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1. Gingival fluid from severely inflamed periodontal tissue represents a 15 to 30% dilution of serum with respect to the proteins studied, with the exception of C3 and in some subjects, C4. 2. A marked decrease in C3 levels is found in most, if not all, gingival fluids, and a marked decrease of C4 levels is found in some gingival fluids. This suggests that complement might be activated during periodontal inflammation. 3. The concentrations of proteins in the gingival fluid are not related to their molecular weight. more...

Crevicular fluid from gingivitis patients contains significant levels of a cysteine protease which was characterized as the lysosomal protease cathepsin B, as judged by substrate specificity, thiol dependence, pH optimum, kinetic parameters, pH stability, and inhibitor sensitivities. A highly-sensitive fluorometric assay procedure was used to establish the mean level of cathepsin B activity for 25 gingivitis patients. more...

The concentration of tetracycline in gingival crevice fluid and blood was determined using a sensitive bioassay after oral administration of repeated doses of tetracycline. Crevicular fluid was sampled by an intracrevicular technique from four gingival sites in each individual and blood was obtained by finger puncture. Four volunteers received doses of 250 mg of tetracycline-HCl either every 6 hours or every 12 hours and were sampled at hours 0 to 15, 21 to 36, 48 to 60 and 96 to 102. Volunteers given 250 mg every 6 hours had average crevicular fluid concentrations between 4 to 8 micrograms/ml and blood concentrations between 2 to 2.5 micrograms/ml after 48 hours. The levels in crevicular fluid and blood of volunteers who received 250 mg every 12 hours were 2 to 4 micrograms/ml and 0.3 to 1.4 micrograms/ml respectively after 48 hours. The results demonstrated that after repeated doses of tetracycline the crevicular fluid levels were typically 2 to 4 times the blood levels. more...

An agar diffusion assay in capillaries, with Fusobacterium nucleatum M2 as the indicator strain, has been developed to measure metronidazole concentrations in gingival crevice fluid. The assay allows the measurement of 1.9 micrograms of metronidazole per ml in sample amounts of 0.6 microliters. more...

Protein concentrations in gingival fluid exudate were obtained in both the clinically minimal and severe inflammatory states. A comparison of the results indicated no significant differences in the two groups studied. Since total protein concentrations do not appear to reflect accurately the clinical inflammatory status of the gingival tissues, specific components of the protein molecule should be studied. more...

A number of factors which might affect the readings of the HAR-600 GCFM were studied: 1. The readings were higher when the filter paper strips were placed between the fron halves of the upper and lower counterparts than when they were placed between the rear halves. No differences in readings were observed when the strips were placed in the middle, the left, or the right areas of the counterparts. 2. The higher the fluid viscosity the lower the reading. Salt water (0.9% NaCl) gave a lower reading than deionized water. 3. Increased room temperature or relative humidity led to higher readings, especially when the fluid volume exceeded 0.2 microliter. 4. More reading time was required for high viscosity fluid, low temperature, and high relative humidity. The HAR-600 GCFM readings and the lengths of ninhydrin-stained areas were compared. Both methods were able to reflect the amounts of serum absorbed. more...

On the whole, the studies on GCF have demonstrated that the flow of this fluid is sufficiently indicative of the inflammatory state that it can be used under a variety of clinical conditions to monitor and control gingival inflammation. Since gingivitis is extremely common, and since some cases of gingivitis presumably do not progress to periodontitis, the question could be posed whether or not a concerted effort to control inflammation (i.e. trying to achieve a GCF flow as near to zero as possible) would be clinically significant. Until there is evidence to the contrary, the answer must be "yes", since few cases are known where periodontitis occurs without being preceded by gingivitis. In other words, the control of all gingivitis, if feasible, should prevent most cases of periodontitis. Although control of all gingivitis would mean the treatment of many cases that would not progress to periodontal breakdown, such efforts would be worth-while if most periodontal destruction were prevented. Even the early destructive lesion exhibiting little or no inflammation may soon be identified, mainly because the minute volume of fluid collected from the gingival crevice can now be measured accurately. Accordingly, the concentration of various constituents in the GCF can be determined, which should lead to the development of tests to differentiate between pockets undergoing active destruction with minimal inflammation from the majority of active lesions that are intimately involved with frank inflammation. Thus, a clinician would measure sub-clinical gingival inflammation by measuring GCF flow, then differentiate destructive from quiescent lesions by analyzing the GCF sample for some constituent(s), chemical or microbial (Listgarten et al. 1975) indicative of the periodontal destructive process. Monitoring the flow of GCF might be of value in other clinical situations. For example, one could monitor the response of gingival tissues to various restorative and prosthetic procedures (Strauss et al. 1975) to ensure that these procedures do not aggravate the periodontal tissues and induce gingivitis or periodontitis. The education of the patient should be easier since patients can read their own numbers on the GCF meter at each examination and self-evaluate their personal periodontal condition and the effectiveness of their home care. Even the education of the dental student should be easier since he or she would have the means of self-evaluating the effectiveness of treatment, and not be as dependent upon the subjective assessment of his efforts by an instructor. Finally, monitoring GCF for various components could provide the dentist with a valuable means of easily screening patients for systemic disease. Obviously, this area of investigation is in its infancy, but does promise an exciting future for the oral diagnostician. more...

