Acta Scientific Orthopaedics (ISSN: 2581-8635)

Volume 6 Issue 5 May 2023

Review Article

Association Of ABO Blood Groups with Malocclusion: A Narrative Review

Anup Kanase*, Shruti Mathur, Tulika Tripathi and Priyank Rai

Received: March 10, 2023
Department of Orthodontics and Dentofacial Orthopaedics, Maulana Azad Institute of
Published: April 23, 2023
Dental Science, New Delhi, India
© All rights are reserved by Anup Kanase.,
*Corresponding Author: Anup Kanase, Department of Orthodontics and et al.
Dentofacial Orthopaedics, Maulana Azad Institute of Dental Science, New Delhi,
India.
DOI: 10.31080/ASOR.2023.06.0739

Abstract
Malocclusion has a multifactorial aetiology and can be attributed to local as well as general factors. Genetics plays a significant
role in aetiology of malocclusion. Malocclusion is considered as a quantitative genetic trait with continuous graded distribution
in the population. Association between various oral diseases with ABO blood groups have been established in the past. ABO blood
groups are one of the most important human genetic traits that follows Mendalian inheritance. Since both the ABO blood groups and
malocclusion are genetic traits, authors have carried out studies to assess if association between the two exists. The purpose of this
narrative review is to enumerate studies that have assessed the association between dental, skeletal malocclusions with the ABO
blood groups.
Keywords: Skeletal Malocclusion; Dental Malocclusion; ABO Blood Groups

Introduction antigens which are present on the cell membranes or secreted into
Malocclusion is the third most common oral disease affecting the plasma and other fluids of the body. The presence or absence
individuals after dental caries and periodontitis [1]. Malocclusion of these antigens results in the four blood groups or blood types:
is defined as an appreciable deviation from the ideal occlusion that A, B, AB, and O. The genes for these antigens are present on the
may be considered aesthetically or functionally unsatisfactory [2]. 9th chromosome and are inherited co-dominantly [9]. Since both
Malocclusion has multifactorial origin and several local and general malocclusion & ABO blood groups have strong underlying genetic
factors attribute to malocclusion. Genetics is one of the significant etiology, authors have hypothesized & evaluated the correlation
etiological factors of malocclusion [2,3]. Twin and familial studies between ABO blood groups & dentoskeletal malocclusion [10-22].
have provided evidence for heritability of malocclusion and have If such association exists, the results can be utilized to infer future
reported greater heritability for skeletal components of malocclu- growth patterns and developing dental malocclusions in children
sion whereas low to moderate heritability for dental component with a specific blood group. The clinical significance of knowing
of malocclusion [5,6]. However, due to the multi-factorial charac- the inheritance of certain dental and skeletal patterns is that we
teristics of facial development, it is difficult to do exact prediction can then use this information to diagnose and intercept developing
of the genetic pattern of malocclusion [10-12]. Thus, studies were malocclusions at an early stage.
carried to determine the relationship between malocclusions and
some other genetic traits. ABO blood group is an important genetic The objective of this article is to discuss and enumerate various
trait and is reportedly associated with several oral diseases like studies that investigated the relation between ABO blood groups
periodontitis, gingivitis, salivary gland tumor etc. [23-26]. and various types of malocclusions. Second objective is to discuss
whether ABO blood groups has more significant association with
The ABO blood group system was first defined by Karl Land- dental malocclusion or components of skeletal malocclusion.
steiner in 1901 [7,8]. ABO blood group system consists of two main

Citation: Anup Kanase., et al. “Association Of ABO Blood Groups with Malocclusion: A Narrative Review”. Acta Scientific Orthopaedics 6.5 (2023): 92-96.
Association Of ABO Blood Groups with Malocclusion: A Narrative Review

