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DEPARTMENT OF PERIODONTOLOGY & ORAL IMPLANTOLOGY

Presented by :Dr. Prateek Khanna Guided By:Dr. MAHESH J. (H.O.D. & PROF.)

GINGIVAL CREVICULAR FLUID

Gingival tissue is constantly subjected to mechanical & bacterial aggression. The saliva, the epithelial surface and the initial stage of inflammatory response provide resistance to these actions. GINGIVAL FLUID AND SULCULAR FLUID The gingival sulcus contain a fluid that seeps into it from gingival connective tissue through the thin sulcular epithelial. It cleanse material from the sulcus. Contain plasma protein that improve adhesion of epithelial to tooth. Possess antimicrobial properties. Exert antibody activity to defend the gingiva. METHOD OF COLLECTION 1. Absorbing paper strips. 2. Sampling by means of micropipettes. 3. Gingival washings. 4. Other methods.

EVALUATION: 1. By weighing the strip 2. By electronic method : using HAR600 VOLUME OF GINGIVAL FLUID: The volume is calculated by isotope dilution method.The mean gingival fluid volume in spaces from molar teeth ranged from 0.43 to 1.56 micro litre.In anterior teeth the volume was between 0.24 to 0.43 micro litre per tooth. PERMEABILITY OF JUNTIONAL& SULCULAR EPITHELIUM: The main pathway for transport across the junctional and sulcular epithelia seems to be the intercellular spaces. In presence of inflammation. Enlargement of intercellular space along with partial destruction of the basal membrane results in the inward passage of foreign substances. Substances shown to penetrate are albumin, endotoxin, thymidine, histamine, phenytoin etc.indicates permeability to substances with high mol. Wt.

COMPOSITION a.Cellular elements. Desquamated epithelial cells. Bacteria leukocytes (PMNs, lymphocytes & monocytes/macrophages) b.Electrolytes potassium sodium calcium c.organic compounds carbohydrates (glucose, hexosamine & hexaronic acid) Proteins (immunoglobulines, complement) IgG lipids d.Metabolic & bacterial products lactic acid Hydroxy proline Prostaglandins Urea Endotoxins Cytotoxic substances Antibacterial factors

e.Enzyme & enzyme inhibitors Acid phosphatase Alkaline phosphatase Pyrophosphatase Beta-glucoronidase Lysozyme Hyaluronidase Proteolytic enzymes Lactic dehydrogenase. CLINICAL SIGNIFICANCE The amount of GCF is greater when inflammation is present. GCF productions is increased by mastication of coarse foods, tooth brushing & gingival massage etc. factors influencing GCF are: Circadian periodicity- the GCF increase from 6AM to 10 PM & a deese afterward. Sex hormones- female sex hormones increase GCF flow, probably because they enhance vascular permeability. pregnancy, ovulation & hormonal contraceptives all increase gingival fluid production

Mechanical stimulation- chewing & vigorous gingival brushing stimulate flow of GCF. Smoking- Smoking produces an immediate transient but marked increase in GSF flow. Periodontal therapy- there is increase in GCF during healing period after periodontal surgery. LUCOCYTES IN THE DENTOGINGIVAL AREA The leucocytes are predominantly PMNs they appear in the connective tissue adjacent to the bottom of the sulcus, from there they travel across the epithelium to gingival sulcus where they era expelled. Differential counts of leucucytes from healthy gingival sulci shows 91.2 % of PMNs & 8.8 % of mononuclear cells. Mononuclear cells identified are 58 % B-lymphocytes, 24 % Tlymphocytes & 18 % mononuclear phagocytes. The majority of these cells found to have phegocytic and killing capacity.

FUNCTION
1. 2. 3. 4. 5. Lubrication Physical protection cleansing Buffering Tooth integrity maintainence

SALIVA Role of saliva in oral health SALIVARY COMPONANT


glycoprotein, mucoids glycoprotein, mucoids physical flow bicarbonate & phosphate minerals glycoprotein pellicle

PROBABLE MECHANISM
coating similar to gastric main coating similar to gastric main clearance of debris & bacteria Antacids maturation remineralization mechanical protection control of bacterial colonization breaks bacterial cell wall oxidation of susceptible bacteria.

6.

Antibacterial action

IgG-A

lysozyme
lactoperoxidase