International Journal of Current Research and Review
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IJCRR - Vol 09 Issue 17, September, 2017

Pages: 32-36

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Effect of Gingival Crevicular Fluid Volume in Smokers

Author: Aishwarya A.S., Jaiganesh

Category: Healthcare

Abstract:The association between smoking and periodontal disease has been proven by many epidemiological evidences. This article reviews the recent studies and compiles the effect of smoking on Gingival crevicular fluid volume. Many studies support the fact that tobacco smoking affects the periodontium through different pathways like microcirculatory, host immune systems, connective tissue and bone mechanisms.

Keywords: Smoking, Periodontal disease, Gingival crevicular fluid

DOI: 10.7324/IJCRR.2017.9175

Full Text:


Periodontal disease is defined as inflammatory destruction of periodontal tissue and alveolar bone supporting the teeth. [5] Smoking is accepted as a risk factor for periodontal disease and detrimental to periodontal tissues. Many investigations suggest negative periodontal effects among smokers in comparison with non smokers. Smokers tend to have greater numbers of deeper periodontal pockets and probing depth. Studies show that cigarette smokers are 2 to 6 times more likely to develop severe periodontitis than in non-smokers [31,32]. Several epidemiological studies indicate that smoking has harmful effects on the response to non surgical and surgical procedures [1].

Paradoxically, smoking tends to mask the gingival inflammation by causing constriction of blood vessels of gingiva [20, 21]. Smoking is known to alter the host response including changes in vascular function, neutrophil activities, adhesion molecule expression, antibody production, release of cytokine inflammatory mediators [33,34].

Biological mechanism of periodontal disease is occurring due to the imbalance between bacterial virulence and host defence activity.[4]. The most possible mechanism that explains the relationship between smoking and periodontal disease is that smoking, an environmental factor, interacts with the host cells and affects the inflammatory changes [25]. These underlying mechanisms can be understood by linking findings of the previous epidemiological studies with in vitro studies.

Biological markers called as biomarkers which are indicative of the status of the disease and have been measured for several studies to reveal the mechanism of disease [27]. For example host immune inflammatory response systems have biomarkers like immune cells, immunoglobulins and metalloproteinase, cytokines, and adhesion molecules. These biomarkers are obtained limitedly particularly from non-diseased smokers. Thus commonly used specimens are saliva, blood serum, gingival crevicular fluid [26].

Gingival crevicular fluid is a fluid present in the sulcus or periodontal pocket between the surface of the tooth and the gingival epithelium [3]. Gingival crevicular fluid is a transudate as well as inflammatory exudates, produced by osmotic gradient containing low protein content. The amount of gingival fluid is greater when inflammation is present. Physiologically the fluid volume increases while masticating, brushing, ovulation etc[23]. Gingival crevicular fluid is a well known marker of gingival health status[1]. This study reviews articles relating the gingival fluid flow in smokers.


This article reviews based on the strategy, keywords like smoking and periodontitis, gingival fluid flow, Gingival crevicular fluid volume in smokers. Many articles reviewed were published in the last 5-7 years. This article constructs the relation between smoking and the gingival crevicular fluid flow rate by reviewing the previously conducted studies.


There are several methods to collect Gingival crevicular fluid

  • By using absorbent papers
  • Brill technique (intra sulcular method) -filter paper strip is placed inside the gingival sulcus until the resistance is felt.
  • Loe and Holm-Pedersen technique (extra sulcular technique) -filter paper strip is placed at the entrance of the gingival sulcus.
  1. Collection of Gingival crevicular fluid using micropipettes
  • Micropipettes with standardized length and diameter and uses the capillary action to collect the fluid.
  1. By using twisted threads
  • Pre weighed twisted threads are placed in the crevice and after placing, the threads are measured and measured.
  1. Collecting Gingival crevicular fluid by using paper points


  1. The amount of Gingival crevicular fluid collected in periopaper can be measured by several means
  • By weighing the absorbent medium:
  • The weight of the twisted threads are measured before and after placing in the gingival crevice and compared.
  • By measuring capillary fill of micropipettes
  • As the capillary tubes are marked with standardized length and diameter.
  • By staining with ninhydrin
  • The wetted area with Gingival crevicular fluid becomes more visible by staining with ninhydrin which can be then measured planimetrically on an enlarged photograph or with a microscope.
  • Electronic method
  • Amount of Gingival crevicular fluidcan be estimated by using an electronic device called as periotron.


