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ORIGINAL ARTICLE
Year : 2021  |  Volume : 48  |  Issue : 2  |  Page : 98-101

Expressivity of ABO antigens and increased predisposition for periodontal disease: A cross-sectional analysis


1 Division of Periodontology, Department of Preventive Dental Sciences, College of Dentistry, University of Ha'il, Saudi Arabia
2 Division of Oral and Maxillofacial Pathology and Microbiology, Department of Preventive Dentistry, College of Dentistry, Jouf University, Sakaka, Saudi Arabia
3 Department of Oral Pathology and Microbiology, Nanded Rural Dental College and Research Center, Nanded, Maharashtra, India
4 Department of Oral and Maxillofacial Surgery, Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Navi Mumbai, Maharashtra, India
5 Division of Periodontics, Preventive Dentistry Department, College of Dentistry, Riyadh Elm University, Riyadh, Kingdom of Saudi Arabia
6 Division of Pedodontics, Department of Preventive Dental Sciences, College of Dentistry, University of Ha'il, Saudi Arabia
7 Department of Oral Medicine and Radiology, Saraswati Dhanwantari Dental College and Hospital and Post-Graduate Research Institute, Parbhani, Maharashtra, India

Date of Submission06-May-2021
Date of Acceptance02-Jun-2021
Date of Web Publication18-Aug-2021

Correspondence Address:
Abhishek Singh Nayyar
Department of Oral Medicine and Radiology, Saraswati Dhanwantari Dental College and Hospital and Post-Graduate Research Institute, Parbhani, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jss.jss_44_21

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  Abstract 


Context and Aim: Association between certain systemic diseases and ABO antigens is a well-known fact. The purpose of this study was to determine whether there is any association between periodontal disease and ABO blood group antigens. Materials and Methods: A cross-sectional study was carried out on 200 subjects who were randomly selected from individuals referred for periodontal treatment. The study subjects were segregated into healthy gingiva/mild gingivitis (Group I), moderate/severe gingivitis (Group II), and varying grades of periodontitis groups (Group III), based on Loe and Silness index and clinical attachment loss as the criteria. The study groups were, further, categorized and graded using Ramfjord's periodontal disease index. Blood samples were collected to identify ABO blood groups. Statistical Analysis Used: Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) version 17.0 (SPSS Inc., Chicago, IL, USA), while Chi-square test was used for statistical analysis. A P < 0.05 was considered statistically significant. Results: The findings of the present study suggested that patients with blood group antigens O and B were more predisposed to develop periodontitis with at least one side with attachment loss of more than 3 mm and with periodontal pocket depth of more than 4 mm (P < 0.001). Conclusion: There is a correlation existing between periodontal disease and ABO blood group antigens as far as this region was concerned. This association could be explained by the various blood group antigens acting as receptors for infectious agents associated with periodontal disease. This broad correlation between periodontal disease and ABO blood group antigens pointed toward susceptibility of the subjects with certain blood groups to periodontal disease.

Keywords: ABO antigens, ABO blood group, periodontal disease, periodontitis


How to cite this article:
Babu J S, Swarnalatha C, Alshammari TN, Muddebihal F, Patil MB, Kolte DR, Alshammari MS, Alshammari FA, Nayyar AS. Expressivity of ABO antigens and increased predisposition for periodontal disease: A cross-sectional analysis. J Sci Soc 2021;48:98-101

How to cite this URL:
Babu J S, Swarnalatha C, Alshammari TN, Muddebihal F, Patil MB, Kolte DR, Alshammari MS, Alshammari FA, Nayyar AS. Expressivity of ABO antigens and increased predisposition for periodontal disease: A cross-sectional analysis. J Sci Soc [serial online] 2021 [cited 2021 Dec 6];48:98-101. Available from: https://www.jscisociety.com/text.asp?2021/48/2/98/324077




