A photograph shows severely inflamed marginal gingiva that bleeds readily on the slightest contact and tears easily. How is this tissue best described?

Correct answer: A. Friable

• A. CORRECT. FRIABLE describes tissue that is soft, oedematous, easily torn and bleeds on minimal provocation. It reflects an OEDEMATOUS inflammatory response — dense inflammatory infiltrate, vascular engorgement, collagen breakdown and ulcerated sulcular epithelium — and is typical of acute plaque-induced gingivitis, particularly with a hormonal, nutritional or haematological modifier.
• B. FIBROTIC tissue is the opposite: firm, dense, resilient, pale and resistant to bleeding, seen where a chronic inflammatory process has produced collagen deposition — for example in drug-influenced gingival enlargement or in a heavy smoker.
• C. STIPPLING is the orange-peel surface texture of HEALTHY attached gingiva, produced by the connective tissue papillae. It is characteristically LOST in oedematous inflammation, so its absence is part of this clinical picture.
• D. KERATINISED describes the normal histological character of attached gingiva and hard palate; it is not a description of an inflammatory state.

Note: Contrast the two inflammatory patterns: OEDEMATOUS — red, swollen, shiny, loss of stippling, friable, bleeds freely; FIBROTIC — pink or pale, firm, enlarged, stippling retained or exaggerated, minimal bleeding. Smoking masks bleeding and pushes the picture toward the fibrotic end, concealing disease severity.