saliva, gingival crevicular fluid (gcf)

1. DR. K.S. STELIN (HOD) DR. MARIYAM MOMIN
DR. PARUL ANEJA (READER) I YEAR PG
DEPARTMENT OF PERIODONTOLOGY & ORAL
IMPLANTOLOGY.

2.  Introduction
 Saliva
 Gingival crevicular fluid
 Junctional epithelium
 Polymorphonuclear leucocytes

3. Defense mechanisms of the oral cavity are due to:
 Saliva
 Sulcular fluid
 Intact epithelial barrier: Junctional epithelium
(JE)
 Presence of normal beneficial flora
 Local antibody production
 Migrating polymorphonuclear leukoctes
(PMNLs) & other leukocytes

4.  Saliva is defined as the
fluid secreted by the
salivary glands that
begins the digestion of
food – Genco.
 Saliva is also called as
‘liquid enamel’ as it is
rich source of various
minerals.
 pH: 6.9-7.2

5.  Xerostomia, a disease
characterized by decreased
salivary gland secretion, is
associated with an increase in
inflammatory gingival
diseases and rapid tooth
destruction along with
cervical or cemental caries.
 Normal value of stimulated
saliva: 1-2ml/minute
 Xerostomic value of
stimulated saliva:
<0.5ml/minute.

6.  Few sialogogues (increases salivary
flow) are:
- Lemonade/ acid drinks
- Xylitol chewing gums
- Pilocarpine
 Few commercially available saliva
substitutes are:
- Saliva orthana (nycomed): Oral
spray containing porcine mucin
- Luborant: Lactose peroxidase
- Salinum: water-soluble extract of
linseed oil
- Salivix pastilles.

8.  Electrolytes
1. Sodium
2. Calcium
3. Potassium
4. Magnesium
5. Phosphorous
6. Bicarbonates
7. Chloride
components

9. Proteins – Acinar cell
families
 Mucin
 Amylase
 Cystatins
 Peroxidases
 Carbonic anhydrases
 Histatins & statherins
 Proline rich proteins &
glycoproteins
 Lipids
 Sulphates
 Lysozyme
 Lactoferrin
 Fibronectin
 Secretary IgA
 Carbohydrates
Ductal and stromal
products

10.  Biological functions of saliva:
1. Flushes and cleans the oral
cavity.
2. Moistens epithelium and
teeth and protects them.
3. Speech
4. Formation of bolus
5. Digestion
6. Precipitation of taste
7. Excretion of body metabolites
(electrolytes, water and
proteins)
8. Bacteriolytic actions

11.  Saliva profoundly influences the state of oral health
of a person including the carious process.
1. Formation of pellicle and plaque deposition
2. Aids in plaque mineralization to form calculus
3. Affects dental caries by cleansing mechanically and
by direct anti-bacterial activity.

13. S.No. Component Mode of action
1 Lysozyme Lysis of bacterial cell wall
2 Lactoferrin Binds to iron leading to inhibition of
bacterial cell growth
3 Lactoperoxidase Catalyzes hypothiocyanate ion which
disrupts bacterial proteins
4 Secretary IgA Interfere with bacterial attachment to the
host tissues by agglunating specific
bacteria
5 Salivary glycoproteins Can act as special bacterial agglutinins
6 Bicarbonates Can buffer organic acids produced during
sugar fermentation

14.  Saliva contains
coagulating factor VIII,
IX, X and Hageman
factor.
 These coagulation
factors hasten the
blood coagulation and
protect the wounds
from bacterial
invasion.

18.  Enzymatic activity in
saliva
1. Aspartate
Aminotransferase
(AST)
2. Proteinases
3. Lactoferrin
4. Metalloproteinases
5. Chitinase &
Hexosaminidase
 Nitric oxide radical
(NO)
Reflotron
multifunction
system

19.  C-Reactive Protein (CRP)
 Fibronectin
 Cystatins
 Neopterin
 Cytokines & other protein
markers
 Oxidative stress.

20.  Diabetes mellitus
- Increased amount of urea
& α-amylase in Type-1
diabetes mellitus patients.
- According to the study of
Lopez et al. (2003), the
increase of these markers
in saliva precedes the
clinical signs of diabetes.
- These markers may be
used in the future for
screening incipient
diabetes.

21.  Cardiovascular disease is a
major cause of death world
wide.
 Determination of total
serum amylase and salivary
amylase activityhave been
made before and after
cardiovascular surgery.
 In ruptured aortic
aneurysm salivary alpha
amylase level is increased.

22.  Sjogren syndrome is a chronic
autoimmune disorder
characterized by salivary and
lacrimal gland dysfunction,
serological abnormalities and
multiple organ system changes(2).
 Most salivary function test
conducted are sialometry,
sialography, sialosyntiography,
salivary synitiography, biopsies
and serological test. These tests
are helpful but invasive method,
expensive and not always
conclusive.

23.  In oncological screening, the detection
of soluble factor CD44 or telomerase is
being considered as their levels in
saliva increase with squamous cell
carcinoma of the head and neck.
 Three salivary metabolites
(phenylalanine, valine, and lactic acid)
could distinguish patients with oral
squamous cell carcinoma from healthy
controls and could also distinguish
patients with oral leukoplakia from
healthy controls.
 A combination of three microbiotas
(Capnocytophaga gingivalis, Prevotella
melaninogenica, and Streptococcus
mitis) in saliva could be used as
diagnostic biomarkers of patients with
oral squamous cell carcinoma.