  Introduction Top


Periodontal disease is the most prevalent disease with a multifactorial etiology affecting a large population worldwide. Plaque, being a constitutional factor, probably of genetic origin and modifiable, is the primary etiologic agent. Hence, it is interesting to emphasize the significance of genetic factors in patients with periodontal disease and to find out whether any innate and nonmodifiable factor is also associated with it. However, if such a relationship between blood group antigens and periodontal disease can be established beyond a reasonable doubt, it can be concluded that the presence of a particular blood group antigen has somehow increased the susceptibility to the disease and will be of great significance in decreasing the risk as well as preventing the further progression and destruction of the tissues. Landsteiner[1] was the first to describe the ABO blood grouping system. He discovered the fundamental principles of blood grouping in the 1900s. He described the blood groups according to the “ABO” blood typing system. Since then, we have been able to categorize individuals based on their blood groups. Further, the history of investigations regarding the relationship between blood groups and dental diseases goes back to 1930.[2] Roberts[3] discussed the relationship between ABO blood group antigens and susceptibility to chronic diseases as an example of genetic basis for family predisposition. Since then, many workers have tried to find out the relationship between ABO blood groups and the various systemic diseases. A plethora of studies have been conducted in the field of medicine proving association between the blood group antigens and the incidence of the various infectious and noninfectious diseases. Surprisingly, very less number of studies has been conducted to determine the relationship between blood group antigens and the various oral and dental diseases. Some researchers have claimed that there is 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 disease among carriers with different blood group antigens using ABO system and to correlate periodontal disease severity with them. It is expected that performing investigations in this research area will make it possible to better understand the risk factors for periodontal disease and to predict the effective methods of prevention and treatment of periodontal disease.


  Materials and Methods Top


A cross-sectional study was carried out on 200 subjects who were randomly selected from individuals referred for periodontal treatment. The study subjects were segregated into healthy gingiva/mild gingivitis (Group I), moderate/severe gingivitis (Group II), and varying grades of periodontitis groups (Group III), based on Loe and Silness index and clinical attachment loss as the criteria. The study groups were, further, categorized and graded using Ramfjord's periodontal disease index. Individuals with periodontitis who had at least 20 teeth and exhibited at least one site with attachment loss of more than 3 mm and periodontal pocket depth of more than 4 mm were included in the study. Further, individuals who had not been on antibiotic treatment for any dental or medical reasons in the last 3 months, who had no history of systemic illness such as diabetes mellitus, leukemia, epilepsy, and metabolic bone disease, who were nonsmokers, and who were in similar socioeconomic strata were included in the study, while healthy subjects who had less than 3 mm of attachment loss and periodontal pocket depth of less than 3 mm and with no signs of gingivitis were excluded from the study. Using a pro forma, the details of each subject, including name, age, sex, past medical and 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 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 gingiva/mild gingivitis), Group II (moderate/severe gingivitis), and Group III (with varying grades of periodontitis; subjects who exhibited at least one site with attachment loss of more than 3 mm and periodontal pocket depth of more than 4 mm). Blood samples were collected using sterile disposable lancets and by finger-prick method. The blood grouping was done using slide agglutination method (visual method) after obtaining the consent form from each subject.

Statistical analysis used

Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) version 17.0 (SPSS Inc., Chicago, IL, USA). Percentage distribution of subjects with their ABO blood grouping was tabulated in each group with various grades of periodontal involvement, while Chi-square test was used for statistical analysis. A P < 0.05 was considered statistically significant.


  Results Top


Majority of the patients with blood group antigens O and B were found to be in Group III, although the variations were found to be more marked in patients with blood group antigen O than with blood group antigen B, wherein almost an equal number of patients were seen in either Group II or Group III. The distribution of patients with blood group antigen A was not found to be statistically significant, with equal number of patients found in all three groups. Patients with blood group antigen B were found to have the least chances to have healthy gingiva and/or mild gingivitis. As far as Group 3 patients, where varying grades of periodontitis were seen, patients were found to have either blood group antigens O or B, and the results were found to be statistically significant results (P < 0.001) [Table 1].
Table 1: Expressivity of ABO antigens and prevalence of periodontal disease

