|Year : 2015 | Volume
| Issue : 1 | Page : 14-18
Is ABO blood group a possible risk factor for periodontal disease?
Hamed Mortazavi1, Ghogha Lotfi2, Elnaz Fadavi3, Shima Hajian3, Maryam Baharvand1, Siamak Sabour4
1 Department of Oral Medicine, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2 Department of Periodontics, International Branch of Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3 General Dental Practitioner, Graduated from International Branch of Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
4 Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
|Date of Web Publication||5-Feb-2015|
Department of Oral Medicine, Dental School, Shahid Beheshti University of Medical Sciences, Daneshjoo Blvd, Tabnak St, Chamran Highway, Tehran
Source of Support: None, Conflict of Interest: None
Introduction: Periodontal disease is a chronic immune inflammatory response associated with both the genetic makeup and the environmental influence. The aim of this study was to determine the association of different types of blood group with periodontal disease in a defined group of Iranian patients. Materials and Methods: One hundred and forty-six persons participated in this case-control study in Shahid Beheshti University of Medical Sciences Dental School, International Branch, Tehran, Iran. The patients were divided into three groups including periodontally healthy, gingivitis, and periodontitis according to approved criteria. Patients' blood groups were determined, and the relationship between periodontal status and ABO antigens was assessed. Data was analyzed on the basis of analysis of variance (ANOVA), Chi-square test, and logistic regression. Results: Logistic regression showed that people with blood group B (compared to blood group O) was at 3.94 times greater risk for developing gingivitis. On the other hand, there was no relationship between periodontitis and ABO blood groups, sex, and types of Rh factor. It was noted that 1 year of aging is associated with a 5% rise in likelihood of periodontitis. Conclusions: People with blood group B are at a greater risk to develop gingivitis, whereas periodontitis did not show any relationship with blood groups.
Keywords: Blood group, gingivitis, Iran, periodontitis
|How to cite this article:|
Mortazavi H, Lotfi G, Fadavi E, Hajian S, Baharvand M, Sabour S. Is ABO blood group a possible risk factor for periodontal disease?. Dent Hypotheses 2015;6:14-8
| Introduction|| |
Periodontal disease, including gingivitis and periodontitis, is a chronic immune inflammatory response associated with both the genetic makeup and the environmental influence, if left untreated may lead to tooth loss. , The prevalence of this condition varies in different regions of the world and it is more frequent in developing countries.  The National Health and Nutrition Examination Survey III conducted in the USA between 1988 and1994 has described that 50% of the adult population has gingival inflammation.  A national survey in the UK showed that 42% of patients between 35-44 years old and 70% of those between 55 and 64 had clinical attachment level greater than 3.5 mm, indicating the presence of periodontitis.  In an epidemiological study in Iran, Kazemnejad found that only 11.3% of cases had healthy gingiva, while 12% had bleeding in probing, 46% had gingival calculus, 30.4% had shallow pockets, and 0.3% had deep pockets in their jaw sextants. 
Although bacterial plaque is the main cause of periodontal disease, the progression of disease can be related to host-based risk factors.  Therefore, the periodontal disease is now recognized as an ecogenic problem, which highlights their multifactorial nature. Genetic variations may act as risk or protective factors for chronic inflammatory conditions.  On the other hand, Offenbacher pointed out that less than 20% of the difference in periodontal disease severity can be explained by quality of specific bacteria observed in disease-associated plaques.  Instead, a key role for genetic characteristics has been suggested.
Roberts discussed the relationship between ABO blood group and susceptibility to chronic diseases as an example of genetic basis for family predisposition.  Weber and Pastern first described the association between different types of blood group and periodontal disease in 1927. It was also noted that antigens of the ABO system can act as receptors for infectious agents. 
According to review of literature, few investigations have been made to explore the relationship between ABO blood group and the incidence of dental and periodontal diseases. Several authors showed a positive correlation between periodontal diseases and blood groups. ,,, In contrast, others did not find any differences between subjects with or without periodontal disease in terms of ABO blood groups. ,
According to data available for us, literature is devoid of credible information about mentioned topic in Iranian subjects. Therefore, the aim of this study was to determine the association of different types of blood group with periodontal disease (including gingivitis and periodontitis) in a defined group of Iranian patients.
| Materials and Methods|| |
The present investigation was carried out on 146 persons with age ranging 17-65 years, with the mean age of 38 ± 12. Subjects were selected on a random base from people seeking dental services at the faculty of dentistry. Patients who had at least 20 teeth (except for third molars) were included in the study.
Participants who were unable to perform routine oral hygiene, alcoholics, smokers, and those with any previous history of periodontal treatment or antibiotic-related therapy for medical or dental reasons three months prior to the study were excluded. Subjects who were suffering from any systemic co-morbidities such as diabetes, leukemia, metabolic bone disease, or epilepsy, etc., that could aggravate periodontal manifestations were also excluded. All participants had a history of tooth brushing at least once a day.
