Delve into the Significance of Gingival Crevicular Fluid in Perio Assessment
Discover how gingival crevicular fluid serves as a vital biomarker for periodontal disease diagnosis and progression.
Gingival crevicular fluid (GCF) is found within the physiologic gingival sulcus and pathologic periodontal pocket.1 Considered an inflammatory exudate,1 GCF seeps through the connective tissue within the gingiva and lining of the sulcus. Research has shown that GCF directly relates to periodontal diseases. In health, the flow rate of GCF is close to nothing;1 however, in a periodontal pocket, its composition changes with the presence of inflammation. Thus, increased GCF flow may be a sign of periodontal disease.1 While many factors contribute to periodontal conditions, this article will discuss how testing GCF can aid in the assessment and diagnosis of the stages of periodontal diseases—and its correlation to systemic disease.
This inflammatory exudate includes serum, inflammatory mediators, antibodies, and materials formed from the breakdown of tissue.2 These components can be divided into several sections, such as cellular elements, electrolytes, and organic compounds. The cellular elements include epithelial cells, leukocytes and bacteria from dental plaque.2 The electrolytes include sodium and potassium in a 3:9 ratio, fluoride, calcium, iodine, and phosphorus.2 The organic compounds are composed of carbohydrates, proteins, immunoglobulins, cytokines, and metabolic bacterial products.2 Produced at a rate of a few microliters per hour,2 the fluid acts as a host defense mechanism by flushing bacteria away from the sulcus through the route of diffusion from the basement membrane to the junctional epithelium and into the sulcus.2 Several factors can stimulate the flow of GCF, including pocket depth, gingival inflammation, mobility, periodontal surgery, enzymes, sex hormones, contraceptives, and smoking.2 Because the amount of GCF changes in the periodontium, this fluid can be used as a biomarker to identify the various stages of periodontal diseases.
Many biomarkers in GCF are currently used to diagnose periodontal disease progression.3,4 Numerous studies suggest that interleukin-1 beta (IL-1β), IL-2, IL-6, IL-8, IL-17 and tumor necrosis factor-alpha (TNF-α) are reliable inflammatory biomarkers in patients with periodontal diseases.1 The most studied biomarker is the bone-resorbing cytokine IL-1β.1 Previous studies demonstrated the volume of IL-1β in GCF was elevated in active sites of periodontal diseases and declined after periodontal treatment.1 Thus, GCF provides a laboratory tool for assessing periodontal disease activity.
Longitudinal studies have found high levels of biomarkers, such as matrix metalloproteinase-8 (MMP-8), MMP-9, and IL-1β in patients with periodontal disease progression.3,4 As a sensitive and unbiased biomarker, MMP-8 helps with the early diagnosis of periodontitis. Furthermore, in a cross-sectional study, mild gingivitis and mild periodontitis were used to compare MMP-8 levels acting as an inflammatory marker in periodontal diseases.3 The results demonstrated that MMP-8 concentrations are higher in individuals with mild periodontitis than in subjects with gingivitis or gingival health.3 These studies show how GCF can act as a biomarker regarding the progression of periodontal diseases and loss of alveolar bone.
- Ghallab NA. Diagnostic potential and future directions of biomarkers in gingival crevicular fluid and saliva of periodontal diseases: review of the current evidence. Arch Oral Biol. 2018;87:115–124.
- Subbarao KC, Nattuthurai GS, Sundararajan SK, Sujith I, Joseph J, Syedshah YP. Gingival crevicular fluid: an overview. J Pharm Bioallied Sci. 2019;11:135.
- Kasuma N, Oenzil F, Darwin E, Sofyan Y. The analysis of matrix metalloproteinase-8 in gingival crevicular fluid and periodontal diseases. Indian J Dent Res.2018;29:450–454.
- Majeed ZN, Philip K, Alabsi AM, Pushparajan S, Swaminathan D. Identification of gingival crevicular fluid sampling, analytical methods, and oral biomarkers for the diagnosis and monitoring of periodontal diseases: a systematic review. Dis Markers. 2016;2016:1804727.
This information originally appeared in Rivera M, Apolinar S, Smith M. Gingival crevicular fluid and periodontal risk assessment. Dimensions of Dental Hygiene. 2021;19(5):32–35.