Public Insitution State University of Medicine and Pharmacy «

Nicolae Testemițanu »
Department of Dental Propaedeutics « Pavel Godoroja »

Gingival sulcus. Gingival

fluid.

ASSISTANT PROFESSOR

DIANA TRIFAN
 Gingival sulcus, notion.

• The gingival sulcus is the relative

space between each tooth and the
gum tissue that surrounds it.
• Is the shallow crevice or space
around the tooth bounded by the
surface of the tooth on one side and
the epithelium lining the free margin
of the gingiva on the other.
• It is V shaped and barely permits the
entrance of a periodontal probe.
Gingival sulcus, notion.

• When it’s healthy, the gingival sulcus is snug around

your teeth from the base of the tooth all the way to
where the tooth emerges from your gums. This leaves
very little room for any external substances, like food,
to enter in the space between the gum and the tooth.
• When it’s unhealthy or diseased, the space between
the sulcus and the tooth is a little larger. This allows
substances to enter that space more easily.
Delimitation of the gingival sulcus

• Inner lateral side is demarcated by the tooth- enamel+cementum

• The base is represented by the junctional epithelium
• Outer lateral side is demarcated by the sulcular epithelium, the lining of
the free marginal gingiva
Depth of the gingival sulcus
• The probing depth of a clinically normal gingival
sulcus is 2-3mm.
Depth of the gingival sulcus
• The clinical maneuver used to
determine the depth is the
introduction of the
periodontal probe – and the
estimation of the distance it
penetrates.
• The histologic depth is not
always equal to the depth of
penetration of the probe.
 The contents of the gingival
sulcus.
It contains components of
• serum,
• inflammatory cells,
• connective tissue,
• epithelium cells,
• microbial flora inhabiting the gingival margin or the
sulcus/pocket.
Liquid of the gingival sulcus =
Gingival crevicular fluid (GCF)
• Gingival crevicular fluid is an inflammatory exudate
derived from the periodontal tissues.
• It is composed of serum and locally generated materials
such as tissue breakdown products, inflammatory
mediators, and antibodies directed against dental plaque
bacteria.
• It plays a special part in maintaining the structure of
junctional epithelium and the antimicrobial defense of
periodontium.
The origin of the gingival fluid.
• Its constituents are derived from a number
of sources, including serum, the connective
tissue, and epithelium through which GCF
passes on its way to the sulcus (crevice).
• The fluid component of gingival crevicular
fluid is derived primarily from
microvascular (postcapillary venule)
leakage.
Composition of gingival fluid
Composition of gingival fluid

A. Cellular elements
1. Desquamated Epithelial cells
2. Leukocytes = immunity cells: the number of cells
increased proportionately with the intensity of
inflammation, whereas the differential count was 95–
97% neutrophils (PMN), 1–2% lymphocytes, and 2–3%
monocytes cells.
3. Bacteria cultured from GCF were similar to those found
in the adjacent dental plaque electrolyte.
B. Electrolytes =An-
organic compounds-
Minerals: Sodium,
Potasium, Fluoride,
calcium, phosphorus
C. Microbial plaque products

• Bacterial enzymes
• Gingival crevicular fluid collected from diseased sites
has been shown to have high levels of host-derived
enzymes such as neutrophil elastase (NE), alkaline
phosphatase (AP), and aspartate aminotransferase
(AST)
• Cytotoxic substances
 D. Inflammatory end products

Proteolytic and hydrolytic enzymes of

inflammatory cell origin

• Inflammatory process leads to the release of

polymorphonuclear neutrophils or leukocytes
(PMN), macrophages, lymphocytes, and mastocyte
cells.

• The lysosomes of these inflammatory cells contain

destructive enzymes that degrade the bacterial
and metabolic by products during the process of
phagocytosis

•.
• These enzymes are, however, capable of degrading
gingival tissue components if released.

