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Defense Mechanisms Of The Gingiva

III. Defence mechanism of gingiva The dentogingival junction seals the tissue The epithelium provides little resistance The sulcular epithelium is permeable The junctional epithelium has particularly wide intercellular space The cervicular fluid are important in defence mechanism The turnover of the junctional epithelium is rapid

Resistance of the gingival tissue to mechanical and bacterial aggressions is provided by the epithelial surface. surface. The initial stage of the inflammatory response, the sulcular fluid and saliva. saliva. The first line of defense against toxic substances, is the surface barrier which has 4 components

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1) The soft tissues are covered by stratified squamous epithellum, a tissue that undergoes rapid regeneration and renewal. renewal. Cells produced in the basal layer traverse toward the surface and are shed, carrying with them toxic substances that may have penetrated the epithellal covering. covering. 2) The gingival and, in part, the oral sulcular epithelium undergo keratinization to produce a tough impenetrable surface layer. layer.

3) The junctional epithellum in contact with calcified tooth surface elaborates a basal laminalaminailke substance which effectively seals the soft tissue tooth interface. interface. 4) A glycoprotein coat covers all the surface tissues, induding the tooth. tooth.

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Polymorphonuclear leukocytes (PMNs) migrate continuously from the vessels of the connective tissue (CT) into the junctional epithelium, the gingival sulcus and the oral cavity. cavity. The magnitude of this migration (> 500/second) 500/second) increases dramatically as the size of the microbial population near the gingiva increases. These increases. cells have the capacity to phagocytose and kill microorganisms. microorganisms.

Macrophages also have the capacity to kill, phagocytize, and digest microorganisms and foreign substances. substances. Lymphoid cells, which have the capacity to trigger cellular and humoral immune responses, are also present in the junctional epithelium and the subjacent CT. CT.

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The structure of the junctional epithelium allows the passage of gingival fluid into the sulcus. This sulcus. fluid contains many of the constituents of blood, Including specific antibody and non-specific nonantimicrobial systems. systems. Immunoglobulins (Igs) are released and synthesized in the CT and passes through this fluid to the sulcus. sulcus.

The cells of the junctional epithelium, especially those located near the base of the gingival sulcus, constitute an important component of host defense, in many respects, the cells resemble epithelial cells migrating over an open wounds. wounds. They contain primary and secondary lysosomes and have phagocytic capacity. capacity. Furthermore, the cells are continuously sloughed Into the sulcus and replaced by cells moving coronally from the basal epithelial region. region.

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The rote of the epithelium through its degree of keratinization and turnover rate in defense mechanism of the gingiva. gingiva. The gingival epithelium constitutes a continuos lining of stratified squamous epithelium. epithelium. Gingival epithelium functionally consists of three different areas: oral or outer areas: epithelium, sulcular epithelium, and junctional epithelium. epithelium.

The main function of the gingival epithelium is the protection of deep structures while allowing a selective interchange with the oral environment. environment. This is achieved by proliferation and differentiation of the keratinocytes (the cell type of the gingival epithelium). epithelium).

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Proliferation of keratinocytes takes place by mitosis in the basal layer and less frequently, in the suprabasal layers. Small layers. proportion of cells remains as a proliferative compartment, while a larger number migrate to the surface. surface.

A complete keratinization process leads to the production of an orthokeratinized superficial horny layer similar to that of the skin, with no nuclei. Some areas of the nuclei. outer gingival epithelium are orthokeratinized; orthokeratinized; the other areas are parakeratinized or nonkensitinized epithelium. epithelium.

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Renewal of gingival epithelium is continuous. continuous. Its thickness is maintained by a balance between new cell formation in the basal and spinous layers and the shedding of old cell at the surface. surface. The mitotic activity exhibits a 24-hour 24periodicity, with highest and lowest rates occurring in the morning and evening. evening.

The mitotic rate is higher in nonkeratinized areas and is increased in gingivitis. Different opinions gingivitis. whether mitotic rate is increased or decreased with age. The mitotic rate age. in experimental animals varies in different areas: buccal mucosa, hard areas: palate, sulcular epithelium, junctional epithelium, outer surface of marginal gingival and attached gingiva. This gingiva. rate occurs in a descending order. order.