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  Discussion Top


Numerous studies conducted in the past have shown a significant correlation between the ABO blood group antigens and systemic diseases such as chickenpox, cholera, malaria, and various cancers, including hematological malignancies and ischemic heart diseases. Few such studies have also shown a similar association between the ABO blood group antigens and common dental diseases such as dental caries and salivary gland tumors.[4],[5],[6],[7],[8],[9],[10],[11] Individuals with blood group antigen A have been reported to be more susceptible to gall stones and colitis and tumors of pancreas as well as ovary.[12],[13] In yet another study, individuals with blood group antigen O were found to be associated with a substantially increased risk for coronary artery disease.[14] In one study, diabetes mellitus was seen to be more prevalent in subjects with blood group antigens A and O.[15] For several decades, the ABO blood group antigens have also been suspected of contributing to infertility and fetal loss though reports have often been conflicting and speculative.[16]

The antigens of the ABO system are an integral part of the red cell membrane and are also found in the plasma and other body fluids. It has also been hypothesized that the presence or absence of certain antigens has been associated with various diseases and anomalies, with these antigens acting as receptors for agents responsible for the causation of numerous infectious diseases. Immunohistochemical studies have demonstrated the presence of A/B antigens on spinous cells in the nonkeratinized oral epithelium in individuals with blood groups A and B, wherein the basal cells express precursor structures and the highly differentiated spinous cells express the A or B antigens. Individuals with blood group O who do not have the A and B gene-coded glycosyltransferases express a fucosylated variant (Ley) of these precursor structures.[17]

Weber and Pastern[18] were the first to study the association of ABO blood group antigens with periodontal disease. Kaslick et al.[19] studied the association of aggressive periodontitis and ABO blood group antigens and found significantly less patients with blood group antigen O and more patients with blood group antigen B to have aggressive periodontitis. Koregol et al.,[20] in a study on 1220 subjects in South India, concluded that individuals with blood group antigen A formed a significantly higher percentage in the gingivitis group and blood group antigen O in the periodontitis group. The blood group antigen AB showed the least percentage of individuals who contracted periodontal disease. The distribution of Rh factor in all groups also revealed a significantly higher distribution of Rh-positive individuals with periodontal disease.[21]

The tissue localization of the histoblood 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 histoblood 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 nonkeratinized epithelium influences the expression of blood group antigens. Keratinized squamous epithelium may express A or B antigens in only a few and highly differentiated cells leaving the precursor H antigen expressed on most spinous cell layer cells. In contrast, in the nonkeratinized epithelium of the buccal mucosa, the precursor structure 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.[22]

Demir et al.[23] found that individuals with different ABO blood group antigens may show significant differences in the rates of colonization of a number of periodontal pathogens that are the main etiologic agents of periodontal disease. A significant correlation between periodontal disease and ABO blood group antigens was also suggested in a similar other study.[24] However, seeing at the literature search, it could never be clearly concluded whether a definitive correlation existed between the different blood group antigens and periodontal disease. The results, largely inconclusive, have always been substantiated by the ethnical and geographical variations and the smaller sample sizes without adequate representation from the age and gender and the control of compounding and modifiable factors, including smoking and other risk factors that play a significant role in the onset as well as progression of established periodontal disease. The study, thus, paves way for further studies with a larger sample size, adequate representation from the different age groups and gender, and socioeconomic background and with the control of important risk factors and a meticulous follow-up to predict the reliability of outcomes. However, if such a correlation gets established, it will be a boon in the management of this ubiquitous set of more often, age-related, morbidity-increasing diseases.


  Conclusion Top


There was a correlation existing between periodontal disease and ABO blood group antigens in this region. The prevalence of blood group antigen O was more in this geographic location followed by blood group antigens A than B, while the least prevalent blood group antigen was AB. Further, from the results, it could be concluded that patients with blood group antigens O and B were more predisposed to develop periodontitis with at least one side with attachment loss of more than 3 mm and with periodontal pocket depth of more than 4 mm with statistically significant results (P < 0.001). This association could 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 antigens points toward an increased susceptibility of subjects with certain blood group antigens to periodontal disease; however, further studies with larger sample sizes and adequate representation from different age groups and genders are required to prove this association so that preventive measures could be taken to prevent the onset and, if present, to treat such cases aggressively to rule out the possibility of excessive damage to the diseased periodontium in such individuals for a better prognosis.

