Gingival crevicular fluid measure

on individual tooth by use of Periotron 8000

Yong-C heol H yun, Yu-Jeong Lee

Dr. Hyun's Dental Clinic, Hwaseong-si, Korea

ABSTRACT

Objective and methods: The authors have experimented for gingival crevicular fluid measurement by use of
Periotron 8000, at the gingival sulcus on 6 teeth as such tooth as upper and lower, right and left first Molar
and upper and lower central Incisor, to calculate the co-relation co-efficient, in order to find the proper and
simple way to measure the Gingival crevicular Fluid Measurement on the simple tooth , instead of checking
at all 6 teeth portions, 30 volunteers who were out-patients, visited at the dental clinic were participated for
the study in the period of December of 2008 to February in 2009 at one of the dental hospital in Hwaseong
district. Corelation coefficient on the Gingival crevicular Fluid Measurement were calculated both in between
at each tooth and at all 6 teeth include at the associated tooth and at each tooth and at all 5 teeth exclude at
the associated tooth.

Results: Co-relation co-efficient was the most in amount of the gingival crevicular between at the upper right
first Molar portion(r=0.821, p<0.001) and the other 6 portions include the indicated tooth portion, and the next
between at the lower right first Molar portion(r=0.6655, p<0.001) and at the other 6 portions. Co-relation
co-efficient was the most in amount of the gingival crevicular between at the upper right first Molar
portion(r=0.6327, p<0.001) and the other 5 portions exclude the indicated tooth portion, and the next between
at the lower right first Molar portion(r=0.4213, p<0.05) and at the other 5 portions.

Conclusion: It was recommended that the gingiva crevicular fluid would be checked with Periotron 8000 at the
upper right 1st Molar area, in consideration of the simplification and the reliability of the technique, instead
of the checking at all portions in clinical.

Key Words: Correlation, PFRI

Corresponding author's e-mail: hyunyc21@chollian.net (Yong-Cheol Hyun)

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 International Journal of Clinical Preventive Dentistry. 2009, Volume 5, Number 1

and related with the results at the whole teeth. For

1. Introduction examples, S-PHP or S-OHI index has been developed and
used in clinical, instead of the standard patient Hygiene
Many researches have reported about the relationship Performance index or Oral Hygiene Index, for checking the
between the gingival crevicular fluid and the severity of dental plaque or oral hygiene state exam.
gingivitis. Gingival fluid in the gingival sulcus would be So in this study, co-relation co-efficient was calculated
increased in amount in case of the cause of the with the result of the gingival cervical fluid at the
inflammation of the gingival tissue(1). Gingival fluid individual tooth and the average of the results or at the
contains lots of thin epithelial cells from the connective teeth as included with the individual tooth or for at the 5
tissue in the gingival sulcus and the gingival sulcus can be teeth as excluded with the individual tooth, in order to find
cleaned with the gingival fluid. The gingival fluid has such the proper tooth to be selected for objectives on measuring
functions as containing the plasma protein which help the the gingival crevicular fluid instead of the examine the
absorption of epithelium to the tooth surface, anti- bacterial whole teeth.
effect and the anti-body reaction for barrier at the gingival
tissue. 2. Materials and Method
Le H. and Holm-Pedersen have defined the gingival
fluid as not fluid flowing contentiously but fluid as a kind 2.1. Subjects
of the exudates liquid(2,3). So it can not be obtained thee 30 volunteers aged 20s to 40s. who were visited as an
gingival crevicular fluid on the normal gingiva. Under the out patients at Dr. Hyun's Dental Clinic, without any
conception above the measurement of the gingival crevicular problems as systemic diseases or specific oral appliance,
fluid is introduced as one important methods to estimate or were participated in the study. Age and the gender
to predict the gingival inflammation and various procedures distribution was shown in table 1.
with the researches have been developed for checking the
amount, component, origins or function of the fluid by the Table 1. Age and gender distribution of the subjects
evidences based. age male female total
Such method as paper strip, micro-capillary tubes, micro 20 S 5 4 9
pipettes, micro syringe and plastic strip are for measuring 30 S 4 4 8
the gingival crevicular fluid. Among them the most frequent 40 S 11 2 13
total 20 10 30
used is known as the method with the use of the paper
strip. Periotron (Harco Electronics, Canada) was developed
as one of the measuring until for gingival crevicular fluid 2.2. Checking Device
amount by use of the paper strip. The principle for acting
Periotron 8000 (Harco. Electronics, Winnipeg, Manitiba,
of Periotron is known that the digital signal can be obtained
Canada) was selected for measuring the gingival crevicular
through the checking the amounts of the electronic flow in
fluid and Periopaper Strip (Oraflow, Smithtown, New York,
wet strip with the gingival fluid. The more electronic flow
USA) was used for the materials of the gingival fluid
can be measured with the wet strip state. The merits of the
collection strips(figure 1).
unit is introduced as easy and simple manipulation with the
quick appearance of the result and the high relationship for
the representatives with the gingival inflammation state(4). 2.3. Procedure
In clinical use of Periotron device 28 of all teeth in the 2.3.1. Adjustment for the device
mouth might be included in the gingival sulcus, but it
1) Turn on the power switch of Periotron 8,000 in
would be incontinent for dental patient because of the long
10 minute's before use.
chair time or relatively high cost for the consummation of
2) Open the sterilized packet for Periopaper strip and
lots strip materials. So it needs for checking it with the
mounting the Periopaper strip sheet on the holder in
simple way by selecting the objective tooth representative
which laid on the upper portion of Periotron device.

