Gingival Crevicular Fluid

http://flipper.diff.org/app/items/info/379
http://www.ncl.ac.uk/dental/oralbiol/oralenv/mcqs/saliva/ging-fluid2.htm

crevicular fluid (cf) is produced by the sulcular epithelium of the oral mucosa. It is contains
immunologic defense mechanisms. In times of inflammatory processes of the gingiva, like
gingivitis or periodontitis, the production of cf is increased, even before the inflammation is
clinical visable. The productionrate may be used to determine the early stage gingival
inflammation.

The production of gingival crevicular fluid seems to be associated with inflammatory processes
and not a product of a healty tissue.
Some of its components are probably more involved than others in the developement of the
periodontal desease:
cathepsin-K
interleukin-4 and interferon-gamma
leptin
osteocalcin
alcaline phosphatase

Answers:
marginal gingiva = 1mm wide.

Gingival sulcus is the shallow crevice or space around the tooth bounded by the surface of the
tooth on one side and the epithelium lining of the free margin of the gingiva on the other.
It has a V shape.
Histologyical depth = The depth of the suclus is a very important parameter = ~1/2 -1 cm
the histological parameter.
Clinical depth = 2-3 mm using periodontal probe.

The sulcular epithelium - extend from coronal part of junctional epithelium to the crest of ginigval
margin.
The sulcular epithelium doesnt contain rete pegs.
It is non keratinized - no granulusom and cornium strada.

Junctional epithelium - stratified squamous non-keratizinied epithelium. The length is 0.25-

1.35mm.
Contains cells of:
Basal cells
Suprabasal cells.

The junctional epithelium is formed by the confluence of the oral epithelium and the REE.
Although, REE is not essential for its formation.

Gingival fluid (sulcular fluid) - gingival crevicular fluid is the fluid that leaks/seeps into the sulcus
from the CT through the sulcular epithelium.

Function:
1. Cleanse material form the sulcus - cells & potentially dangerous bacterial molecules.
2. Contain sticky plasma proteins, that may improve adhesion of the epitheliumto the tooth.
3. Posses antimicrobial properties (immonoglubins) - immunologic defense mechanisms.
4. Exert antibody activity to defend the gingiva.
5. Plaque formation - induced by calcium ions on the gingival margin.

Crevice = narrow opening or fissure.

High amount of cytokin (any substance secreted by the immune system & have effect on other
cells) may be a sigh of periodontal disease.

The GCF is secreted in minute amounts. ? about 0.04ml

Composition:
Polymorphonuclear leikocytes (neutrophils).
Lymphocytes.
Monocytes.
Organic ions: Sodium, potassium, calcium, magnesium, phosphate.
Organic molecules:
Proteins 70 g/l
Albomins 35 g/l
Gammaglobulin 7.5 g/l.
immunoglobins.
Minerals (salts).
Enzymes:
Acid phosphatase.
Alcaline phosphatase.
Cathepsin B, D.
Collagenase.
Dipeptidil peptidase.
Elastase.
glucuronidase.
Hyalunonidase.
Lactate dehydrogenase.
Lactoferrin.
Lysozyme.
Plasminogen activator.
Bacterial products.
 Epithelial cells (shedded/desquamation).

Negative effects;
Tartar formation induced by alcaline phosphatase. (Tartar - hard calcified deposite that
forms on the tooth and contributes to the formation of the decay). Deposite of various
salts from food - e.g. calcium carbonate.
Proteolytic enzymes are dangeroud for the gingival sulcus and other gingival tissue.

Composition information -
Contains more potassium and sodium than serum (is the blood component without RBC,
WBC or clotting factors).
Derived from serum.
It doesnt inhibit the growth of bacterial anaerobes. Because anaerobes inhibitions would
occure only on oxygen presence or the presence of a substance which provided oxygen.
(i.e. an oxidising agent).
IgA present but not the secretory form because gingival fluid is an exudate or
transudate.

Exudate - fluid that filters through the circulatory system to cavities or inflamation or lesions. It is
cause by increases permeability. Secreted during inflamation
Transudate - caused by increased hydrostatic pressure (the pressure that fluid exerts when it
is at rest). Healthy gingiva secretion.

Components of the dental pellicle include:

Albumin.
Lysozyme.
Amylase.
Immunoglobulin A.
Proline-rich proteins and mucins.
The formation of pellicle is the first step in plaque formation.

Collecting the fluid-

1. by absorbent paper strips - inserted into the gingival crevice. The fluid will be collected
from the paper strips by centrifugation (seperation of substance of different densities).
2. By holding a thin glass tube against the gingival crevice.

Saliva consists of 95-97% water, pH 6.75-7, digestive enzymes - amylase and lipase, mucin
(glycoproteins) - water & mucus.

inhibition of secretion :
1. Dehydratioon
2. Strong sympathetic control (decreases saliva gland secretion) - stress low blood flow.

Gingival fluid:
 It is potential use as a diagnostic or prognostic biomarker of the biologic state of the
epithilium in healthy and disease.
Contains components of connective tissue epithelium, inflammatory cells, serum, and
microbial flora inhabiting the gingival margin or the sulcus.
Amount of gingival sulcus is very small in healthy sulcus.
During inflamatiom the gingival fluid increases.
The main root of the gingival fluid diffusion is through the basement membrane, though
the relatively wide intra cellular spaces of the junctional epithelium, and then into the
sulcus.
Quantity = 0.5-2.5mm of liquid thickness in gingival sulcus.
1-10 microliter flow hourly is ~1.7-4 microliter. -wrong?
1.7microliter is normal hourly flow.

fluid quantity from summaries of 1st semester 0.4-0.6ml of fluid.

Dental calculus (tartar) caused by calcification of dental plaque.

Periodontal probes tipped instrument with millimeter markings. healthy depth is 1-3mm. Depth =
from the crest of marginal gingiva and apical portion of the gingival sulcus. (when the depth of
the sulcus is reached selient resistance is encountered.
Bleeding after probing occurs as a result of bacterial plaque affecting the gingival tissue.