gcf seminar

GINGIVAL GINGIVAL CREVICULAR CREVICULAR FLUID(GCF)FLUID(GCF)

By:Neeharika Kharbanda

Roll no:53Final Year

CONTENTS

• Gingival Sulcus• GCF:definition• Generation Of GCF• Methods Of Collection• Composition• Cellular and Humoral activity in

GCF• Clinical Significance• Drugs in GCF

The gingival sulcus is the shallow crevice or space around the tooth ,bounded by the surface of the tooth on one side and the epithelial lining the free margin of the gingiva on the other.

• It is V Shaped and in clinically healthy human gingiva,a sulcus of some depth can be found. The depth as determined with histological sections is 1.8mm.

• The so-called probing depth of a clinically normal gingival sulcus is 2 to 3 mm

• Sections show presence of three types of epithelium ,1. the oral or keratinized epithelium

covering the gingival connective tissue in continuation with

2. the sulcular epithelium ,which is not keratinized .It forms the soft tissue wall of the gingival sulcus and the

3. junctional epithelium is in continuation with the oral and sulcular epithelium .It is formed by few strata of cells,with long flat basal layer and a very small desquamting surface that forms the base of the gingival sulcus.

•THE presence of sulcular fluid has been known since the 19th century

•BRILL AND KRAUSE introduced filter paper into the gingival sulci of dogs previously injected intramuscularly with fluoroscien, within 3 minutes the fluorescent material was recovered on the paper strips .This indicated the passage of fluid from the bloodstream through the tissues and exiting via the gingival sulcus.

•In further studies BRILL confirmed the presence of GCF in humans and considered it a transudate •But later it was demonstrated that it a an inflammatory exudates ,and not continuous transudate as in strictly normal gingiva little or no fluid can be collected.

A fluid occurring in minute amounts in the gingival crevice, believed by some authorities to be an inflammatory exudate and by others to cleanse material from the crevice, containing sticky plasma proteins which improve adhesions of the epithelial attachment, have antimicrobial properties, and exert antibody activity. (From Jablonski, Illustrated Dictionary of Dentistry, 1982

Significance of gingival vasculature and crevicular fluid:

•EGELBERG has demonstrated that the production of GCF is primarily related to the increase in permeability of the vessels underlying junctional and sulcular epithelium

•In the presence of inflammation the width and length of capillary and post capillary venules increases ,resulting in their twisting and looping and subsequent damaging of these vessels in a flat layer. Also, these epithelium do no possess ridges projecting into connective tissue , thus their vasculature network is in a very superficial location

BACTERIA DERIVED

BACTERIA DERIVEDBACTERIA DERIVEDBACTERIA DERIVED

ENZYMATIC COMPONENTS NON ENZYMATIC COMPONENTS

HOST DERIVED AND OTHER PRODUCTS

BACTERIA DERIVEDHOST DERIVEDAND

OTHER PRODUCTS

CELLULAR COMPONENT ELECTROLYTES

ORGANICCOMPONENTS

Acid phosphatesAlkaline phosphataseAlpha 1 antitrypsinArylsulphatseAspartate aminotransfaraseChondroition sulphateCitric acidCystatinsB-glucuronidaseCathepsinMatrix metalloproteinsElastase

Acid phosphatase Alkaline phosphataseCollagenaseHyaluronidasePhospholipse-APhospholipase-C

BacteriaDesquamted epithelial celssLeucocoytes(pmn’s,monocytes/macrophages)

PotassiumCalciumSodium

Carbohydrates-GLUCOSEHEXOSAMINE -HEXURONIC ACIDProteins

METABOLIC END PRODUCTS

Lactic acidUreaHydroxyprolineEndotoxinsCytotoxic substancesHydrogen sulphide


METHOD OF COLLECTION

ABSORBING PAPERSTRIPS

TWISTEDTHREADSMICROPIPETTES

INTRACREVICULARWASHINGS


Intrasulcular method :when the strips are placed within the sulcus

Extrasulcular method :strip placed at its entranceThe placement of the filter paper strip in realtion to the sulcus or pocket is important.THE BRILL technique inserts into the pocket till resistance is encountered.this method introduces a degree of irritation of the sulcular epithelium that can by itself trigger the flow of fluidLOE AND HOLM PEDERSON placed the filter paper strip just at the entrance of the pocket or over the pocket entrance .In this way,fluid seeping out is picked by the strip,but the sulcular epithelium is not in contact with the paper


a)direct viewing and staining;

Proposed by EGELBERG and ATTSTROMThe strip is stained with an alcoholic solution of ninhydrin at conc of 0.2%The stained area can be measured with a scale ,calipers

b)by weighing the stripThe strip is weighed before the collection within a sealed microcentrifugation plastic tube and is then weighed immediately after the collection of the sample


c)use of periotron:it is an electronic device for measuring the amount of fluid collected on the filter paperdeveloped by harco electronics,HAR600

ADVANTAGES:•Simple procedure,can be viwed directly•Quantitave assessment•Compatible with subsequent chemical analysis•By using periotron evaporation is minimum

DISADVANTAGES•CONTAMINATION can occur •Dislocation of the paper strip thus disturbing the integrity of marginal tissues•When using peritron ,care should be taken to insert the paper strips into the machine in a standardized position for correct reading


•Measurements performed by CIMASONI showed that a strip of paper 1.5mm wide and 1mm within the sulcus of a slightly inflamed gingiva absorbs 0.1mg of GCF in 3 minutes

•CHALLACOMBE,by using isotope dilution method calculated the amount of GCF present in humans with a mean gingival index of less than 1.

