018.defense mechanisms of gingiva

1. Dr Jaffar Raza Syed Page 1
Defense Mechanisms of Gingiva
Various defense mechanisms of oral cavity
(i) Saliva
(ii) Sulcular fluid (GCF)
(iii) Intact epithelial barrier + Basement membrane
(iv) High tissue turnover
(v) Presence of normal flora  (Bacterial balance)
(vi) Local antibody production
(vii) Migrating PMNs and other leukocytes

2. Dr Jaffar Raza Syed Page 2
--Imbalance of the host-microbial relationship is occurring in the destructive lesions
Normal gingiva VS clinical healthy gingiva
--Pink color, firm consistency and scalloped
outline for gingival margin.
--The interdental papillae are firm, do not bleed
on gentle probing and fill the space below
the contact areas.
--Can only be established experimentally after supervised meticulous daily plaque
control for several weeks
--The gingivae we would routinely classify as "clinically healthy gingivae" are not as
histological perfect as the "normal gingivae“
--Clinically healthy gingivae would be typically that level of health which could be
attained by patients regularly practicing a good standard of plaque control.

3. Dr Jaffar Raza Syed Page 3
Sulcular fluid = Gingival creivicular fluid (GCF)
--firstly discovered at 1950s.
--In normal gingiva called transudate
--In disease gingiva called inflammatory exudates
Phagocytosis
By PMNLs and macrophages
Aided by complement  C3, C4 and C5 cleavage  C3a, C4a and C5a
C3a, C4a and C5a  anaphylotoxins
--they can induce smooth muscle contraction,
--increase permeability of blood vessels
--causes the release of histamine from mast cells and basophils
C5a  chemotactic for neutrophils and monocytes

4. Dr Jaffar Raza Syed Page 4
Inflammatory Reaction
changes in the local microcirculation  hyperemia
increased vascular permeability
formation of a fluid and cellular exudate

5. Dr Jaffar Raza Syed Page 5
composition of saliva
A. Electrolytes:
(a) Potassium
(b) Sodium
(c) Chloride
(d) Bicarbonate
(e) Calcium
(f) Magnesium
(g) Phosphorous

6. Dr Jaffar Raza Syed Page 6
B. Organic:
(i) Acinar cell families:
• Mucin
• Proline rich proteins and glycoproteins
• Histatins and statherins
• Cystatins
• Amylase
• Peroxidases
• Carbonic anhydrases
(ii) Ductal and stromal products:
• Lactoferrin
• Lysozyme
• Secretory IgA
• Kallikrein
• Fibronectin
• Lipids
• Carbohydrates
• Sulfates

7. Dr Jaffar Raza Syed Page 7
Composition of GCF
A. Cellular elements:
(i) Epithelial cells
(ii) Leukocytes
(iii) Bacteria
B. Electrolytes:
(i) Sodium
(ii) Potassium
(iii) Calcium
C. Organic compounds:
(i) Carbohydrates
(ii) Proteins
• Immunoglobulins
• Complement components
(iii) Lipids

8. Dr Jaffar Raza Syed Page 8
D. Metabolic and bacterial products:
(i) Lactic acid
(ii) Hydroxyproline
(iii) Prostaglandins
(vi) Urea
(v) Endotoxins
(vi) Cytotoxic substances
(vii) Antibacterial factors

9. Dr Jaffar Raza Syed Page 9
E. Enzymes and enzyme inhibitors:
(i) Acid phosphatase
(ii) Alkaline phosphatase
(iii) Pyrophosphatase
(iv) β - glucuronidase
(v) Lysozymes
(vi) Hyaluronidase
(vii) Proteolytic enzymes
• Mammalian proteinases
• Bacterial proteinases
• Serum proteinases inhibitors
(viii) Lactate dehydrogenase.

10. Dr Jaffar Raza Syed
Methods of collection of GCF
(i) Absorbing paper strip
(a) Intracrevicular
(b) Extracrevicular
(ii) Preweighed twisted threads
(iii) Sampling by means of micropipettes
(iv) Gingival washings
(v) Other strips
(a) Plastic strips
(b) Platinum loops
ethods of collection of GCF
(iii) Sampling by means of micropipettes
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11. Dr Jaffar Raza Syed
How the amount of GCF collected is evaluated
(i) By direct viewing and staining
Stain the strip with ninhydrin
(ii) By weighing:
Strip is weighed before and after collecting the GCF
(iii) By electronic device Periotron:
Sample strip paper is inserted
on the screen.
How the amount of GCF collected is evaluated
nd staining:
ninhydrin and then measured.
Strip is weighed before and after collecting the GCF sample.
By electronic device Periotron:
Sample strip paper is inserted between the two jaws, which gives reading
Page 11
between the two jaws, which gives reading

12. Dr Jaffar Raza Syed Page 12
Problems associated with GCF collection and data interpretation
(i) Contamination
Usually sample is contaminated with blood, saliva or plaque.
(ii) Small sample size.
(iii) Sampling time
Prolonged sampling at the site results in protein concentrations approaching
those of serum.
(iv) Volume determination
Evaporation is a significant problem in accurate volume determination of GCF
(v) Recovery of strips
It depends on type of paper, binding of GCF protein to the filter paper
and concentration of the original protein sample.

13. Dr Jaffar Raza Syed Page 13
Volume of gingival fluid
The mean gingival fluid
molar teeth  0.43 to 1.56 μl
anterior teeth  0.24 to 0.43 μl
Collective calculated amount  0.5 to 2.4 μl of fluid/day

14. Dr Jaffar Raza Syed Page 14
Clinical Significance
General Health and Gingival Fluid
Gingival fluid flow and sex hormones
--Menstruation  Increase
--birth control pills  Increase
--pregnancy  Increase (max values in last trimester)
--Gingival fluid flow and Diabetes  higher production of gingival fluid due to
increase in width of the basal membrane of capillaries, small arteries and venules.