The contents of Gingival crevicular fluid are usually as a result of interaction between the bacterial biofilm and the periodontal tissues. It contains the products of tissue breakdown, inflammatory mediator and antibody produced against them[7]. From the hypothesis postulated by Pashley which suggested that the initial fluid produced represents interstitial fluid which appears in the crevice as the result of osmotic gradient. This initial, pre-inflammatory fluid is a transudate and on stimulation it becomes as an inflammatory exudates [8].

Composition of Gingival crevicular fluid

Enzymatic components

  • Host derived and other products
  • Bacteria derived
  • Non enzymatic components
  • Cellular components
  • Electrolytes
  • Organic components

Organic compounds: Glucose hexosamine and hexuronic acid are two main components of Gingival crevicular fluid, where the glucose level of blood do not coincide with the level of glucose in Gingival crevicular fluid, its concentration is three or four times greater than in serum level [6].


Tobacco smoke contains millions of noxious chemicals which comprises of gaseous phase and particulate phase. The gas phase contains carbon monoxide, ammonia, formaldehyde, hydrogen cyanide and 60 known carcinogen such as benzo(a)pyrine, dimethylnitrosamine. The particulate phase includes nicotine, benzene, and tar. Tar is in condensate form, sticky substance that stains the fingers and teeth yellow/brown. Nicotine an alkaloid found in tobacco leaves evaporates when the cigarette is lighted. It's quickly absorbed in the lungs and reaches the brain within 10-19 seconds. Nicotine is highly addictive and causes rise in blood pressure, increased heart rate and respiratory rate with peripheral vasoconstriction. Plasma and saliva cotinine concentration in smokers is approximately 300ng/ml and the urine concentration s approximately 1500 ng/ml. Non-smokers has plasma and saliva concentration


Effect on microvasculature

Smaller number of vessels was observed in inflamed gingival tissues of smokers compared to non smokers. Smoking causes decrease in gingival blood flow and vascular conductance, leading to delay in healing and increases the risk of periodontal health [27,28]. Smoking causes inflammatory activation by inducing endothelial dysfunction which increases the cytokine adhesion molecules [14].

Host immune response

Smoking can affect the neutrophil count in blood in a dose-dependent manner [30]. Smoking reduces the proliferation of T lymphocytic cells and affects B cell function and antibody generation [30].

Connective tissue and bone metabolism:

Crevicular fluid in smokers has increased levels of Interleukins (IL 6, IL 8, IL 4), MMP, and free radicals. Gingival crevicular fluid has decreased levels interleukins (IL 1a), osteoprotegrin, prostaglandins, and gingival fibroblasts [4]

Viability of PMNs was significantly lower in light, moderate and heavy smokers compared to non-smokers. The ability of PMNs to phagocytose was significantly impaired in light, moderate and heavy smokers compared to non-smokers [13]. In periodontally diseased subjects the total amounts of IL-1β, IL-6 and IL-8 were significantly elevated as compared to healthy subjects, whereas IL-4 showed an inverse relationship to periodontal status and higher amounts were found in the healthy group[14].The levels of calprotectin, a leukocyte protein, in body fluids of patients with some inflammatory diseases are raised. Recently, we detected calprotectin in Gingival crevicular fluid and its concentrations in periodontal pockets were higher than those in healthy gingival crevices[16,17]. Investigations done by Jun-ichi Kido found the correlations between Gingival crevicular fluid calprotectin levels and clinical indicators (probing depth and bleeding on probing, BOP), and the IL-1β and PgE2 levels[14].


Smoking is highly prevalent and can be considered an epidemic both developed and developing nations, smoking was higher in younger groups than older groups. Studies estimate that 1.3 billion people smoke per year worldwide on an average[6]. Smoking is detrimental to body tissues such as lungs, heart muscles, blood vessels, periodontium etc.

