An oral examination of Mrs. Connors, a new patient, reveals numerous restorations and two porcelain crowns. Mrs. Connors has been concerned about two maxillary molars where floss shreds or breaks. She also mentions that her gums "always hurt around my big crown." The painful gingiva surrounding her overcontoured crown is caused by

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The "big crown" described by Mrs. Connors was overcontoured by the restorative dentist. The extreme curvature of such restorations results in food being deflected in such a way that the gingival tissue is inadequately stimulated and cleaned by frictional action. This causes bacterial accumulation and proliferation at the free gingival margin with resultant gingival damage. Edematous, puffy, inflamed tissues contribute to breakdown of supporting periodontal structures.

An Oral Examination of Mrs