JICDRO is a UGC approved journal (Journal no. 63927)

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Year : 2020  |  Volume : 12  |  Issue : 2  |  Page : 127-131

Correlation between A, B, and O Blood Group System and Dental Anxiety in Children of Age 6–12 Years in East Bengaluru

Department of Pediatric and Preventive Dentistry, M. R. Ambedkar Dental College and Hospital, Bengaluru, Karnataka, India

Date of Submission16-Feb-2020
Date of Decision27-Jun-2020
Date of Acceptance26-Jul-2020
Date of Web Publication14-Dec-2020

Correspondence Address:
Dr. Swathi Kakathkar
Department of Pediatric and Preventive Dentistry, M. R. Ambedkar Dental College and Hospital, Bengaluru - 560 005, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jicdro.jicdro_8_20

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Background: Dental anxiety is a term used to describe fear or stress in a dental setting which a pedodontist has to face routinely. Studies have shown that genetics of blood group plays an important role in human behavior. The genes which code for ABO blood group system are also responsible for the activity of certain neurotransmitters like dopamine. The aim of this study was to assess the correlation between dental anxiety and different blood groups in children. Materials and Methods: The study included 80 healthy children of age 6–12 years requiring Class I and Class II cavity restorations. Dental anxiety was measured using the Animated Emoji Scale during the procedure. Data regarding the blood group of patients were collected using past medical records from parents or guardians. Results: The results showed that the mean dental anxiety score was highest in blood Group AB (3.60), followed by B (2.48), O (2.19), and A (2.00) which was statistically significant. No statistically significant results were found in terms of gender and Rh factor. Conclusion: Dental anxiety scores show a correlation with blood groups.

Keywords: Animated Emoji Scale, anxiety, blood groups, genetics, pediatric dentistry

How to cite this article:
Kakathkar S, Srinivasan I, Setty JV, Akhil P, Suting C, Nayana K M. Correlation between A, B, and O Blood Group System and Dental Anxiety in Children of Age 6–12 Years in East Bengaluru. J Int Clin Dent Res Organ 2020;12:127-31

How to cite this URL:
Kakathkar S, Srinivasan I, Setty JV, Akhil P, Suting C, Nayana K M. Correlation between A, B, and O Blood Group System and Dental Anxiety in Children of Age 6–12 Years in East Bengaluru. J Int Clin Dent Res Organ [serial online] 2020 [cited 2021 Apr 21];12:127-31. Available from: https://www.jicdro.org/text.asp?2020/12/2/127/303410

   Introduction Top

One of the major challenges in pediatric dentistry is dental anxiety and fear. It is a common reason for avoiding dental treatment, which ultimately leads to deteriorated oral health. Dental anxiety shows a multifactorial etiology among pediatric patients. A number of interacting factors, personal as well as environmental, play a role in the development of fear and anxiety in a dental setup.[1]

Assessment of dental anxiety during the first dental visit will allow the pedodontist to plan and use accordingly different behavior modification techniques in the consequent visits.[2] The term personality comes from the Latin word “persona” which means mask used by the actors on stage. It is defined as the sum of an individual’s trait which determines all behavior. Personality is the pattern of characteristic thoughts, feelings, and behaviors that distinguishes one individual from another.[3]

A blood group is defined as “An inherited character of the red cell surface, detected by a specific alloantibody.” In 1900, Landsteiner divided blood groups into A, B, O, and AB groups. According to a popular belief in Japan, Korea, and other East Asian countries, an individual’s personality, temperament, and compatibility with others can be predicted by her/his ABO blood type.[3],[4]

There is no scientific proof that a relationship exists between the ABO blood group and personality trait. However, a recent study hypothesized that dopamine beta-hydroxylase gene is in linkage with the ABO gene. Temperament traits, which are the basic part of personality, have been correlated with neurotransmitter systems and are genetically controlled. Since ABO blood group type is genetically predetermined and easily identified, it can be used as a biological marker to assess the influence of genetic factors on personality. A possible correlation between blood types and personality characteristics, neurological disorders and other diseases has been prevalent for a long time.[5]