In this study, the patients fell into "gingivitis" category if they had attachment loss less than 3 mm, pocket depth less than 3 mm, no radiographic bone loss together with signs of gingivitis such as gingival bleeding, erythematous enlargement of marginal and papillary gingivae, and changes in surface texture. On the other hand, the diagnostic criteria for periodontitis were at least one site of radiographic bone loss, attachment loss over 3 mm, and periodontal pocket depth more than 4 mm. Finally, those with attachment loss less than 3 mm, periodontal pockets depth less than 3 mm, no radiographic bone loss, and no signs of gingivitis were considered periodontally healthy. ,
Intraoral examination was carried out after the subject had been interviewed about their socioeconomic and behavior background. Periodontal status was recorded using a dental mirror and William's periodontal probe under artificial light. Subjects were examined for the presence of bacterial plaque, gingival bleeding, and signs of gingivitis, clinical attachment level, and probing pocket depth. According to index scores, subjects were divided into three groups: people with healthy gingiva (group1), gingivitis (group2), and periodontitis (group3). Finally, the type of blood group was obtained on the basis of patients' medical records. In cases with incomplete past medical history, they were referred to the pathobiologic laboratory for determination of ABO blood group.
All patients were provided with comprehensive information about the study, and signed written consent forms. The study procedure was accomplished according to World Medical Association Declaration of Helsinki, and has been approved by the committee of Medical Ethics of Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Analysis of variance (ANOVA) was used to analyze mean scores among multiple groups (gingivitis, periodontitis, and healthy persons). Chi-square test was used to analyze qualitative variables. In addition, logistic regression was used to determine the association of different types of blood group with developing risk of periodontal disease. In this study P-value less than 0.05 was considered significant. Data analysis performed via SPSS software (IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp).
| Results|| |
Characteristics of the study population were shown in [Table 1]. According to this table, the mean age of study sample was 38 ± 12(gingivitis group: 37 ± 11; periodontitis group: 43 ± 11) and that of control group was 37 ± 12, with the age range of 17-65 years. Patients with periodontitis were significantly older than those with gingivitis and healthy group (P = 0.018).
On the other hand, out of 80 persons with periodontal disease, there were 58 men (73%) and 22 (27%) women. In healthy group (66 persons), there were 48 men (73%) and 18 (27%) women. No significant difference was found between patients with periodontal disease and controls in terms of sex (P = 1.000). However, more than 70% of patients were male in a way that female to male ratio was 1:2.7.
The distribution of ABO blood group and Rh factor among gingivitis, periodontitis, and healthy subjects were summarized in [Table 2], which indicates that 43% of the study samples were of blood group O, followed by A (29%), B (14%), and AB (14%). In addition, over 90% of patients were Rh-positive. According to this table, all patients (100%) with gingivitis were Rh-positive. There were no significant differences between studied groups, according to Chi-square test, regarding ABO blood types and status of Rh (P = 0.355, P = 0.050). There was no significant difference between males and females in terms of ABO blood groups (P = 0.270). However, logistic regression showed that people with blood group B (compared to blood group O) were at 3.94 times greater risk (odds ratio (OR)) to develop gingivitis (df = 1, confidence interval (CI) 95% : 1.074-14.46, P = 0.039) [Table 3].
On the other hand, logistic regression showed that there was no relationship between periodontitis and ABO blood groups, sex, and types of Rh factor [Table 4]. But it is noted that by increasing 1 year of age, the risk of periodontaitis to develop becomes greater as 1.05 times. In other words, 1 year of aging is associated with a 5% rise in likelihood of periodontitis.
|Table 2: Distribution of ABO blood groups and Rh factor among gingivitis, periodontitis, and healthy subjects|
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|Table 3: Relationship between ABO blood groups and gingivitis according to logistic regression|
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|Table 4: Relationship between ABO blood groups and periodontitis according to logistic regression|
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| Discussion|| |
Our results showed that people with periodontitis were significantly older than those with gingivitis, and two-third of patients with periodontal disease (gingivitis and periodontitis) were men with a F/M ratio of 1:2.7. Logistic regression showed that people having blood group B have a 3.9-fold higher risk to develop gingivitis. However, no relationship was found between periodontitis and blood groups, and the risk of periodontitis increases with aging.
Possible mechanisms regarding the effects of ABO blood antigens in developing risk of periodontal disease are included as follows:
- According to Malena, the ABO specificity of different bacteria is well-established and antibody titers to those specificities vary with the host blood type. These data suggest that genetic factors may alter oral environment and the process of periodontal disease through limitations imposed by Landsteiner's law: Specific antibody secretion would be expected to be low or undetectable to antigens recognized as "self" and perhaps, more importantly, high to antigens recognized as "non-self." Experimentation is being conducted to further investigate this hypothesis. 
