Defense mechanism of gingiva / /certified fixed orthodontic courses by Indian dental academy

Defense mechanisms of
Gingiva

INDIAN DENTAL ACADEMY
Leader in Continuing Dental Education
www.indiandentalacademy.com

Introduction
Sulcular fluid
Leukocytes
saliva

Introduction
This describes the permeability of the junctional &
sulcular fluid ,leukocytes & saliva.

The gingival tissue is constantly subjected to
mechanical & bacterial aggressions.

The saliva the epithelial tissue surface & the initial
stage of the inflammatory response provide
Resistance to there actions.


Gingival tissues

Bacterial aggressions
Mechanical aggressions

Epithelial surface
Role of sulcular fluid
Saliva


Gingival Crevicular Fluid

Composition and possible role in oral
defense mechanisms were elucidated
by Waerhaug and Brill & Krause in
1950.
They consider it to be a transudate
but others demonstrated it to be a
exudate.
Recently it is used for detection or
prediction ofwww.indiandentalacademy.com
periodontal diseases.

METHODS OF COLLECTION

As used to see changes in priodontium
.
GCF is collected but it is difficult to
convene the fluid

Methods include:
 Absorbing paper strips

 Twisted threads

 Micropipettes

 Intracrevicular washings


Absorbing paper strips
These are
Extrasulcular
intarsulcular
 Placement of filter paper is important
•Brill technique places it into the pocket until
resistance is encountered but it introduces a
degree of irritation which can trigger flow.

•To minimize irritation they can be placed at
the entrance of the pocket or over the pocket
entrance www.indiandentalacademy.com

Microcapillary pipettes

•Microcapillary pipettes collects fluid
by capillarity.

•Capillary tubes of standard length
and diameter are placed, and their
content is centrifuged and analyzed.


Twisted Threads
Preweighed twisted threads
were placed in the crevice
and the amount of fluid
collected was estimated by
weighing the same thread.


Crevicular washings

Crevicular washings are used to
study GCF from normal gingiva.

There are two methods:
1. acrylic plate and peristaltic
pump
2. two injection and continuous
suction.

Permeability of Junctional and
Sulcular Epithelia:
Studies by Brill and Krasse using India
ink and saccharated iron oxide.
Substances that penetrate SE include
albumin, endotoxin, thymidine,
histamine, phenytoin and horseradish
peroxidase.
These indicate permeability to
substances with a molecular wt of upto
1 million. www.indiandentalacademy.com

Permeability of Junctional and Sulcular
Epithelia:


Amount

Amount collected on paper strips
evaluated in various ways.
Wetted area is made more visible by
Ninhydrin staining.
Electronic methods (Periopaper and
Periotron)
Mean GCF volume in proximal spaces
of molar teeth ranged from 0.43 to
1.56µl www.indiandentalacademy.com

Composition
Characterized according to proteins,
specific antibodies, antigens, enzymes
(majority) and cellular elements.
Around 40 compounds have been
attempted to detect or diagnose
active disease or predict the risk for
periodontal disease.
These compounds can be host derived
or by the bacteria.

Enzymes found
Acid and alkaline phosphatase
AST
B-glucuronidase
Cytokines(il-1a, il-1b, 6,8)
Ig G, A, M
Endo & Exopeptidases
Fibronectin
Lactoferrin
Lysozymes
Myeloperoxidase
PGE2 www.indiandentalacademy.com

Cellular Elements:
• Bacteria
• Desquamated epithelial cells
• Leukocytes

Electrolytes:
• Potassium, sodium and calcium have been
studied.
• They showed a positive correlation of calcium
and sodium concentrations and the sodium-to-
potassium ratio with inflammation.


Organic Compounds:
Carbohydrates and proteins have been
investigated
Glucose hexosamine and hexuronic acid found
in GCf.
Blood glucose levels do NOT correlate with
GCF glucose levels
Glucose concentration in GCF is 3 to 4 times
greater than that in serum.( due to metabolic
activity of adjacent tissues and of the local
bacteria.)
The total protein content is much less than
that of serum, but no significant correlations
have been found between protein and disease.

