You are on page 1of 36

DEFENSE MECHANISMS

OF GINGIVA
OF GINGIVA
1. Epithelium – Degree of keratinization & turn over rate. 2. Sulcular Fluid 3. Leukocytes 4.
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
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.
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)
INTRASULCULAR
METHOD
(Placed within the
sulcus)
EXTRASULCULAR METHOD (Placed at its entrance)
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

PREWEIGHED TWISTED

THREADS • THREADS PLACED IN THE GINGIVAL CREVICE AROUND THE TOOTH ,AND THE AMOUNT OF FLUID
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
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
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
GROOVE FOLLOWING GINGIVAL MARGIN
CREVICULAR SHAVINGS • STUDY GCF FROM CLINICALLY NORMAL GINGIVA. • METHOD 1: USES AN APPLIANCE CONSISTING
CREVICULAR SHAVINGS • STUDY GCF FROM CLINICALLY NORMAL GINGIVA. • METHOD 1: USES AN APPLIANCE CONSISTING
CONNECTED TO FOUR COLLECTION TUBES
CONNECTED TO FOUR COLLECTION TUBES
WASHINGS OBTAINED BY RINSING THE CREVICULAR AREAS FROM ONE SIDE TO
WASHINGS OBTAINED BY RINSING THE
CREVICULAR AREAS FROM ONE SIDE TO

8

MODIFICATION MARGIN.
MODIFICATION
MARGIN.

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

MODIFICATION MARGIN. • TWO INJECTION NEEDLES FITTED ONE WITHIN THE ANOTHER SUCH THAT DURING SAMPLING, THE

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
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
ELECTRONIC DEVICE FOR MEASURING THE AMOUNT OF FLUID COLLECTED ON FILTER PAPER 11

ELECTRONIC DEVICE FOR MEASURING

THE AMOUNT OF FLUID COLLECTED ON

FILTER PAPER

PLACEMENT OF FILTER STRIP IN GINGIVAL SULCUS FOR COLLECTION OF FLUID A: INTRASULCULAR METHOD B &

PLACEMENT OF FILTER STRIP IN GINGIVAL SULCUS FOR COLLECTION OF FLUID

A: INTRASULCULAR METHOD B & C: EXTRASULCULAR METHOD

COMPOSITION Proteins, specific Ab, Ag, enzyme, cellular elements 40 compounds analyzed so far. eg β glucuronidase,
COMPOSITION
Proteins,
specific
Ab,
Ag,
enzyme,
cellular
elements 40 compounds analyzed so far.
eg
β
glucuronidase,
LDH,
fibroblast,
PMN,
collagenases
phospholipase.
CELLULAR ELEMENTS

Bacterial desquamated epithelial cells, leukocytes [PMNs,lymphocytes,monocytes]

COMPOSITION Proteins, specific Ab, Ag, enzyme, cellular elements 40 compounds analyzed so far. eg β glucuronidase,
INORGANIC COMPONENTS
INORGANIC COMPONENTS

Na,K,Ca

ORGANIC COMPONENTS

ORGANIC COMPONENTS – Lactic acid – Urea – Hydroxyproline • Carbohydrates and proteins • Glucose hexosamine
ORGANIC COMPONENTS – Lactic acid – Urea – Hydroxyproline • Carbohydrates and proteins • Glucose hexosamine
ORGANIC COMPONENTS – Lactic acid – Urea – Hydroxyproline • Carbohydrates and proteins • Glucose hexosamine

Lactic acid Urea Hydroxyproline

ORGANIC COMPONENTS – Lactic acid – Urea – Hydroxyproline • Carbohydrates and proteins • Glucose hexosamine
ORGANIC COMPONENTS – Lactic acid – Urea – Hydroxyproline • Carbohydrates and proteins • Glucose hexosamine

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

14

ENZYMES IN GCF

• • α 1 ANTITRYPSIN • ARYLSULFATASE • • • • CITRIC ACID CYSTATINS CYTOKINES •
α 1 ANTITRYPSIN
• ARYLSULFATASE
CITRIC ACID
CYSTATINS
CYTOKINES
• ENDOPEPTIDASES
• EXOPEPTIDASES
FIBRIN

FIBRONECTIN

ENZYMES IN GCF • • α 1 ANTITRYPSIN • ARYLSULFATASE • • • • CITRIC ACID

ACID PHOSPHATASE ALKALINE PHOSPHATASE

ENZYMES IN GCF • • α 1 ANTITRYPSIN • ARYLSULFATASE • • • • CITRIC ACID
ASPARTATE AMINOTRANSFERASE CHONDROITAN SULFATASE
ASPARTATE AMINOTRANSFERASE
CHONDROITAN SULFATASE

15

COMPOUNDS AND ENZYMES OF

POSSSIBLE BACTERIAL ORIGIN DETECTED IN GCF • ACID PHOSPHATASE • • AMINOPEPTIDASES • CHONDROITAN SULFATASE CHYMOTRYPSIN
POSSSIBLE BACTERIAL ORIGIN
DETECTED IN GCF
ACID PHOSPHATASE
• AMINOPEPTIDASES
• CHONDROITAN SULFATASE
CHYMOTRYPSIN LIKE PRODUCT
• COLLAGENASE
• DEOXYRIBONUCLEASE
ALKALINE PHOSPHATASE
FIBRINOLYSIN
GLUCOSIDASES
HEMOLYSIN

