|Year : 2020 | Volume
| Issue : 3 | Page : 138-141
Analysis of lip prints as a predictive tool in screening Type 2 diabetes mellitus – A cross-sectional study
Vineeth Ramanathan, Jimsha Vannathan Kumaran, Subramanian Vasudevan Srinivasan, Mariappan Jonathan Daniel
Department of Oral Medicine and Radiology, Mahatma Gandhi Postgraduate Institute of Dental Sciences, Puducherry, India
|Date of Submission||25-Apr-2020|
|Date of Acceptance||20-Aug-2020|
|Date of Web Publication||15-Oct-2020|
Dr. Vineeth Ramanathan
Department of Oral Medicine and Radiology, Mahatma Gandhi Postgraduate Institute of Dental Sciences, Puducherry
Background: Globally, the prevalence of diabetes is soaring among middle- and low-income countries. Lip print is a noninvasive procedure which is being genetically determined to serve as a tool in forensic dentistry. Hence, the present study was conducted to assess the role of lip prints among Type 2 diabetes mellitus (DM). Aims and Objectives: The aim and objective of the study were to assess the lip pattern of the individual among diabetic and nondiabetic individuals, and the objective was to compare and correlate lip print pattern in patients with Type 2 DM. Materials and Methods: The study was conducted on 25 uncontrolled Type 2 DM patients and 25 healthy controls. Lip prints were obtained and classified using Suzuki and Tsuchihashi's classification. Statistical Analysis: The software SPSS (Statistical Package for the Social Sciences) version 20 was used for statistical analysis. Chi-square test was used for comparison. Results: The results of the present study demonstrated that Type 4 reticular pattern was significantly higher among diabetic patients. Conclusion: The present study showed that lip prints may serve as a predictive tool in screening Type 2 DM.
Keywords: Diabetes mellitus, lip prints, reticular pattern
|How to cite this article:|
Ramanathan V, Kumaran JV, Srinivasan SV, Daniel MJ. Analysis of lip prints as a predictive tool in screening Type 2 diabetes mellitus – A cross-sectional study. SRM J Res Dent Sci 2020;11:138-41
|How to cite this URL:|
Ramanathan V, Kumaran JV, Srinivasan SV, Daniel MJ. Analysis of lip prints as a predictive tool in screening Type 2 diabetes mellitus – A cross-sectional study. SRM J Res Dent Sci [serial online] 2020 [cited 2020 Oct 25];11:138-41. Available from: https://www.srmjrds.in/text.asp?2020/11/3/138/298260
| Introduction|| |
Diabetes mellitus (DM) is a metabolic disorder characterized by a common feature of chronic hyperglycemia with disturbance of carbohydrate, protein, and fat metabolism (WHO 2018). There is an immense rise in the diabetic people from 108 million in 1980 to 422 million in 2014. Normal lines and fissures in the form of wrinkles and grooves present in the zone of transition of human lip between the inner labial mucosa and outer skin are called lip prints, and examination of which is known as cheiloscopy. “Cheilos” is derived from Greek word meaning lip and “scopy” meaning to examine. In 1902, R. Fischer, an anthropologist was the first to describe the biological phenomenon of systems of furrows on the red part of human lips. Type 2 DM is a complex disorder, and it is influenced by genetic factors. The biochemical level of blood or urine is assessed for glucose estimation in an individual. Many patients with diabetes are left undiagnosed and lead to many serious complications such as coronary artery disease, stroke, and peripheral vascular disease. Recently, the increased prevalence of diabetes in the medical field leads to an interest in search of potential early biomarkers. The present study was conducted to assess the association of lip prints in diabetic and nondiabetic patients among the South Indian population. In our present study, analysis of lip print patterns was done with a magnifying lens and image scanner. The objective of the present study was to ascertain whether there is an association of lip print patterns with diabetics and to compare lip print patterns of diabetic and nondiabetic individuals.
| Materials and Methods|| |
The materials used for the lip print pattern analysis were as shown in [Figure 1]. Blood samples were collected from the Outpatient Department of Oral Medicine and Radiology, at Mahatma Gandhi Post Graduate Institute of Dental Sciences, Pondicherry, and confirmed by clinical and laboratory assessment of the last three consecutive fasting blood sugar values >140 mg/100 ml was set as the criteria to proffer the uncontrolled state of the disease. Individuals with age limit between 35 and 55 years (mean age = 45) who are willing to participate and for those diabetes are confirmed by laboratory assessment were included in Group II. Individuals with three consecutive fasting blood sugar values between 126 and 140 mg/100 ml were included in Group I. Individuals with genetic disease, other systemic diseases, inflammation, trauma, malformation, deformity, surgical scars, ulcers, burns, and other abnormalities of the lips were excluded from both the groups.
Method of collection of data
The procedure was clearly explained to the participants. The data were collected by utilizing a structured questionnaire that includes the demographic data such as name, age, gender, marital status, place, and education. An informed consent was obtained from the subjects, and they were categorized in the following groups.
- Group I: 25 normal individuals without Type 2 DM
- Group II: 25 individuals with Type 2 DM.
