European Archives of Paediatric Dentistry

https://doi.org/10.1007/s40368-020-00570-6

ORIGINAL SCIENTIFIC ARTICLE

Fingerprints as an index for investigating cooperation by children

in dentistry: a pilot study
Saeedeh Mokhtari1 · Sepideh Mokhtari2 · M. Salehi Shahrabi1

Received: 3 December 2019 / Accepted: 23 September 2020

© European Academy of Paediatric Dentistry 2020

Abstract
Behavioral management and patient cooperation are very important in pediatric dentistry. Some studies have indicated that
individual behavior can vary in terms of fingerprint patterns (loop, whorl, and arch). Therefore, fingerprint patterns might
help to predict the extent of cooperation by children during dental procedures. The present study aimed to investigate the
possible relationship between fingerprint patterns and cooperation by children. In this pilot investigation, 51 children aged
3–6 years were examined. The children meeting the inclusion criteria in the first visit were scheduled for a dental procedure
in the second visit. Another examiner assessed children’s behavior during the dental procedure according to the designed
questionnaire and based on the Frankl scale. A third examiner, along with the second examiner, randomly evaluated the chil-
dren’s behavior to determine the inter-examiner agreement. The subjects were categorized as cooperative or uncooperative
during dental procedures, according to the Frankel questionnaire. The fingerprints of all subjects were recorded, and the data
were compared with SPSS 21 using the chi-squared test at a significance level of P < 0.05. The uncooperative and coopera-
tive groups consisted of 20 and 31 children, respectively. The main fingerprint pattern in the uncooperative children was the
whorl; while in the cooperative group, it was the loop. This difference in the fingerprint effect was significant between the
groups (P = 0.01). The arch type exhibited the minimum frequency and was not significantly different between the groups.
The current findings revealed a relationship between fingerprint type and children’s behavior during dental treatment.

Keywords  Behavior · Children’s fingerprint · Cooperation · Dentistry · Management

Introduction
In pediatric dentistry, an essential skill is an assessment of
the behavior of children before initiating treatment. Famili-
arity with children’s behavioral characteristics and the ability
to predict their behavior in different situations can determine
the success of dental therapy and visits, especially during
the first visit (Ahmed et al. 2015; Brill 2001; Salehi Shah-
rabi et al. 2020). Undoubtedly, children manifest different
* M. Salehi Shahrabi
salehipegah7@gmail.com
Saeedeh Mokhtari
sa.mokhtari@yahoo.com
Sepideh Mokhtari
mokhtaris@sina.tums.ac.ir
1
Department of Pediatric Dentistry, School of Dentistry,
Tehran University of Medical Sciences, Tehran, Iran
2
Education Development Office, School of Dentistry, Tehran
University of Medical Science, Tehran, Iran
behaviors when visiting the dentist, which arise from their
characteristics. Some children do not cooperate at all, while
others are calm and composed and cooperate with the den-
tist (Berge et al. 2001). Aminabadi’s research revealed that
emotional intelligence and intelligence quotient (IQ) have a
significant effect on child anxiety and behavior in the dental
setting (Aminabadi et al. 2011a, b). A child’s behavior in the
dental environment is affected by factors such as the child’s
age, the parents’ behavior and anxiety, the level of educa-
tion, and even the parents’ ideology, previous medical and
dental experience, and personality factors, such as mood. In
addition to environmental factors, genetic factors can affect
individual behavior (Hetherington et al. 1999).
Dermatoglyphics is the analysis of fingerprints. Finger-
print patterns have been established as a genetic character-
istic that is unique and constant over the lifetime and can be
used for identity recognition. Fingerprint patterns are cat-
egorized as loop, whorl, or arch types (Henry 1937; Agarwal
et al. 2012) (Fig. 1, Vaidya et al. 2017).

