GINGIVAL FLUID

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GINGIVAL FLUID
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GINGIVAL FLUID

• Permeability of JE SE
• Role of GCF, Leucocyte Saliva

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GCF

• Sulcular fluid /Gingival Crevicular Fluid
• 19th Century
• Waerhaug and Brill and Krasse 1950
• Transudate(Brill)
• Inflammatory Exudate(Others)

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METHODS OF COLLECTION

• Absorbing paper strips
• Twisted threads
• Micropipettes
• Intracrevicular washings

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PERMEABILITY OF JESE

• Fluorescein initially(BrillKrasse)
• Confirmed with India inksaccharated iron
• Albumin,endotoxin,thymidine,histamine,phenytoin
  Horseradish peroxidase
• Mol wt 1000kD

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AMOUNT OF GCF

• Wetted Paper strip(ninhydrin stain) evaluated
  with Microscope
• Periotron(Electronic Methods)
• 1.5mm wide 1mm within GS 0.1mg GCF(3min)
• Molar 0.43-1.56m L

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COMPOSITION

• Cellular Elements
• Electrolytes
• Organic Compounds

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CELLULAR ELEMENT

• Bacteria
• Desquamated epithelial cells
• Leukocytes(PMNs,Lymphocytes,Monocytes/Macrophages)

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ELECTROLYTES

• Potassium
• Sodium
• Calcium

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ORGANIC COMPOUNDS

• Carbohydrates Proteins
• Glucose hexosamine hexuronic acid
• Glucose conc(GCF) 3-4timesgtgtSerum
• Total Protein(GCF) much less than Serum
• MetabolicBacterial Products

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EnzymesOther Compounds

• Acid phosphatase,Alkaline phosphatase,a1
  Antitrypsin,Arylsulfatase,Aspartate
  aminotransferase,
• Cathelicidin LL-37,Alanine
• aminotransferase,Chondroitin sulfatas,Citric
  acid,Cystatins,
• Cytokines (interleukins), IL-1a  IL-1ß  IL-4,
  IL-6, and IL-8  IL-11, IL-12  IF-gamma.

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EnzymesOther Compounds contd..

• Endopeptidases  Cathepsin D, Cathepsin
  B/L, Cathepsin G,  Cathepsin K,  Elastase,Plasmino
  gen activator
• Collagenase,Tryptase-like enzyme,Trypsin-like
  enzyme,Dipeptidylpeptidase IVlike
  enzyme,Elastasea1-proteinase inhibitor

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EnzymesOther Compounds contd..

• Exopeptidases,Fibrin,Fibronectin,ß-glucuronidase,G
  lycosidases, a1-Fucosidase  Sialidase 
•  ß-N-acetylglucosaminidase  ß-Galactosidase  ß-Man
  nosidaseHyaluronidase
• Immunoglobulins (IgG, IgA, IgG4, IgM),

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EnzymesOther Compounds contd..

• Lactate dehydrogenase,Lactoferrin,Lactic
  acid,Lysozyme,a2-Macroglobulins
• Medullasin,Metalloproteinases,Myeloperoxidase,Pros
  taglandin E2 (PGE2),Transferrin,Thromboxane.

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CompoundsEnzymes of Bacterial Origin

•   Acidphosphatase, Alkalinephosphatase,  
• Aminopeptidases,  Chondroitin sulfatase,
•  Chymotrypsin-like product, Collagenase,
•  Deoxyribonuclease, DNase,
•  Dipeptidylaminopeptidase IVlike enzyme, 

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CompoundsEnzymes of Bacterial Origin contd

• Fibrinolysin, Glucosidases,  Hemolysin, Hyaluronid
  ase,  Iminopeptidases,   Immunoglobulinases, ß-Lac
  tamase,
• Lysophospholipase,   Phospholipase
  A,   Phospholipase C,  Prostaglandin-like
  product,   Trypsin-like enzyme

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Cellular Humoral Activity

• Non invasive methods
• Identify cellhumoral responses in Health/Disease
• IL-1alphaIL-1Beta increase the binding of
  PMNsmonocyte/macrophages
• Interferon-alpha may have protective role
• Analysis of specificity of antibodies

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Clinical Significance

• Amount of GCF directly proportional to the
  severity of inflammation
• GCF production increase by mastication,toothbrushi
  ng,gingival massage,ovulation,oral
  contraceptivesmoking.
• Circadian Periodicity- 6am-10pm

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Clinical Significance contd

• Sex Hormone female sex hormone increase GCF
• Mechanical stimulation chewing vigorous Tooth
  brushing
• Smoking transient marked increase GCF
• Periodontal therapy

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Drugs in GCF

• Drugs that are excreted in GCF
• BaderGoldhaber Dogs GCF (Tetracyclin)
• Metronidazole

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Leuckocytes in the Dentogingival Area

• Predominantly PMNs
• Clinically healthy sulci 91.2-91.5PMNs8.5-8.8m
  ononuclear cells
• Mononuclear cells 58B-lymphocyte,24T-lymphocyte
  18mononuclear phagocyte
• Peripheral blood T/B lymphocyte 31
• GCF T/B lymphocyte 13

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MCQ -1

• Which of the following cytokines in Gingival
  crevicular fluid may have protective role in
  periodontal diseases
• a-Interleukin 1-alpha
• b-Interleukin 1-beeta
• c-Interferon-alpha
• d-Prostaglandin-E2

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MCQ-2

• Most common antibiotic that is excreted
• through the gingival crevicular fluid may be
• used advantageously in periodontal therapy
• a-Amoxicillin
• b-Doxycyclin
• c-Cefalosporin
• d-Erythromycin

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MCQ-3

• The following factors are responsible for
• enhancement of production of gingival
• crevicular fluid EXCEPT
• a-smoking
• b-trauma from occlusion
• c-vigorous brushing
• d-healing period after curettage

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MCQ-4

• Which is the correct statement of glucose
• and protein content in gingival crevicular
• fluid(GCF)
• a-glucose conc.3-4times greater than serum
• b-glucose conc. 3-4times lesser than serum
• c-total protein is more than that of serum
• d-total protein is equal to that of serum

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MCQ-5

• What are the ratio of T-lymphocytes to B
• lymphocytes in Gingival crevicular fluid
• a-12
• b-21
• c-13
• d-31