Clinical Significance
• GCF is an inflammatory exudate and its
presence in clinically normal sulci is due to
subclincal inflammation.
• The amount is greater when inflammation is
present and sometimes proportional to the
severity of inflammation.
• Is not increased in TFO but increased by
mastication of coarse foods, tooth brushing,
gingival massage, ovulation, hormonal
contraceptives, and smoking

Other factors that influence the amount of GCF

Circadian Periodicity: Increase from 6am to
10pm and decrease afterward.
Sex Hormones: Female sex hormones Increase
GCF flow, as they enhance vascular
permeability.
Mechanical Stimulation: Chewing and vigorous
gingival brushing stimulate the flow of GCF.
Smoking: Produces an immediate transient but
marked increase in GCF flow.
Drugs in GCF:
Tetracycline and Metronidazole.


Leukocytes in the
Dentogingival area:
Found even in healthy gingival sulci
most predominant are PMN.
Differential counts from healthy sites
show
92% of PMN and
8% mononuclear cells
B lymphocytes 58%
T lymphocytes 24%
Phagocytes 18%

.
The ratio of T to B lymphocytes was
reversed form the normal ratio of about
3:1 found in peripheral blood to about 1:3
in GCF
The majority of these cells are viable
with phagocytic and killing capacity.
Thus they constitute major protective
mechanism against the extension of
plaque into the gingival sulcus and also
oral cavity.

Saliva
 They are protective in nature because they
maintain the oral tissues in a physiological state
 It exerts a major influence on plaque by
mechanically cleansing the exposed oral surfaces,
by buffering acids produced by bacteria, and by
controlling bacterial activity.


Antibacterial factors
Inorganic factors: ions, gases,
bicarbonate, sodium, potassium,
phosphates, calcium, fluorides,
ammonium and carbon dioxide.
Organic factors: lysozyme, lactoferrin,
myeloperoxidase, lactoperoxidase, and
agglutinins such as glycoproteins,
mucins, macroglobulins, fibronectins and
antibodies.

Lysozyme is a hydrolytic enzyme
that cleaves the linkage between
structural components of muramic
acid-containing region of the
bacterial cell wall.
It works on both Gram
positive and Gram negative
organsims, veillonella species and
AAC.

Lactoperoxidase-thiocyanate
system is bactericidal to strains of
Lactobacillus and Streptococcus by
preventing the accumulation of
lysine and glutamic acid, which are
essential for bacterial growth.
Lactoferrin and Myeloperoxidase
are other antibacterial factors
which has added effect of
inhibiting the Actinomycosis stains
to hydroxyapatite.

Salivary antibodies:

The preponderant immunoglobulin in
saliva is IgA, although IgG and IgM are
also seen.
Major and minor salivary glands
contribute all the secretory IgA,
whereas GCF contributes most of the
IgG, complement and PMNs.
Enzymes in saliva: are derived from
salivary glands, bacteria, leukocytes,
oral tissues, and ingested substance.

Enzymes that are increased periodontal disease
are:

hyaluronidase, lipase, β-glucuronidase,
chondrotin sulfatase, amino acid decarboxylases,
catalase, peroxidase, collagenase.

Saliva contains both proteolytic enzymes and
antiproteases which are generated by both the
oral bacteria and the host.


Salivary buffers and coagulation
factors:
In saliva the most important buffer
system is bicarbonate-carbonic acid
system.
Saliva contains factor VIII, IX, X,
Plasma thromboplastin antecedent, and
Hageman factor that hasten
coagulation.

Leukocytes:
Principal leukocytes are PMNs
PMNs reach the oral cavity by migrating
through the lining of the gingival sulcus.
Living PMNs in saliva are referred to as
orogranulocytes and there rate of
migration as orogranulocyte migratory
rate.
Orogranulocyte migratory rate is said to
be increased with increasing severity of
gingival inflammation.

Role in periodontal pathology:
Exerts major influence on plaque
initiation, maturation and metabolism.
Its flow and composition influence
calculus formation, periodontal disease
and caries.
Removal of salivary glands in exp. Animals
significantly increases caries, pdl disease
and delays wound healing.


FINALE
In humans, an increase in inflammatory gingival
diseases,dentalcaries & rapid tooth
Destruction associated with cervical cemental caries
is partially a consequence of xerostomia
•Xerostomia is a condition where there is decreased

saliva due to decreased salivary gland secretion which

may result from variety of factors – sialolithiasis,

sarcoidosis, sjogrens syndrome, mikuliczs disease,

irridiation, and surgical removal of salivary glands.

Defense mechanism of gingiva / /certified fixed orthodontic courses by Indian dental academy

Defense mechanism of gingiva / /certified fixed orthodontic courses by Indian dental academy

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