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 Gingival crevicular fluid measure on individual tooth by use of Periotron 8000
Figure 1. Periotron 8000 (Harco. Electronics,
Winnipeg, Manitiba, Canada)
3) Hold the one of Periotron strip with the cotton
pliers and lay it on the sensor of the Periotron
meter.
4) Adjust the 0 point with the frontal control wheel
of Periotron.
5) Acting for 16 seconds in order to control for 0
point.
6) Discard used strip after controlling for 0 point.
7) Preparation for measuring the gingival crevicular
fluid.
2.3.2. Interview for subjects
1) Collect the volunteers for the study and let them
sign on the agreement sheet.
2) Prohibit tooth-brushing or flossing in 2 hours
before measuring.
3) Explain the procedure to subjects as safe and
simple.
4) Check the menstruations period for woman because
of the higher value in the period of ovulation
5) Check the medical history, hormonal contraception
agent, or smoking.
2.3.3. Procedure for checking
1) Select 6 portions of the teeth as 4 first Molars
and upper and lower Incisors, to measure the
amount of the gingival crevicular fluid.
2) Isolate the indicated tooth by use of the cotton
roll.
Figure 2. GCF checking by using Periotron
3) Dry the indicated tooth and surrounding gingiva by
use of the air syringe.
4) Using cotton piers, grasp the orange plastic handle
of a Periopaper strip and pull a fresh strip from its
clean plastic support mounted on the Periopaper strip
holder.
5) Insert the white portion of the strip into the
gingival crevice carefully, for applying the
intra-sulcular method, and remove out the pliers
holding on the strip and waiting for 5 seconds in
order to absorb the gingival crevicular fluid to the
strip.
6) Remove out the strip from the gingival crevice by
holding the orange colored handle of the strip with
the cotton pliers.
7) Move the strip to Periotron meter for checking the
measure.
8) Lay the white portion of the strip on the lower
sensor of Periotron and full the movable upper
sensor arm to frontal direction, to close or to
contact for both sides of the sensors to the strip.
9) Read the digital number of the amounts for the
gingival crevicular fluid at the reading panel in
front.
10) Measure it repeatedly at all subjected teeth, and it
will takes about 1 minute for a measurement.
11) If the remnant cervical fluid or debris are on the
sensor, it should be cleaned with the paper tissue
with 70% alcohol and dried paper. And then, 0-point
re adjustment should be done again.
12) 0-point readjustment should be done if needed.
13) The criteria of the result for Periotron meter
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 International Journal of Clinical Preventive Dentistry. 2009, Volume 5, Number 1

Table 2. Co-relation co-efficient on the Gingival Crevicular Fluid Measurement between at each tooth and at all 6 teeth include at the
associated tooth
Associated tooth Number n r p App
16 30 0.8278 0 **
11 30 0.352 0.0564 -
26 30 0.4461 0.0135 *
36 30 0.6211 0.0002 **
31 30 0.4572 0.0111 *
46 30 0.6655 0.0001 **

