GINGIVAL CREVICULAR FLUID AS A VIRAL DIAGNOSTIC

 INTRODUCTION

Body fluids other than blood serum are currently being assayed for numerous kinds of antibodies. urine and oral fluids (Gingival crevicular transudation and saliva) are promptly obtained by non- invasive suggests that, not requiring a puncture for sample assortment.

Gingival fissure, a well-established microbic niche has been related to respiratory diseases.

Various viruses that are investigated for a attainable role in dentistry pathological process embrace 

• Herpes simplex virus-1 (HSV-1)
• HSV-2
• Human herpesvirus-6 (HHV-6)
• HHV-7
• HHV-8
• Human cytomegalovirus (CMV)
• Epstein–Barr virus (EBV)
• Human immunodeficiency Virus (HIV) 
• Varicella zoster virus
• Human T-lymphotropic virus - 1
• torquetenovirus
• Hepatitis virus B 
• Hepatitis virus C 
• SARS CoV
• Human papilloma virus.

Herpesviruses are known in supragingival and subgingival plaque samples, gingival biopsies, and gingival crevicular fluid (GCF) of healthy and periodontal disease patients.

In terms of clinical manifestations,HCV infection the molecular expression of biomarkers at intervals oral fluids and its significance for medical practitioners, each periodontists and hepatologists, with a consequent interest upon whether or not the presence of dentistry inflammation may enhance the danger of hepatitis C virus transmission through the oral fluids, particularly the gingival crevicular fluid (GCF). 

As technology evolves, alternatives to the classic tests and testing ways arise. every offers one or a lot of enticing options which will modify assortment, testing or interpretation of results. 

Though usually remarked as “saliva”, the fluid used for testing is crevicular fluid, that could be a transudation of blood and thus almost like the samples employed in blood serum primarily based tests. 

GINGIVAL CREVICULAR FLUID 

Gingival crevicular fluid (GCF) is an inflammatory exudate derived from the periodontic tissues.

GCF is an exudate of variable composition found within the sulcus/periodontal pocket between the tooth and marginal gingiva.

It consists of 

• Blood serum 
• Locally generated materials reminiscent of tissue breakdown products
• Inflammatory mediators
• Antibodies directed against plaque microorganism. 

GCF is a little stream, sometimes solely a couple of microliters per hour. 

Its constituents are derived from variety of sources, as well as serum, the connective tissue, and epithelial tissue through that GCF passes on its thanks to the crevice.

Various investigators have confirmed that GCF may be a complicated mixture of drugs derived from 

• serum
• leukocytes and 
• structural cells of the periodontium
• oral microorganism.

During inflammation, the GCF flow will increase and its composition starts to check that of an inflammatory exudate. 

A - crown of the tooth, covered by enamel.

B - root of the tooth, covered by cementum. 

C - alveolar bone. 

D - subepithelial connective tissue. 

E - oral epithelium. 

F - free gingival margin. 

G - gingival sulcus

H - principal gingival fibers. 

I - alveolar crest fibers of the PDL. 

J - horizontal fibers of the PDL. 

K - oblique fibers of the PDL.

Photo credit: Goran tek-en (Wikipedia commons) 

GINGIVAL CREVICULAR FLUID AS A DIAGNOSTIC 

GCF may also be of selection rather than humor owing to 

• non-invasiveness
• painless
• low cost
• less sample
• straightforward collection
• safer disposal and 
• conjointly higher for clinicians owing to patients better compliance.

Gingival Crevicular Fluid contains a lot of immunoglobulin concentration than secretion and since of this it's become the logical focus of diagnosis diseases and therefore the Gingival Crevicular Fluid is used as a diagnostic medium.

Gingival crevicular transudation but contains in the main immunoglobulin G in concentrations like those in serum and several other times bigger than secretion, so it may be used for diagnostic procedures.

COLLECTION OF GCF

Filter paper strips were wont to collect GCF by inserting the strips into the crevice (apical direction) till delicate resistance was detected or by inserting the strips at or over the entrance of the pocket to choose up the oozy fluid.

The threads were placed within the gingival crevice round the tooth, and therefore the quantity of fluid collected was calculable by consideration the sample threads. 

Capillary tubes of standardized length and diameter were placed within the pocket and their content was later centrifuged and analyzed.

HERPESVIRUSES

Single site of active periodontic destruction might harbor quite 1,000,000 copies of herpesvirus genomes.

Herpesviruses are known in supragingival and subgingival plaque samples, gingival biopsies, and gingival crevicular fluid (GCF) of healthy and periodontal disease patients.

The gingival sulcus or periodontic pocket has conjointly been planned to act as a reservoir between periods of repeat of herpetic medical infections.

HERPES SIMPLEX VIRUS

The presence of herpesviruses will increase with the rise in unwellness severity in chronic periodontal disease cases.

The prevalence of herpes simplex 1 was considerably higher in periodontitis and chronic periodontal disease patients as compared to healthy controls.

The reduction of herpes simplex 1 population once phase-I periodontic therapy may be attributed to a reduced flow of herpes simplex 1 infected cells, resolution of gingival inflammation and reduction in pocket depth because of tissue shrinkage.

HSV-2 primarily causes anogenital infections; but, the virus has been recovered from the oral cavity as well.

Photo credit: Dr. Erskine Palmer (Wikipedia commons) 

EPSTEIN-BAR VIRUS 

EBV may be a herpesvirus, that has been involved within the pathologic process of varied sorts of disease. 

The virus infects periodontic B-lymphocytes, which can impair the periodontic defense and incline to overgrowth of periodontal infective microorganism.

