Defense mechanism of Gingiva

Gingival tissue
Constantly subjected to mechanical trauma and
bacterial aggression
 Epithelial barrier

 Gingival sulcular fluid

 Orogranulocytes

 Saliva
Epithelial barrier
Barrier between body and environment
Stratified epithelia
Tight cell adhesion
Retain dead keratinized squames
 Epithelial barrier
• Keratinized epithelia with cornified cell envelop
provide critical barrier
• Acute, chronic and neonatal stress effects the mucosal
barrier by increasing the permeability of epithelial
tight junction
• Junctional epithelium forms first line of defense
against microbial invasion into the tissues
• Constant and rapid cell turnover is an important factor
to remove bacteria adhering on them
• Active antimicrobial substance such as defensins,
lysosomal enzymes,chemokines released by junctional
epithelium in response of microorganism activates
defense cells.
Gingival Crevicular fluid Inflammatory
Transudate
exudate

Inflammatory Exudate

Has been known since 19th century

Composition and role in periodontal disease has been

elucidated by pioneering work of Brill and Krasse in

1950
Filter paper in the sulcus of animals previously injected

im with flourescein; within 3 minutes the flourescent from

the filter paper
Anatomy of the gingival crevice
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.

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CONCEPTS OF GCF PRODUCTION
Brill & Krasse 1958, Brill & Bjorn 1959 and Egelberg
1966 Production of fluid is related to an
inflammatory permeability of vessels underlying the
sulcular & junctional epithelium.
 METHODS OF COLLECTION:

Intra crevicular

Extra crevicular

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Method of collection of GCF
Absorbing paper strips

Twisted threads

Micropipettes

Intracrevicular Washings
 Absorbent Paper strip
These strips are placed within the
sulcus (Intrasulcular method) or at its
entrance (Extrasulcular method). The
placement of filter paper strip in relation
to the sulcus or pocket is important.
The Brill technique places it into
the pocket until resistance is
encountered.
DISADVANTAGE ---- This method
introduces a degree of irritation of the
sulcular epithelium than can, by itself
trigger the oozing of fluid.

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Pre-weighed twisted threads
(Weinstein et al 1967)

Capillary tubes / Micropipettes

(Krause and Egelberg, 1962)
 Advantages - provides undiluted sample- ‘native’ GCF

 Disadvantages
 Collection of fluid
 Obtaining sample
Gingival washings
 Method given by Skapski and Lehner, 1976

 Hamilton’s microsyringe
 10 l of Hanks balanced solution
 Compounds found permeable to junctional and sulcular
epithelium
[Brill and krasse (flourecein dye)]

 Albumin

 Endotoxin

 Thymidine

 Histamine

 Phenytoin

 Horse radish Peroxidase

 Substances with mol wt upto 1000kD were permeable

How the amount of GCF is evaluated
 By direct viewing and staining:(stain the strip with ninhyderin and
then measured)
 By weighing: (strip is weighed before and after collecting the GCF
sample)
 By electronic device peritron: (sample strip paper is inserted
between two jaws,which gives reading on the screen)
Showing Periotron measuring amount of
GCF collected
Composition
More than 40 compounds from GCF have been analysed but their origin is

not known with certainity

Primarily consist of enzymes, cellular elements, electrolytes, organic

compounds and antibacterial factors

 Cellular elements:

• Bacteria
• Desquamated epithelial cells
• leukocytes(PMN’s, Lymphocytes, Monocytes/ macrophages)
• erythrocytes
 Electrolytes:

K, Na , Ca ,flouride , magnasium and phosphates have been studied in GCF

Positive correlation of Ca and Na conc and Na/K ratio with inflammation

Organic compounds:
• CARBOHYDRATES (Glucose , hexosamine and hexuronic acid)

Blood glucose is 3-4 times greater than serum

Total protein content similar serum

PROTEINS

LIPIDS

 Metabolic products in GCF

lactic acid,
urea,
hydroxyproline,
 endotoxin,
cytotoxic substances,
Hydrogen sulphide and antibacterial factors
Cellular and Humoral activity in GCF
Cellular immune Humoral immune
component component
PMNs(95-97%) IgG (IgG 1 - IgG 4)
IgA
Monocytes(2-3%) IgM
T cells (29%)
B cells (71%)

Both IL - 1 and IL - 1 have pro-inflammatory effects and depending

on a variety of factors can stimulate either bone formation or
resorption.
Interferon-alpha may have protective role in periodontal disease
because of its ability to inhibit the bone resorption activity of IL - 1
The ratio of T-lymphocytes to B-lymphocytes is reversed from
normal 3:1 in peripheral blood to 1:3 in GCF
 Clinical significance
GCF is inflammatory exudate and positively correlates
with amount and severity of inflammation
GCF secretion follows cicardian periodicity increases 6am to 10 pm then
decreases afterwards