The periodontal probing depth and attachment loss were higher in smokers compared to non smokers [3]. Smoking tends to mask gingival inflammation by causing constriction of blood vessels of the gingiva [20,21,22]Smoking decreases oxygen tension in the gingival tissues. Smoking decreases tissue oxygen from from 65 7 to 44 ???????3 mmHg. Oxygen tension of 40-50 mmHg has increased risk of infection [9]. Vasoconstriction of blood vessels leads to reduced clinical signs and suppressed clinical expression of disease[11].A study done by Kemal et al showed that smoking significantly increased Gingival crevicular fluid flow/volume when compared to non-smokers. Purnima et al conducted a study with Gingival crevicular fluid, marginal and sub gingival plaque that revealed early acquisition and colonization of oral biofilm in smokers [12].

Cigarette smokers with periodontitis have increased periodontal destruction especially in palatal region of maxilla [35]. Study done by Xia Chen et al showed that 16% of smokers had higher chance of becoming edentulous within 10 years while only 0.3% of non-smokers become edentulous in the same period of time [15].

The research by Kaushal Luthra et al shows a clinically significant decrease in Gingival crevicular fluid volume in smokers when compared to non smokers and an increase in the volume of Gingival crevicular fluid 10 minutes post smoking[1]. Nicotine plays a major role in altering the gingival blood flow which subsequently correlates with the volume of Gingival crevicular fluid in smokers [2]. A similar result was reported by Morozumi et al[1]. There is an immediate increase in Gingival crevicular fluid volume five days after smoking cessation.


The Gingival crevicular fluid volume is known to increase with the degree of inflammation. The increased Gingival crevicular fluid volume shows the presence of masked inflammation in smokers. Smoking alters the gingival blood flow which concomitantly relates to the Gingival crevicular fluid volume. This review concludes that the result may vary according to the pattern of smoking, methods of collection of Gingival crevicular fluid and sample size.


The Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.


1. Ustun K, Nilgun A. Alptekin. The effect of tobacco smoking in gingival crevicular fluid. European Journal Dentistry, 1(4): 236-239, 2007.

2. Mokeem SA, Vellappally S , Preethanath RS , Hashem MI , Al-Kheraif AA , Anil S. Influence of Smoking on Clinical Parameters and Gingival Crevicular FluidVolume in Patients with Chronic Periodontitis, OHDM - Vol. 13 - No. 2,2014.

3. Luthra K, Grover HS, Aggarwal N, Luthra S. Smoking swings of gingival crevicular fluid secretion, Journal of Indian Society of Periodontology volume 16(1); 101-103, 2012.

4. Ojima, Hanioka: Destructive effects of smoking on molecular and genetic factors of periodontal disease. Tobacco induced diseases 2010 8: 4.

5. Sabrina C. Gomes, Flávia B. Piccinin, Rui V. Oppermann, Cristiano Susin, Rosemary Adriana C. Marcantonio. The effect of smoking on gingival crevicular fluid volume during the treatment of gingivitis.Acta Odontol. Latinoam Vol. 22 (3); 201-206,2009.

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12. Kumar PS, Matthews CR, Joshi V, de Jager M, Aspiras M. Tobacco Smoking Affects Bacterial Acquisition and Colonization in Oral Biofilms. Morrison RP, ed. Infection and Immunity. 2011;79(11):4730-4738.

13. Güntsch A, Erler M, Preshaw PM, Sigusch BW, Klinger G, Glockmann E. (2006), Effect of smoking on crevicular polymorphonuclear neutrophil function in periodontally healthy subjects. Journal of Periodontal Research, 41: 184-188.

14. Giannopoulou C, Kamma JJ, Mombelli A: Effect of inflammation, smoking and stress on gingival crevicular fluid cytokine level. J Clin Periodontol.2003, 30: 145-153.

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16. Kido J, Nakamura, T, Kido R, Ohishi K, Yamauchi N, Kataoka M. and Nagata T(1999), Calprotectin in gingival crevicular fluid correlates with clinical and biochemical markers of periodontal disease. Journal of Clinical Periodontology, 26: 653-657.

