Cheiloscopy Pattern And Its Relation With Dental Caries And The Permanent Molar Relationship Among Dental Students - A Cross Sectional Study

Keywords

Chieloscopy; Lip Pattern; Dental Caries; Malocclusion.

Introduction

The labial mucosa forms a characteristic pattern of skin creases and grooves called lip prints. The study of lip prints is known as cheiloscopy [1]. Cheiloscopy was first described by R.Fischer in 1902. In the period 1968-1971 two Japanese scientists, Y.Tsuchihashi and T.Suzuki examined 1364 persons and proved that the arrangement of furrows on the lips can be used for identification of a person as it is unique for each human being [2]. Lip prints are the same throughout the lifespan of the individual and recover to original pattern after any deformities hence it adds to the forensic value and is used as a tool for human identification [3].

The impact of oral health on one’s quality of life is termed as oral health related quality of life. This oral health related quality of life is associated with two important diseases: dental caries and malocclusion [5]. Dental caries is a multifactorial disease which is a common problem for mankind [6]. Malocclusion is one of the major oral health problems ranking number three after dental caries and periodontal disease. Malocclusion is the deviation from normal occlusion, which results in misalignment of teeth and produces detrimental effects on overall esthetics and decreases a person’s self-esteem [7]. Malocclusion is influenced mostly by the genetic and environmental factors. There are various treatments and preventive measures to treat dental caries and malocclusion, but there can be an alternate solution to these oral conditions which is the prediction with respect to lip pattern. It is known that the development of facial skeleton particularly the lips begins to form during the 6th-7th week of embryonic life [8]. Interestingly, teeth develop at the same time of intrauterine life. This area of interest is analysed in various studies but there is no racial comparison between two different populations. Hence this study fulfills the void of comparing racially by comparing Tamilnadu and Andhra pradesh population.

Malocclusion can lead to various skeletal deformities in the future if not properly channelized at early stages. Dental caries also may lead to lower oral health related quality of life. Hence lip pattern as a non invasive tool may lead to predict the possibilities of a person having malocclusion and dental caries. Hence the present study aims to determine a predominant lip pattern for the predilection of malocclusion and dental caries.

Materials and Methods

Study Design: A cross sectional study

Study Setting: The study was done in Saveetha dental college in Chennai, among the dental students who have their origin from Tamilnadu and Andhra pradesh.

Study Population: The inclusion criteria for the present study was the dental students with 18-30 years of age and are from Tamilnadu and Andhra Pradesh. Study included the participants whomever willing and consented to participate in the study. Students with pathological condition of the lip are excluded from the study. A total of 60 students were included in this study. Out of this 60 students 30 students belong to tamilnadu and 30 students belong to andhra pradesh population.

The sample size was calculated using Epi Info sample size calculation software.

N= z p (1-p) /d2

Where, z=1.96 for 95% confidence interval, 1.645 for 90% confidence interval

p = Highest prevalence of dental caries among types of lip pattern i.e. 95% d = acceptance margin of error i.e 5% The sample size was calculated to be 51. Hence the sample size can be rounded off to 60.

Study duration

The present study was done in February 2021

Methodology

For recording lip prints, students were asked to open their mouth widely and apply vaseline around lips, later lipstick was applied evenly in the upper and lower lips in a single motion. They were asked to gently rub both the lips so that lipstick spreads evenly [Fig 1]. Cellophane tape was cut with scissors and pasted in the lips. Then the tape was cautiously removed beginning at one end to the other, preventing any smudging of the print and fixed on the white paper chart [9]. After recording the lip pattern, the recordings were separated based on origin. Tsuchihashi classification was used for determining the type of lip pattern [10].

Statistical analysis

Data collected was analysed using the Statistical package of social sciences (SPSS) Version 23. Chi-square test was used to determine the association between lip pattern with Angle’s molar relationship and dental caries status.

Results

All the lip prints were cautiously observed and patterns were verified. Out of the 60 people, 30 were from Andhra pradesh and 30 were from Tamil nadu. 50% of the study participants were males and 50% were females. Among Tamil study participants, lip patterns were distributed as Type I (16.67%), Type II pattern (62.5%), Type III pattern (20.83%). [Figure 2]. Among the Telugu study participants, the lip patterns were distributed as Type I (19.44%), Type II pattern (58.33%), Type III pattern (22.22%) [Figure 3].

Correlating the determined lip patterns of Tamil nadu and Andhra study participants, there was a significant association between lip pattern with malocclusion status (p-value=0.000) (Table 1) (Figure 4). Angle’s class I molar relationship was most common among participants with Type II lip pattern (38.33%), Angle’s class II molar relationship was most common among participants with Type II lip pattern (18.33%) and 13.33% of participants with type III lip pattern had class III molar relation suggesting that participants with type III lip pattern was more prone to get malocclusion. None of the study participants with Type III lip pattern had Angle’s class 1 molar relationship. There was a significant association between lip pattern and dental caries status of the population (p-value=0.005) (Table 2) (Figure 5). DMFT score of less than 3 was reported among 56.67% of participants with type II lip pattern. More than DMFT score 3 was common among type I lip pattern participants (6.67%), suggesting that participants with type II lip pattern had less caries experience when compared with type I and III lip patterns.

