relatively higher percentage of blood group B and O patients have greater proving pocket depth (4.09 mm and 3.45
mm) and clinical attachment level (2.42 mm and 1.50 mm). Similarly Probing pocket depth and loss of clinical
attachment level was significantly higher among Rhesus positive groups when compared with Rhesus negative
groups (p= 0.000). Conclusion: Significant correlation between the prevalence and severity of periodontal disease
and blood groups existed in this study. This broad correlation between periodontal disease and ABO blood group
points toward the susceptibility of subjects with certain blood groups to periodontal disease. However, long-term
studies with greater sample size are required to make more comprehensive assessment of this association.

Key Words: Blood Group, Clinical Attachment Level, Periodontal Disease and Pocket Depth

INTRODUCTION
Periodontitis may be defined as inflammation of the supporting tissues of the teeth. It is usually a progressively
destructive change leading to loss of bone and periodontal ligament due to extension of inflammation from gingiva
into the adjacent bone and ligament. It is progressive and episodic in nature, with tissue destruction resulting from
the host response to bacterial antigens and irritants, resulting ultimately to tooth loss in susceptible person (Page and
Kornman, 1997). Periodontal disease is one of the two major dental diseases that affect human populations
worldwide at high prevalence rates. World Health Organization (WHO) in its report in 2005 published that almost
10-15 % of the population worldwide is suffering from severe form of periodontitis (Petersen and Ogawa
2005).Analysis of epidemiological studies on oral disease in Nepal has concluded that 29 % of Nepalese aged 35-44
years are suffering from deep periodontal pockets (Palenstein Helderman, 1898). According to this it can tentatively
be concluded that Nepal belongs to the 15% of countries in the world where periodontal conditions of the population
are among the worst (Helderman,1898).
Dental biofilm, also known as plaque is considered as the main etiological factor for initiation and progression of
periodontal diseases. The incidence and severity of plaque-induced periodontal diseases can be modified by
an individual’s inflammatory response, systemic health, and various local factors that predispose to plaque
accumulation (Page and Kornman 1997). The inflammatory response in periodontal disease includes the activation
of leucocytes, neutrophils, T-lymphocytes and plasma cells and the release of antibodies, lipopolysaccharides and
chemical inflammatory mediators that include cytokines, chemokines and C-reactive protein. The
lipopolysaccharides are present in the gram-negative bacteria cell walls and act as powerful stimulants for the
complex host response. The level of periodontal destruction depends on the balance between destructive and
protective inflammatory mediators.While periodontal bacteria are required for infective periodontal disease,
individual response determines disease progression (Page et al., 1976; Page and Kornman, 1997; Kinney et al.,
2009). Although bacterial plaque is a primary etiological factor, the occurrence and severity of periodontal disease
varies among the individuals having similar amount of deposits. Hence, it is important to emphasize the significance
of the role of genetic factors in the etiology of periodontal disease and to find any innate factor is associated with it.
In 1930 Karl Landsteiner, an Australian physician, discovers the first three human blood groups, A, B, and C. Blood
type C was later changed to O. His colleagues Alfred Decastello and Adriano Sturli add AB, the fourth type, in

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Ind. J. Sci. Res. and Tech. 2014 2(3):66-70/Humagain & Rokaya ISSN:-2321-9262 (Online)
Online Available at: http://www.indjsrt.com
Research Article