Table 3. Co-relation co-efficient on the Gingival Crevicular Fluid Measurement between at each tooth and at all 5 teeth exclude at the
associated tooth
Associated tooth Number n r p App
16 30 0.6327 0.0002 **
11 30 0.1163 0.5406 -
26 30 0.2457 0.1905 -
36 30 0.3064 0.0996 -
31 30 0.3238 0.0809 -
46 30 0.4213 0.0204 *

would be as followings; 4. Discussion

a: 0-20 ; Tissue is healthy show little or no
inflammation,
b: 20-60 ; Mild inflammation but not
periodontitis,
c: 60-150 ; Indicates moderately severe condition,
d: >150 ; Very severe inflammation
2.4. Statistical analysis
Co-relation co-efficient was calculated between the value
of the amounts for gingival crevicular fluid measured at the
indicated tooth and those of the average means measured at
6 portions as 44 first Molars and upper & lower central
Incisor include the indicated tooth portion or the means
measured at 5 portions excluded the indicated tooth portion,
by use of SPSS 1.0 program.
3. Results
Table 2 shows co-relation co-efficient on the Gingival
Crevicular Fluid Measurement between at each tooth and at
all 6 teeth include at the associated tooth, and table 3
shows Co-relation co-efficient on the Gingival Crevicular
Fluid Measurement between at each tooth and at all 5 teeth
exclude at the associated tooth.
The existence of the gingival crevicular fluid has been
known since 19C and the researches for its compositions,
defense mechanism in oral cavity and its function had begun
to be studied by Waerhaug(5), Brill and Krasse(6) in 1958.
Brill and Krasse(6) had experimented with the dog that
fluorescent materials could be found on the filler paper strip
which was inserted into the gingival sulcus of the dog, with
in 3 minutes, after injecting the fluorescent materials through
intra muscular injection to the body of the dog. It was
explained that the fluorescent materials would be flew with
the blood to gingival sulcus. Moreover Brill(7,8) had found
the existence of the gingival crevicular fluid in human body
as considered as transudation. But many researchers(1,2) had
insisted it as the inflammatory exudates.
One of the difficulties for collecting the gingival
crevicular fluid is getting very little amount of the exudates
from the gingival sulcus. Many procedures and
techniques(2,9-16) have been tried to collecting the gingival
crevicular fluid as such methods as using the filter paper,
inserting the silk strip into the gingival sulcus, using the
micro tube or cleaning the gingival sulcus.
The method for inserting the absorbed paper strip is
classified as the intra sulcular and Extra sulcular method.
The placement of the filter strip in relation to sulcus or