These preliminary investigations seem to indicate that the periotron may be useful in assessment of the presence of gingival inflammation in the clinical periodontal pockets. Successive recordings of the same volume varied from 5 to 11%. Data from the periotron showed a high correlation with increased known volumes of fluid and with assessment of gingival inflammation using the GI. Assessment with the periotron varied with the dissipation constant of fluids. Since the dissipation constant of gingival fluid varied among individuals, this constant must be evaluated when the instrument is used in clinical and research efforts. more...

Gingival fluid from eight control subjects and ten diabetics was collected and the content of cAMP and protein in the fluid was assayed to determine the nature of the biochemical changes occurring in the gingival fluid due to diabetes. The gingival fluid of the control subjects had a cAMP concentration of 2.4 X 10(-6) M, which was a hundredfold greater than that seen in serum, thus suggesting that the cAMP in the fluid resulted from active synthesis by the gingival cells and was not merely a transudate from the blood. The gingival fluid of the diabetics contained only one-seventh the level of cAMP seen in the control group. It is suggested that the decreased level of cAMP seen in the givgival fluid of diabetics may be a manifestation of a defect in the cAMP forming mechanism of the gingival tissue, which may reflect the systemic etiology of diabetes. It was also found that in the control subjects the content of cAMP in the gingival fluid was in inverse proportion to the volume of exudate in the gingival crevice. No such relationship was seen in the diabetic group. It appears that the level of cAMP present in the gingival fluid of normal individuals without any generalized endocrine deficiencies may be used as an additional indicator of the inflammatory status of the gingival tissues, along with the clinical evaluation based on gingival index. more...

This study was designed to determine if quantitation of lysosomal products in crevicular fluid may be useful as a diagnostic test to evaluate clinical status in periodontal disease. Levels of lysozyme and lactoferrin were quantitated in crevicular fluid from patients with gingivitis, generalized adult periodontitis, localized juvenile periodontitis and normals. Crevicular fluid (CF) was collected from each patient by standardized filter paper strips and evaluated for lysozyme and lactoferrin by rocket immunoelectrophoresis. Levels of lysozyme (micrograms of protein per microliter of CF) were significantly higher in localized juvenile periodontitis patients as compared to gingivitis and adult periodontitis. On the other hand, levels of lactoferrin (micrograms of protein per microliter of CF) did not show significant differences between gingivitis, adult periodontitis and localized juvenile periodontitis. These results indicate that a lysozyme to lactoferrin ratio could be of value as a diagnostic test for localized juvenile periodontitis patients. more...

The effects of mechanical tooth cleaning and 0.2% chlorhexidine mouthrinses on healing after gingivectomy were compared in 8 patients by means of a "split mouth" technique. The experiment began after periodontal pack removal on day 7. Gingival fluid was sampled immediately before and on days 14, 21, 28, 35 after gingivectomy. The results showed that mechanical and chemical plaque control were equally effective in promoting healing after gingivectomy as evaluated by gingival fluid measurements. more...

Total fucose and protein was measured in gingival fluid samples collected from 16 human subjects. A significantly higher total protein concentration was found for the control (clinically normal) group when compared to the experimental (severe clinical inflammation) group. This is probably due to the higher gingival flow rate found in the experimental group. The total fucose analyses showed no statistical difference between both groups, but when fucose to protein ratios were studied, a significantly higher ratio was found for the experimental group when compared to the controls. This probably represents the breakdown of plasma and tissue glycoproteins which may occur as a result of inflammation. more...

