Dr. Devrathnamma

1. Presented by
Dr. Devarathanama M.V
MDS Sr. Lecturer

2. The epithelial keratinization
Sulcular fluid
The initial stages of inflammatory response
provide resistance to mechanical and bacterial
aggressions of gingival tissue

3. SULCULAR FLUID
BRILL

4. METHODS OF COLLECTION
1 ABSORBING PAPER STRIPS
2 TWISTED THREADS
3 MICROPIPETTES
4 INTRA-CREVICULAR WASHINGS

5. 1 ABSORBING PAPER STRIPS are placed within the
-- sulcus [intrasulcular method] or
-- its entrance [extrasulcular]
The placement of filter paper strip in relation
to the sulcus or pocket is important
The brill technique places it into the pocket
until a degree of irritation is encountered that
can by itself, trigger the flow of
fluid

6. BRILL TECHNIQUE

7. To minimize this irritation
LOE AND HOLM-PADERSEN placed the filter
paper strip just at the entrance of the pocket so
that the fluid seeping out is picked up by the strip
A . INTRASULCULAR B / C . EXTRASULCULAR

8. 2 TWISTED THREADS were used by WEINSTEIN
and placed in the gingival crevice around the
tooth and the amount of fluid collected was
estimated by weighing the sample thread

9. 3 MICROPIPETTES
Permits the collection of fluid by capillarity
Capillary tubes of standardized length and
diameter are placed in the pocket and their
content is later centrifuged and analyzed

10. 4 CREVICULAR WASHINGS
This method uses an appliance consisting of a
hard acrylic plate covering the maxilla with
soft borders and a groove following the
gingival
margins
It is connected to four collection tubes
The washings are obtained by rinsing the
crevicular areas from one side to the other
using a peristaltic pump

11. PERMEABILITY
OF
JUNCTIONAL & SULCULAR EPITHELIUM
Substances that penetrate the sulcular epithelium
include :
Albumin
Endotoxin
Thymidine
Histamine
Phenytoin
Horseradish peroxide

12. AMOUNT
The amount of GCF collected on a paper strip
can be evaluated in a variety of ways
1 MANUAL
The wetted area can be made more visible by
staining with ninhydrin
It is then measured with the help of a
magnifying glass or a microscope

13. 2 ELECTRONIC METHOD
Has been devised for measuring the fluid
collected on a “blotter”[periopaper] employing an
electronic transducer
The wetness of the paper strip affects the flow
of electronic current and gives a digital read out

14. Measurements performed showed that a strip
of paper 1.5mm wide inserted 1mm within the
gingival sulcus of a slightly inflamed gingiva
absorbs about 0.1mg of GCF in 3minutes

15. COMPOSITION
1 CELLULAR ELEMENTS
Bacteria
Desquamated epithelial cells
Leokocytes[PMNs, lymphocytes and
monocytes/macrophages]

16. 2 ELECTROLYTES
Potassium
Sodium
Calcium

17. 3 ORGANIC COMPOUNDS
a CORBOHYDRATES :
glucose hexasamine
hexaronic acid
glucose concentration in GCF is three to four
times greater than that in serum

18. b PROTEINS :
The total protein content of GCF is much
less than that of serum

19. C METABOLIC AND BACTERIAL PRODUCTS :
Lactic acid
Urea
Hydroxyproline
Endotoxins
Hydrogen sulphide
Antibacterial factors

20. d ENZYMES :
acid and alkaline phosphatase
chondroitin sulphatase
citric acid
cytokines arylsulphatase
elastase fibrin
fibronectin
glycosidases
hyaluronidase
lactate dehydrogenase
lactoferin
lysozyme
myeloperoxidase

21. CLINICAL SIGNIFICANCE
1 CIRCADIAN PERIODICITY:
There is gradual increase in GCF amount from
6am to 10pm and a decrease afterward
2 SEX HORMONES :
Female sex hormones increase GCF flow, because
they enhance vascular permeability
Pregnancy,ovulation and hormonal contraceptives
all increase gingival fluid production

22. 3 MECHANICAL STIMULATION :
Chewing and vigorous gingival brushing
stimulate the flow of GCF
4 SMOKING :
Smoking produces an immediate increase in
GCF flow
5 PERIODONTAL THERAPY:
Healing period after periodontal surgery
increase GCF
6 DRUGS IN GCF :
Tetracyclines
Metronidazole

23. LEUKOCYTES IN THE DENTOGINGIVAL AREA
PMNs = 91.2 – 91.5%
MONONUCLEAR CELLS = 8.5% -- 8.8%
B-LYMPHOCYTES = 58%
T-LYMPHOCYTES = 24%
MONONUCLEAR PHAGOCYTES = 18%
The ratio of T-lymphocytes to B-lymphocytes was found
to be reversed from the normal ratio of about 3:1 found
in peripheral blood to about 1:3 in GCF

24. SALIVA
Salivary secretions are protective in nature by :-
mechanical cleansing the exposed oral surfaces,
by buffering, acids produced by bacteria and
by controlling bacterial activity

25. ORGANIC FACTORS INCLUDE :
LYSOZYME : works on both gram negative and
gram positive organisms
LACTOPEROXIDASE : Thiocynate system in saliva is
bactericidal to lactobacillus and streptococcus
LACTOFERRIN : works against actinobacillus species
MYELOPEROXIDASE ENZYME : bactericidal against
actinobacillus

26. SALIVARY ANTIBODIES
The predominant immunoglobilin found in
saliva is IgA
IgG is more prevalent in GCF

27. SALIVARY BUFFERS / COAGULATION FACTORS
Most important salivary buffer is the
bicorbonate-corbonic acid system
Saliva also contains coagulation factors
FACTORS VIII , IX , X
PLASMA THROMBOPLASTIN ANTECEDENT [PTA]
HAGEMAN FACTOR
which protect wounds from bacterial invasion

28. LEUKOCYTES
The principal cells are PMNs
Living PMNs in saliva are referred as
“Orogranulocytes”

29. ROLE IN PERIODONTAL PATHOLOGY
Salivary flow and composition influence
Calculus formation
Periodontal disease and
Caries
The removal of the salivary glands significantly
Increase the incidence of dental caries
Increase periodontal disease and
Delays wound healing