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Gingival crevicular fluid measure

on individual tooth by use of Periotron 8000


Yong-C heol H yun, Yu-Jeong Lee

Dr. Hyun's Dental Clinic, Hwaseong-si, Korea

ABSTRACT

Objective and methods: The authors have experimented for gingival crevicular fluid measurement by use of
Periotron 8000, at the gingival sulcus on 6 teeth as such tooth as upper and lower, right and left first Molar
and upper and lower central Incisor, to calculate the co-relation co-efficient, in order to find the proper and
simple way to measure the Gingival crevicular Fluid Measurement on the simple tooth , instead of checking
at all 6 teeth portions, 30 volunteers who were out-patients, visited at the dental clinic were participated for
the study in the period of December of 2008 to February in 2009 at one of the dental hospital in Hwaseong
district. Corelation coefficient on the Gingival crevicular Fluid Measurement were calculated both in between
at each tooth and at all 6 teeth include at the associated tooth and at each tooth and at all 5 teeth exclude at
the associated tooth.

Results: Co-relation co-efficient was the most in amount of the gingival crevicular between at the upper right
first Molar portion(r=0.821, p<0.001) and the other 6 portions include the indicated tooth portion, and the next
between at the lower right first Molar portion(r=0.6655, p<0.001) and at the other 6 portions. Co-relation
co-efficient was the most in amount of the gingival crevicular between at the upper right first Molar
portion(r=0.6327, p<0.001) and the other 5 portions exclude the indicated tooth portion, and the next between
at the lower right first Molar portion(r=0.4213, p<0.05) and at the other 5 portions.

Conclusion: It was recommended that the gingiva crevicular fluid would be checked with Periotron 8000 at the
upper right 1st Molar area, in consideration of the simplification and the reliability of the technique, instead
of the checking at all portions in clinical.

Key Words: Correlation, PFRI

Corresponding author's e-mail: hyunyc21@chollian.net (Yong-Cheol Hyun)

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International Journal of Clinical Preventive Dentistry. 2009, Volume 5, Number 1

and related with the results at the whole teeth. For


1. Introduction examples, S-PHP or S-OHI index has been developed and
used in clinical, instead of the standard patient Hygiene
Many researches have reported about the relationship Performance index or Oral Hygiene Index, for checking the
between the gingival crevicular fluid and the severity of dental plaque or oral hygiene state exam.
gingivitis. Gingival fluid in the gingival sulcus would be So in this study, co-relation co-efficient was calculated
increased in amount in case of the cause of the with the result of the gingival cervical fluid at the
inflammation of the gingival tissue(1). Gingival fluid individual tooth and the average of the results or at the
contains lots of thin epithelial cells from the connective teeth as included with the individual tooth or for at the 5
tissue in the gingival sulcus and the gingival sulcus can be teeth as excluded with the individual tooth, in order to find
cleaned with the gingival fluid. The gingival fluid has such the proper tooth to be selected for objectives on measuring
functions as containing the plasma protein which help the the gingival crevicular fluid instead of the examine the
absorption of epithelium to the tooth surface, anti- bacterial whole teeth.
effect and the anti-body reaction for barrier at the gingival
tissue. 2. Materials and Method
Le H. and Holm-Pedersen have defined the gingival
fluid as not fluid flowing contentiously but fluid as a kind 2.1. Subjects
of the exudates liquid(2,3). So it can not be obtained thee 30 volunteers aged 20s to 40s. who were visited as an
gingival crevicular fluid on the normal gingiva. Under the out patients at Dr. Hyun's Dental Clinic, without any
conception above the measurement of the gingival crevicular problems as systemic diseases or specific oral appliance,
fluid is introduced as one important methods to estimate or were participated in the study. Age and the gender
to predict the gingival inflammation and various procedures distribution was shown in table 1.
with the researches have been developed for checking the
amount, component, origins or function of the fluid by the Table 1. Age and gender distribution of the subjects
evidences based. age male female total
Such method as paper strip, micro-capillary tubes, micro 20 S 5 4 9
pipettes, micro syringe and plastic strip are for measuring 30 S 4 4 8
the gingival crevicular fluid. Among them the most frequent 40 S 11 2 13
total 20 10 30
used is known as the method with the use of the paper
strip. Periotron (Harco Electronics, Canada) was developed
as one of the measuring until for gingival crevicular fluid 2.2. Checking Device
amount by use of the paper strip. The principle for acting
Periotron 8000 (Harco. Electronics, Winnipeg, Manitiba,
of Periotron is known that the digital signal can be obtained
Canada) was selected for measuring the gingival crevicular
through the checking the amounts of the electronic flow in
fluid and Periopaper Strip (Oraflow, Smithtown, New York,
wet strip with the gingival fluid. The more electronic flow
USA) was used for the materials of the gingival fluid
can be measured with the wet strip state. The merits of the
collection strips(figure 1).
unit is introduced as easy and simple manipulation with the
quick appearance of the result and the high relationship for
the representatives with the gingival inflammation state(4). 2.3. Procedure
In clinical use of Periotron device 28 of all teeth in the 2.3.1. Adjustment for the device
mouth might be included in the gingival sulcus, but it
1) Turn on the power switch of Periotron 8,000 in
would be incontinent for dental patient because of the long
10 minute's before use.
chair time or relatively high cost for the consummation of
2) Open the sterilized packet for Periopaper strip and
lots strip materials. So it needs for checking it with the
mounting the Periopaper strip sheet on the holder in
simple way by selecting the objective tooth representative
which laid on the upper portion of Periotron device.