1902. Landsteiner and his team receive Nobel Prize for Medicine for this discovery in 1930 (Watkins, 2001).
Landsteiner classify people into one of the four groups A, B, O, and AB, depending on whether their red cells
contained agglutinogen “A”, agglutinogen “B”, neither A nor B or both A and B (Watkins, 2001). The Rh system
was discovered in 1940 by Landsteiner and Wiener. They injected rabbits and guinea pigs with the red cells from
Macacus rhesus monkeys and the resulting antibody reacted with the red cells of 85% of New York blood donors.
Those who reacted were said to have the Rhesus factor and were Rhesus positive, whilst those that did not react
lacked the Rhesus factor and were Rhesus negative. The terms Rhesus positive or Rhpositive and Rhesus negative or
Rh negative (Watkins, 2001). Since then, ABO system and the Rh system are the most commonly used blood
grouping systems.
The clinical significance of ABO blood type is not only limited transfusion medicine and solid organ/hematopoietic
transplantation but also its correlation various systemic diseases has been investigated. Various reports have
suggested important associations between ABO blood groups and systemic diseases, like, gastric cancer(Hajj,
Hashash et al., 2007; Liu et al., 2012), pancreatic cancer (Lu et al., 2013; Joo et al., 2013), diabetes mellitus (Jassim,
2012) and cardiovascular diseases(Wolpin et al., 2012).Although several studies have been carried out to investigate
the association between ABO blood group and incidence of many systemic diseases, little investigations has been
made to explore the relationships between ABO blood groups and the incidence of oral and dental diseases. Some
researchers claimed that there was a relation whereas some others could not find any, which could be attributed to
geographical diversity, socioeconomic conditions and dietary habits of the population. This leads to a controversy
regarding the association between ABO blood groups and oral diseases in the earlier years(Aitchison and
Carmichael, 1962; Barros and Witcop, 1963). The aim of this study was to investigate the association between ABO
blood group and periodontal disease prevalence and severity among Nepalese adults.

MATERIALS ANDMETHODS
This study was conducted in the Department of Periodontology, Kathmandu University School of Medical sciences,
Dhulikhel, Kavre, Nepal from March 2012 to February 2013. 553 patients between the ages of 20- 65 years were
recruited from the department who came for regular dental treatment. Patients who were aware of their blood group
were selected for this study and were counseled about their role in the study. A detail of medical history was
recorded and informed consent was taken from all the participants.
Inclusion criteria: All the participants were systemically healthy without any systemic disease that may alter
periodontal health and patient who were aware of their blood group were selected for this study.
Exclusion Criteria: Patient having systemic debilitating disease that may alter periodontal health and patient who
underwent periodontal treatment and systemic antibiotic therapy in last three months was excluded from this study.
Data collection: Full mouth periodontal examination excluding the 3rd molars was conducted for all patients. Four
sites were examined for each tooth (Mesio-buccal, Buccal, disto-buccal and palatal). Bleeding on probing (BOP),
probing depth (PD) i.e: the distance from gingival margin to the base of the sulcus and clinical attachment loss
(CAL) i.e; distance from Cemento enamel junction to base of the sulcus were measured using graduated William’s
Priodontal probe. Numbers of missing teeth were also recorded.
Statistical Analysis: Collected data was analyzed using Statistical Package for social Sciences (SPSS, version 16)
PD, CAL and number of missing teeth (MT) were compared across ABO blood, Rhesus groups and gender using the
ANOVA statistical test. Periodontal parameters were compared between Rh- positive and Rh- negative individuals
using the Student’s t-test.

RESULTS
This investigation was carried out on 553 subjects, 289 (53.3%) females and 264 (47.7%) males aged 20 to 64 years
with the mean age 40.56 years. Out of total 553 subjects examined, the prevalence of subjects with blood groups A,
B, AB and O was 161 (29.1%), 142 (25.7%), 94 (17.0 %) and 156 (28.2%) respectively( Table 1). Almost 90.2 % of
the subjects were Rhesus group positive and 9.8 % were Rhesus negative, 70.7% of the subjects had bleeding on
probing, the objective sign of gingival and periodontal diseases.
Comparison of periodontal parameters between male and female gender using the criteria of probing pocket depth
(PD), loss of clinical attachment level (CAL) and number of missing teeth (MT) is shown in table 2. No significant
difference was seen between the genders while comparing the mean PD and CAL (P= 0.164 and 0.511 respectively).
While comparing the mean number of missing teeth (MT); there was significant difference between the male and
females (P value 0.005) (Table 2). The mean number of missing teeth was significantly greater among the male
patients.