Literature says that the gene which controls blood type expression was probably also linked to the genes that code for the activity of dopamine beta-hydroxylase, catechol-O-methyltransferase, and argininosuccinate synthetase. These enzymes influence our neurohormonal response to environmental factors. It is also shown that the chemical structure of dopamine resembles the ABO antigens. Previous studies have demonstrated only associations between ABO phenotype (blood type) and personality traits.[5] Although many studies confirm the association between blood group and psychological disorders, there are relatively scarce reports that would investigate the relationship between blood types and dental anxiety in pediatric patients. No study in the past has tried to find the correlation between dental anxiety and ABO blood group system. Thus, this pilot study was designed to find dental anxiety levels among children of various blood groups.[4]

   Materials and Methods Top

The study was conducted at the Department of Pediatric and Preventive Dentistry, M. R. Ambedkar Dental College and Hospital, Bengaluru, Karnataka. The samples were selected from patients coming to the department based on inclusion and exclusion criteria. The study was commenced after obtaining approval from the Institutional Ethical Committee and Review Board, Dr B R Ambedkar Medical College and Hospital, Bengaluru (EC NO – EC644). Based on the published literature,[3] the sample size for the present study was estimated using GPower software version[Heinrich- Heine- Universität, Dusseldorf, Germany] considering the effect size to be measured (f) at 40%, power of the study at 80%, and the margin of the error at 5%, the total sample size was estimated to be 80. The sample size calculation was done using dental anxiety score as a variable (dependent variable).

Inclusion criteria

  1. Patients who fall under Frankel’s 3 and Frankel’s 4 Behavioral Rating Scale, between the ages of 6 and 12 years of both the sexes with no history of systemic illness
  2. First dental visit
  3. Children with a Class I or Class II carious lesion on the primary molars, limited to the enamel and two-third of dentin and requiring a restoration without local anesthesia
  4. Patients who willfully assented and whose parents gave written consent to be a part of the study.

Exclusion criteria

  1. Teeth indicated for extraction
  2. Teeth with lesions involving the pulp
  3. Patients with special health-care needs
  4. Patients who were not willing and whose parents refused to give consent for the treatment
  5. Patients suffering from any other debilitating systemic illness.

Patients who required restorative procedures using airotor handpiece were selected based on inclusion criteria. The use of an Animated Emoji Scale (AES) was explained to both parents as well as the patients prior to the procedure. An assent was obtained from the patient and written informed consent from the parents/guardians before the dental anxiety was recorded. Data regarding the blood group of the patient were collected using past medical records from parents/guardians. Cavity preparation was done using a high-speed airotor handpiece. Dental anxiety was determined using AES during the procedure, by asking the patient to choose the appropriate emoji based on their experience while undergoing treatment with airotor handpiece [Figure 1]. The prepared tooth was then restored using glass ionomer cement.
Figure 1: measurement of dental anxiety using Animated Emoji Scale

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The AES has five graphic interchange formats of animated emoji faces showing different feelings ranging from very happy/laughing to very unhappy/sad and crying (most positive to most negative feelings). The scale had scores from 1 (very happy emoji) to 5 (very unhappy emoji).[2]

The data collected were tabulated and subjected to statistical analyses using Statistical Package for the Social Sciences software, version 22.0 [Heinrich- Heine- Universität, Dusseldorf, Germany]. Descriptive analysis of all the explanatory and outcome parameters was done using mean and standard deviation for quantitative variables, frequency, and proportions for categorical variables. One-way ANOVA test was used to compare the mean dental anxiety scores between subjects of different blood groups. Independent Student t-test/Mann–Whitney U-test was used to compare the mean dental anxiety scores between RH factors and between genders. The level of significance was set at P < 0.05.