Acknowledgment

To all the patients who contributed to the study without whom this study would not have been feasible.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Demir T, Tezel A, Orbak R, Eltas A, Kara C, Kavrut F. The effect of ABO blood types on periodontal status. Eur J Dent 2007;1:139-43.  Back to cited text no. 4
    
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Pinkston JA, Cole P. ABO blood groups and salivary gland tumors (Alabama, United States). Cancer Causes Control 1996;7:572-4.  Back to cited text no. 5
    
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Chakravartti MR, Chakravartti R. ABO blood groups and chicken pox in an Indian population. Acta Genet Med Gemellol (Roma) 1977;26:297-8.  Back to cited text no. 6
    
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Singh N, Shukla MM, Uniyal VP, Sharma VP. ABO blood groups among malaria cases from district Mandla, Madhya Pradesh. Indian J Malariol 1995;32:59-63.  Back to cited text no. 7
    
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Janardhana V, Propert DN, Green RE. ABO blood groups in hematologic malignancies. Cancer Genet Cytogenet 1991;51:113-20.  Back to cited text no. 9
    
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Whincup PH, Cook DG, Phillips AN, Shaper AG. ABO blood group and ischaemic heart disease in British men. BMJ 1990;300:1679-82.  Back to cited text no. 10
    
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Glass RI, Holmgren J, Haley CE, Khan MR, Svennerholm AM, Stoll BJ, et al. Predisposition for cholera of individuals with O blood group. Possible evolutionary significance. Am J Epidemiol 1985;121:791-6.  Back to cited text no. 11
    
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Jesch U, Endler PC, Wulkersdorfer B, Spranger H. ABO blood group. Related investigations and their association with defined pathologies. ScientificWorldJournal 2007;7:1151-4.  Back to cited text no. 12
    
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Henderson J, Seagroatt V, Goldacre M. Ovarian cancer and ABO blood groups. J Epidemiol Community Health 1993;47:287-9.  Back to cited text no. 13
    
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Biswas J, Islam MA, Rudra S, Haque MA, Bhuiyan ZR, Husain M, et al. Relationship between blood groups and coronary artery disease. Mymensingh Med J 2008;17:S22-7.  Back to cited text no. 14
    
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Okon UA, Antai AB, Osim EE, Ita SO. The relative incidence of diabetes mellitus in ABO/Rhesus blood groups in South-Eastern Nigeria. Niger J Physiol Sci 2008;23:1-3.  Back to cited text no. 15
    
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Matsunaga E, Itoh S. Blood groups and fertility in a Japanese population, with special reference to intra-uterine selection due to maternal-foetal incompatibility. Ann Hum Genet 1958;22:111-31.  Back to cited text no. 16
    
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Campi C, Escovich L, Valdés V, García Borrás S, Racca L, Racca A, et al. Secretor status and ABH antigens expression in patients with oral lesions. Med Oral Patol Oral Cir Bucal 2007;12:E431-4.  Back to cited text no. 17
    
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Weber R, Pastern W. On the question of constitutional readiness for so-called alveolar pyorrhea. Dtsch Mschr Zahnerlk 1927;45:704-9.  Back to cited text no. 18
    
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Kaslick RS, Chasens AI, Tuckman MA, Kaufman B. Investigation of periodontosis with periodontitis: Literature survey and findings based on ABO blood groups. J Periodontol 1971;42:420-7.  Back to cited text no. 19
    
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Koregol AC, Raghavendra M, Nainegali S, Kalburgi N, Varma S. ABO blood groups and Rhesus factor: An exploring link to periodontal diseases. Indian J Dent Res 2010;21:364-8.  Back to cited text no. 20
[PUBMED]  [Full text]  
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Kinane DF, Bartold PM. Clinical relevance of the host responses of periodontitis. Periodontol 2000 2007;43:278-93.  Back to cited text no. 21
    
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Dabelsteen E. ABO blood group antigens in oral mucosa. What is new? J Oral Pathol Med 2002;31:65-70.  Back to cited text no. 22
    
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Demir T, Uslu H, Orbak R, Altoparlak U, Ayyildiz A. Effects of different blood groups on the reproduction of periodontal pocket bacteria. Int Dent J 2009;59:83-6.  Back to cited text no. 23
    
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Pradhan AC, Chawla TN, Samuel KC, Pradhan S. The relationship between periodontal disease and blood groups and secretor status. J Periodontal Res 1971;6:294-300.  Back to cited text no. 24
    



 
 
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