GINGIVAL FLUIDGINGIVAL FLUID

GINGIVAL FLUIDGINGIVAL FLUID

Permeability of JE & SEPermeability of JE & SE

Role of GCF, Leucocyte & SalivaRole of GCF, Leucocyte & Saliva

GCFGCF

Sulcular fluid /Gingival Crevicular Sulcular fluid /Gingival Crevicular FluidFluid

1919thth Century Century Waerhaug and Brill and Krasse 1950Waerhaug and Brill and Krasse 1950 Transudate(Brill)Transudate(Brill) Inflammatory Exudate(Others)Inflammatory Exudate(Others)

METHODS OF COLLECTIONMETHODS OF COLLECTION

Absorbing paper stripsAbsorbing paper strips Twisted threadsTwisted threads MicropipettesMicropipettes Intracrevicular washingsIntracrevicular washings

PERMEABILITY OF JE&SEPERMEABILITY OF JE&SE

Fluorescein initially(Brill&Krasse)Fluorescein initially(Brill&Krasse) Confirmed with India Confirmed with India

ink&saccharated ironink&saccharated iron Albumin,endotoxin,thymidine,histamiAlbumin,endotoxin,thymidine,histami

ne,phenytoin &Horseradish ne,phenytoin &Horseradish peroxidaseperoxidase

Mol wt 1000kDMol wt 1000kD

AMOUNT OF GCFAMOUNT OF GCF

Wetted Paper strip(ninhydrin stain) Wetted Paper strip(ninhydrin stain) evaluated with Microscopeevaluated with Microscope

Periotron(Electronic Methods)Periotron(Electronic Methods) 1.5mm wide &1mm within GS 1.5mm wide &1mm within GS

=0.1mg GCF(3min)=0.1mg GCF(3min) Molar 0.43-1.56m LMolar 0.43-1.56m L

COMPOSITIONCOMPOSITION

Cellular Elements Cellular Elements

ElectrolytesElectrolytes

Organic CompoundsOrganic Compounds

CELLULAR ELEMENTCELLULAR ELEMENT

BacteriaBacteria

Desquamated epithelial cellsDesquamated epithelial cells

Leukocytes(PMNs,Lymphocytes,MonoLeukocytes(PMNs,Lymphocytes,Monocytes/Macrophages)cytes/Macrophages)

ELECTROLYTESELECTROLYTES

PotassiumPotassium

SodiumSodium

CalciumCalcium

ORGANIC COMPOUNDSORGANIC COMPOUNDS

Carbohydrates & ProteinsCarbohydrates & Proteins Glucose hexosamine & hexuronic Glucose hexosamine & hexuronic

acidacid Glucose conc(GCF) 3-Glucose conc(GCF) 3-

4times>>Serum4times>>Serum Total Protein(GCF) much less than Total Protein(GCF) much less than

SerumSerum Metabolic&Bacterial ProductsMetabolic&Bacterial Products

Enzymes&Other Enzymes&Other CompoundsCompounds

Acid phosphatase,Alkaline Acid phosphatase,Alkaline phosphatase,α1 phosphatase,α1 Antitrypsin,Arylsulfatase,Aspartate Antitrypsin,Arylsulfatase,Aspartate aminotransferase,aminotransferase,

Cathelicidin LL-37,AlanineCathelicidin LL-37,Alanine

aminotransferase,Chondroitin aminotransferase,Chondroitin sulfatas,Citric acid,Cystatins,sulfatas,Citric acid,Cystatins,

Cytokines (interleukins), IL-1α  IL-1β  IL-Cytokines (interleukins), IL-1α  IL-1β  IL-4, IL-6, and IL-8  IL-11, IL-12  IF-gamma.4, IL-6, and IL-8  IL-11, IL-12  IF-gamma.

Enzymes&Other Compounds Enzymes&Other Compounds contd..contd..

Endopeptidases:  Cathepsin Endopeptidases:  Cathepsin D, Cathepsin B/L, Cathepsin D, Cathepsin B/L, Cathepsin G,  Cathepsin K,  Elastase,Plasminogen G,  Cathepsin K,  Elastase,Plasminogen activatoractivator

Collagenase,Tryptase-like Collagenase,Tryptase-like enzyme,Trypsin-like enzyme,Trypsin-like enzyme,Dipeptidylpeptidase IV–like enzyme,Dipeptidylpeptidase IV–like enzyme,Elastase–α1-proteinase inhibitorenzyme,Elastase–α1-proteinase inhibitor

Enzymes&Other Compounds Enzymes&Other Compounds contd..contd..

Exopeptidases,Fibrin,Fibronectin,β-Exopeptidases,Fibrin,Fibronectin,β-glucuronidase,Glycosidases, α1-glucuronidase,Glycosidases, α1-Fucosidase  Sialidase Fucosidase  Sialidase 

  β-β-NN-acetylglucosaminidase  β--acetylglucosaminidase  β-Galactosidase  β-Galactosidase  β-MannosidaseHyaluronidaseMannosidaseHyaluronidase

Immunoglobulins (IgG, IgA, IgG4, Immunoglobulins (IgG, IgA, IgG4, IgM),IgM),

Enzymes&Other Compounds Enzymes&Other Compounds contd..contd..

Lactate Lactate dehydrogenase,Lactoferrin,Lactic dehydrogenase,Lactoferrin,Lactic acid,Lysozyme,α2-Macroglobulinsacid,Lysozyme,α2-Macroglobulins

Medullasin,Metalloproteinases,MyeloMedullasin,Metalloproteinases,Myeloperoxidase,Prostaglandin E2 peroxidase,Prostaglandin E2 (PGE2),Transferrin,Thromboxane.(PGE2),Transferrin,Thromboxane.