93

What is the rationale behind association of malocclusions and Tariq et al found significant association between dental maloc-
ABO blood groups? clusion & ABO blood groups in population of Lahore. They further
Association of ABO blood groups with various craniofacial de- reported gender wise association difference between the classes of
formities and oral diseases have been reported in the past. Kore- dental malocclusion and ABO blood group [13].
gal., et al. investigated relationship between ABO blood groups and
Does skeletal malocclusion have a greater association with
Gingivitis and found that patients with blood group A had higher
ABO blood groups than dental malocclusion?
percentages in gingivitis group. They also reported significant as-
sociation between ABO blood groups & periodontitis with greater Various twin and familial studies were carried out regard- ing
percentage of periodontitis in blood group A patients [23]. Vivek., the inheritance pattern of malocclusion and have established that
et al. reported significant relationship between periodontitis and O there is a stronger genetic component of skeletal component of
blood group [24]. Other authors have also reported association be- craniofacial form while the dental malocclusions are primarily ac-
tween ABO blood groups & risk of oral cancer with Blood group B quired with low heritability [6]. Studies on lateral cephalograms
at higher risk of developing oral cancern [25]. In 2008, Gheisari., et of fraternal and identical twins have concluded that there is a
al. carried a cross-sectional study in Iranian population to identify stronger genetic component of heritability for the vertical skeletal
association between blood groups and maxillofacial deformities cephalometric measurements than anteroposterior skeletal cepha-
and found that maxillo- facial deformities have greater incidence lometric measurements [6]. Various authors like Rathi et al, Dat-
of association with blood group B and fewer deformities in blood tani et al, Ghiseri et al, John G have reported association between
group A individuals. The results of these studies showed that blood skeletal malocclusions and ABO blood groups [16,21,22]. However,
groups have significant association with craniofacial diseases [16]. Shokor et al, Flannery et al. did not find significant association be-
tween skeletal malocclusions and ABO blood groups [18,19].
Malocclusions are a quantitative genetic trait with continuous
graded distribution in the population [5,6]. ABO blood groups are Which component of skeletal malocclusion has more associa-
qualitative traits with typical Mendalian inheritance [5,6]. Since, tion with ABO blood groups: Sagittal component or vertical
literature had reported association between oral diseases & ABO skeletal parameters?
blood groups, further studies were then conducted to assess the
Association of ABO blood groups with sagittal malocclusion:
association between malocclusions & ABO blood groups.
John G investigated association between sagittal malocclusion
Does dental malocclusion have any association with ABO and ABO blood group and reported significant association between
blood groups? Yen angle and ABO blood group [22]. Similar association was found
by Ghieseri et al. between maxillofacial deformities and ABO blood
Sharma R et al, 2015 carried out cross sectional study to evalu- groups [16]. Rathi et al. also reported that there may be associa-
ate the relationship between ABO blood groups and dental maloc- tion between sagittal malocclusions and ABO blood groups how-
clusion & found statistically significant association of ABO blood ever they did not find any correlation between ANB angle and ABO
groups with dental malocclusions with greater prevalence of mal- blood groups [21].
occlusions in the blood group B and least prevalence of malocclu-
sion in blood group AB. [10]. Rashid A et al. in 2019 investigated Association of ABO blood groups with vertical facial patterns
relationship between blood groups and maloc- clusion in Egyptian Dattana S et al. 2018, conducted study in Maharashtrian popula-
population also found significant association between blood group tion to find correlation between Vertical growth pattern and ABO
and dental malocclusion with prevalence of malocclusion greatest blood group types and found correlation between vertical skeletal
in blood group A followed by O, B and least prevalent in AB [12]. parameters and ABO blood groups & found significant correlation
Gupta P also found significant co-relation between ABO blood between vertical skeletal parameters and ABO blood groups [20].
groups with dental malocclusions in population of Mysuru [11].

Citation: Anup Kanase., et al. “Association Of ABO Blood Groups with Malocclusion: A Narrative Review”. Acta Scientific Orthopaedics 6.5 (2023): 92-96.
Association Of ABO Blood Groups with Malocclusion: A Narrative Review

