Analysis of Gingival Crevicular Fluid as Applied to the Diagnosis of Oral and Systemic Diseases

Abstract:  Gingival crevicular fluid (GCF), a serum transudate or inflammatory exudate, can be collected from the gingival crevice surrounding the teeth. As such, the fluid reflects the constituents of serum, the cellular response in the periodontium, and contributions from the gingival crevice. The study of GCF has focused on defining the pathophysiology of periodontal disease, and identification of a potential diagnostic test for active periodontitis. The majority of markers that have been identified as potential candidates for such a test are measures of inflammation (i.e., prostaglandin E2 (PGE2), neutrophil elastase, and the lysosomal enzyme β‐glucuronidase). Further, analysis of inflammatory markers in GCF may assist in defining how certain systemic disorders (e.g., diabetes mellitus) can modify periodontal disease, and how periodontal disease/periodontal inflammation can influence certain systemic disorders (i.e., cardiovascular/cerebrovascular diseases). Methodological concerns related to the collection and analysis of GCF are important factors that need to be considered when studying GCF. Practical concerns argue against the widespread clinical application of GCF as an adjunct to periodontal diagnosis. Rather, analysis of GCF‐derived mediators in saliva may serve as a means of rapid screening for periodontal disease.

[1]  I. Lamster,et al.  Infantile agranulocytosis with survival into adolescence: periodontal manifestations and laboratory findings. A case report. , 1987, The Journal of Periodontology.

[2]  T. Alpagot,et al.  Longitudinal evaluation of GCF IFN-gamma levels and periodontal status in HIV+ patients. , 2003, Journal of clinical periodontology.

[3]  C. Overall,et al.  Microbiota and crevicular fluid collagenase activity in the osseointegrated dental implant sulcus: a comparison of sites in edentulous and partially edentulous patients. , 1989, Journal of periodontal research.

[4]  B. Loos,et al.  Host-derived diagnostic markers for periodontitis: do they exist in gingival crevice fluid? , 2005, Periodontology 2000.

[5]  I. Lamster,et al.  Inflammatory and immune mediators in crevicular fluid from HIV-infected injecting drug users. , 1997, Journal of periodontology.

[6]  W. T. McFall Tooth loss in 100 treated patients with periodontal disease. A long-term study. , 1982, Journal of periodontology.

[7]  T. Tözüm,et al.  Relationship between the quantity of gingival crevicular fluid and clinical periodontal status. , 2000, Journal of oral science.

[8]  I. Lamster,et al.  The relationship of beta-glucuronidase activity in crevicular fluid to probing attachment loss in patients with adult periodontitis. Findings from a multicenter study. , 2005, Journal of clinical periodontology.

[9]  J. Egelberg Permeability of the dento-gingival blood vessels. IV. Effect of histamine on vessels in clinically healthy and chronically inflamed gingivae. , 1966, Journal of periodontal research.

[10]  R. Arnold,et al.  Inflammatory mediator response as a potential risk marker for periodontal diseases in insulin-dependent diabetes mellitus patients. , 1997, Journal of periodontology.

[11]  I. Lamster,et al.  GCF IL-1β profiles in periodontal disease , 2002 .

[12]  T. Modéer,et al.  Prostaglandin E2 level in gingival crevicular fluid from patients with Down syndrome. , 1997, Acta odontologica Scandinavica.

[13]  R. Boyd,et al.  Long-term monitoring of adult periodontitis patients in supportive periodontal therapy: correlation of gingival crevicular fluid proteases with probing attachment loss. , 1999, Journal of clinical periodontology.

[14]  P. Söder,et al.  Increased leukotriene concentrations in gingival crevicular fluid from subjects with periodontal disease and atherosclerosis. , 2007, Atherosclerosis.

[15]  B. Eley,et al.  A 2-year longitudinal study of elastase in human gingival crevicular fluid and periodontal attachment loss. , 1996, Journal of clinical periodontology.

[16]  K. Balos,et al.  IL-6 levels in gingival crevicular fluid (GCF) from patients with non-insulin dependent diabetes mellitus (NIDDM), adult periodontitis and healthy subjects. , 1999, Journal of oral science.

[17]  M. Jabra-Rizk,et al.  Enhanced interleukin 1 beta, interleukin 6 and tumor necrosis factor alpha in gingival crevicular fluid from periodontal pockets of patients infected with human immunodeficiency virus 1. , 2000, Oral microbiology and immunology.

[18]  B. Wasserman,et al.  A long-term survey of tooth loss in 600 treated periodontal patients. , 1978, Journal of periodontology.