- Al Ghamdi pointed out that the secretion of the ABO antigens into the saliva probably inhibits the ability of bacteria to attach to teeth surfaces this is because many of these bacteria have surface lectins, which they use to attach to body surface and are often ABO specific. 
- Singh demonstrated that the antigens of ABO system also acting as receptors for infectious agents.  Furthermore, Demir found that various ABO blood groups might show differences in significant rates in the colonization number of bacteria that are the main etiologic agents of periodontal disease. 
Generally, it is noted that ABO blood antigens had an increased effect on development of oral cavity diseases.  On the basis of the present study, logistic regression showed that people with blood group B had 3.94 times greater risk of developing gingivitis. In accordance to our findings, Ghalyani in an epidemiological study from Iran reported that gingivitis was more frequent in blood group B (39%), which was followed by AB (35%), O (33%), and A (31%).  Singh also demonstrated that blood group B (43.6%) had a higher incidence of gingivitis followed by A (26.5%), O (15.4%), and AB (12.4%).  In addition, Pai showed a relatively high percentage of blood group B and A in moderate/severe gingivitis, while the distribution percentage of blood group O and AB was more in healthy/mild gingivitis.  Contrary to our findings, Koregol concluded that blood group A had a significantly higher frequency in patients with gingivitis.  Furthermore, Kaslick in a study of ABO blood groups, Human Leukocyte Antigen (HLA), and periodontal disease in young adults described that people with gingivitis had a higher proportion of type AB and a smaller percentage of type O.  In contrast, some authors did not find any relationship between periodontal disease and types of blood groups. ,
In our study, blood group O had the highest frequency in patients with periodontitis. However, we did not find any significant relationship between periodontitis and different types of blood groups. The same results have been reported in some previous studies. , A higher percentage of blood group O in periodontitis was also reported by several researchers. ,, In addition, some investigators demonstrated that patients with blood group B were found to be at greater risk of developing periodontitis. ,,,
In our study, patients with periodontal disease were mostly of Rh-positive factor. In agreement with this finding, it has been shown that gingivitis and periodontitis patients with Rh-positive had a higher distribution than those with Rh-negative factor. This may be related to difference in substitutes of cell membrane proteins, which is determined by a series of allelic genes at a single locus.  According to Al Ghamdi, people with negative Rh factor tend to have better periodontal status.  It is noteworthy that people with Rh-positive factor are more frequent than those with Rh-negative in general population. For example, Rh-positive has been reported in 99%, 96%, 90%, and 87% of individuals in India, Kenya, Iran, and Turkey, respectively.  These differences in findings may be attributed to difference in sample size, study design, races, and geographic localization.
The blood group distribution shows variety according to races. It was reported that blood group A has a wider distribution in Eskimos, the blood group B in Chinese and Indians, the blood group O in American and Canadian Indians and Czechoslovakian and those living in Kenia.  According to statistical distribution of blood group types in the Iran, 30.25% had type A, 24.36% had type B, 7.77% had type AB, and 37.62% had type O blood group.  These numbers in Tehran population (location of present study) for A, B, AB, and O blood groups were as 31.51%, 24.06%, 7.62%, and 36.76%, respectively, which are close to the distribution of blood groups in our studied sample. 
Pourfatholah pointed out that frequency of blood group O and B have increased 1.3% during 20 years from 1982 to 2001 among Iranian population.  Dental health providers in screening and prevention programs should consider this finding in addition to our results.
As the relationship between ABO blood groups and diseases might vary in different racial and ethnic groups, our study attempted to elucidate it in Iranian patients. However, more elaborate studies with greater sample size are warranted to reach conclusive results.
In accordance with Shiau  , men constituted about two-third of our patients; however, for definitive results in terms of gender, further sex-matched studies are recommended.
According to data available for us, no systematic review is accomplished about relationship between ABO blood groups and periodontal disease, and any attempts in this regard can help better understanding of disease underlying mechanisms. Our study proposed group B as a possible unchangeable risk factor for gingivitis in Iranian patients; therefore, people with this type of blood group should be advocated to consider oral health to diminish controllable risk factors such as dental plaque as a preventive measure. As the results of this study is contrary to some previous ones ,, , studies in different countries and even in various ethnical groups in a country would shed more light on this area of conflicts.
| Conclusion|| |
People with blood group B are at a greater risk to develop gingivitis, whereas periodontitis did not show any relationship with blood groups.
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[Table 1], [Table 2], [Table 3], [Table 4]