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

1. - Plaque biofilm increases and extends sub gingivally into the junctional epithelium. - Increased migration, infiltration and production of white blood cells/chemical defenders (leukocytes, neutrophils- PMNs, macrophages, cytokines, PGE2, MMPs, lymphocytes, T-Cells, B-Cells, fibroblasts and leukocytes/plasma cells-produce antibodies) into connective tissue and sulcus. Plasma cells are in areas of chronic inflammation. Their processes destroy connective tissue. - Established gingivitis is reversible when professionally treated, if not advanced lesion/periodontitis occurs. 2. - Junctional epithelium loosens its attachment and forms a pocket epithelium - Proliferation of JE and sulcus to “wall out” inflammation - Continued collagen loss - Deeper extension of epithelial ridges - Increased crevicular fluid 3. - All clinical features of gingivitis are evident and more pronounced than earlier stages (inflammation, red/blue gingiva, bleeding, spongy, exudate) - Observed 21 days after plaque biofilm accumulation