17. Rai B, Kaur J, Anand S C, Laller K, The effect of smoking on gingival crevicular fluid levels of myeloperoxidase, Indian J Dent Res [serial online] 2010; 21:20-2.

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23. Preber H, Bergstrom J. occurrence of gingival bleeding in smoker and non smoker patients. Acta Odontol Scand. 1985:43:315-20.

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26. Shield PG. Molecular epidemiology of smoking and lung cancer. Oncogene 2002, 21: 6870-6876.

27. Mavropoulos A, Aars H, Brodin P. Hyperaemic response to cigarette smoking in healthy gingiva. J Clin Periodontol 2003, 30: 214-221.

28. Mavropoulos A, Brodin P, Rosin CK, Aars H. Gingival blood flow in periodontitis patients before and after periodontal surgery assessed in smokers and non smokers. J Periodontol 2007, 78: 1774-1782.

29. Koundouros E, Odell E, Coward P, Wilson R, Palmer RM. Soluble adhesion molecules in serum of smokers and non smokers, with and without periodontitis. J Periodontal Res 1996, 31: 596-599.

30. Loos BG, Roos MTL, Schellekens PTA, Velden van der U, Miedema F. Lymphocyte numbers and function in relation to periodontitis and smoking. J Periodontol 2004, 75: 557-564.

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33. Raulin LA, McPherson JC, 3rd, McQuade MJ, Hanson BS. The effect of nicotine on the attachment of human fibroblasts to glass and human root surfaces in vitro. Journal of Periodontology. 1998; 59: 318-325.

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Dr. Pramod Kumar Manjhi joined Editor-in-Chief since July 2021 onwards

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Awards, Research and Publication incentive Schemes by IJCRR

Best Article Award: 

One article from every issue is selected for the ‘Best Article Award’. Authors of selected ‘Best Article’ are rewarded with a certificate. IJCRR Editorial Board members select one ‘Best Article’ from the published issue based on originality, novelty, social usefulness of the work. The corresponding author of selected ‘Best Article Award’ is communicated and information of award is displayed on IJCRR’s website. Drop a mail to for more details.

Women Researcher Award:

This award is instituted to encourage women researchers to publish her work in IJCRR. Women researcher, who intends to publish her research work in IJCRR as the first author is eligible to apply for this award. Editorial Board members decide on the selection of women researchers based on the originality, novelty, and social contribution of the research work. The corresponding author of the selected manuscript is communicated and information is displayed on IJCRR’s website. Under this award selected women, the author is eligible for publication incentives. Drop a mail to for more details.

Emerging Researcher Award:

‘Emerging Researcher Award’ is instituted to encourage student researchers to publish their work in IJCRR. Student researchers, who intend to publish their research or review work in IJCRR as the first author are eligible to apply for this award. Editorial Board members decide on the selection of student researchers for the said award based on originality, novelty, and social applicability of the research work. Under this award selected student researcher is eligible for publication incentives. Drop a mail to for more details.

Best Article Award

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A Study by Avijit Singh"Comparison of Post Operative Clinical Outcomes Between “Made in India” TTK Chitra Mechanical Heart Valve Versus St Jude Mechanical Heart Valve in Valve Replacement Surgery" is awarded Best Article for Vol 12 issue 19
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A Study by Jabbar Desai et al. entitled "Prevalence of Obstructive Airway Disease in Patients with Ischemic Heart Disease and Hypertension" is awarded Best Article for Vol 12 issue 17
A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
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A Study by entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for  Vol 12 issue 07
A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09

List of Awardees

A Study by Ese Anibor et al. "Evaluation of Temporomandibular Joint Disorders Among Delta State University Students in Abraka, Nigeria" from Vol 13 issue 16 received Emerging Researcher Award

A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award

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Disclaimer: International Journal of Current Research and Review (IJCRR) provides platform for researchers to publish and discuss their original research and review work. IJCRR can not be held responsible for views, opinions and written statements of researchers published in this journal.


International Journal of Current Research and Review (IJCRR) provides platform for researchers to publish and discuss their original research and review work. IJCRR can not be held responsible for views, opinions and written statements of researchers published in this journal


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