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Fig. 1  Ridge patterns on the distal phalanges of the fingertips arches (a). Loops (b). Whorls (c)
Studies conducted in genetics and biology indicate that
fingerprints can help to understand behavioral charac-
teristics, talents, skills, and personality traits (Singh and
Majumdar 2015). Shrestha et al. reported that individuals
with loop fingerprint patterns tend to be shy, while those
with whorl fingerprints have a stable personality and tend
not to change their beliefs. Individuals with arch finger-
prints tend to be less sociable and do not like to live in
groups (Shrestha et al. 2016).
Dermatoglyphics is a noninvasive and inexpensive
diagnostic tool for acquiring information about diseases.
Researchers have recommended dermatoglyphics as an
index in congenital heart disease, rheumatoid arthri-
tis, and Alzheimer’s disease (Sambashivaiah and Naidu
2018). Most studies have focused on non-psychiatric medi-
cal problems; thus, psychological disorders and antisocial
behavior have been less studied (Zarghami et al. 2010).
Studies have examined the relationship between finger-
prints and oral and dental diseases (Prabhu et al. 2014).
This research examined the relationship between finger-
print type and periodontal disease (Vaidya et al. 2017;
Tikare et al. 2010; Sambashivaiah and Naidu 2018), den-
tal caries (Singh et al. 2016; Chinmaya et al. 2016), and
malocclusion (Jindal et al. 2015). However, no study has
examined the relationship between fingerprints and chil-
dren’s behavior in the dental office and their cooperation
with the dentist.
Since children’s cooperation and behavioral manage-
ment are important in pediatric dentistry, the current study
investigated the possibility of such a relationship. The
results might be used as an accessible index for determin-
ing the extent of children’s cooperation in dentistry before
initiating treatment. This approach could help choose
proper behavioral management techniques for patients,
even during the first visit.
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European Archives of Paediatric Dentistry
Materials and methods
In this pilot cross-sectional study, 51 children referring
to the Pediatric Department, Faculty of Dentistry, Tehran
University of Medical Sciences in 2017 were studied. The
study protocols were approved by the Regional Committee
for Medical Research Ethics. The inclusion criteria con-
sisted of age 3–6 years, consent to participate in the study,
general health, no medical, congenital psychological, and
mental disorders, and no history of penetrating trauma or
burning that might have changed the dermatoglyphic pat-
tern, the presence of carious primary mandibular molars
requiring restoration under local anesthesia, and no previ-
ous dental experience/treatment.
The first session of treatment included oral and den-
tal examination with a dental mirror. In this session, the
child entered the operating room, accompanied by his/her
mother, and was kindly requested to sit on the dental chair.
Only a dental mirror was used for the clinical oral exami-
nation. The tell-show-do behavioral control technique was
used in this session.
The children’s mothers were instructed to fill out the
questionnaire; they were ensured about the confidentiality
of their information. The children who met the inclusion
criteria were scheduled for a dental procedure in the next
visit.
In the second treatment session, the child entered the
operating room without his/her mother. The chief exam-
iner who performed the clinical examination administered
a standard inferior alveolar nerve block, using 1 mL of
2% lidocaine plus 1:100,000 epinephrine for the amalgam
restoration of a mandibular primary first molar tooth. A
cavity was prepared using #1 fissure bur in a high-speed
handpiece (NSK, Japan). Caries was removed using a #2
bur in a low-speed handpiece (NSK, Japan). The tooth was
European Archives of Paediatric Dentistry

then restored with amalgam. The process was stopped in Table 2  Comparison of the age and gender of subjects between
case of an intense fear of the child. The subjects with a groups
chief complaint of dental pain or infection were excluded Variable Cooperative Uncooperative P value
from the study. N (percentage) N (percentage)
Another postgraduate student of pediatric dentistry was
Gender
asked to assess the children’s behavior during the treatment
 Male 16 (51.6) 10 (50.0) 0.9
process. A questionnaire designed based on the Frankl scale
 Female 15 (48.4) 10 (50.0)
was used for this purpose (Table 1). A third examiner ran-
Age Mean (%) SD (%) Mean (%) SD (%)
domly evaluated the children’s behavior to assess the inter-
4–8 (1.1) 4.3 (0.86) 0.08
examiner agreement.
The therapist noted children as having + or ++ degree
of cooperation as being cooperative, while those with—or
– were deemed uncooperative (Aminabadi et al. 2011a, b; the uncooperative group, the primary fingerprint type was
Asokan et al. 2014; Motlagh et al. 2015). whorl, and in the cooperative group, the primary fingerprint
In the next stage, the fingerprints of all the fingers of the type was the loop. There was a statistically significant dif-
subjects’ both hands were recorded using a digital scanner ference for these types of fingerprints between the groups
(Supreme Biomini Fingerprint Scanner; Korea). In the case (P = 0.01; Table 3).
of a poor resolution of an image, the procedure was repeated.
Recognition and classification of the fingerprints were per-
formed based on standard classifications by a trained dentist Discussion
separately and blindly (Henry 1937; Agarwal et al. 2012).
The trained and calibrated dentist classified the fingerprint The present study constituted a preliminary analysis of the
patterns twice for each subject. If there was a difference relationship between fingerprint types and children’s behav-
between the results, it was checked and classified by another ior and level of cooperation in a dental environment. The
blinded, trained, and calibrated dentist, and the classification findings indicated that the whorl and loop types showed a
was repeated. The data were compared in SPSS 21 using the significant maximum frequency in the uncooperative and
chi-squared test in terms of the most common fingerprint cooperative groups, respectively.
type in the cooperative and uncooperative groups. The sig- Personality and individual behavior are ambiguous and
nificance level was considered to be P < 0.05. unknown. Humans manifest different behaviors in different
conditions. Fingerprints can bring insight into individuals’
emotions, motivations, and performance in specific situa-
Results tions (Singh and Majumdar 2015). Studies have suggested
that individual behavior and personality differ according
In this investigation, 51 children participated, aged 3–6 years to fingerprint type (Singh and Majumdar 2015; Shrestha
with a mean age of 4.6 years (26 boys and 25 girls). Specifi- et al. 2016). Generally, fingerprint patterns are categorized
cally, 20 children were in the uncooperative group, and 31 as loop, whorl, or arch patterns, accounting for 60–65%,
children were in the cooperative group. There was no signifi- 30–35%, and 5% of all fingerprints, respectively (Agarwal
cant difference between groups in age and gender (Table 2). et al. 2012).
Table 3 shows the frequency of each fingerprint in the two Singh et  al. 2016 suggested that individuals with
groups. Overall, the maximum frequency for a fingerprint arch-type fingerprints prefer a simple lifestyle and like
pattern was for the loop type, and the minimum was for the to communicate with others. This group of individuals
arch type. Comparison of the two groups indicated that in skillfully perform what they have learned. However, when