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Ind. J. Sci. Res. and Tech. 2014 2(3):66-70/Humagain & Rokaya ISSN:-2321-9262 (Online)
Online Available at: http://www.indjsrt.com
Research Article

Table 1: Distribution of samples according to blood groups, Rhesus Groups and Gender
Number (n) Percentage (%)
A 161 29.1
B 142 25.7
Blood Group
AB 94 17.0
O 156 28.2
Negative 54 9.8
Rhesus Group
Positive 499 90.2
Females 289 53.3
Gender
Males 264 47.7
Negative 162 29.3
BOP
Positive 391 70.7
BOP: Bleeding on probing

Table 2: Comparison of Periodontal parameters by Gender

Male Female
P- value
Mean SD Mean SD
PD ( mm) 3.49 1.10 3.61 1.04 0.164
CAL (mm) 1.66 1.88 1.56 1.77 0.511
Missing Teeth (n) 1.23 1.38 0.88 1.46 0.005
PD: pocket depth, CAL: Clinical attachment loss

Table 3: Comparison of Periodontal parameters by blood groups

Blood
A B AB O
Group P-value
Mean SD Mean SD Mean SD Mean SD
PD (mm) 3.37 1.09 4.09 0.91 3.27 0.98 3.45 1.07 0.000
CAL (mm) 1.40 1.91 2.42 1.60 0.90 1.66 1.50 1.76 0.000
Missing
1.01 1.50 1.18 1.38 0.78 1.43 1.13 1.39 0.165
teeth (n)

Table 4: Comparison of periodontal parameters by Rhesus Groups

Rh Positive Rh Negative
P-value
Mean SD Mean SD
PD (mm) 3.64 1.04 2.79 1.09 0.000
CAL (mm) 1.73 1.85 0.43 0.84 0.000
Missing Teeth (n) 1.11 1.47 0.44 0.84 0.001

Comparison of periodontal parameters among different blood groups (A, B, AB and O) is shown in table 4. Mean
probing pocket depth (PD) and clinical attachment loss (CAL) was significantly greater in blood group B patients (p
<0.005) (Table 3). However there was no significant difference on number of missing teeth (MT) among the
different blood groups (p = 0.165). Similarly, comparison of periodontal parameters by Rhesus Groups shows
significantly greater amount of mean PD (3.64 mm Vs 2.79 mm) and CAL (1.73 mm Vs o.43 mm) with the p value
<0.005 (Table 4). The mean number of missing teeth was also significantly higher among the Rh positive groups (p=
0.001).

DISCUSSION
Periodontitis is a poly-microbial and multifactorial disease that differs in etiology, natural history, disease
progression and response to therapy, but has a common underlying chain of events, that are influenced by disease
modifiers (Ekstein, 2010). The presence of microorganism is a crucial factor in inflammatory disease, but the
progression of disease depends on host related risk factors. A wide range of background factors such as age, sex,
education, place of residence, oral hygiene habits, socio-economic status, genetic characteristics and smoking habits
have been identified as risk factors for the occurrence and progression of periodontal disease (Michalowicz, 1994).

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Ind. J. Sci. Res. and Tech. 2014 2(3):66-70/Humagain & Rokaya ISSN:-2321-9262 (Online)
Online Available at: http://www.indjsrt.com
Research Article