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Gingival crevicular fluid measure on individual tooth by use of Periotron 8000

Figure 1. Periotron 8000 (Harco. Electronics, Figure 2. GCF checking by using Periotron
Winnipeg, Manitiba, Canada)

3) Hold the one of Periotron strip with the cotton 3) Dry the indicated tooth and surrounding gingiva by
pliers and lay it on the sensor of the Periotron use of the air syringe.
meter. 4) Using cotton piers, grasp the orange plastic handle
4) Adjust the 0 point with the frontal control wheel of a Periopaper strip and pull a fresh strip from its
of Periotron. clean plastic support mounted on the Periopaper strip
5) Acting for 16 seconds in order to control for 0 holder.
point. 5) Insert the white portion of the strip into the
6) Discard used strip after controlling for 0 point. gingival crevice carefully, for applying the
7) Preparation for measuring the gingival crevicular intra-sulcular method, and remove out the pliers
fluid. holding on the strip and waiting for 5 seconds in
order to absorb the gingival crevicular fluid to the
strip.
2.3.2. Interview for subjects 6) Remove out the strip from the gingival crevice by
holding the orange colored handle of the strip with
1) Collect the volunteers for the study and let them the cotton pliers.
sign on the agreement sheet. 7) Move the strip to Periotron meter for checking the
2) Prohibit tooth-brushing or flossing in 2 hours measure.
before measuring. 8) Lay the white portion of the strip on the lower
3) Explain the procedure to subjects as safe and sensor of Periotron and full the movable upper
simple. sensor arm to frontal direction, to close or to
4) Check the menstruations period for woman because contact for both sides of the sensors to the strip.
of the higher value in the period of ovulation 9) Read the digital number of the amounts for the
5) Check the medical history, hormonal contraception gingival crevicular fluid at the reading panel in
agent, or smoking. front.
10) Measure it repeatedly at all subjected teeth, and it
2.3.3. Procedure for checking will takes about 1 minute for a measurement.
11) If the remnant cervical fluid or debris are on the
1) Select 6 portions of the teeth as 4 first Molars sensor, it should be cleaned with the paper tissue
and upper and lower Incisors, to measure the with 70% alcohol and dried paper. And then, 0-point
amount of the gingival crevicular fluid. re adjustment should be done again.
2) Isolate the indicated tooth by use of the cotton 12) 0-point readjustment should be done if needed.
roll. 13) The criteria of the result for Periotron meter

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International Journal of Clinical Preventive Dentistry. 2009, Volume 5, Number 1

Table 2. Co-relation co-efficient on the Gingival Crevicular Fluid Measurement between at each tooth and at all 6 teeth include at the
associated tooth
Associated tooth Number n r p App
16 30 0.8278 0 **
11 30 0.352 0.0564 -
26 30 0.4461 0.0135 *
36 30 0.6211 0.0002 **
31 30 0.4572 0.0111 *
46 30 0.6655 0.0001 **