   Results Top

Among the study subjects, 44 were males and 36 were females, with the mean age of 8 years. Comparison of mean dental anxiety level based on blood groups showed a statistically significant (P < 001) result with the highest mean dental anxiety score in the blood Group AB (3.60), followed by B (2.48), O (2.19), and A (2.00) [Figure 2]. When Rh factor was considered, the highest score was seen in Group AB–ve (5.00) and the lowest score was seen in Groups A+ve, A−ve, B+ve, and O−ve with the score of 2.00 [Figure 3]. However, there were no statistically significant results found between different Rh factors (P = 0.17) and between genders (P = 0.77) [[Figure 4] and [Table 1], respectively].
Figure 2: mean dental anxiety levels based on blood groups of study subjects

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Figure 3: mean dental anxiety levels between different Rh Factors among study subjects

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Figure 4: mean dental anxiety level based on blood groups and Rh factor of study subjects

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Table 1: Comparison of mean dental anxiety levels between genders using Mann-Whitney U-Test

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   Discussion Top

Understanding the personality of an individual will help in maintaining good mental and physical health. Due to multifactorial nature, it is difficult to know the roots of human behavior. Personality is a stable and complex combination of traits, attitudes, interests, needs, behaviors, emotions, and other factors that are formed in interaction with the environment. The first study on the relationship between blood types and personality was published in 1930. After further studies in Japan in the mid-1980s, several other countries conducted studies on the relationship between blood types and personality traits.[6]

Dental anxiety has been defined as an “Abnormal fear or dread of visiting the dentist for preventive care or therapy and unwarranted anxiety over dental procedures” and can have physiological, cognitive, and behavioral consequences.[7]

In the present study, 80 subjects participated, in which the maximum number belonged to blood Group A+ve (23), O+ve (19), and B+ve (19). The results showed a statistically significant correlation between blood groups and dental anxiety, with the highest mean dental anxiety score in the blood Group AB (3.60), followed by B (2.48), O (2.19), and A (2.00).

The results of this study are in line with the study done by Furukawa in 1930 on blood type and personality which concluded that human blood is one of the most important determinants of his mood.[8] A study by Senthamil Selvi et al. showed that there is no association between blood type and mood changes such as anxiety, depression, and stress. However, among the three parameters, type A and type O samples were found to have statistically significant higher scores in anxiety.[4]

ABO blood group system has shown an association with disorders such as myocardial infarction (MI), duodenal ulcer, tumors of the salivary glands, rheumatic diseases, and gastric cancer. Rate of occurrence of MI is higher in Group A than O. Duodenal ulcer patients, on the other hand, are statistically more likely to be blood type O than A.[9] A study by Mohammad Sharifi et al. where the relationship between the big five personality factors, namely neuroticism, extraversion, openness, agreeableness, and conscientiousness with blood type was considered, it was found that the three factors namely neuroticism, conscientiousness, and agreeableness showed no relationship with blood types; however, both extraversion and openness were linked with different blood types.(P = 0.04).[6]

AES was used as children in today’s scenario are more attracted towards cartoon and multimedia than lifeless two-dimensional pictures. AES is a valid scale and shows a high degree of agreement with Venham picture test (VPT) and Facial Image Scale. It is also shown that children preferred the AES as there was no confusion with the figures as seen in VPT cards where certain figures looked similar and were often time consuming to interpret. Furthermore, it is attractive to children because of the moving emoticons which are used commonly in today’s scenario.[2]

Studies have been conducted to find an association between different blood groups and caries status of individuals along with depression and oral health status. It was found that depression and oral hygiene might not be affected by the different blood groups, but the caries status showed a statistically significant positive correlation.[10]

Few studies have been conducted to determine the relationship between ABO blood group and the incidence of oral and dental diseases such as dental caries, periodontal disease, and malocclusion. The reports of some researchers claimed that there was a relationship, whereas some others could not find any relationship, which may be attributed to the geographic diversity of the population.[11] In the current study, dental anxiety among females was slightly higher than males. However, this was not statistically significant. Similar results were found in a study conducted by Molaei Zadeh et al.[12]

In the present study, the Rh factor showed no statistically significant results in terms of mean dental anxiety, with the mean score of 0.94 for Rh+ve subjects and 1.33 for Rh−ve participants. Similar studies done by Yadav et al. to find the relation between blood group and psycho wellness of an individual showed that Blood types “A” and “Rh+” were more prone to psycho morbidity and “B” for suicidal tendency, while “O” had the least suicidal tendency, but this variation was not found significant which is in partial agreement with the findings of the current study.[13]

Thus, this study showed a significant correlation between the blood group of an individual and experience of anxiety during dental procedures, which supports the influence of genetic factors on personality.

