Richard I. Vogel

Development of a Biochemical Profile for Gingival Crevicular Fluid: Methodological Considerations and Evaluation of Collagen-Degrading and Ground Substance-Degrading Enzyme Activity during Experimental Gingivitis*

The potential application of gingival crevicular fluid (GCF) analysis to periodontal diagnosis has been examined for more than 25 years. Unfortunately, the information available has not provided the clinician with a more sensitive means of diagnosing periodontal disease or an effective means of monitoring periodontal therapy. A careful review of the literature on GCF, however, suggests that discrepancies occur in the method of GCF collection, the use of GCF for analysis from pooled or isolated crevicular locations, the method of analyzing the samples and the way in which the data is reported. Studies in our laboratory have suggested a technique for GCF analysis that collects GCF from individual crevices with a filter paper strip inserted for a standard time, determines the volume of GCF collected with a calibrated electronic meter and elutes the material into a larger volume of diluent. This approach allows for detection of site-to-site and patient-to-patient differences in GCF volume while providing sufficient samples to analyze GCF for multiple constituents. We have used this approach to evaluate GCF for vertebrate forms of the enzymes collagenase (latent and active forms), β-glucuronidase and arylsulfatase during the development of experimental gingivitis in man. Interproximal and midradicular areas were studied. Our results indicate that during the 4 weeks of the gingivitis, the absolute amount of active collagenase in GCF increased 550% at the interproximal sites and 190% in the midradicular sites, and the per cent of active collagenase increased from 15 to 71% at the interproximal sites, and from 16 to 36% at the midradicular sites. In contrast, the increase in ground substance-degrading enzyme activity during the experimental gingivitis was proportionally less. The increase in β-glucuronidase activity in GCF was 180% for the interproximal sites and 40% for the midradicular sites, and the increase in arylsulfatase activity in GCF was 240% for the interproximal sites and 20% for the midradicular sites. These data suggest that the degree of collagen degradation in the periodontium may be modulated by a relative lack of ground substance-degrading enzyme activity in the gingival environment. In addition, this study supports the use of our sampling and processing approach for GCF analysis.

Treatment of periodontal disease

Omega-3, 20-22 carbon atom, hexa- or penta-unsaturated fatty acids are used in the treatment of periodontal disease.Periodontal surgery is used to control advanced lesions affecting the support for teeth. The choice between conservative treatment and surgical treatment is a technical issue, but client compliance plays an important role. Excision surgical techniques (e.g., gingivectomy) and incisional surgical techniques (e.g., flap surgery) are described in this article. Postoperative, recall, and retreatment programs are explored.

Gingival hyperplasia and folic acid deficiency from anticonvulsive drug therapy: a theoretical relationship.

Abstract The use of anticonvulsive drugs has been associated with hyperplasia of the gingival connective tissue in approximately 40% of individuals taking them. Inflammation from local etiologic factors, e.g. bacterial plaque, has been demonstrated to be a necessary requisite for this response. It therefore appears that anticonvulsive drugs predispose the gingival tissues to undergo an exaggerated inflammatory response, hyperplasia, in the presence of local irritants. These drugs have likewise been shown to illicit a folic acid deficiency in a large percentage of patients. It has been reported that a deficiency of this vitamin can lend the gingival tissues susceptible to inflammation by causing degenerative changes in the gingival sulcular epithelium, the principle physical barrier against local irritants. Therefore, a cause and effect relationship between anticonvulsive drug induced folic acid deficiency and gingival hyperplasia associated with the use of these drugs is being proposed. Though the concepts in this paper focus on the relationship between folic acid deficiency and gingival hyperplasia from anticonvulsive drugs, they may be applied to other phenomena. A high incidence of folic acid deficiency has been reported to be associated with pregnancy and with the use of oral contraceptives, both of which have also been associated with exaggerated inflammatory responses of the gingiva and with atypical cellular changes in other organs, most notable the uterus.

Iatrogenic root fractures: a case report.

Summary A case of fractured roots on the mandibular left first and second premolars is presented. The fractures may have been due to the use of excessive pressure during placement of endodontic posts in the pulp canals of the two premolars.These findings were accompanied by radiographic radiolucencies, which were the first indication that a pathologic condition existed. The fractures and the resultant bone resorption required extraction of the both the first and second premolars.

Tetracycline-induced extrinsic discoloration of the dentition

Tetracycline, a broad-spectrum antibiotic, is known to cause intrinsic discoloration of the dentition. A case is being presented of extrinsic discoloration of the teeth associated with the use of this drug. This is believed to be the first such reported case in the literature. Possible mechanisms of how tetracycline may cause extrinsic tooth discoloration are discussed.

The experimental use of anti-inflammatory drugs in the treatment of periodontal disease. A review

Plaque is the major etiologic agent of inflammatory periodontal disease. It has become apparent, however, that the plaque-induced destruction of the periodontium results primarily from the various immunologie and inflammatory responses of the host to the flora. Many of these responses are brought about through the action of several mediators of the inflammatory response such as histamine, kinins and fibrin peptides. Another class of mediators of inflammation are several metabolites ofboth the cyclo-oxygenase and lipoxygen-