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Table 1:

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Table 1. Association between Lip pattern and DMFT Index.

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Table 2:

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Table 2. Association between lip pattern and Angle’s molar relationship group.

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Figure 1:

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Figure 1. Recording lip print.

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Figure 2:

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Figure 2. Distribution of lip pattern among Tamil study participants.

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Figure 3:

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Figure 3. Distribution of lip pattern among Telugu study participants.

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Figure 4:

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Figure 4. Bar chart depicts association between lip pattern and DMFT Index.

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Figure 5:

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Figure 5. Bar chart depicting the association between lip pattern and Angle’s malocclusion group.

Discussion

Lip print pattern is unique to an individual and hence this anatomical character of the human lips may be useful in identification and diagnosis of congenital diseases and anomalies [11, 12]. Since the facial structures like lip, alveolus, teeth and palate are formed from the same embryonic tissues , this study was done on the basis of co- relating lip patterns with most prevalent oral conditions, i.e. dental caries and malocclusion [13].

In this study, type II lip pattern was mostly prevalent in both tamil and telugu population. There was a significant association between lip pattern and DMFT index, malocclusion status. Most of the students with type II lip pattern had class I angle’s molar relationship. Most of the students with type II lip patterns had DMFT scores less than 3.5. Hence lip pattern is a good marker for identification of dentition and malocclusion and can be widely used in forensics. This proves that in forensics the soft tissue analysis like lip pattern can be used to predict the status of hard tissue. Previous studies also suggest that lip prints can be used to predict the malocclusion status in study done by Vignesh et al, in this study type II pattern was the most predominant pattern like the current study [14]. In this study type I lip pattern was more common for class I malocclusion, Type IV lip pattern was more common for class II malocclusion.For class III malocclusion males showed an increased type II pattern and females showed an increased type IV pattern. In another study done by Pradeep Raghav et al, the prevalence of vertical lip pattern was significantly higher in subjects having skeletal class III malocclusion [15]. In this study branched lip pattern was most common in the North Indian adult population. The study done by Srishti et al, the author concluded the study by suggesting lip print will help in criminal investigations and also help in predicting type of malocclusion beforehand for the successful execution of preventive and interceptive procedures [16]. This study proved that in skeletal Class I group partial vertical groove lip pattern was most prevalent.

Study done by Anuradha et al, the results were skeletal class I group showed more branched pattern. Other patterns in decreasing order were intersected, reticular and vertical lip patterns while skeletal class II group showed branched patterns as most common [17]. In a study conducted by Govindarajan et al, type II branched pattern had highest caries prevalence another study conducted by Madhusudan et al, concluded that prevalence of dental caries was higher among subjects with type II lip pattern but in the current study participants with DMFT score was less than score 3 in type II lip pattern group which showed less caries prevalence. [18, 19]

Limitations of the current study is that the results cannot be generalised to the whole population of Tamilnadu and Andhra pradesh population as only the students with 18-30 age group were assessed. Future scope of this study aims to study the cheiloscopy pattern to predict dental caries and malocclusion status in a large population.

Health Effects Of Passive Smoking

It was reported in a systematic review that there exists a positive relationship between passive smoke and the risk of invasive meningococcal disease in children, cervical cancer, Neisseria meningitidis carriage, Streptococcus pneumoniae carriage, lower respiratory infections in infancy, food allergy, childhood asthma, lung cancer, stroke, allergic rhinitis and allergic dermatitis [12]. A causal relationship was found between exposure of mothers to second hand smoke during pregnancy and a small reduction in birth weight. [10] Preterm birth is the major cause of neonatal deaths and is associated with various infant morbidities, such as acute respiratory illness, neurological handicaps, gastrointestinal and immunologic deficits, and chronic diseases, that can continue into adulthood. [13] Several factors are believed to predispose women to preterm delivery, including individual-level behavioural and psychological factors, environmental exposure, medical conditions, infertility treatments socio-demographic and biological factors. [14]

Exposure to second hand smoke is significantly associated with increased risk of cardiovascular disease incidence and mortality [15] Passive smoking decreases the ability of the blood to deliver oxygen to the heart and compromises the ability of the myocardium to use oxygen to produce adenosine triphosphate and is manifested as reduction in exercise capability among those exposed to second hand smoke. There is an increase in the activity of platelets, acceleration in the atherosclerosis, increases tissue damage following myocardial infarction. The effects of passive smoke on the cardiovascular system are caused by the effects of nicotine, carbon monoxide, polycyclic aromatic hydrocarbons. [16] A study that reported the cardiovascular events among children exposed to passive smoking revealed that passive smoking may cause unfavourable high-density lipoprotein levels and deteriorated vascular function in children. [17]

Conclusion

Type II lip pattern was the most common lip pattern among the study participants and was related with less caries experience and Angle’s class I molar relation. It can be concluded from the study that lip pattern can be used as a predictive tool to determine the dental caries prevalence and malocclusion status.