What are the Pathological/Histological Changes To The Periodontium From Disease during Bacterial Accumulation (INITIAL LESION) 1. Bacterial/Cellular Features 2. Tissue Level 3. Clinical Features/Time

1. - Bacteria build up along the gingival margin. - Migration, infiltration and production of white blood cells/chemical defenders (leukoocytes, neutrophils-PMNs, cytokines, PGE2, MMPs, TNFs) in the JE and gingival sulcus/connective tissue to fight infection/inflammation by destroying some connective tissue to get to the bacteria and destroy that too (through phagocytosis). - If bacteria are destroyed tissues can be repaired and the infection can be stopped and progression to gingivitis will not occur. 2. - Vascular dilation (blood vessels widen) - Increase of gingival crevicular/sulcus fluid. 3. - Gingiva looks clinically healthy- no clinical evidence of change - Develops 2-4 days after plaque biofilm accumulation