Gingival Crevicular Fluid (GCF) PDF

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Summary

The gingival sulcus which is a groove around the tooth structure ranged in depth
from 0.5-2mm is normally filled with a fluid called gingival crevicular fluid (GCF).
Increasing of GCF is defined as one of the most important feature of the inflammatory diseases; the fluid could be seen no...

Description

Lecture 18 Periodontics Gingival Crevicular Fluid (GCF) The gingival sulcus which is a groove around the tooth structure ranged in depth from 0.5-2mm is normally filled with a fluid called gingival crevicular fluid (GCF). Increasing of GCF is defined as one of the most important feature of the inflammatory diseases; the fluid could be seen normally in the gingival sulcus, but its flow increased with the presence and severity of the inflammation.

Mechanism of production: When we have injury to the blood vessels (chemical, bacterial---), this irritation induces temporary blood vessels contraction, this contraction will lead to a temporary local anemia. After that the blood flow will increased leading to local hyperemia in that area due to the blood vessels dilation (arteriolar, capillary and venular) & seepage of the GCF through the blood vessel wall. This dilation will increase the vascular permeability & then seepage of the plasma fluid & proteins of high & low molecular weight through the blood vessel. This phenomenon (injury, local anemia, dilation & increase in the permeability & seepage of plasma fluid & proteins) is called exudation, which is one of the most important features of any inflammatory reaction.

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Functions of GCF: 1 – Washing out the gingival sulcus. 2 – Contain plasma proteins that improve epithelium adhesion to the tooth surface. 3 – Has antimicrobial activity by means of leukocytes. 4 – Has immunologic defense action as it contain certain types of antibodies.

Compositions of GCF 1-Cellular elements for example Epithelial cells. . 2- Electrolytes: for example Sodium. 3- Organic compounds: for example Carbohydrates.

4- Metabolic & bacterial products: for example Lactic acid. . 5- Enzymes: for example Acid phosphatase. 2

Clinical measuring and analysis of GCF. A – Staining the paper strip with 0.2% Ninhydrin stain B – Electronically by using of Periotron.

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Clinical significance 1 – Formation of gingival crevicular fluid & its relation to inflammation. One of the characteristic features of inflammatory P.D. disease is the production of GCF. This fluid flows into the oral cavity through the orifice of the gingival sulcus or

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gingival pocket. Studies had correlate the GCF flow & severity of inflammation, they assess the severity of the gingival inflammation by means of Gingival Index (GI) & correlate this severity with the GCF flow, they found that GCF out flow increased directly with the severity of the gingival inflammation. Other studies try to correlate the GCF flow & the histological changes in the gingiva. They found a fluctuant correlation between the GF flow & histological degree of inflammation when taken from different types of gingival inflammation.

As a conclusion they reached into a fact that this fluid reported as inflammatory exudates & they agreed that the flow of GCF started few days before appearance of the clinical signs & symptoms of gingival inflammation. Note: GCF is exudate & serum is transudate & the difference between them is in the Na\K ratio. 2 – Relation of GCF to oral hygiene measures. Several experiments conducted by different researchers showed that the GCF flow correlated directly with the PLI scores. First of all, they treated a group of dental students & cleaned their teeth in order to remove any dental plaque and gingival inflammation until they reach zero scores on PLI. Then the oral hygiene measures were omitted to allow plaque accumulation and gingivitis to occur. GCF out flow was collected through out this experiment and data was analyzed. They found that the GCF flow increased with the increasing of plaque amount & severity of the inflammation. Then those students told to restart the oral hygiene measures, they found that the GCF flow tends to decreased & return to normal .

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3 – Monitoring GCF to assess the response of tissue to various periodontal therapy measures . Group of researchers had selected a number of patients & subjected them to different types of periodontal treatment; they tried to measure the GCF flow before & after each type of treatment. They used the GCF weight. (Weighting the filter paper points before & after insertion in the pocket), or by using the Periotron. to assess the effectiveness of the treatment. These procedures were followed for different periodontal treatment as scaling; root planning, curettage, gingivectomy and flaps. 4 – Monitoring GCF composition to evaluate the rate of local destruction. A – Hydroxyproline enzyme. B – Collagenase activity. 5 – Relation between GCF composition & systemic diseases. A – Glucose level increased in D.M. B – Urea level altered in alteration of protein kidney function. C - Lactic acid level increased in liver diseases. D - Calcium level increased in hyperparathyroidism. E - Alkaline phosphatase level increased in Paget's diseases & rickets. F - Acid phosphatase level altered during certain forms of carcinoma. Note : type of diet (soft or hard) was found to have an effect on GCF out flow ,it was found that hard diet induced more GCF out flow compared with soft diet.

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