Gingival Crevicular Fluid

What is it, and why should you care?

Charles W Martin By Charles W Martin, DDS

We've talked here many times about how people who have diabetes are more susceptible to gum disease. And, when you get gum disease, it can interfere with your glucose control. Because these health issues often don't seem logically related, many people struggle to understand these dynamics. Here's a straightforward and brief explanation that underscores the importance of good dental care as an element in successfully living with diabetes. The culprit? gingival crevicular fluid, or GCF.

One of the key links between diabetes and oral health is the effect of elevated blood sugar on your gum tissue. If you have diabetes, your increased glucose levels also show up in the fluid in your gums. The technical term for this is the gingival crevicular fluid. The gingiva is the dental term for the tissues that surround your teeth and their supporting structures. It's commonly referred to as the gum. Crevicular refers to the tiny space between the surface of the tooth and the gum tissue.

When you have gum disease – inflammation and infection – the amount of GCF increases. For people with diabetes, the increased glucose levels in their GCF provide a great food source for the bacteria that lurk under your gum line.

In my column titled "Better Blood Glucose Control May Keep Gum Disease Away," I talk about the hundreds of bacteria that live in your mouth and what a nice, cozy little paradise they find under the gum line. Bacteria thrive here because it's so hard to reach them with floss or your toothbrush. It's kind of a bacterial vacation resort where the party goes on 24/7 and the hundreds of revelers enjoy unlimited servings of sweet desserts. Their host or hostess gift to you is increasingly serious gum disease.

As they continue feeding on the glucose-rich gingival crevicular fluid, the bacteria breed entire populations that colonize the crevices between your teeth and gums. As these communities expand and strengthen, they form barriers called biofilms. Here, bacteria seem to form a pact to get along and support each other. Biofilms can act like a single organism, erecting barricades against the body's normal defenses and becoming almost impermeable to typical dental home care techniques like brushing and flossing.

With accumulating toxic wastes, the bacterial communities become more irritating to the surrounding gum tissue. The body's immune system mobilizes its containment forces that rush to the site and try to surround or kill the bacteria. The more the immune cells fight with the bacteria, the more gum tissue gets damaged in the process.

It's much like a battleground after a major engagement. The oral health equivalent of bombed-out buildings, fires and rubble is a growing area of ulcerated gum tissue that's inflamed, red, tender and oozing GCF. The increased gingival crevicular fluid, of course, fuels the bacterial fires once again and perpetuates the whole process. Eventually the ulcerated areas will spread and continue to worsen.

In fact, to put it in perspective, the total area of ulcerated tissue that can accumulate in your mouth from untreated gum disease, if laid out on your hand, would cover most of your palm. If you had that kind of an injury you'd be hightailing it to your physician, and well you should. And your physician would treat that wound on your hand like an emergency, which it is. That's why it's important to treat your gum disease as a serious situation as well.

Why is it so serious? Well, gum disease in your mouth may not stay there. Bacteria can enter your blood stream and that can lead to systemic inflammation. We've talked before how systemic inflammation can be related to catastrophic health events like heart attack and strokes, risks that your diabetes compounds.

What you want to do is avoid an inflammation cascade from your mouth throughout your body. The best way to do that is to take care of your teeth and gums with regular, careful home care and get regular checkups from a dentist who understands the links between diabetes and gum disease. The payoff? You'll look and feel healthier and you'll have a great smile!

For more information about dental care for people who have diabetes, visit and Dr. Martin's blog,

To learn more about the two-way connection between diabetes and gum disease, check out Dr. Martin's other columns here on or his book, Don't Sugar Coat It.

Read Dr. Charles Martin's bio here.

Read more of Dr. Martin's columns.

NOTE: The information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition. 

Last Modified Date: July 01, 2013

All content on is created and reviewed in compliance with our editorial policy.

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by Brenda Bell
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