Table 1  Frankel scale of subjects’ behavior

Frankel scale Type of behavior

Definitely negative Resenting treatment, severe crying, fear, phobia, or any evident sign of extreme negativism
Negative Unwillingness to accept the treatment, lack of cooperation, some evidence of negative behavior but not consider-
able (bad temper, isolation)
Positive Accepting the treatment while being careful, the tendency to agree with the dentist, the child cooperates with the
dentist conditionally
Definitely positive The child well communicates with the dentist, is interested in dental procedures, laughs, and enjoys the treatment

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Table 3  Relationship between Cooperation finger- Uncooperative
fingerprint types in terms of prints N (percentage)
cooperation
Loop (l) 22 (70.9)
Whorl (w) 6 (19.4)
Arch (a) 3 (9.7)
expressing their emotions, they act conservatively. They
are also more creative in science and medicine and have
good memories. These individuals tend to think less about
the future and prefer to live in the moment, and as such,
they usually encounter problems (Singh and Majumdar
2015; Campbell 2012).
Individuals with loop fingerprint type express their emo-
tions easily, adapt to the environment, and have better com-
munication skills than others. They are highly adaptive to
environmental changes (Singh and Majumdar 2015). This
characteristic explains the high percentage of this type of
fingerprint among cooperative children. Highly adaptive
individuals would be more able to adapt to the new environ-
ment of dentistry.
Individuals with whorl fingerprint type tend to have
strong personalities and high intelligence and possess high
cognitive power. Such individuals dislike performing repeti-
tive daily routines and are more successful in engineering
and architecture. This group tends to exhibit complex behav-
ior and personality. They are sensitive to the expression of
emotions in interactions, and others should take care during
their treatment (Prabhu and Ravikumar 2013; Singh and
Majumdar 2015). Given these characteristics, the more dif-
ficult interaction and lower cooperation of this group and the
higher percentage of this fingerprint type in the uncoopera-
tive group can be explained.
In addition to studies on the relationship between per-
sonal behavioral characteristics and fingerprints, some inves-
tigations have examined the relationship between fingerprint
types and antisocial behavior and psychological disorders,
such as schizophrenia, bipolar disorder, and autism (Saxena
et al. 2016). Zarghami et al. reported that the whorl pattern
was significantly higher in individuals with bipolar disorder
than the control group. On the other hand, the arch type was
less frequent in individuals with schizophrenia than in the
control group (Zarghami et al. 2010). Sikov observed dif-
ferent fingerprint types in patients with and without schizo-
phrenia (Sivkov et al. 2009). Shakibaei reported that the
fingerprint is a biomarker for identifying individuals predis-
posed to schizophrenia (Shakibaei et al. 2011). Therefore,
individuals’ behavior and personality and the incidence of
abnormal behavior can be associated with a specific finger-
print pattern (Agarwal et al. 2012). Kazemi also observed
more loops in the fingerprints of patients with autism than
those without autism, suggesting that fingerprints could be
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European Archives of Paediatric Dentistry
Cooperative P value
N (percentage)
7 (35.0) Comparing loop–whorl = 0.01
10 (50%) Comparing loop–arch = 0.32
3 (15.0) Comparing arch–whorl = 0.65
one factor when screening children for autism (Kazemi et al.
2017).
Our study had some limitations, too. Recording finger-
prints would cause some stress for some children, affecting
their behavior. However, it was assumed as an enjoyable play
for most of the subjects. Also, to have a high-quality finger-
print screen, repeated recording was sometimes necessary.
Conclusions
Considering the limitations of the present pilot study, the
following conclusions can be made:
(a) A relationship between fingerprint type and behavior
mode of children during dental treatment was shown.
(b) When the existence of such a relationship will be fur-
ther confirmed in larger-scale studies, it could be used
to predict the type of children’s behavior in the dental
environment according to fingerprint type.
Acknowledgements  No finding has been received for the conduct of
this study and /or preparation of this manuscript.
Compliance with ethical standards 
Conflict of interest  There is no conflict of interest to declare.
Research involving human participants and/or animals  The study pro-
tocols were approved by the Regional Committee for Medical Research
Ethics.
Informed consent  Parent signed informed consent forms.
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