Female sex hormone increase GCF flow as they enhance vascular

permeability
 Mechanical stimulation like chewing and vigorous tooth brushing increases
GCF flow
 Smoking causes immediate transient but marked increase in GCF flow

 There is increase in GCF production during healing peroid following

periodontal surgery
Drugs in GCF
Tetracycline and Metronidazole are secreted through GCF
 OROGRANULOCYTES

It has been estimated that 30,000 neutrophils per minute enter the
oral cavity via gingival sulcus through the junctional epithelium
surrounding the teeth.
These viable nutrophils present in saliva are termed as
orogranulocytes or salivary corpuscles.
 Orogranulocyte migratory rate(OMR) is said to be increased with
increasing severity of gingival inflammation.
Saliva
It’s a physiologic secretion by various major and minor

salivary glands

Its has got certain major functions like mechanical

cleansing, lubricating and buffering actions

It has got antibacterial property as well

 Antibacterial factors
Can be divided into
1. Inorganic factor

2. Organic factor
1.Inorganic factors;

Includes ions and gases like

Bicarbonate, Na, k, Phosphate, Ca, Ammonium, and

Carbon dioxide
2.Organic factors; includes enzymes like

 Lysozyme: Hydrolytic enzyme that

cleaves the linkages of cell wall of both
Gm+ve and Gm –ve bacteria.
Targets Veillonella and A a
 Lactoperoxide-thiocyanate system:
Bactericidal to Lactobacillus and
Streptococcus by preventing accumulation
of lysine and glutamic acid essential for
their growth.
Lactoferrin;
Effective against Actinobacillus species

Myelperoxidase:
Released by leukocytes and is bactericidal to
Actinobacillus .
Also inhibits attachment of Actinomyces to
Hydroxyapatite.
It is similar to salivary peroxidase
Salivary enzymes
Following Enzymes are increased in periodontal disease
Hyaluronidase,

β-glucouronidase,

Chondroitin sulfate,

Aspartate aminotransferase,

Alkaline phosphatase,

Amino acid decarboxylases, Catalase, Peroxidase and

Collagenase
Saliva also contains TIMP which inhibit collagenases
Salivary Antibodies
Predominant antibody in saliva is IgA although IgG and

IgM are present

IgG is more prevalent in GCF

Major and Minor salivary gland contribute to all the

secretory IgA (sIgA)

GCF contributes to most of IgG, Complement and

PMN that, in conjunction with IgG or IgM, inactivate

or opsonize bacteria
Salivary Antibodies are synthesized locally as

they react with strains of bacteria indigenous to

mouth but not that of intestinal tract

Antibodies in saliva impairs the abilty of bacteria to

attach to mucosal or tooth surface

Salivary Buffers and Coagulation factors
Salivary buffers maintain physiologic hydrogen conc (pH)

both at mucosal surface and tooth surface

Bicarbonate-carbonic acid system is the salivary

buffer
Saliva also contains Coagulation factors

viz; (Factors VIII,IX and X, PTA, Hageman factor)

which hasten blood coagulation and protect

wound from invasion

Leukocytes
Saliva contains all types of leukocytes, but principal cells are

PMN

PMN numbers varies from person to person and at different

times of day and are increased in gingivitis

PMN in saliva are called Orogranulocyte

PMN reach the oral cavity through gingival sulcus and

this is called Orogranulocyte migration.

Role in Periodontal pathology
Saliva effects plaque intiation, maturation and metabolism

Salivary flow and composition also influences calculus

formation, periodontal disease and dental caries
There is increase in prevalance and severity of periodontal

disease as a consequence of reduced salivary flow in

Mikulicz’sdisease,

Sjogren’syndrome,

Sialothiasis,

Sarcoidosis and

Xerostomia following radiotherapy

MCQ -1
Which of the following cytokines in Gingival crevicular
fluid may have protective role in periodontal diseases
a-Interleukin 1-alpha
b-Interleukin 1-beeta
c-Interferon-alpha
d-Prostaglandin-E2
MCQ-2
Most common antibiotic that is excreted through the
gingival crevicular fluid may be used advantageously
in periodontal therapy…
a-Amoxicillin
b-Tetracycline
c-Cefalosporin
d-Erythromycin
MCQ-3
The following factors are responsible for enhancement
of production of gingival crevicular fluid EXCEPT
a-smoking
b-trauma from occlusion
c-vigorous brushing
d-healing period after curettage
MCQ-4
Which is the correct statement of glucose and protein
content in gingival crevicular fluid(GCF)
a-glucose conc.3-4times greater than serum
b-glucose conc. 3-4times lesser than serum
c-total protein is more than that of serum
d-total protein is equal to that of serum
MCQ-5
What are the ratio of T-lymphocytes to B
lymphocytes in Gingival crevicular fluid
a-1:2
b-2:1
c-1:3
d-3:1