The purpose of this study was to explore the possibility and to correlate ABO blood group and severity of
periodontal disease using the parameters probing pocket depth, loss of clinical attachment level and number of
missing teeth in Nepalese adult samples. The distribution of ABO blood group sample in our study group of 553 is
almost similar to the distribution seen on other similar studies done in Nepal (Subba et al., 2005; Pramanik, 2006).
90.2 % (n= 499) of the study population were rhesus positive and 9.8 % (n= 54) were rhesus negative .This finding
is little higher than the findings of Pramanik et al., (2006), Chapagain et al., (2005) who found only 0.8% and 0.14
% of rhesus negative groups.
The possibilities of occurrence of certain oral diseases like dental caries, denture stomatitis and maxillofacial
deformities in some blood group phenotypes have been investigated earlier (Kornstad et al., 1976; Kotani et al.,
1991). Very few literatures are available in an attempt to evaluate the association between ABO blood group, Rh
factor and periodontal diseases. Our study shows greater mean probing pocket depth and attachment loss among
blood groups B (4.09 mm and 2.42 mm) and O (3.45 mm and 1.50 mm) and least among the blood group AB (3.27
mm and 0.90 mm). However there was no significant difference on mean number of missing teeth among the
different blood groups. Periodontal parameters were significantly better in Rh positive than Rh negative groups
(p<0.005). Several recent studies show contradictory findings about the distribution and severity of periodontal
diseases among different blood groups. Similar finding was seen by Ghamdi (2009) in his study done in Saudi
population and Pai et al., (2012) in their study done in Indian population, however there was no significant
difference between Rh positive and negative in evaluating the periodontal parameters. A study done on Indian
population, shows significantly higher level of gingivitis among the blood group A and higher percentage of
periodontitis in blood group O (Raghavendra et al., 2010). Similar finding was achieved by Demir et al., (2007) on
his study on effects of ABO blood types on Periodontal Status among Turkish people.
In the present study and various other studies (Demir, 2007; Tezelet al., 2007; Ghamdi, 2009; Koregol, 2010
Raghavendra et al., 2010) 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 groups with different degree of periodontal
parameters like probing pocket depth and clinical attachment loss. It is very difficult to elaborate a hypothesis on
why subjects with particular blood groups are found in increased pocket depth, periodontal attachment loss and
greater number of missing teeth. Periodontal disease, a multi factorial polymicrobial entity has a genetic influence in
its etiology. As this study and most of the other studies related to the association between ABO blood groups and
prevalence and severity of periodontal diseases were done in small sample population, it will be too early to
conclude the definite association between these two, until universal figures are made available.

CONCLUSION
Significant relationships between ABO blood type and severity of periodontitis were determined in this study.
Patients with blood group B and O appear to be at greater risk of having deep pocket depth and severe attachment
loss. Similarly Rhesus positive groups have greater prevalence and severity of periodontal disease than Rhesus
negative groups. This broad correlation between periodontal disease and ABO blood group points toward the
susceptibility of subjects with certain blood groups to periodontal disease. However, long-term studies with greater
sample size are required to make more comprehensive assessment of this association.

REFERENCES
Aitchison J & Carmichael A (1962). The relationship between the ABO blood mutations and dental caries.Dental
Practice,13 93-95.
Arneberg P, Kornstad L, Nordibo H & Gjermo P (1976). Less dental caries among secretors than among non-
secretors of blood group substance. Scandevian Journal of Dental Research, 84(6) 362-366.
Barros L & Witcop C (1963). Oral and genetic study of Chileans 1960 III. Periodontal disease and nutritional
factors. Archives of Oral Biology, 8 195.
Chapagain RH, Subba B, Kunwar CB, Subedi J, Blengero J, Williams S & Towne B (2005). Trend of blood
group distribution among the Jirels of Nepal. Journal of Nepal Medical Association,44(160) 121-123.
Demir T, Tezel A, Orbak R, Eltas A, Kara C & Kavurt F (2007). The effect of ABO blood types on Periodontal
Status. European Dental Journal, 1 139-143.
Ekstein J, Shapira L & Van Dyke TE (2010). The pathogenesis of periodontal disease: a paradigm shift. Refuat
Hapeh Vehashinayim (Israel), 27(3) 35-39.
Ghamdi AS (2009). Association between ABO blood groups and severity of chronic periodontitis. Journal of King
Abdulaziz Medical Sciences, 16(3) 31-41.