[19]  C. McCulloch,et al.  Evidence of a direct relationship between neutrophil collagenase activity and periodontal tissue destruction in vivo: role of active enzyme in human periodontitis. , 1995, Journal of periodontal research.

[20]  P. Imrey,et al.  A longitudinal study of aspartate aminotransferase in human gingival crevicular fluid. , 1991, Journal of periodontal research.

[21]  S. Socransky,et al.  New concepts of destructive periodontal disease. , 1984, Journal of clinical periodontology.

[22]  Tetsuro Suzuki,et al.  Quantitative Detection of Hepatitis C Virus (HCV) RNA in Saliva and Gingival Crevicular Fluid of HCV-Infected Patients , 2005, Journal of Clinical Microbiology.

[23]  I. Lamster,et al.  Gingival crevicular fluid levels of interleukin-1beta and glycemic control in patients with chronic periodontitis and type 2 diabetes. , 2004, Journal of periodontology.

[24]  B. Eley,et al.  Investigations into the cellular contribution to host tissue proteases and inhibitors in gingival crevicular fluid. , 1997, Journal of clinical periodontology.

[25]  Y. Iwayama,et al.  ELISA detection of glycosaminoglycan (GAG)-linked proteoglycans in gingival crevicular fluid. , 1993, Journal of periodontal research.

[26]  M. Poljak,et al.  Detection of hepatitis C virus RNA from gingival crevicular fluid and its relation to virus presence in saliva. , 2001, Journal of periodontology.

[27]  G. Cimasoni,et al.  Osteocalcin, prostaglandin E2 and alkaline phosphatase in gingival crevicular fluid: their relations to periodontal status. , 1994, Journal of clinical periodontology.

[28]  D. Kaner,et al.  Calprotectin and cross-linked N-terminal telopeptides in peri-implant and gingival crevicular fluid. , 2006, Clinical oral implants research.

[29]  T. Modéer,et al.  Enhanced levels of prostaglandin E2, leukotriene B4, and matrix metalloproteinase-9 in gingival crevicular fluid from patients with Down syndrome , 2003, Acta odontologica Scandinavica.

[30]  S. Offenbacher,et al.  The use of crevicular fluid prostaglandin E2 levels as a predictor of periodontal attachment loss. , 1986, Journal of periodontal research.

[31]  M. Curtis,et al.  Contamination of human gingival crevicular fluid by plaque and saliva. , 1992, Archives of oral biology.

[32]  G. Cimasoni,et al.  Neutrophil Elastase and its Inhibitors in Human Gingival Crevicular Fluid during Experimental Gingivitis , 1992, Journal of dental research.

[33]  I. Mandel,et al.  The salivary secretions in health and disease. , 1976, Oral sciences reviews.

[34]  Tadashi Sato,et al.  Smoking cessation increases gingival blood flow and gingival crevicular fluid. , 2004, Journal of clinical periodontology.

[35]  A. Mombelli,et al.  Cytokine profile in gingival crevicular fluid of aggressive periodontitis: influence of smoking and stress. , 2004, Journal of clinical periodontology.

[36]  T. Cabras,et al.  Peptides of human gingival crevicular fluid determined by HPLC-ESI-MS. , 2005, European journal of oral sciences.

[37]  S. Offenbacher,et al.  Measurement of prostaglandin E in crevicular fluid. , 1981, Journal of clinical periodontology.

[38]  I. Kato,et al.  Granulocyte medullasin levels in gingival crevicular fluid from chronic adult periodontitis patients and experimental gingivitis subjects. , 1990, Journal of periodontal research.

[39]  S. Mukherjee,et al.  Aspartate aminotransferase increases in crevicular fluid during experimental periodontitis in beagle dogs. , 1984, Journal of periodontology.

[40]  I. Lamster Evaluation of components of gingival crevicular fluid as diagnostic tests. , 1997, Annals of periodontology.

[41]  I. Lamster,et al.  Beta-glucuronidase activity in saliva: relationship to clinical periodontal parameters. , 2003, Journal of periodontology.

[42]  E. Rossomando,et al.  Relationships between clinical parameters, Interleukin 1B and histopathologic findings of gingival tissue in periodontitis patients. , 1996, Cytokine.

[43]  J. Fiorellini,et al.  Crevicular fluid osteocalcin and pyridinoline cross-linked carboxyterminal telopeptide of type I collagen (ICTP) as markers of rapid bone turnover in periodontitis. A pilot study in beagle dogs. , 1995, Journal of clinical periodontology.

[44]  M. Scarbecz,et al.  Augmented transforming growth factor-beta1 in gingival crevicular fluid of smokers with chronic periodontitis. , 2004, Journal of periodontology.