EBV is related to a shift from periodontic health to disease is in agreement with findings of previous studies that rumored on a high prevalence of Epstein-Barr virus in chronic periodontitis.

CYTOMEGALOVIRUS 

CMV has often been related to periodontitis. 

The virus infects periodontic monocytes/macrophages and T-lymphocytes, and reactivation of cytomegalovirus in periodontitis lesions tends to be related to progressive disease.

CMV might preponderantly occur in gingival tissue instead of in GCF. 

HUMAN IMMUNODEFICIENCY VIRUS 

Acquired immunodeficiency syndrome (AIDS) is that the most devastating example of secondary immunodeficiency and was discovered in 1981. 

It's a retroviral malady caused by human immunodeficiency virus (HIV) and is characterised by profound immunological disorder resulting in infection, secondary neoplasms, and neurological manifestations.

The diagnosing of HIV infection is habitually administered by the enzyme-linked immunosorbent assay (ELISA).

The use of oral fluids conjointly has been advocated as a trouble-free and non-invasive different to the gathering of blood for detection of antibodies to variety of specific bacterial, viral, fungal, and parasitic agents.

Oral fluids are a mix, with secretion and gingival crevicular fluid (GCF; conjointly referred to as as oral mucosal transudate) being the most elements. 

GCF and secretion are known as distinct body fluids. 

Gingival crevicular transudation but contains in the main immunoglobulin G in concentrations like those in serum and several other times bigger than saliva. 

Whole secretion and GCF is distinguished by the actual fact that the immunoglobulin G (IgG) content of the GCF is many times bigger than that of saliva.

HIV antibodies in GCF were detected with the assistance of latest investigational device (the microcapillary), is promising screening procedure in diagnosing of HIV infection.

HEPATITIS C VIRUSES 

Hepatitis C virus (HCV) infections may have a crucial impact on the oral health standing of patients, affirmative conditions comparable to periodontitis and carcinoma.

The untreated infection results in chronic inflammation of the liver. 

Chronic infectious disease has complications comparable to hepatic cirrhosis of the liver and hepatocarcinoma that are fatal for the patient.

It is believed that the virus are often hosted within extrahepatic tissues, creating it additional susceptible to transmission and harder to treat. 

Hence, the development of viral infection complications such as hepatocellular carcinoma can have a critical impact on the patient's immune system, creating it even harder to be tackled by the defensive physiological mechanisms.

HCV infection on the oral cavity, highlight each the dental pathological changes and different extrahepatic manifestations (EHMs) with oral implications, whereas others reveal the impact type A, B, and C hepatitis has on oral fluids, recognizing the doable carriage of the hepatitis viruses within the whole spit and gingival fluid. 

Gingival cervicular fluid contains 

• bacterial plaque elements
• Inflammatory cells of the system
• Traces of connective tissue and 
• Different blood serum factors. 

The viral molecules are ready to pass down into spit, thus making the GCF the source of contamination of HCV-infected patients' saliva.

The presence of ribonucleic acid HCV molecules within the gingival fluid refers to infected leukocytes that contain infective agent strains and find transferred from the bloodstream into the gingival fluid, chiefly within the case of gingival inflammation. 

Diagnosis by HCV RNA oral detection kits for saliva, whereas conjointly giving ways in which within which this less invasive methodology may be improved

Hepatitis c virus produced in cell culture. 

Photo credit: HCV_pictures (Wikipedia commons) 

SARS-CoV

A study has prompt that the SARS-CoV RNA has been according to be present within the spit even before respiratory organ changes were detected.

viral presence within the rima and therefore the development of respiratory pathologies. 

Angiotensin-converting enzyme 2 (ACE2), the foremost receptor for the SARS-CoV2 virus is present in several tissues within the body, together with the epithelial tissue of the secretion glands and gingiva. 

Future studies should assess the presence of SARS-CoV-2 within the gingival crevicular fluid and salivary samples of COVID-19 patients each throughout the illness progression and post-recovery.  

CONCLUSION 

HSV-1 and Epstein-Barr virus viruses in GCF is higher in patients affected by periodontitis and chronic periodontal disease compared to periodontally healthy subjects. 

Phase-I periodontic therapy leads to reduction of herpesvirus level in GCF of periodontitis and chronic periodontal disease patients. 

REFERENCE 

• Krishnan Chandragiri Subbarao, Gowri Shankar Nattuthurai, Satheesh Khannaa Sundararajan, Indhu Sujith, Jennifer Joseph, and Yasmin Parvin Syedshah. Gingival Crevicular Fluid: An Overview. J Pharm Bioallied Sci. 2019 May; 11(Suppl 2): S135–S139.
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• Supriya Kheur,Mohit Kheur,Archana A. Gupta, and Thirumal Raj A. The gingival sulcus a potential niche for SARS-Corona virus-2?. Med Hypotheses. 2020 Oct; 143: 109892. 
• Rucha Shah, Dhoom Singh Mehta. Prevalence of herpesviruses in gingivitis and chronic periodontitis: relationship to clinical parameters and effect of treatment. J Indian Soc Periodontol. 2016 May-Jun; 20(3): 279–285. 
• Dorin Nicolae Gheorghe,  Liliana Foia, Vasilica Toma, Amelia Surdu, Elena Herascu, Dora Maria Popescu, Petra Surlin, Cristin Constantin Vere,  and Ion Rogoveanu. Hepatitis C Infection and Periodontal Disease: Is there a Common Immunological Link?. J Immunol Res. 2018; 2018: 8720101.
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