24.  Currently, the following steroids can
be accurately assessed in saliva; they
are cortisol, dehydroepiandrosterone,
estradiol, estriol, and testosterone.
 These assays can be useful in
evaluations of mood and cognitive
emotional behaviour, to study child
health and development, in
considerations of premenstrual
depression and to screen for cushing’s
syndrome and also salivary steroid
hormone levels can also be used to
assess ovarian function, to monitor
full-term and pre-term neonates and
also to evaluate risk for preterm
labour and delivery.
Salivary Estriol
Immunoassay Kit

25.  Psychiatry
- Saliva has been used to
monitor therapeutic responses
in the treatment of anxiety by
measuring salivary level of 3-
methoxy-4-hydroxy phenyl
glycol.
- It has been used to measure
post – traumatic stress disorder
associated with wartime.
 Nephrology
- Salivary creatinine
concentrations show a high
sensitivity and specificity for
determining the presence of
renal diseases.

26.  Saliva can be used
to detect and
monitor cotinine,
cocaine,
phencyclidine,
opioids,
barbiturates,
diazepines,
amphetamines,
and ethanol(12).
Saliva Multidrug
test kit

27.  Saliva is used for the
diagnosis of Helicobacter
Pylori infection, which is
the critical pathogen
associated with peptic
ulcer.
 H. Pylori antibodies in
saliva may be valuable for
predicting risk for gastric
adenocarcinoma.

28.  Testing for the human
immunodeficiency virus is
an excellent example of the
potential usefulness of
saliva in infectious disease
diagnosis.
 PCR is used to measure
many viruses herpes virus
6,7and 8, cytomegalovirus
and Epstein bar virus.
 Saliva also been used for
the measurement of
hepatitis C, virus a leading
cause of cirrhosis.
ELISA test

29.  SALIVA is a promising,
diagnostic tool for to
detect COVID -19.
 Because COVID -19
completely associated with
human to human
association and also saliva
has higher consistent rate
greater than 90% when
compared to
nasopharyngeal swabs .

30.  Infected COVID – 19 patients saliva
which may contain live viruses and
there is possibility of transmission
of viruses from person to person.
 Salivary droplets and nasal
discharge is a main resource of
spreading infection if we stand less
than 2 meters.
 As health care workers especially
dental professionals who are all
dealing with saliva can take
precautionary measures before
taking up the patient. Careful
history, health status, contact and
residence history may be helpful to
find out the patient present
condition.

31.  Tissue fluid that seeps
through the crevicular
epithelium is known as
gingival crevicular
fluid. It is increased in
the presence of
inflammation – PLR.

32.  Cellular elements
1. Bacteria
2. Leukocytes
3. Epithelial cells
 Electrolytes
1. Sodium
2. Calcium
3. Potassium
 Organic compounds
1. Lipids
2. Carbohydrates
 Proteins
1. Immunoglobulins
2. Complement
components

33.  Metabolic and
bacterial products
1. Urea
2. Endotoxins
3. Lactic accid
4. Prostaglandins
5. Hydroxyproline
6. Antibacterial factors
7. Cytotoxic substances
 Enzyme and enzyme
inhibitors
1. Acid phosphatase
2. Alkaline phosphatase
3. Pyrophosphatase
4. ᵝ- glucuronidase
5. Lysozyme
6. Hyaluronidase
7. Proteolytic enzymes
 Lactic dehydrogenase
1. Bacterial proteinases
2. Mammalian proteinases
3. Serum proteinase inhibitors

34. S.No. GCF component Defense mechanism
1 Leucocytes Phagocytosis & killing of
microorganisms
2 Immunoglobulins Control of inflammatory action,
preparation of microbes and foreign
bodies for phagocytosis
3 Salivary antibacterial
factors
Prevents growth of bacteria
4 Acid phosphatase Attacks techoic acid one of the
components of bacterial cell wall
5 Lysozyme Bactericidal properties
6 Streptokinase Plays a role in inflammation.

35.  Brill (1958) & Egelberg (1966)
theory of GCF formation
Permeability of vessels
Seepage of fluids in sulcus
Formation of GCF

36. Interstitial fluid
Change in osmotic gradient
Seepage of fluids in sulcus
Fluids changed into inflammatory exudate
Formation of GCF

37.  Methods of collection of GCF
Common methods
1. Use of absorbent filter paper strips
2. Pre-weighted twisted threads
3. Macro capillary pipettes
4. Intra-crevicular washings
Other methods
1. Plastic strips
2. Platinum loops

42.  Methods of gingival
washing
Main methods
1. First method – Acrylic
appliance
2. Second method –
Injection and respiration
of known amount of GCF
Other methods
1. Plastic strips
2. Platinum loops

43.  Small sample size
 Usually sample is contaminated with blood,
saliva or plaque.
 Prolonged sampling at the site results in protein
concentrations approaching those of serum
 Evaporation is a significant problem in accurate
volume determination of GCF samples.
 Recovery of strips depends on type of paper,
bindingof GCF protein to the filter paper and
concentration of original protein sample.

44.  Synonyms
- Circadian rhythms
- Diurnal variations
 Definition
Circadian periodicity is
the rhythmic repetition of
certain phenomenon in
living organisms at about
the same time each day.

45.  Conditions increasing
the GCF production
1. Inflammation
2. Sex hormones
3. Diabetes mellitus
4. Mechanical
stimulation
5. Smoking
6. Periodontal therapy