An in vitro model consisting of enamel from extracted human molars, suspended from wires in inoculated culture tubes, was used to study the adhesion of bacteria to enamel. Under conditions in which there was no macroscopically visible plaque formation, electron micrographs showed no bacterial deposits on the enamel surface. In samples where Streptococcus mutans attached to enamel, an extracellular, pellicle-like material was'associated with the bacteria adjacent to the enamel. This material appeared to bind to the enamel surface and to mediate bacterial attachment. Membrane-filtered (Millipore Corp.) saliva deposited a thin surface layer on the enamel, but there were no observable alterations of S. mutans attachment to enamel pretreated with saliva. It was noted that Bratthall serotype c and e strains of S. mutans, when grown in glucose-containing medium, attached, although less tenaciously, to enamel and nichrome wires. Chemical and gas chromatographic analyses of cell-associated materials formed by serotype c and e strains cultured in glucose-containing medium revealed low amounts of glucosepositive material and no polymer linkages characteristic of glucan; yet the same strains cultured in sucrose-containing medium had relatively high amounts of glucose-positive material, with polymer linkages characteristic of glucan. Serotype a, b, and d strains could attach only in sucrose-containing media.Bacterial plaque formation on tooth enamel may be dependent on two types of adhesion phenomena. Organisms must sorb to the tooth or to organic films on the enamel surface, and organisms must be able to adhere to each other as the plaque enlarges. The abilities of certain bacteria to become attached to enamel and to proliferate while localized there seem to be the major ecological determinants influencing formation of plaque and pathogenicity (11,41). The events and mechanisms are, however, not completely understood.A large body of evidence strongly implicates Streptococcus mutans as a prime pathogen in dental caries of humans and experimental animals (2,5,7,10,22,24). S. mutans is known to form glucans from sucrose via glucosyl transferase activity, and the synthesis of cell surfaceassociated glucans from sucrose has been thought essential for this species to form bacterial accumulations termed dental plaque (9,11,13,21,25,29,30,35,40,41, 50).Most models for bacterial attachment to tooth surfaces involve growth of bacteria on wires, glass, plastic, or hydroxyapatite powder. Few ultrastructural studies of plaque formation have used intact tooth enamel (46). However, because of the purported structural distinctness of enamel, its characteristic wettability (14), and the possible specificity of bacterial-enamel interac-tions (12), the early attachment of bacteria to tooth enamel in vitro rather than to enamel substitutes may better parallel events in vivo. The recent development of a technique for making thin sections of the enamel-plaque interface (45) has enabled a study of enamel-bacteria interactions. The purpose of this ...