[45]  B. Eley,et al.  Correlation between gingival crevicular fluid dipeptidyl peptidase II and IV activity and periodontal attachment loss. A 2-year longitudinal study in chronic periodontitis patients. , 2008, Oral diseases.

[46]  I. Lamster,et al.  Enzyme activity in crevicular fluid for detection and prediction of clinical attachment loss in patients with chronic adult periodontitis. Six month results. , 1988, Journal of periodontology.

[47]  K. Otsuka,et al.  Profiling the cytokines in gingival crevicular fluid using a cytokine antibody array. , 2006, Journal of periodontology.

[48]  I. Lamster,et al.  A comparison of 4 methods of data presentation for lysosomal enzyme activity in gingival crevicular fluid. , 1988, Journal of clinical periodontology.

[49]  A. Mombelli,et al.  Effect of smoking on gingival crevicular fluid cytokine profile during experimental gingivitis. , 2003, Journal of clinical periodontology.

[50]  J. Bernard,et al.  Elastase, alpha2-macroglobulin and alkaline phosphatase in crevicular fluid from implants with and without periimplantitis. , 2002, Clinical oral implants research.

[51]  E. Ben‐Porath,et al.  The relationship between antigenaemia and excretion of hepatitis B surface antigen in human whole saliva and in gingival crevicular fluid. , 1985, Archives of oral biology.

[52]  G. Petropoulos,et al.  The association between neutrophil numbers and interleukin-1alpha concentrations in gingival crevicular fluid of smokers and non-smokers with periodontal disease. , 2004, Journal of clinical periodontology.

[53]  W. Giannobile,et al.  Treatment of periodontal disease in a patient with Ehlers-Danlos syndrome. A case report and literature review. , 2002, Journal of periodontology.

[54]  J. Egelberg,et al.  Emigration of blood neutrophils and monocytes into the gingival crevices. , 1970, Journal of periodontal research.

[55]  G Cimasoni,et al.  A longitudinal study of various crevicular fluid components as markers of periodontal disease activity. , 1996, Journal of clinical periodontology.

[56]  G. Armitage Analysis of gingival crevice fluid and risk of progression of periodontitis. , 2004, Periodontology 2000.

[57]  R. Genco,et al.  Host Responses Host Responses in Periodontal Diseases , 1984 .

[58]  R. Hanemaaijer,et al.  Gingival Tissue and Crevicular Fluid Co-operation in Adult Periodontitis , 2006, Journal of dental research.

[59]  I. Lamster,et al.  Gingival crevicular fluid levels of interleukin-1beta and glycemic control in patients with chronic periodontitis and type 2 diabetes. , 2004, Journal of periodontology.

[60]  W. Lundergan,et al.  Crevicular fluid elastase levels in relation to periodontitis and metabolic control of diabetes. , 2001, Journal of periodontal research.

[61]  L. Sreebny Salivary flow in health and disease. , 1989, Compendium.

[62]  P. Güneri,et al.  Vascular endothelial growth factor in gingival tissues and crevicular fluids of diabetic and healthy periodontal patients. , 2004, Journal of periodontology.

[63]  I. Lamster,et al.  GCF IL-1beta profiles in periodontal disease. , 2002, Journal of clinical periodontology.

[64]  N. Brill,et al.  The Passage of Tissue Fluid into the Clinically Healthy Gingival Pocket , 1958 .

[65]  R. Genco,et al.  Host responses in periodontal diseases. , 1984, Journal of dental research.

[66]  R. Page,et al.  Relationship between gingival crevicular fluid levels of aspartate aminotransferase and active tissue destruction in treated chronic periodontitis patients. , 1990, Journal of periodontal research.

[67]  T. Oates,et al.  Relation Between Smoking and Biomarkers of Bone Resorption Associated With Dental Endosseous Implants , 2004, Implant dentistry.

[68]  B. Eley,et al.  Cathepsin B, alpha2-macroglobulin and cystatin levels in gingival crevicular fluid from chronic periodontitis patients. , 1998, Journal of clinical periodontology.

[69]  Y. Konttinen,et al.  Collagenases in gingival crevicular fluid in type 1 diabetes mellitus. , 2006, Journal of periodontology.

[70]  I. Lamster,et al.  Epidemiology and diagnosis of HIV-associated periodontal diseases. , 1997, Oral diseases.

[71]  T. Sorsa,et al.  Changes in gingival crevicular fluid matrix metalloproteinase-8 levels during periodontal treatment and maintenance. , 2003, Journal of periodontal research.

[72]  F. Dewhirst,et al.  Prostaglandin E2 levels and human periodontal disease. , 1974, Prostaglandins.