•The GCF volume from proximal surfaces of molar teeth is 0.43 to 1.56ul

Threads were placed in the gingival crevice around the tooth ,and the

amount of fluid collected was estimated by weighinf the sample

thread

Used by WEINSTEIN et all

Threads were placed in the gingival crevice around the tooth ,and the amount of fluid collected was estimated by weighing the sample thread



thread

KRASSE AND EGELBERG were first to utilize capillary tubing.

This permits the collection of fluid by capillarity

Capillary tubes of standardized length and diameter are placed in the pocket and their content is then centrifuged and analyzed

DISADVANTAGES:The collection of the fluid is difficult because the viscosity of the fluid makes the aspiration difficult



thread

IT CONSISTS OF AN APPLAINCE consisting of a hard acrylic plate covering the maxilla with soft borders and a groove following the gingival margins ,it is connected to 4 collection tubes

The washings are obtained by rinsing the crevicular areas from one side to other using a peristaltic pump.

ADVANTAGES:USEFUL FOR LONGITUDNAL STUDIESPermits collection without disturbing the integrity of the marginal tissuesContamination is least

DISADVANTAGES:COMPLEX PROCEDURERepresents a dilution of crevicular fluid



thread

A MODIFICTAION of this is to use two injection needles fitted one within the other such that during sampling ,the inside (ejection )needle is at the bottom of the pocket and the outside (collecting) needle is at the gingival margin. The collecting needle is drained into a sample tube by continuous suction.

ADVANTAGESUseful for cases of clinically normal gingivalUseful for studying the number and state of cells and bacteria form the crevicular area

DISADVANTAGES;DOES NOT PERMIT ABSOLUTE Quantitative assessment as the dilution factor cannot be determined

Increase the binding of pmn’s and monocytes to endothelial celss

• Analysis of GCF has identified cell and humoral responses in both healthy individuals and those with periodontal disease.The cellular immune response includes the appearance of cytokine in GCF

Interleukin 1 alpha and interleukin 1 beta

Increase the binding of pmn’s and monocytes to endothelial cells

Stimulate the production of PGE2 and release of lysosomal enzymes

Stimulate bone resorption• Also presence of interferon alpha in GCF,

which has a protective role in periodontitis because of its ability to inhibit bone resorption

Threads were placed in the gingival crevice around the tooth ,and the CELLULAR AND HUMORAL ACTIVITY IN GCF

Analysis of gcf has identified cell and humoral responses in both healthy individuals and those with Because the amount of fluid recoverable is very small only the use of very sensitive immunoassays permits

the analysis of the specificity of the antibodies.The role of antibodies in the gingival defence mechanisms is difficult to ascertain.

periodontal disease.The cellular immune response includes the appearance of cytokine in GCF

amount of fluid collected was estimated by weighinf the sample thread

Increase the binding of pmn’s and monocytes to endothelial celss

Because the amount of fluid recoverable from the gingival crevices is small ,only the use of very sensitive immunoassays permits the analysis of the specificity of antibodies. The role of antibodies in the the gingival defence mechanisms is difficult to ascertain.it is found that IgG is more prevalent in GCF



thread

•Though GCF is an inflammatory exudate its presence in clinically normal sulci can be explained as gingiva that appears clinically normal invariably exhibits inflammation when examined microscopically•The amount of GCF is greater when inflammation is present and is sometimes proportional to the severity of inflammation.

CIRCADIAN PERIODICTY;There is gradual increase in GCF amount from 6 am to 10pm and a decrease afterward

SEX HORMONES;Female sex hormones increase GCF ,because they enhance the vascular permeabilityPregnancy,ovulation,and hormonal contraceptives all increase its production



thread

MECHANICAL STIMULATION:chewing and vigorous gingival brushing stimulate the flow of GCF SMOKINGit produces an immediate transient but marked increase IN GCF flow

PERIODONTAL THERAPY:1)oral prophylaxis;decrease in the fluid flow one week after and then slowly returned to pre treatment values2)after surgical procedures:increase in GCF during the healing period after periodontal surgery



thread

Drugs that are excreted in GCF may be used advantageously in periodontal therapy

Drugs that have been detected in GCF are metronidazole ,minocycline and erythromycin

BADER AND GOLDHABER demonstared in dogs that tetracyclines are excreted through GCF and concentarion found in GCF is higher(5 times)as found in serum In cases of local drug delivery, where tetracycline fibres are packed into the periodontal pocket, the concentration of tetracycline is 1300ug/ml whereas the GCF concentration is only 4 to 8ug/ml after systemic administration.

summary

Gingival crevicular fluid (GCF) is an inflammatory exudate that can be collected at the gingival margin or within the gingival crevice. The biochemical analysis of the fluid offers a non invasive means of assessing the host response in periodontal disease. Active phase of periodontal disease process can be measured or assessed by the constituents of gingival fluid. Bacterial enzymes, bacterial degradation products, connective tissue degradation products, host mediated enzymes, inflammatory mediators, extracellular matrix proteins either together or individually can be detected in higher levels in gingival crevicular fluid during active phase of periodontitis.