Chapter 13

Insight: The first host response events against a pathological biofilm are vascular changes, such as dilated capillaries and increased blood flow. These initial inflammatory changes occur in response to the microbial activation of leukocytes and the subsequent stimulation of endothelial cells resident in the gingiva. The increase in the migration of neutrophils and monocytes and their accumulation within the gingival sulcus may be correlated with an increase in the flow of gingival fluid into the sulcus. The character and intensity of the host response determine whether this Initial lesion resolves rapidly, with the restoration of the tissue to a normal state for example after treatment. Alternatively the early disease in the gingiva may evolve into a chronic inflammatory lesion. If the latter occurs, an infiltrate of macrophages and lymphoid cells appears within a few days.

Clinical Consideration: Clinically, this initial inflammatory response of the gingiva to bacterial plaque (i.e., subclinical gingivitis) is not apparent. The early (or stage I) lesion evolves from the initial lesion (stage II) within about 1 week after the beginning of plaque accumulation. As time goes on, clinical signs of erythema may appear, mainly because of the proliferation of capillaries and the increased formation of capillary loops between rete pegs or ridges. Bleeding on probing may also be evident.

See more on chapter 13 and 14 about cellular events that are hallmark of early and advanced lesions.