Gingival Crevicular Fluid (GCF)
Gingival sulcus consists of fluid known as gingival crevicular fluid or sulcular fluid.
- Gingival crevicular fluid is an important diagnostic marker.
- Gingival crevicular fluid is an inflmmatory exudate.
- Gingival crevicular fluid is composed mainly of blood electrolytes and organic molecules, i.e. albumins, globulins, lipoproteins or fibrinogen and cellular components as well as peptides, bacteria and enzymes.
Production of Gingival Crevicular Fluid
It is obtained from gingival plexus of blood vessels in gingival connective tissue subjacent to epithelial lining of dentogingival space. GCF production is governed by passage of fluid from capillaries into tissues and removal of this fluid by lymphatic system. When the rate of capillary fitrate exceeds lymphatic uptake, fluid collects as edema and get expressed as gingival crevicular fluid.
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Gingival Crevicular Fluid (GCF) Clinical Signifiance
Following is the clinical significance:
- Circadian periodicity: Increase in the amount of gingival crevicular fluid is from 6 am to 10 pm and decreases afterwards.
- Sex hormones: Female sex hormones increase the gingival crevicular fluid flow as these hormones lead to the vascular permeability.
- Mechanical stimulation: Chewing and gingival brushing stimulates flow of gingival crevicular fluid.
- Smoking: It causes too much increase in gingival crevicular fluid flow.
- Periodontal therapy: There is increase in gingival crevicular fluid production at the time of healing after periodontal therapy.
Composition of GCF
GCF is composed of following:
- Epithelial cells: Presence of intense mitotic activity in both junctional and sulcular epithelium attibute to presence of desquamated epithelial cells in gingival crevicular fluid. Remnants of epithelial cells along with adhered microorganisms are found in gingival crevicular fluid.
- Leucocytes: PMN is predominant inflmmatory cell in gingival crevicular fluid. Most of crevicular polymorphoneutrophils are viable cells capable of protecting dentogingival junction and prevents apical extension of subgingival plaque in spite of decreased efficiency. Crevicular PMNs in diseased areas show decrease in phagocytic activity and decreased migration when compared to healthy sites.
- Bacteria: Microorganisms are found free floating or attached to epithelial cells in gingival crevicular fluid.
- Products of microbial plaque:
- Endotoxin such as bacterial LPS.
- Enzymes such as proteinases, MMPs, hyalurodinases
- End products of microbial metabolism, i.e. short chain fatty acids, ammonia, etc.
- Tissue breakdown products: Collagens, proteoglycans, hyaluronic acid, ECM components and enzymes.
- Product of host cells: Collagenases, Aspartate aminotransferase, Alkaline phosphatase, elastase, cathepsin, lysozyme, lactoferrin.
- Product of host immunity: Immunoglobulins, complements, Cytokines, Arachidonic acid metabolites.
Signifiance of Gingival Crevicular Fluid in Health and Disease
- Gingival crevicular fluid consists of multiple biochemical factors which act as diagnostic and prognostic markers of biologic state of periodontium in health and disease.
- In healthy sulcus quantity of crevicular fluid is very small while during inflmmation flw of crevicular fluid increases and its composition is of inflmmatory exudate.
- In healthy it cleans material from the sulcus.
- Gingival crevicular fluid improves adhesion of epithelium to tooth since it consists of plasma proteins.
- GCF flow decreases progressively in parallel with clinical changes postperiodontal treatment.
- GCF flow follows circadian rhythm. There is increase in flow of GCF early in morning and it decreases afterwards.
- GCF flow increases during pregnancy, puberty and menstruation.
- Smoking produces immediate transient but marked increase in GCF flw.
- Systemically administered drugs were found to expressed in GCF especially drugs such as tetracycline and metronidazole. Concentration of these drugs in GCF is found to be higher than saliva.
Functions of GCF
Following are the functions of gingival crevicular fluid:
- Gingival crevicular fluid consists of many biochemical factors which offr it as a diagnostic or prognostic biomarker of biologic state of periodontium in health and disease.
- Gingival crevicular fluid consists of components of connective tissue, epithelium and inflmmatory cells, serum and microbial flra inhabiting gingival margin or sulcus.
- Gingival crevicular fluid clean material from the sulcus.
- Gingival crevicular fluid consists of plasma proteins which improve adhesion of epithelium to the tooth.
- Gingival crevicular fluid possess anti-microbial properties.
- Gingival crevicular fluid exerts antibody activity for defending the gingiva.
- PMN activity releases granules which disengages plaque adherence to tooth.
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