DEFENSE MECHANISMS OF GINGIVA

1. Epithelium Degree of keratinization &

turn over rate.

2. Sulcular Fluid 3. Leukocytes 4. Saliva

SULCULAR FLUID/GINGIVAL CREVICULAR FLUID

Waerhaug & Brill & Krasse 1950. Brill transudate Other exudate

METHOD OF COLLECTION
In a strictly normal gingiva little or no GCF a. Absorbing paper strips. b. Pre weighed twisted threads c. Micropipettes d. Intracrevicular washing

ABSORBING PAPER STRIPS INTRASULCULAR METHOD (Placed within the sulcus) EXTRASULCULAR METHOD (Placed at its entrance)

BRILL TECHNIQUE INSERTS IT INTO THE POCKET:CAUSES IRRITATION OF THE SULCULAR EPITHELIUM THAT CAN BY ITSELF TRIGGER THE FLOW OF FLUID. LOE and HOLM-PEDERSEN :PLACED FILTER PAPER JUST AT THE ENTRANCE OF THE POCKET
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PREWEIGHED TWISTED THREADS

THREADS PLACED IN THE GINGIVAL CREVICE AROUND THE TOOTH ,AND THE AMOUNT OF FLUID COLLECTED WAS ESTIMATED BY WEIGHING THE SAMPLE THREAD.

MICROPIPETTES
COLLECTION OF FLUID BY CAPILLARY CAPILLARY TUBES OF STANDARDIZED LENGTH AND DIAMETER ARE PLACED IN THE POCKET AND THEIR CONTENT IS LATER CENTRIFUGED AND ANALYSED

CREVICULAR SHAVINGS
STUDY GCF FROM CLINICALLY NORMAL GINGIVA. METHOD 1: USES AN APPLIANCE CONSISTING OF A HARD ACRYLIC PLATE COVERING THE MAXILLA WITH SOFT BORDERS AND A GROOVE FOLLOWING GINGIVAL MARGIN CONNECTED TO FOUR COLLECTION TUBES WASHINGS OBTAINED BY RINSING THE CREVICULAR AREAS FROM ONE SIDE TO OTHER,USING A PERISTALTIC PUMP.

MODIFICATION
TWO INJECTION NEEDLES FITTED ONE WITHIN THE ANOTHER SUCH THAT DURING SAMPLING, THE INSIDE (EJECTION) NEEDLE IS AT THE BOTTOM OF THE POCKET,AND THE OUTSIDE (COLLECTING) NEEDLE IS AT THE GINGIVAL MARGIN. THE COLLECTION NEEDLE IS DRAINED INTO A SAMPLE TUBE BY CONTINUOUS SUCTION.

AMOUNT
Wetted area stained with ninhydrin Electronic method-wetness affect the flow of an electronic current-digital read out. Strip of paper 1.5 mm wide and inserted 1mm within the gingival sulcus absorbs 0.1 mg of GCF in 3 mins Mean crevicular fluid volume in proximal spaces from molar teeth ranged from 0.43 to 1.56 micro lt
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ELECTRONIC DEVICE FOR MEASURING THE AMOUNT OF FLUID COLLECTED ON FILTER PAPER
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PLACEMENT OF FILTER STRIP IN GINGIVAL SULCUS FOR COLLECTION OF FLUID A: INTRASULCULAR METHOD B & C: EXTRASULCULAR METHOD
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COMPOSITION
Proteins, specific Ab, Ag, enzyme, cellular elements 40 compounds analyzed so far. eg glucuronidase, LDH, fibroblast, PMN, collagenases phospholipase.

CELLULAR ELEMENTS Bacterial desquamated epithelial cells, leukocytes [PMNs,lymphocytes,monocytes] INORGANIC COMPONENTS Na,K,Ca
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ORGANIC COMPONENTS

Carbohydrates and proteins Glucose hexosamine & hexuronic acid Glucose concentration is 3-4 times greater than in serum Protein content much less then serum Metabolic and bacterial products
Lactic acid Urea Hydroxyproline
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ENZYMES IN GCF
ACID PHOSPHATASE ALKALINE PHOSPHATASE 1 ANTITRYPSIN ARYLSULFATASE ASPARTATE AMINOTRANSFERASE CHONDROITAN SULFATASE CITRIC ACID CYSTATINS CYTOKINES ENDOPEPTIDASES EXOPEPTIDASES FIBRIN FIBRONECTIN

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COMPOUNDS AND ENZYMES OF POSSSIBLE BACTERIAL ORIGIN DETECTED IN GCF

ACID PHOSPHATASE ALKALINE PHOSPHATASE AMINOPEPTIDASES CHONDROITAN SULFATASE CHYMOTRYPSIN LIKE PRODUCT COLLAGENASE DEOXYRIBONUCLEASE FIBRINOLYSIN GLUCOSIDASES HEMOLYSIN HYALURONIDASE

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CELLULAR/ HUMORAL ACTIVITY

CytokinesInterleukin-1,IL-1.IL-6 and IL-8 Interleukin 1 and IL 1 increase the binding of PMN and monocytes/macrophages to endothelial cells,stimulate the production of PGE2 and release of lysosomal enzymes and stimulate bone resorption Interferon :- inhibits bone resorption activity of interleukin 1- .

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CLINICAL SIGNIFICANCE
G.F. increased by mastication of coarse foods, tooth brushing, gingival massage, ovulation, hormonal contraceptives and smoking
The amount of GCF is greater when inflammmation is present and is sometimes proportional to the severity of inflammation. GCF production not increased by trauma from occlusion.
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CIRCADIAN PERIODICITY:gradual increase from 6am-10pm & a decrease afterwards. SEX HORMONE:female sex hormones increase flow-enhance vascular permeability.