• Collagenases are a part of matrix metalloproteinase family

that degrades collagen. They are synthesized by
macrophages, neutrophils, and fibroblasts and
keratinocytes

• They are secreted by these cells as latent enzymes when

stimulated by some bacterial products and cytokines.
• Immunoglobulins
• Complement – has protective
functions
• Cytokines
• Interleukin-1 (IL-1) and tumor
necrosis factor alpha (TNF-α) are
produced by activated
macrophages and other cells.
• IL-1α and IL-1β are present in
inflamed gingiva, they have pro-
inflamatory effects, can lead to
bone formation or resorbtion
• Metabolic and bacterial products
E. Host derived products (from the organism)

• Host production of cytokines ang immunoglobulins in response

to bacterial infection may be the trigger for periodontal
disease progression

• Immunoglobulins IgA, IgG,

• Cytokines Interleukin-1 (IL-1) and tumor necrosis factor alpha

(TNF-α) are produced by activated macrophages and other cells.
IL-1α and IL-1β are present in inflamed gingiva, they have pro-
inflamatory effects, can lead to bone formation or resorbtion
 Complement
• Although the complement system is centrally involved in host defense,
its overactivation or deregulation (e.g., due to inherent host genetic
defects or due to pathogen subversion) may excessively amplify
inflammation and contribute to immunopathology.
DRUGS IN THE SULCULAR FLUID

• Metronidazole and tetracycline are excreted through

the GCF

• They can eliminate tissue bacteria, and in conjunction

with scaling and root planning, they suppress
actinomycetemcomitans levels.
Functions of gingival fluid.
• Possesses antibacterial properties
• Cleanses materials from the sulcus
• Contains plasma proteins that may improve adhesion
of the epithelium to the tooth
• Exert antibodies activity in defense of gingiva
Factors stimulating gingival
crevicular fluid flow
• Physiological
• Circadian periodicity: There is gradual increase in gingival fluid
amount from 6 am to 10 pm and a decrease afterward.
• Chewing hard foods, vigorous brushing and gingival massage
• Enzymes and sex hormones: Female sex hormones increase the
gingival fluid flow because they enhance vascular permeability.
• hormonal contraceptives,
• pregnancy
• smoking (instant but transitory increase of GCF).
Quantitative ratio of gingival fluid to
norm and pathological conditions.
• Factors stimulating gingival crevicular fluid flow
• Gingival inflammation,
• intracrevicular scraping, scaling,
• histamine topical application.
• increased body temperature,
• Post-periodontal surgery, restorative procedures
 Description of factors affecting the amount
of GCF in the human oral cavity.
Factors Description
Chewing coarse foods, vigorous
Mechanical brushing and gingival massage are
known to increase GCF production
The amount of GCF increases
Circadian periodicity gradually from 6 a.m. to 10 p.m. and it
decreases after that
GCF production increases after
Periodontal surgeries periodontal surgeries, during the
healing period
Smoking increases GCF flow.
Smoking This increase in GCF due to smoking
is immediate and transient
Methods of collecting gingival
fluid
• Absorbing paper strips
• Filter paper strips were used to collect GCF by inserting
the strips into the crevice (apical direction) until mild
resistance was detected or by inserting the strips at or
over the entrance of the pocket to pick up the seeping
fluid (30 sec).
 Methods of collecting gingival
fluid
• Micropipettes
• The use of micropipettes permits
the absorption of fluid by
capillarity. Capillary tubes of
standardized length and
diameter were placed in the
pocket and their content was
later centrifuged and analyzed.
Amount of GCF collected
• The total fluid flow is between 0.5 and 2.4 µL per
day
• The mean GCF volume in proximal spaces of
anterior teeth are 0,24-0,43 µl
• Its rate of flow is related to the degree of gingival
inflammation, and a rate of 0.05 to 0.20 µL per
minute was reported in cases of apparent minimal
inflammation.
 Significance of gingival crevicular
fluid
1.To assess the severity of gingival diseases, the effectiveness of
periodontal therapy and oral hygiene, the healing following gingival
surgery, and the effectiveness of oral hygiene.

2.To evaluate the rate of local destruction, to assess the

permeability of junctional and sulcular epithelium, and to assess
the relationship between periodontal and systemic diseases.
 Clinical importance of gingival
fluid

• GCF is exploited to
analyze the biochemical
parameters to identify the
periodontal disease at its
early stage before the
commencement of the
clinical damage
Clinical importance of GS and JE
• The junctional epithelium is located at a strategically
important interface between the gingival sulcus,
populated with bacteria, and the periodontal soft and
mineralized connective tissues that need protection
from becoming exposed to bacteria and their products.
• Its unique structural and functional adaptation enables
the junctional epithelium to control the constant
microbiological challenge.
Clinical importance of GS and JE

• Research has shown that the junctional epithelial cells

may play a much more active role in the innate defense
mechanisms than previously assumed. They synthesize
a variety of molecules directly involved in the combat
against bacteria and their products.
• In addition, they express molecules that mediate the
migration of polymorphonuclear leukocytes toward the
bottom of the gingival sulcus.
Thank you for your
attention!