69
 Ind. J. Sci. Res. and Tech. 2014 2(3):66-70/Humagain & Rokaya ISSN:-2321-9262 (Online)
Online Available at: http://www.indjsrt.com
Research Article

Hajj E, Hashash J, Abdul-Baki EM & Sarara H (2007). ABO blood group and gastric cancer: rekindling an old
fire?. Southern Medical Journal, 100(7) 726-727.
He M, Wolpin B, Rexrode K, Manson JE, Rimm E & Qi L (2012). ABO blood group and risk of coronary heart
disease in two prospective cohort studies. Arteriosclerosis Thrombosis andVascular Biology, 32(9) 2314-2320.
Jassim WE (2012). Association of ABO blood group in Iraqis with hypercholesterolaemia, hypertension and
diabetes mellitus. Eastern Mediterranean Health Journal, 18(8) 888-891.
Koregol AC, Raghavendra M, Nainegali S, Kalburgi N & Varma S (2010). ABO blood groups and Rhesus
factor: An exploring link to periodontal diseases. Indian Journal of Dental Research, 21(3) 364-368.
Lavine WS, Page RC & Padgett GA (1976). Host response in chronic periodontal disease. V. The dental and
periodontal status of mink and mice affected by Chediak-Higashi syndrome. Journal of Periodontology, 47(11) 621-
635.
Michalowicz BS (1994). Genetic and heritable risk factors in periodontal disease. Journal of Periodontology,65(5
Suppl) 479-488.
Nikawa H, Kotani H, Sadamori S & Hamada T (1991). Denture stomatitis and ABO blood types. Journal of
Prosthetic Dentistry, 66(3) 391-394.
Page RC & Kornman KS (1997). The pathogenesis of human periodontitis: an introduction. Periodontology 2000,
14 9-11.
Pai G, Dayakar M, Shaila M & Dayakar A (2012). Correlation between "ABO" blood group phenotypes and
periodontal disease: prevalence in south Kanara district, Karnataka state, India. Journal of Indian Society of
Periodontology, 16(4) 519-523.
Petersen PE & Ogawa H (2005). Strengthening the prevention of periodontal disease: the WHO approach. Journal
of Periodontology, 76(12) 2187-2193.
Pramanik TAP (2006). Trend of blood group distribution among the different ethnic groups of Kathmandu Valley.
Nepal Medical College Journal, 8(4) 248-249.
Ramseier CA, Kinney JS, Herr AE, Braun T, Sugai JV, Shelburne CA, Raybum LA, Tran HM, Singh AK &
Giannobile AW (2009). Identification of pathogen and host-response markers correlated with periodontal disease.
Journal of Periodontology, 80(3) 436-446.
Risch HA, Lu L, Wang J, Zhang W, Gao YT & Yu H (2013). ABO blood group and risk of pancreatic cancer: a
study in Shanghai and meta-analysis. American Journal of Epidemiology, 177(12) 1326-1337.
Van Palenstein Helderman W, Jan Truin G, Kumar Shrestha B, Bajracharya M & Stringer R (1898).
Analysis of epidemiological data on oral diseases in Nepal and the need for a national oral health survey.
International Dental Journal, 48(1) 56-61.
Wang Z, Liu L, Ji J, Zhang J, Yan M, Liu B, Zhu Z & Yu Y (2012). ABO Blood Group System and Gastric
Cancer: A Case-Control Study and Meta-Analysis. International Journal of Molecular Science, 13(10) 13308-
13321.
Watkins WM (2001). The ABO blood group system: historical background. Transfusion Medicine, 1(4) 243-265.
Woo SM, Joo J, Lee WJ, Park SJ, Han SS, Kim TH, Koh YH, Kim HB & Hong EK (2013). Risk of pancreatic.
Korean Medical Sciences,28(2) 247-251.

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