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PERIODONTAL THERAPY:Increase during healing. DRUGS:Tetracycline excreted through GCF Metronidazole

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LEUKOCYTES IN DENTO GINGIVAL AREA

Leukocytes have been found in clinically healthy gingival sulci (Neutrophils) 58% B lymphocytes 24% T lymphocytes 18% mononuclear phagocytes T:B :: 1:3
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 Leukocytes are attracted by different plaque bacteria but can also be found in the dentogingival region of germ free adult animals. Leukocytes in the gingival sulcus in nonmechanically irritated(resting) healthy gingiva,indicating that their migration may be independent of an increase in vascular permeability Majority of cells are viable and have phagocytic and killing capacity. Leukocytes constitute major protective mechanism against extension of plaque into the gingival sulcus.

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SALIVA
Salivary secretions are protective because they maintain the oral tissues in physiologic state. Exert major influence on plaque by mechanically cleansing the exposed oral surface by buffering acid produced by bacteria and by controlling bacterial activity
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FUNCTION

SALIVARY COMPONENTS PROBABLE MECHANISM

LUBRICATION
PHYSICAL PROTECTION CLEANSING BUFFERING TOOTH INTEGRITY MAINTENANCE

GLYYCOPROTEINS, MUCOIDS
GLYCOPROTEINS, MUCOIDS PHYSICAL FLOW BICARBONATE AND PHOSPHATE MINERALS, GLYCOPROTEIN PELLICLE

COATING SIMILAR TO GASTRIC MUCIN

COATING SIMLAR TO GASTRIC MUCIN CLEARANCE OF DEBRIS AND BACTERIA ANTACIDS MATURATION,REMINERA LIZATION, MECHANICAL PROTECTION

ANTIBACTERIAL ACTION

IgA.
LYSOZYME, LACTOPEROXIDASE

CONTROL OF BACTERIAL COLONIZATION BREAKS BACTERIAL CELL WALLS OXIDATION OF 24 SUSCEPTIBLE BACTERIA

ANTIBACTERIAL FACTORS
Contains numerous organic & inorganic factors that influence bacteria & their products in the oral environment IgG maximum in GCF IgA maximum in saliva IgM also present
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INORGANIC Ions & gases, bicarbonates, Na, K, PO4 ,Ca, F, NH4 & CO2 ORGANIC Lysozyme , lactoferrin, Myeloperoxidase, lactoperoxidase & agglutinins such as glycoproteins, mucins, beta-2 macroglobulins, fibronectin and antibodies.
Lysozyme is hydrolytic enzyme, that cleaves the linkage between structural components of the glycopeptide muramic acid containing region of the cell wall of certain bacteria in vitro.
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The Lactoperoxidase-thiocynate system: bactericidal to some strains of lactobacillus & streptococcus.

Lactoferrin :- Effective against actinobacillus sp. Myeloperoxidase :- Bactericidal for actinobacillus.
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SALIVARY ANTIBODIES
Appear to be synthesized locally for they react with strains of bacteria of mouth but not with organisms characteristic of intestinal tract. The enzymes normally found in saliva are derived from salivary glands, bacteria, leukocytes, oral tissues & ingested substances Major enzymes PAROTID AMYLASE.
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Proteolytic enzymes in Saliva are generated by both the host & oral bacteria. They have been recognized as contributors to the initiation & progression of PD disease To combat these enzymes Saliva contains anti proteases. Eg TIMP (tissue inhibitors of matrix metallo proteinases) inhibits the activity of collagen degrading enzyme.
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 High molecular weight mucinous glycoproteins in saliva bind specifically to many plaque forming bacteria. The glycoprotein-bacteria interactions facilitate bacterial accumulation on the exposed tooth surface The interbacterial matrix of human plaque appears to contain polymers similar to salivary glycoproteins---aid in maintaining integrity of plaque. These glycoproteins selectively adsorb to the hydroxyapatite to make up part of acquired pellicle.

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 Other salivary glycoproteins inhibit the sorption of some bacteria to the tooth surface and to epithelial cells of the oral mucosa Mucin also causes deletion of bacterial cells from the oral cavity by aggregation with mucin rich films.

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SALIVARY BUFFERS & COAGULATION FACTORS

Maintenance of PH at mucosal epithelial cell surfaces & tooth surfaces. E.g. bicarbonate carbonic acid system. Saliva contains coagulation factors Factors VIII, IX, X plasma thromboplastin antecedent & hageman factor that hasten blood coagulation (PTA) & protect wounds from bacteria
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LEUKOCYTES
PMNS Living PMNS in saliva-OROGRANULOCYTE & their rate of migration in oral cavity is termed as

OROGRANULOCYTIC MIGRATORY RATE

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ROLE IN PERIODONTAL PATHOLOGY

SALIVA EXERTS INFLUENCE * Plaque initiation * Maturation *Metabolism SALIVARY FLOW & COMPOSITION *Calculus formation *Periodontal disease *Caries
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 The removal of the salivary glands in experimental animals significantly increases the incidence of dental caries and periodontal disease and delays wound healing In humans,an increase in inflammatory gingival diseases,dental caries and rapid tooth destruction associated with cervical or cemental caries is partially a consequence of decreased salivary gland secretion (Xerostomia)
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Xerostomia results from:

Sialolithiasis Sarcoidosis Sjogrens syndrome Mikuliczs disease Irradiation Surgical removal of salivary glands

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