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pocket is important. On Brill method, the absorption paper
should be inserted until be felt for resistance, in order to
stimulate to gingival epithelium to induce the fluid from
there.
Le and Holm-Pedersen(2) have suggested the inserting
technique of the absorption paper on the entrance of the
gingival pocket, in order to minimize the gingival irritation.
The gingival crevicular fluid might be absorbed in the paper
without contact with the gingival epithelium by this
technique.
Weinsteim et al.(3) have estimated the amount of the
gingival crevicular fluid through inserting the twisted silk
into the gingival sulcus and measuring the weight after full
it out. Osmotic pressure was applied by use of the micro
tube to measure the gingival fluid with inserting the
standard size and length micro tube into the gingival sulcus
and then analyze the contents by use of the centrifuge(8-10).
Gingival sulcus cleaning technique is used for analysis on
normal gingiva in clinical. Among the various types of the
methods, absorption paper strip technique is the most
frequently used because of it's convenience, and the fluid
with the wet absorption paper would be used to be
measured. The wet portion on the absorption paper can be
shown distinctly through the dying with Ninhydrin.
Two methods can be introduced for analyzing the fluid as
Ninhydrin staining method as observing the stained area on
the paper with the microscope or magnifying glass, and the
electronic method as changing the wet amount with the
gingival crevicular fluid on the paper strip into the
electronic current by use of the electronic transducer, such
as Periotron device. There was no difference the value of
the measure for gingival crevicular fluid, between these two
methods1(7).
It was known that the value of measured score would be
various according to gingival inflammatory state. Under the
score 60, it might be judged as normal or mild
inflammation. In case of over score 60, it would be
estimated as active bacterial activities and high risk for
process on periodontitis, with showing the epithelial
attachment loss and periodontal pocket formation with
probing in clinical, so it can be imagined more severe in
periodontitis according to increase the value for measuring,
in over score 60.
The amount of the gingival crevicular fluid collected
might be very few.
Gingival crevicular fluid measure on individual tooth by use of Periotron 8000
Climason(18) has reported that about 0.1mg of the
gingival crevicular fluid could be absorbed by use of the
absorption paper of 1.5mm width and 1mm inserting into
the gingival sulcus for 3 minutes, in mild gingivitis area.
Challacombe(25) has tried to measure the gingival
crevicular fluid by use of the injecting the dilution of the
radioactive materials(isotope) into the body.
Through this method, he has got average 0.45 to 1.5ml
of the gingival crevicular fluid at the inter proximal area of
the molar tooth from the volunteers who were below the
degree 1 of average gingival index.
Gingival fluid is known as the inflammatory exudate(2).
Gingival crevicular fluid can be found an inflammatory
tissue in microscopic findings even though on healthy
gingiva in clinical.
The amount of the fluid is increased proportion to the
severity of the gingival inflammation (20,21).
It can be increased on such situations as chewing the
rough foods, tooth-brushing, gingival massage, ovulation(24),
in take the hormonal contraceptives(25) and smoking, even
though not influenced by the trauma from occlusion(22).
Also, it can be increased in the day time and decreased in
naught time or sleeping time(2).
Periodontal treatment can be one of the causing factors to
influence the amount of the gingival crevicular fluid(28).
Estrogen as a female hormone can influence to increase the
gingival crevicular fluid by increasing the permeability of
the blood vessel(29). So in case of the ovulation(30),
pregnancy and the using the oral pill(31),it can be increased.
Mastication(8) or hard brushing also influence the flow of
the gingival fluid by stimulation of the gingival tissue with
mild degrees, like as inserting the absorption paper into the
gingival sulcus.
In spite of the effectiveness of the measuring the gingival
crevicular fluid for checking the presence or the prediction
of early stage of the gingivitis or the periodontitis, it might
be inconvenient for checking at all portions of the gingival
sulcus for each patient in clinical. So, 6 portions checking
method, like examining the simplified oral hygiene index or
modified patient hygiene performance index, would be
suggest by clinicians. More over 1 portion checking method
at the most representative portion would be needed for
checking with convenient in clinical.
According to the results of this study, the most
representative portion was estimated at upper right
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 International Journal of Clinical Preventive Dentistry. 2009, Volume 5, Number 1
molar(r=0.8278, p<0.01) and lower right molar
portion(r=0.6655, p<0.01) in next, calculated with the
co-relation co-efficient.
It was the same result in significant test both in
calculating the co-relation co-efficient between at the
indicated tooth and the other 6 portions include the
indicated portion(table 2), and between the indicated tooth
portion and the other 5 portion excluded the indicated
portion.(table 3)
Even though it was not clear for the evidence why it
revealed the high relationship on right side portion of molar
tooth, the measurement of the gingival crevicular fluid at
upper/lower right molar portion could be a representative
value for ones mean value for the amount of the gingival
crevicular fluid.
It should be needed for further studies to find the reasons
to be more related at the upper and right portion than at
the lower, left or anterior portion.
According the clinical experiment, the measurement of the
gingival crevicular fluid at the upper right molar portion
would be recommended, instead of checking at whole teeth
in clinical, in consideration of the simplification and
reliability of the test.
5. Conclusion
The authors have experimented for gingival crevicular
fluid measurement by use of Periotron 8,000, at the gingival
sulcus on 6 teeth as such tooth as upper and lower, right
and left first Molar and upper and lower central Incisor, to
calculate the co-relation co-efficient, in order to find the
proper and simple way to measure the Gingival crevicular
Fluid Measurement on the simple tooth , instead of
checking at all 6 teeth portions, 30 volunteers who were
out-patients, visited at the dental clinic were participated for
the study in the period of December of 2008 to February in
2009 at one of the dental hospital in Hwaseong district.
Corelation coefficient on the Gingival crevicular Fluid
Measurement were calculated both in between at each tooth
and at all 6 teeth include at the associated tooth and at
each tooth and at all 5 teeth exclude at the associated tooth.
The obtained results were as followings.
1. Co-relation co-efficient was the most in amount of the
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gingival crevicular between at the upper right first Molar
portion(r=0.821, p<0.001) and the other 6 portions include
the indicated tooth portion, and the next between at the
lower right first Molar portion(r=0.6655, p<0.001) and at the
other 6 portions.
2. Co-relation co-efficient was the most in amount of the
gingival crevicular between at the upper right first Molar
portion(r=0.6327, p<0.001) and the other 5 portions exclude
the indicated tooth portion, and the next between at the
lower right first Molar portion(r=0.4213, p<0.05) and at the
other 5 portions.
It was recommended that the gingiva crevialar fluid
would be checked with Periotron 8000 at the upper right 1st
Molar area, in consideration of the simplification and the
reliability of the technique, instead of the checking at all
portions in clinical.
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