Table 3. Co-relation co-efficient on the Gingival Crevicular Fluid Measurement between at each tooth and at all 5 teeth exclude at the
associated tooth
Associated tooth Number n r p App
16 30 0.6327 0.0002 **
11 30 0.1163 0.5406 -
26 30 0.2457 0.1905 -
36 30 0.3064 0.0996 -
31 30 0.3238 0.0809 -
46 30 0.4213 0.0204 *

would be as followings; 4. Discussion


a: 0-20 ; Tissue is healthy show little or no
inflammation, The existence of the gingival crevicular fluid has been
b: 20-60 ; Mild inflammation but not known since 19C and the researches for its compositions,
periodontitis, defense mechanism in oral cavity and its function had begun
c: 60-150 ; Indicates moderately severe condition, to be studied by Waerhaug(5), Brill and Krasse(6) in 1958.
d: >150 ; Very severe inflammation Brill and Krasse(6) had experimented with the dog that
fluorescent materials could be found on the filler paper strip
2.4. Statistical analysis which was inserted into the gingival sulcus of the dog, with
in 3 minutes, after injecting the fluorescent materials through
Co-relation co-efficient was calculated between the value intra muscular injection to the body of the dog. It was
of the amounts for gingival crevicular fluid measured at the explained that the fluorescent materials would be flew with
indicated tooth and those of the average means measured at the blood to gingival sulcus. Moreover Brill(7,8) had found
6 portions as 44 first Molars and upper & lower central the existence of the gingival crevicular fluid in human body
Incisor include the indicated tooth portion or the means as considered as transudation. But many researchers(1,2) had
measured at 5 portions excluded the indicated tooth portion, insisted it as the inflammatory exudates.
by use of SPSS 1.0 program. One of the difficulties for collecting the gingival
crevicular fluid is getting very little amount of the exudates
3. Results from the gingival sulcus. Many procedures and
techniques(2,9-16) have been tried to collecting the gingival
Table 2 shows co-relation co-efficient on the Gingival crevicular fluid as such methods as using the filter paper,
Crevicular Fluid Measurement between at each tooth and at inserting the silk strip into the gingival sulcus, using the
all 6 teeth include at the associated tooth, and table 3 micro tube or cleaning the gingival sulcus.
shows Co-relation co-efficient on the Gingival Crevicular The method for inserting the absorbed paper strip is
Fluid Measurement between at each tooth and at all 5 teeth classified as the intra sulcular and Extra sulcular method.
exclude at the associated tooth. The placement of the filter strip in relation to sulcus or

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Gingival crevicular fluid measure on individual tooth by use of Periotron 8000