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Is there a consensus between association of dentoskeletal there is lack of molecular evidence to support any associations be-
malocclusions and ABO blood groups? tween SNPs of skeletal & dental malocclusions with alleles of ABO
blood groups.
Several authors have assessed the association of dental & skel-
etal malocclusions with ABO blood groups in different populations. Future scope
Gupta SP, Al- Khatieeb et al. found no significant association be- Studies have reported statistically significant association between
tween dental malocclusion and ABO blood groups [14,15]. Stud- dentoskeletal malocclusions and ABO blood groups at population
ies by Schnibben et al, Flannery et al, Shokor et al. evaluated asso- level but there is lack of data regarding any correlation/association
ciation of sagittal cephalometric parameter ANB angle with blood between the genotypes of the dental and skeletal malocclusions
groups but reported no association between the two [17-19]. Simi- with alleles of ABO blood groups. Hence, in future studies we may
larly, John G reported no significant association between vertical focus on molecular analysis to ascertain association between SNPs
skeletal parameters and ABO blood groups [22]. The contrasting of dental, sagittal malocclusions and vertical facial patterns with
results in the different investigations may be due to the geographic ABO blood group alleles.
differences, racial and ethnic variations among the different popu-
lations for distribution of ABO blood groups as well as dentoskel- Conclusion
etal malocclusions. • Studies have shown significant association of dental maloc-
clusion with ABO blood groups. But several authors have also
What is the genetic basis of dental and skeletal malocclusions?
reported contrary results. The varying results in the different
Genomic wide association and molecular studies have reported
investigations were because of the geographic differences, ra-
significant association of various genetic pathways and sagittal
cial and ethnic variations among the different populations for
malocclusion and vertical facial patterns. Genes like ACTN3 and
ABO blood groups and malocclusions.
MYO1H are reportedly associated with vertical skeletal pattern
• Evidence from twin and familial studies have strongly suggest-
[26]. Also, association of ABCA4-ARHGAP 29 locus have been as-
ed greater component of heritability for skeletal malocclusion
sociated with vertical facial phenotypes like skeletal open bites
as compared dental malocclusions with a stronger genetic
and deep bites [27]. Sagittal Class II and Class III malocclusions
component of variability for the vertical skeletal cephalomet-
have also been associated with SNPs of genes like COL1A1, FGFR2,
ric measurements than anteroposterior skeletal cephalomet-
MYO1H [27]. It has also been observed that SNPs of FGFR2 were
ric measurements. Studies have investigated the association of
associated with increased risk of developing skeletal Class II and
Sagittal and vertical malocclusion with ABO blood groups but
Class III [27]. Certain genes like KAT6B and HDAC4 are found to be
there is no consensus regarding the association between ABO
expressed more in skeletal class III whereas deficiency of RUNX2 is
blood groups and skeletal malocclusions.
associated with Skeletal Class II [28].
• So far, the studies have investigated the association between
ABO blood groups at an epidemiological level. But, in order to
In the past, studies have reported that dentoalveolar traits of
have conclusive evidence regarding the association between
malocclusion are primarily acquired with lower heritability. How-
ABO blood groups and dentoskeletal malocclusions, further
ever, there is molecular evidence that has shown correlation be-
investigations may focus on molecular level to assess whether
tween genes like EDA and XEDAR dental crowding and MSX1 gene
there is any association between SNPs of dentoskeletal maloc-
with dental patterning [6,27].
clusions with ABO blood group alleles.

Is there any molecular evidence regarding the association be-

tween ABO blood groups and dentoskeletal malocclusions?
Literature has contrasting views regarding the association of
dentoskeletal malocclusions with ABO blood groups. These stud-
ies were assessing the association between dentoskeletal maloc-
clusions & ABO blood groups at an epidemiological level. However,

Citation: Anup Kanase., et al. “Association Of ABO Blood Groups with Malocclusion: A Narrative Review”. Acta Scientific Orthopaedics 6.5 (2023): 92-96.
Association Of ABO Blood Groups with Malocclusion: A Narrative Review

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Bibliography 14. Al-Khatieeb MM., et al. “Association of ABO blood group and
rhesus factor with dental malocclusion in a population of
1. Alhammadi MS., et al. “Global distribution of malocclusion
Baghdad, Iraq”. International Journal of Medical Research and
traits: A systematic review”. Dental Press Journal of Orthodon-
Health Sciences 7 (2018): 165-169.
tics (2018): 40-e41.
15. Gupta SP. “Association of ABO blood groups with occlusal pat-
2. Houston WJ., et al. “A textbook of orthodontics”. Wright (1992).
tern among Orthodontic patients of Kathmandu district”. Jour-
nal of Institute of Medicine Nepal 17.12 (2018): 2119-2129.
3. Kharbanda OP. “Orthodontics: Diagnosis and Management of
Malocclusion and Dentofacial Deformities, E-Book”. Elsevier
16. Gheisari R., et al. “The association between blood groups and
Health Sciences (2019).
maxillofacial deformities”. Indian Journal of Plastic Surgery
41.02 (2008): 138-140.
4. Agarwal SS., et al. “An overview of malocclusion in India”. Jour-
nal of Dental Health, Oral Disorders and Therapy 3.3 (2015):
17. Schnibben Charles Louis. “A Study of the Relationships of the
00092.
ABO Human Blood Groups, the Rh Factor and Hereditary Mal-
occlusions of the Skeletal Type, Class II, Division 1” (1968).
5. Mossey PA. “The heritability of malocclusion: Part 1-Genetics,
Master’s Theses. Paper (1969): 2251.
principles and terminology”. British Journal of Orthodontics
26.2 (1999): 103-113.
18. Flannery Patrick Michael. “The Abo Human Blood Groups and
Skeletal Class IIi Malocclusions”. Master’s Theses (1969): 2363.
6. Mossey PA. “The heritability of malocclusion: part 2. The influ-
ence of genetics in malocclusion”. British Journal of Orthodon-
19. Shokor FF., et al. “Craniofacial morphology with genetic influ-
tics 26.3 (1999): 195-203.
ence of ABO blood Group in malaysian orthodontic patients”.
International Journal of Pharma and Bio Sciences 6.4 (2015):
7. Daniel G. “Human blood groups. 2nd edition”. Oxford: Blackwell
412-418.
(2002): 3-8.