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The turnover times in experimental animals occur as follows, palate, tongue, and cheek, 5 to 6 days, gingiva, 10 to 12 days, with the same or more times required with age, and junctional epithelium, 1 to 6 days. days.

Oral or outer epithelium is keratinized or parakeratinized. The parakeratinized. degree of its keratinization is diminished with age, and onset of menopause. menopause. Sulcular epithelium is nonkeratinized stratified squamous epithelium junctional epithelium is nonkeratinized stratified squamous epithelium. epithelium.

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Gingival Crevicular Fluid (GCF) GCF is considered to be a transudate until investigators in 1969 demonstrated that GCF Is an inflammatory exudate, not a continuous transudate. In a transudate. strictly normal gingiva, little or no fluid can be collected. collected. Methods of Collection GCF is little in amount to be obtained from the sulcus, so that numerous methods were tried

1) Absorbing paper strips are placed within the sulcus (intrasukular) or at its entrance (extrasulcular). (extrasulcular). 2) Twisted threads placed around and into the sulcus. sulcus. 3) Micropi which permit the absorption of fluid by capillarity. capillarity.

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4) Intracrevicular washings can be used to study CF from clinically normal gingiva. This is done by using gingiva. a hard acrylic plate CO verlag the maxilla with soft borders and a groove following the gingival margins connected to 4 collection tubes. The tubes. washings are obtained by rinsing the crevlcular areas from one side to the other, using a peristaltic pump. pump.

Permeability of Junctional Epithelium and Sulcular Epithelium Junctional and sulcular epithelia are permeable to substances (e.g., albumin, (e. endotoxin, thymidine, histamine, phenoytoin and harseradish peroxidase) with a molecular weight of up to 1 million. million. The mechanisms of penetration through an intact epithelium seem to be through an intercellular movement of molecules an ions along intracellular spaces. Substances spaces. taking this route do not traverse the cell membranes. membranes.

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Methods of Measuring GCF 1. Fluid can be collected on a paper strip, the wetted area could be stained with ninhydrin then measured planirnetrically (by enlarged photograph or magnifying glass or microscope). microscope). 2. Fluid could be measured electronically using electronic transducer (Perio Tron). Tron). Strip of paper that absorb the fluid showed 0.2 mg of fluid in 3 minutes. minutes. GCF from normal volunteers is ranged from 0.43 to 1.36 uL. uL.

Composition of Gingival Sulcular Fluid GCF contains proteins, antibodies, antigens, enzymes and cellular elements. elements. These compounds can be host-derived, or hostproduced by gingival crevice bacteria. bacteria. Examples: Examples: p-glucuronidase (lysosomal enzyme), lactic acid dehydrogenase (cytoplasmic enzyme). The source for enzyme). these enzymes which produce collagenases can be flbroblasts, and PMNs, or could be secreted by bacteria. bacteria.

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Cellular elements include bacteria, desquamated epithelial cells and leukocytes that migrate through the sulcular epithelium. epithelium. Electrolytes, e.g. potassium, sodium, and calcium, are GCF components. components. Organic compounds, e.g. carbohydrates and proteins, are found GCF. GCF. Glucose hexosamine and hexuronic acid are also found in GCF. Glucose concentration in GCF GCF. is 3 to 4 times greater than that in serum. serum. Total protein content in GCF is less than that of serum. serum.

Metabolic and bacterial products are lactic acid, urea, hydroxyproline, endotoxins, cytotoxic substances as hydrogen sulphide and antibacterial factors. factors. Cytokines (Interleukin-ict, IL-113) and (InterleukinIL-113) IgA, IgG, IgG 1gM, are also of the components of GCF. IgG is the most GCF. predominant immunoglobulin found in GCF. GCF.

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Clinical Significance of GCF GCF could be used to: to: 1) Detect or diagnose active disease. disease. 2) Predict patients at risk for periodontal disease. disease. GCF is proportional to the severity of inflammation. inflammation. GCF is not increased by trauma from occlusion. occlusion. GCF is increased by mastication, tooth brushing, gingival massage, ovulation, hormonal contraceptives and smoking. smoking.

