Gingival crevicular fluid in the diagnosis of periodontal and systemic diseases

Abstract

Gingival crevicular fluid (GCF) can be found in the physiologic space (gingival sulcus), as well as in the pathological space (gingival pocket or periodontal pocket) between the gums and teeth. In the first case it is a transudate, in the second an exudate. The constituents of GCF originate from serum, gingival tissues, and from both bacterial and host response cells present in the aforementioned spaces and the surrounding tissues. The collection and analysis of GCF are the noninvasive methods for the evaluation of host response in periodontal disease. These analyses mainly focus on inflammatory markers, such as prostaglandin E2, neutrophil elastase and β-glucuronidase, and on the marker of cellular necrosis - aspartat aminotransferase. Further, the analysis of inflammatory markers in the GCF may assist in defining how certain systemic diseases (e.g., diabetes mellitus) can modify periodontal disease, and how peridontal disease can influence certain systemic disorders (atherosclerosis, preterm delivery, diabetes mellitus and some chronic respiratory diseases). Major factors which influence the results obtained from the analyses of GCF are not only the methods of these analyses, but the method of GCF collection as well. As saliva collection is less technique-sensitive than GCF collection, some constituents of saliva which originate from the GCF can be analyzed as more amenable to chairside utilization.

Gingivalna tečnost (GT) je tečnost koja se nalazi u fiziološkom (gingivalni sulkus) ili u patološkom prostoru između desni i zuba (gingivalni xep ili parodontalni xep). Ona može da bude transudat seruma ili inflamatorni eksudat. Elementi GT potiču iz seruma, epitela i vezivnog tkiva gingive, kao i iz inflamatornih ćelija i bakterija koje se nalaze u tom prostoru i okolnim tkivima. Prikupljanje i analiza GT je neinvazivna metoda procene odgovora osobe obolele od parodontopatije. Ove analize se uglavnom odnose na pokazatelje zapaljenja, kao što su prostaglandin E2, elastaza neutrofila i beta-glukuronidaza, ili na pokazatelj nekroze ćelija, aspartat- aminotransferazu. Osim toga, analiza pokazatelja zapaljenja u GT mogla bi da pomogne u razjašnjenju načina na koji neke sistemske bolesti (npr. diabetes mellitus) menjaju kliničku sliku parodontopatije s jedne strane, i kako zapaljenje parodoncijuma, tj. parodontopatija, može da utiče na razvoj nekih sistemskih bolesti (kardiovaskularnih, cerebrovaskularnih) sa druge. Važni činioci koji utiču na rezultate analiza GT su ne samo metode tih analiza, već i metode prikupljanja GT. Praktični razlozi upućuju i na analizu nekih sastojaka u pljuvački koji potiču od GT zbog njenog jednostavnijeg sakupljanja.