A method for the detection of prostaglandin E (PGE) in crevicular fluid has been developed which provides a sensitive, noninvasive technique for measurement of local concentrations of this mediator of inflammation. Assay sensitivity sufficient for the detection of 4 picograms of PGE2 was achieved by utilizing a high-affinity anti-PGE2 antibody, a solid-state second antibody and low isotope concentrations. The method permits detection of concentrations equivalent to 10(-8) M PGE2 in 1 microliter of crevicular fluid. Crevicular fluid PGE (CFPGE) concentrations were determined in samples from 12 patients with periodontal disease. Patients with periodontitis had significantly higher mean CFPGE concentrations than patients with gingivitis (179.5 +/- 51.4 pg/microliter vs 32.1 +/- 15.5 pg/microliter, mean +/- SEM). Periodontitis sites were selected on the basis of clinical and radiographic evidence of periodontal destruction. Some sites displayed low CFPGE levels, while others had CFPGE concentrations which were elevated tenfold, suggesting the presence of both inactive and active periodontal lesions. CFPGE levels greater than 100 pg/microliter were positively associated with gingival erythema and pain on probing. more...

The success of various periodontal treatments can be demonstrated by the quantitative determination of the gingival sulcus fluid if these treatments improve the peripheral blood supply. Compared to the manual method of determining the diffusion height of the exudate prior and after periodontal therapy (the extent of exudate reduction being used as a criterion for the degree of regression of the inflammatory circulatory disorder), the photometric-planimetric techniques yield exacter and even more favourable results. Due to its easiness and rapidity, the measurement of the diffusion height of the exudate is, as an additional control examination, useful in assessing the success of periodontal treatment. more...

Crevicular fluid was collected from patients with periodontitis by a capillary tube procedure. Complement component activities were determined by functional assay systems, with human complement, and partially purified human first complement component (C1) as controls. The complement-fixing properties of the dental plaque of each patient were also examined C1 activity in the crevicular fluid of all patients was approximately 1/8 of whole serum C1 and diminished rapidly with time after collection. There was no significant relationship between C1 concentration and crevicular fluid flow rate. Hemolytic activity of whole complement was also invariable detected when sufficient amounts (8 micronl) of crevicular fluid could be obtained. Dental plaque was found to fix C1. A role for crevicular complement in inflammatory periodontal disease is suggested. more...

To objectify the healing process after gingivectomy and flap operation, the gingival sulcus liquid was determined in 20 patients before and after the operation. It was drawn off in the labial part of the sulcus of anterior teeth by means of microcapillaries and then measured. At the same time, the gingival index (M-index) was checked and the depth, of the pocket was measured. Four weeks after the operation, a clear reduction in the amount of the gingival liquid, the index and the depth of the pocket was observed. The group of probands on which flap operations were performed, had twice as much sulcus liquid than those undergoing gingivectomy, and consequently the amount of exudate decreased considerably more within the first three weeks. After the third postoperative week, the average values converged and after the fourth week they were almost identical. The M-index changed accordingly, the average pocket depth was between 1 and 1.5 mm after four weeks. more...

Gingival fluid samples were collected from 12 healthy adult women who ranged in age from 19 to 34 years. Seven subjects with normal menstrual cycles who received no medications acted as controls while five subjects who had been using oral contraceptives for a minimum of 17 months constituted the experimental group. The women using birth control pills showed a 53% increase in the gingival fluid volume versus the controls. Radioimmunoassay revealed a mean concentration of cyclic adenosine monophosphate (cAMP) in the gingival fluid of 3.8-10(-6)M in the controls and 1.9-10(-6)M in subjects using oral contraceptives, although the total amount of cAMP present in the fluid from both groups was equal. These gingival fluid cAMP levels were a hundredfold higher than those measured in serum and saliva. more...

In 30 men and 29 women the mean gingival exudate ratio alpha-1-antitrypsin (A1AT)/transferrin (Tr) was higher than the mean blood ratio for A1AT/Tr, when determined by double electroimmunoassay. It suggests that A1AT penetrates the tissue more easily than transferrin probably due to its smaller molecular size or that migration into the extracellular space occurs due to consumption by proteolytic enzymes. The gingival exudate ratio and the blood ratio for A1AT/Tr were not related to periodontal disease when considered separately. However, the difference between the exudate ratio and the corresponding blood ratio was significantly less (P = 0.02) for individuals with periodontal disease. This suggests that the ratio difference is of importance in the destruction of tooth-supporting collagen fibers. more...

A study was done in an attempt to develop a simple test for the severity of periodontal disease. Gingival fluid collected on filter paper was tested for protein content, and the resulting color was compared to standard color filters. Tissue was excised and prepared for histologic examination. The inflammatory cell infiltrate on each slide was graded on a scale of zero to three. Zero was least and three was the highest number of inflammatory cells. The results indicate that the white cell infiltrate graded 0 or 1 on the histologic inflammatory index has a color index of B 1/8 TO B1 whereas the tissue graded 2 or 3 HII has a range of B2 to B6 on the color scale. This test can give the dental practitioner a general idea of the severity of the inflammation. more...