HYALURONIDASE

16

CELLULAR/ HUMORAL ACTIVITY • Cytokines- Interleukin-1α,IL-1β.IL-6 and IL-8 Interleukin 1α and IL 1β – increase the
CELLULAR/ HUMORAL
ACTIVITY
Cytokines-
Interleukin-1α,IL-1β.IL-6 and IL-8
Interleukin 1α and
IL
1β – 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 α :- inhibits bone resorption activity of interleukin
1-β .
CLINICAL SIGNIFICANCE
CLINICAL SIGNIFICANCE
• G.F. increased by mastication of coarse foods, tooth brushing, gingival massage, ovulation, hormonal contraceptives and
• 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.
18
CIRCADIAN PERIODICITY:- gradual increase from 6am-10pm & a decrease afterwards. SEX HORMONE:- female sex hormones increase
CIRCADIAN PERIODICITY:-
gradual increase from 6am-10pm & a decrease
afterwards.
SEX HORMONE:-
female sex hormones increase flow-enhance vascular
permeability.
PERIODONTAL THERAPY:- Increase during healing. DRUGS:- Tetracycline excreted through GCF
PERIODONTAL THERAPY:-
Increase during healing.
DRUGS:-
Tetracycline excreted through GCF
Metronidazole
Metronidazole
PERIODONTAL THERAPY:- Increase during healing. DRUGS:- Tetracycline excreted through GCF Metronidazole 20
LEUKOCYTES IN DENTO GINGIVAL AREA 58% B lymphocytes 24% T lymphocytes 18% mononuclear phagocytes T:B ::
LEUKOCYTES IN DENTO
GINGIVAL AREA
58% B lymphocytes
24% T lymphocytes
18% mononuclear phagocytes
T:B :: 1:3

Leukocytes have been found in clinically healthy gingival sulci (Neutrophils)

• Leukocytes are attracted by different plaque bacteria but can also be found in the dentogingival
• 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 22
• Leukocytes constitute major protective
mechanism against extension of plaque into the
22

gingival sulcus.

SALIVA
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

FUNCTION

SALIVARY COMPONENTS

PROBABLE MECHANISM

LUBRICATION

PHYSICAL PROTECTION

CLEANSING

BUFFERING

TOOTH INTEGRITY MAINTENANCE

ANTIBACTERIAL ACTION

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

IgA.

LYSOZYME,

LACTOPEROXIDASE

CONTROL OF BACTERIAL

COLONIZATION BREAKS BACTERIAL CELL WALLS OXIDATION OF SUSCEPTIBLE BACTERIA

24

ANTIBACTERIAL FACTORS
ANTIBACTERIAL FACTORS
Contains numerous organic & inorganic factors that influence bacteria & their products in the oral environment
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

INORGANIC

INORGANIC Ions & gases, bicarbonates, Na, K, PO Ca, F, NH & CO ORGANIC Lysozyme ,

Ions & gases, bicarbonates, Na, K, PO 4 , Ca, F, NH 4 & CO 2

ORGANIC Lysozyme , lactoferrin, Myeloperoxidase, lactoperoxidase & agglutinins such as glycoproteins, mucins, beta-2 macroglobulins, fibronectin and
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.

The Lactoperoxidase-thiocynate system: bactericidal to some strains of lactobacillus & streptococcus. Lactoferrin :- Effective against actinobacillus
The Lactoperoxidase-thiocynate
system: bactericidal to some strains of
lactobacillus & streptococcus.
Lactoferrin :- Effective against
actinobacillus sp.
Myeloperoxidase :- Bactericidal for
actinobacillus.
SALIVARY ANTIBODIES •Appear to be synthesized locally for they react with strains of bacteria of mouth
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

SALIVARY ANTIBODIES •Appear to be synthesized locally for they react with strains of bacteria of mouth
• Major enzymes – PAROTID AMYLASE.
• Major enzymes – PAROTID AMYLASE.

28

•Proteolytic enzymes in Saliva are generated by both the host & oral bacteria. •They have been
•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.

High molecular weight mucinous glycoproteins

in saliva bind specifically to many plaque forming bacteria. • The glycoprotein-bacteria interactions facilitate bacterial accumulation
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.

30

• Other salivary glycoproteins inhibit the sorption of some bacteria to the tooth surface and to
• 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.
SALIVARY BUFFERS & COAGULATION FACTORS •Maintenance of PH at mucosal epithelial cell surfaces & tooth surfaces.
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
32
• PMN’S LEUKOCYTES • Living PMN’S in saliva - OROGRANULOCYTE & their rate of migration in

PMN’S

LEUKOCYTES
LEUKOCYTES
• PMN’S LEUKOCYTES • Living PMN’S in saliva - OROGRANULOCYTE & their rate of migration in

Living PMN’S in saliva-OROGRANULOCYTE & their rate of migration in oral cavity is termed as

OROGRANULOCYTIC MIGRATORY RATE
OROGRANULOCYTIC MIGRATORY RATE

ROLE IN PERIODONTAL

PATHOLOGY • SALIVA EXERTS INFLUENCE * Plaque initiation
PATHOLOGY
• SALIVA EXERTS INFLUENCE
* Plaque initiation
*Periodontal disease *Caries
*Periodontal disease
*Caries

* Maturation *Metabolism SALIVARY FLOW & COMPOSITION *Calculus formation

ROLE IN PERIODONTAL PATHOLOGY • SALIVA EXERTS INFLUENCE * Plaque initiation *Periodontal disease *Caries * Maturation
• The removal of the salivary glands in experimental animals significantly increases the incidence of dental
• 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)

35

Xerostomia results from:
Xerostomia results from:
Xerostomia results from: • Sialolithiasis • Sarcoidosis • Sjogren’s syndrome • Mikulicz’s disease • Irradiation •

Sialolithiasis Sarcoidosis Sjogren’s syndrome Mikulicz’s disease Irradiation Surgical removal of salivary glands

Xerostomia results from: • Sialolithiasis • Sarcoidosis • Sjogren’s syndrome • Mikulicz’s disease • Irradiation •