   Conclusion Top

Dental anxiety is a multifactorial trait which has made it a difficult parameter to assess or find a correlation with. In this study, a statistically significant correlation between dental anxiety and ABO blood group system was found. The highest dental anxiety score was found in the individuals with blood Group AB followed by blood Groups B, O, and A, but a significant correlation was not found in terms of gender and Rh factor. Hence, these results should be regarded as preliminary and exploratory. Further population-based studies with the larger and equal sample size in all the groups should be performed for more conclusive results.


The authors would like to thank and acknowledge Dr. Santhosh for helping us with statistical analyses.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

   References Top

Dahlander A, Soares F, Grindefjord M, Dahllöf G. Factors associated with dental fear and anxiety in children aged 7 to 9 years. Dent J (Basel) 2019;7:68.  Back to cited text no. 1
Setty JV, Srinivasan I, Radhakrishna S, Melwani AM, Dr MK. Use of an animated emoji scale as a novel tool for anxiety assessment in children. J Dent Anesth Pain Med 2019;19:227-33.  Back to cited text no. 2
Nahida A, Chatterjee N. A study on relationship between blood group and personality. Int J Home Sci 2016;2:239-43.  Back to cited text no. 3
Senthamil Selvi K, Rohini C, Senthil Velou M, Deepika V. Relation between blood group and mood changes. Indian J Basic Applied Med Res 2017;6:118-25.  Back to cited text no. 4
Tsuchimine S, Saruwatari J, Kaneda A, Yasui-Furukori N. ABO blood type and personality traits in healthy Japanese subjects. PLoS One 2015;10:e0126983.  Back to cited text no. 5
Sharifi M, Ahmadian H, Jalali A. The relationship between the big five personality factors with blood types in Iranian university students. J Chem Pharm Res 2015;7:233-40.  Back to cited text no. 6
Kritsidima M, Newton T, Asimakopoulou K. The effects of lavender scent on dental patient anxiety levels: A cluster randomised-controlled trial. Community Dent Oral Epidemiol 2010;38:83-7.  Back to cited text no. 7
Furukawa T. A study of temperament and blood-groups. J Soc Psychol 1930;1:494-509.  Back to cited text no. 8
Neumann JK, Arbogast BW, Chi DS, Arbogast LY. Effects of stress and blood type on cortisol and VLDL toxicity preventing activity. Psychosom Med 1992;54:612-9.  Back to cited text no. 9
Yadav K, Solanki J, Dileep CL, Adyanthaya BR, Mishra P, Yadav O. Association between different blood groups, depression and oral health status of dental students. Clujul Med 2018;91:317-21.  Back to cited text no. 10
Sharma R, Preethi PN, Nagarathna C, Navin HK. Association of ABO blood groups with malocclusion in population of Jaipur, India: A prospective study. Int J Sci Stud 2015;2:45-51.  Back to cited text no. 11
Molaei Zadeh SZ, Molaei Zadeh M, Nirouzad F, Rastegarpour F, Bagheri Kahkesh S, Tosang MA, et al. The relationship between blood type a and anxiety in the students of dezful learning Centers. J. appl. Environ Biol Sci 2015;5:361-6.  Back to cited text no. 12
Yadav A, Sankhla M, Gaur KL, Gupta ID. Association of psycho-wellness with various blood types in young medical students. Int J Res Med Sci 2016;4:3468-72.  Back to cited text no. 13


  [Figure 1], [Figure 2], [Figure 3], [Figure 4]

  [Table 1]


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