GCF increases in amount from 6 to 10 a.m and then decreases (circadian periodicity). periodicity). Sex hormones, pregnancy, ovulation, and hormonal contraceptives, all increase gingival fluid. fluid. Mechanical stimulation stimulates the oozing of GCF. Minor stimuli by GCF. intrasulcular paper strips increases the production of the GCF. GCF. GCF increases during the periodontal healing period. period.

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Drugs (e.g., (e. tetracyclines and metronidazole) have been detected in human GCF. GCF. Neutrophils are found in GCF in healthy gingival sulci. They are found sulci. in small numbers adjacent to the bottom of the sulcus, the travel across the epithelium to the gingival sulcus. sulcus. T- to B-lymphocytes is 1 : 3 in GCF (3 : 1 in peripheral blood). blood).

Salvia Saliva maintains the oral tissues in a physiologic state. state. Saliva exerts a major influence on plaque by mechanically cleansing the exposed oral surfaces, by buffering acids produced by bacteria, and by controlling bacterial activity. activity.

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Salivary Contents Saliva contains inorganic and organic factors which influence bacteria and their products. products. I- Antibacterial Factors Inorganic factors are : ions and gases, bicarbonate, sodium, potassium, phosphates, calcium, fluorides, ammonia, and carbon dioxide. dioxide. Organic factors are: lysozymes, lactoferrin, are: myeloperoxidase, lactoperoxidase, Agglutinins such as glycoproteins, mucins, 13 fibronectins. fibronectins. Antibodies

II- Antibodies IISaliva contains antibodies (Abs) which react with indigenous oral bacterial species. species. The most preponderant immunoglobulin (Ig) is IgA. IgA. Saliva also contains IgG and 1gM. gM. Salivary Abs are synthesized locally. locally. Many bacteria found in saliva have been shown to be coated with IgA, and the bacterial deposits on teeth contain both IgA and IgG. IgG. IgA inhibits the attachment of oral Streptococcus species. species.

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III- Enzymes IIIThe major enzyme is parotid amylase. amylase. Other enzymes increased in periodontal disease, e.g., hyaluronidase, lipase, p gluronidase, and chondroitin sulfatase, amino acid decarboxylases, catalase, peroxidase, and collagenase. collagenase. Proteolytic enzymes in saliva are generated by the host and oral bacteria. bacteria.

IV. Buffers IV. Bicarbonate carbonic acid system is the most important salivary buffer. buffer. This buffer system maintains the physiologic hydrogen ion concentration (pH) at the mucosal epithelial cell surface and the tooth surface. surface.

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V. Coagulation Factors Saliva contains factors VIII, IX, and X, plasma thromboplastin antecedent (PTA) and Hageman factor. These factor. factor protect wounds from bacterial invasion. invasion. VI. Cells VI. Saliva Contains desquamated cells and all forms of leukocytes, mostly PMNs. PMNs. These cells vary from person to person. person. Leukocytes reach the oral cavity by migrating through the gingival sulcus. sulcus.

Role of Saliva in Oral Health Saliva protects the oral cavity by its functions which are Lubrication via glycoproteins and mucoids. mucoids. Physical protection via glycoproteins and mucoids. mucoids. Cleansing via physical flow which clear the debris and bacteria. bacteria. Buffering via bicarbonate and phosphate through antiacids mechanisms. mechanisms.

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Tooth integrity maintenance via glycoprotein pellicle and minerals by maturation, remieralization, and mechanical protection. protection. Antibacterial action via IgA, lyzozyme and tactoperoxidase through control of bacterial colonization, breaks bacterial cell walls and oxidation of susceptible bacteria. bacteria.

Role of Saliva in Periodontal Pathology Saliva initiates plaque accumulation, maturation and metabolism. metabolism. Salivary flow also has an influence on calculus formation and caries. caries. Decreased salivary 190w 190w (xerostomia) causes inflammatory gingival disease, dental caries, and rapid tooth destruction (due to cervical and cemental caries). caries).

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