Compounds&Enzymes of Compounds&Enzymes of Bacterial OriginBacterial Origin

    Acidphosphatase, Alkalinephosphatase,  Acidphosphatase, Alkalinephosphatase,  

Aminopeptidases,  Chondroitin sulfatase, Aminopeptidases,  Chondroitin sulfatase,

   Chymotrypsin-like product, Collagenase,Chymotrypsin-like product, Collagenase,

   Deoxyribonuclease, DNase,Deoxyribonuclease, DNase,

   Dipeptidylaminopeptidase IV–like Dipeptidylaminopeptidase IV–like enzyme, enzyme, 

Compounds&Enzymes of Compounds&Enzymes of Bacterial Origin contd…Bacterial Origin contd…

Fibrinolysin, Glucosidases,  HemolysiFibrinolysin, Glucosidases,  Hemolysin, Hyaluronidase,  Iminopeptidases,   n, Hyaluronidase,  Iminopeptidases,   Immunoglobulinases, β-Lactamase,Immunoglobulinases, β-Lactamase,

Lysophospholipase,   Phospholipase Lysophospholipase,   Phospholipase A,   Phospholipase C,  Prostaglandin-A,   Phospholipase C,  Prostaglandin-like product,   Trypsin-like enzymelike product,   Trypsin-like enzyme

Cellular & Humoral ActivityCellular & Humoral Activity

Non invasive methodsNon invasive methods Identify cell&humoral responses in Identify cell&humoral responses in

Health/DiseaseHealth/Disease IL-1alpha&IL-1Beta increase the IL-1alpha&IL-1Beta increase the

binding of binding of PMNs&monocyte/macrophages PMNs&monocyte/macrophages

Interferon-alpha may have protective Interferon-alpha may have protective rolerole

Analysis of specificity of antibodiesAnalysis of specificity of antibodies

Clinical SignificanceClinical Significance

Amount of GCF directly proportional Amount of GCF directly proportional to the severity of inflammationto the severity of inflammation

GCF production increase by GCF production increase by mastication,toothbrushing,gingival mastication,toothbrushing,gingival massage,ovulation,oral massage,ovulation,oral contraceptive&smoking.contraceptive&smoking.

Circadian Periodicity- 6am-10pmCircadian Periodicity- 6am-10pm

Clinical Significance contd…Clinical Significance contd…

Sex Hormone: female sex hormone Sex Hormone: female sex hormone increase GCFincrease GCF

Mechanical stimulation: chewing Mechanical stimulation: chewing &vigorous Tooth brushing&vigorous Tooth brushing

Smoking: transient marked increase Smoking: transient marked increase GCFGCF

Periodontal therapyPeriodontal therapy

Drugs in GCFDrugs in GCF

Drugs that are excreted in GCFDrugs that are excreted in GCF

Bader&Goldhaber : Dogs GCF Bader&Goldhaber : Dogs GCF (Tetracyclin)(Tetracyclin)

Metronidazole Metronidazole

Leuckocytes in the Leuckocytes in the Dentogingival AreaDentogingival Area

Predominantly PMNsPredominantly PMNs Clinically healthy sulci 91.2%-Clinically healthy sulci 91.2%-

91.5%PMNs&8.5-8.8%mononuclear cells91.5%PMNs&8.5-8.8%mononuclear cells Mononuclear cells 58%B-Mononuclear cells 58%B-

lymphocyte,24%T-lymphocyte,24%T-lymphocyte&18%mononuclear lymphocyte&18%mononuclear phagocytephagocyte

Peripheral blood T/B lymphocyte 3:1Peripheral blood T/B lymphocyte 3:1 GCF T/B lymphocyte 1:3GCF T/B lymphocyte 1:3

MCQ -1MCQ -1

Which of the following cytokines in Which of the following cytokines in Gingival crevicular fluid may have Gingival crevicular fluid may have protective role in periodontal protective role in periodontal diseasesdiseases

a-Interleukin 1-alphaa-Interleukin 1-alpha

b-Interleukin 1-beetab-Interleukin 1-beeta

c-Interferon-alphac-Interferon-alpha

d-Prostaglandin-E2 d-Prostaglandin-E2

MCQ-2MCQ-2

Most common antibiotic that is excretedMost common antibiotic that is excreted

through the gingival crevicular fluid may through the gingival crevicular fluid may bebe

used advantageously in periodontal used advantageously in periodontal therapytherapy

a-Amoxicillina-Amoxicillin

b-Doxycyclinb-Doxycyclin

c-Cefalosporinc-Cefalosporin

d-Erythromycind-Erythromycin

MCQ-3MCQ-3

The following factors are responsible forThe following factors are responsible for

enhancement of production of gingivalenhancement of production of gingival

crevicular fluid crevicular fluid EXCEPTEXCEPT

a-smokinga-smoking

b-trauma from occlusionb-trauma from occlusion

c-vigorous brushingc-vigorous brushing

d-healing period after d-healing period after curettagecurettage

MCQ-4MCQ-4

Which is the correct statement of glucoseWhich is the correct statement of glucose

and protein content in gingival crevicularand protein content in gingival crevicular

fluid(GCF) fluid(GCF)

a-glucose conc.3-4times greater than a-glucose conc.3-4times greater than serumserum

b-glucose conc. 3-4times lesser than b-glucose conc. 3-4times lesser than serumserum

c-total protein is more than that of serumc-total protein is more than that of serum

d-total protein is equal to that of serumd-total protein is equal to that of serum

MCQ-5MCQ-5

What are the ratio of T-lymphocytes to What are the ratio of T-lymphocytes to BB

lymphocytes in Gingival crevicular fluidlymphocytes in Gingival crevicular fluid

a-1:2a-1:2

b-2:1b-2:1

c-1:3c-1:3

d-3:1d-3:1