20. Datana SS and Bhandari S. “Correlating Vertical Skeletal Pat-

8. Schwarz HP and Dorner F. “Karl Landsteiner and his major
terns with ABO Blood Grouping System: A Cross-Sectional
contributions to haematology”. British Journal of Haematology
Study”. Journal of Contemporary Orthodontics 3.3 (2019): 33-
121.4 (2003): 556-565.
37.
9. Lewis M., et al. “Genetic linkage analyses of chromosome 9
21. Rathi A., et al. “Association of ABO blood group with crowding
loci ABO and AK1”. Cytogenetic and Genome Research 22.1-6
among patients with different malocclusions”. Journal of Den-
(1978): 452-455.
tistry Defence Section 14.1 (2020): 4.
10. Sharma R., et al. “Association of ABO Blood Groups with Mal-
22. Johns G. “Association of blood groups with malocclusion”. In-
occlusion in Population of Jaipur, India: a prospective study”.
ternational Dental Journal of Student’s Research 9.3 (2021):
International Journal of Scientific Study 2.11 (2015): 45-51.
133-139.
11. Gupta P., et al. “Correlation of ABO and Rh Blood Group with
23. Koregol AC., et al. “ABO blood groups and Rhesus factor: An ex-
Dental Malocclusion in Population of Mysuru”. Dental Hypoth-
ploring link to periodontal diseases”. Indian Journal of Dental
eses 11.2 (2020): 47.
Research 21.3 (2010): 364.
12. Rashid A and El Feky H. “Correlation between ABO Blood
24. Vivek S., et al. “Association of ABO Blood Group and Rh fac-
Groups and Malocclusion in a sample of Egyptian Populations:
tor with periodontal disease in a population of Virajpet, Kar-
A cross sectional study”. Egyptian Dental Journal 65 (2019):
nataka: A cross-sectional study”. Journal of International Oral
875-880.
Health: JIOH 5.4 (2013): 30.
13. Tariq B., et al. “Gender wise association between dental maloc-
clusion classes and ABO blood group system”. Dentistry 9.532
(2019): 2161-1122.

Citation: Anup Kanase., et al. “Association Of ABO Blood Groups with Malocclusion: A Narrative Review”. Acta Scientific Orthopaedics 6.5 (2023): 92-96.
Association Of ABO Blood Groups with Malocclusion: A Narrative Review

96

25. Mortazavi H., et al. “ABO blood groups in oral cancer: a first
case-control study in a defined group of Iranian patients”.
Asian Pacific Journal of Cancer Prevention 15.3 (2014): 1415-
1418.

26. Cunha A., et al. “Genetic variants in ACTN3 and MYO1H are
associated with sagittal and vertical craniofacial skeletal pat-
terns”. Archives of Oral Biology 97 (2019): 85-90.

27. Da Fontoura CG., et al. “Candidate gene analyses of skeletal

variation in malocclusion”. Journal of Dental Research 94.7
(2015): 913-920.

28. Huh A., et al. “Epigenetic influence of KAT6B and HDAC4 in the
development of skeletal malocclusion”. American Journal of
Orthodontics and Dentofacial Orthopedics 144.4 (2013): 568-
576.

Citation: Anup Kanase., et al. “Association Of ABO Blood Groups with Malocclusion: A Narrative Review”. Acta Scientific Orthopaedics 6.5 (2023): 92-96.