pocket is important. On Brill method, the absorption paper Climason(18) has reported that about 0.1mg of the
should be inserted until be felt for resistance, in order to gingival crevicular fluid could be absorbed by use of the
stimulate to gingival epithelium to induce the fluid from absorption paper of 1.5mm width and 1mm inserting into
there. the gingival sulcus for 3 minutes, in mild gingivitis area.
Le and Holm-Pedersen(2) have suggested the inserting Challacombe(25) has tried to measure the gingival
technique of the absorption paper on the entrance of the crevicular fluid by use of the injecting the dilution of the
gingival pocket, in order to minimize the gingival irritation. radioactive materials(isotope) into the body.
The gingival crevicular fluid might be absorbed in the paper Through this method, he has got average 0.45 to 1.5ml
without contact with the gingival epithelium by this of the gingival crevicular fluid at the inter proximal area of
technique. the molar tooth from the volunteers who were below the
Weinsteim et al.(3) have estimated the amount of the degree 1 of average gingival index.
gingival crevicular fluid through inserting the twisted silk Gingival fluid is known as the inflammatory exudate(2).
into the gingival sulcus and measuring the weight after full Gingival crevicular fluid can be found an inflammatory
it out. Osmotic pressure was applied by use of the micro tissue in microscopic findings even though on healthy
tube to measure the gingival fluid with inserting the gingiva in clinical.
standard size and length micro tube into the gingival sulcus The amount of the fluid is increased proportion to the
and then analyze the contents by use of the centrifuge(8-10). severity of the gingival inflammation (20,21).
Gingival sulcus cleaning technique is used for analysis on It can be increased on such situations as chewing the
normal gingiva in clinical. Among the various types of the rough foods, tooth-brushing, gingival massage, ovulation(24),
methods, absorption paper strip technique is the most in take the hormonal contraceptives(25) and smoking, even
frequently used because of it's convenience, and the fluid though not influenced by the trauma from occlusion(22).
with the wet absorption paper would be used to be Also, it can be increased in the day time and decreased in
measured. The wet portion on the absorption paper can be naught time or sleeping time(2).
shown distinctly through the dying with Ninhydrin. Periodontal treatment can be one of the causing factors to
Two methods can be introduced for analyzing the fluid as influence the amount of the gingival crevicular fluid(28).
Ninhydrin staining method as observing the stained area on Estrogen as a female hormone can influence to increase the
the paper with the microscope or magnifying glass, and the gingival crevicular fluid by increasing the permeability of
electronic method as changing the wet amount with the the blood vessel(29). So in case of the ovulation(30),
gingival crevicular fluid on the paper strip into the pregnancy and the using the oral pill(31),it can be increased.
electronic current by use of the electronic transducer, such Mastication(8) or hard brushing also influence the flow of
as Periotron device. There was no difference the value of the gingival fluid by stimulation of the gingival tissue with
the measure for gingival crevicular fluid, between these two mild degrees, like as inserting the absorption paper into the
methods1(7). gingival sulcus.
It was known that the value of measured score would be In spite of the effectiveness of the measuring the gingival
various according to gingival inflammatory state. Under the crevicular fluid for checking the presence or the prediction
score 60, it might be judged as normal or mild of early stage of the gingivitis or the periodontitis, it might
inflammation. In case of over score 60, it would be be inconvenient for checking at all portions of the gingival
estimated as active bacterial activities and high risk for sulcus for each patient in clinical. So, 6 portions checking
process on periodontitis, with showing the epithelial method, like examining the simplified oral hygiene index or
attachment loss and periodontal pocket formation with modified patient hygiene performance index, would be
probing in clinical, so it can be imagined more severe in suggest by clinicians. More over 1 portion checking method
periodontitis according to increase the value for measuring, at the most representative portion would be needed for
in over score 60. checking with convenient in clinical.
The amount of the gingival crevicular fluid collected According to the results of this study, the most
might be very few. representative portion was estimated at upper right

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International Journal of Clinical Preventive Dentistry. 2009, Volume 5, Number 1

molar(r=0.8278, p<0.01) and lower right molar gingival crevicular between at the upper right first Molar
portion(r=0.6655, p<0.01) in next, calculated with the portion(r=0.821, p<0.001) and the other 6 portions include
co-relation co-efficient. the indicated tooth portion, and the next between at the
It was the same result in significant test both in lower right first Molar portion(r=0.6655, p<0.001) and at the
calculating the co-relation co-efficient between at the other 6 portions.
indicated tooth and the other 6 portions include the
indicated portion(table 2), and between the indicated tooth 2. Co-relation co-efficient was the most in amount of the
portion and the other 5 portion excluded the indicated gingival crevicular between at the upper right first Molar
portion.(table 3) portion(r=0.6327, p<0.001) and the other 5 portions exclude
Even though it was not clear for the evidence why it the indicated tooth portion, and the next between at the
revealed the high relationship on right side portion of molar lower right first Molar portion(r=0.4213, p<0.05) and at the
tooth, the measurement of the gingival crevicular fluid at other 5 portions.
upper/lower right molar portion could be a representative
value for ones mean value for the amount of the gingival It was recommended that the gingiva crevialar fluid
crevicular fluid. would be checked with Periotron 8000 at the upper right 1st
It should be needed for further studies to find the reasons Molar area, in consideration of the simplification and the
to be more related at the upper and right portion than at reliability of the technique, instead of the checking at all
the lower, left or anterior portion. portions in clinical.
According the clinical experiment, the measurement of the
gingival crevicular fluid at the upper right molar portion Reference
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