Lip print procedure and analysis
The lips were cleaned thoroughly with tissue paper to avoid contamination, and then lipstick was taken on one end of an ear bud applied gently starting at the midline and moving laterally in the upper lip. The same technique was repeated for the lower lip. The participants were asked to gently rub his/her lips for its uniform application. The individuals were asked to retain a relaxed lip position, and the impression was taken on the glued portion of the cellophane tape. Lip prints were obtained by dabbing the tape in the center first and then pressing it comfortably toward the corner of the lips [Figure 2]. The tape was carefully lifted from one end of the lip to avoid any smudging of the print. The impression was then stuck on plain A4 paper [Figure 3]. Sterilized cotton and Vaseline were used to clean the lips properly. After acquiring the patterns of the individuals, each of them was assigned a definite number and studied.
The lip prints were divided into four quadrants and recorded as:
- Right upper lip quadrant RU
- Right lower quadrant RL
- Left upper quadrant LU
- Left lower quadrant LL
The slides were studied carefully with a magnifying lens., The lip prints of each individual were scanned using an image scanner. They were stored as JPEG (Joint Photographic Experts Group) files for maximum details to analyse the lip patterns  denoting the type according to Suzuki and Tsuchihashi's (1970) classification. Only 10 mm area from the center portion of the upper lip was considered to avoid any errors from overlapping of lip prints on the right and left sides of the lip.
The software SPSS version 20 (Statistical package for the social sciences) was used for statistical analysis. Chi-square test was used for comparison.
Suzuki and Tsuchihashi's lip print pattern [Figure 4]
- Type I: complete straight grooves
- Type I': partial straight grooves
- Type II: branched grooves
- Type III: intersected grooves
- Type IV: reticular grooves
- Type V: undifferentiated grooves.
| Results|| |
In our study, of 50 study participants (Groups 1 and 2), reticular type of lip print pattern was significantly higher (52%) than controls.
Lip print pattern
The pattern of lip print in cases and controls was classified into Types I, I', II, III, IV, and V. The percent distribution of each lip print pattern in cases was 12% Type I, nil cases in Type I' and III, 32% Type II, 52% Type IV, and 4% Type V patterns. The percentage distribution of lip print patterns in controls was 32% Type I, 8% Type I', 24% Type II, 24% Type III, 4% Type IV, and 8% Type V patterns.
[Table 1] shows lip print patterns among cases and controls. The difference in lip print patterns between cases and controls was statistically highly significant (P ≤ 0.001). The difference was also compared in both sexes [Table 2].
|Table 1: Distribution of cases and controls based on the types of lip prints|
Click here to view
| Discussion|| |
India represents the world's diabetes burden, with an estimated 72 million cases in 2017, expected to double to 134 million by 2025. Diabetic prevalence in the midst of adults over 18 years of age has increased from 4.7% in 1980 to 8.5% in 2014 (WHO 2018). The major causes of diabetes are blindness, kidney failure, heart attacks, stroke, and lower limb amputation. It is estimated that 1.6 million deaths were directly caused by diabetes in the year 2016. Nearly 50% of all deaths caused due to high blood glucose occur before the age of 70 years. Diabetes was the seventh leading cause of death in 2016, stated by the World Health Organization.
The result shows that the people with a reticular type of lip pattern are common among Type 2 DM. The distribution of the cases and controls based on gender and types of lip prints showed in [Graph 1]. Reticular pattern was higher in cases among males (50%) and females (53.8%), followed by Type I 8.3% and 15.4%, Type II 33.3% and 30.8%, and Type IV 8.3% and nil cases, respectively. Complete straight, branched, and intersected pattern was higher in controls among males with equal distribution of 33.3% each. Reticular pattern was least among females with 4.5%. Thus, people with reticular lip print patterns may have a greater chance of developing Type 2 DM.
The present study showed that 52% of cases were Type IV (reticular) pattern, and in controls, the highest percentage was found for Type I (32%), further Type IV (4%) was the least pattern type in controls. Reticular type pattern was higher in cases than controls. The observation of the present study is in correlation with the study conducted by ManjushaandSudha  who reported the percentage distribution of each lip print pattern in cases as 57% Type IV, followed by 20% Type III, 8% Type I, 6% Type I', 4% Type II, and 5% Type V patterns.
Manjusha andSudha  in their study found that 63.0% of female patients had reticular pattern compared with female controls (20.5%). Branched and vertical pattern was prevalent among female controls than cases. This study was similar to the study by Umana et al. who found that reticular and undifferentiated patterns had chances of developing diabetes compared with branched and intersected pattern.
According to the Indian Council of Medical Research, the North Indian population is less likely to develop DM than the South Indian population. Arora et al. suggested that this difference could be due to the fact that the North Indians are migrant Asian populations, and South Indians are the host populations. The people of the Malabar region with reticular pattern are at high risk of developing diabetes, whereas people with branched pattern have less chances to develop the disease.
Lip prints with reticular pattern may serve as a potential risk factor in assessing the Type 2 DM. Long-term follow-up studies to be carried out among different parts of the country to further validate these results. Therefore, to conclude, the individuals with reticular type of lip pattern are more likely to develop DM.
It includes a small sample size, since diabetes is influenced by environmental and genetic factors, it is necessary to confirm the present study from various areas of the country and globally. Recommendations are put forth to study the lip prints of the offspring to predict the presence of diabetes, especially those with a family history, to further validate the findings of this study.
| Conclusion|| |
Our results showed that Type IV reticular pattern of lip print was significantly more in diabetic than nondiabetics, thus suggesting that this pattern has a greater predilection of developing DM, which can be used as a predictive tool in mass screening of DM.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2]