- The ability of a bacterium to adhere to its host is crucial for the induction of infectious

diseases, such as gingivitis or periodonti- tis.310 Oral bacteria and especially pathogenic
bacteria, such as Porph romonas gingivalis (Figure 8-1, and ) and ggregati bacter
actinom cetemcomitans (Figure 8-1, ), have a large battery of virulence factors, one of
which is the ability to adhere to hard intraoral surfaces and/or to the oral mucosae (Figure
8-2).
- Bio lms are composed of microbial cells encased within a matrix of extra- cellular
polymeric substances, such as polysaccharides, proteins, and nucleic acids.
- Dental plaque (see Figure 8-7) is defned clinically as a structured, resilient, yellow-
grayish substance that adheres tenaciously to the intraoral hard surfaces, including
removable and xed restora- tions.30
Materia alba refers to soft accumulations of bacteria, food matter, and tissue cells that
lack the organized structure of dental pla ue and that are easily displaced with a water
spray. Calculus is a hard deposit that forms via the mineralization of dental pla ue and
that is generally covered by a layer of unmineralized plaque
- The process of pla ue formation can be divided into several phases: (1) the formation of
the pellicle on the tooth surface (2) the initial adhesion/attachment of bacteria and (3)
colonization/pla ue maturatio
- Stage I Gingival Inflammation: The Initial Lesion
The rst manifestations of gingival in ammation are vascular changes that consist of
dilated capillaries and increased blood flow.
- Stage II Gingival Inflammation: The Early Lesion
- clinical signs of erythema may appear, mainly because of the proliferation of capillaries
and the increased forma- tion of capillary loops between rete pegs or ridges (Figure 14-
5). Bleeding on probing may also be evident.
- Stage III Gingival Inflammation: The Established Lesion
- The result is localized gin- gival anoxemia which superimposes a somewhat bluish hue
on the reddened gingiva
- Stage IV Gingival Inflammation: The Advanced Lesion
The extension of the lesion into alveolar bone characterizes the fourth stage, which is
known as the a vance lesion40 or phase o perio ontal breakdown

- The two earliest signs of gingival in ammation that precede estab- lished gingivitis are as
follows: (1) increased gingival crevicular fluid production rate and (2) bleeding from the
gingival sulcus on gentle probing
- The surface of normal gingiva usually exhibits numerous small depressions and
elevations that give the tissue an orange-peel appearance referred as stippling 13 Stippling
is restricted to the attached gingiva
- In patients with chronic inflammation, the gingival surface is either smooth and shiny or
rm and nodular, depending on whether the dominant changes are exudative or brotic
-