Carranza’s Clinical Periodontology, 12th Ed, Chapter 69

Figure 69-4: A) Hyperplastic gingivitis related to crown margins and plaque accumulation in a 27-year-old woman.  B) Four months after treatment, there is significant improvement.  However, some inflammation around crown margins still exists, which cannot be resolved without replacing the crowns.

These 2 images convey the issue of best practices in communicating with patients.  How would a clinician best inform a patient that the crowns which were likely a sizeable financial investment, are contributing to the present disease condition?  The 4 month time span from image A to image B after scaling and plaque biofilm control have likely been instituted can be utilized to show the patient that our customary and standard methods of treatment have not resolved the situation.  This may help her see that ‘something else’ is contributing.  The wording might be, “It appears that these crowns are not ideally contoured for the current condition and position of your gums”.  This would convey the situation to the patient without directly incriminating the providing dentist.  If the patient directly asks if ‘poor dentistry’ is what created the crowns and inflammation, the clinician is presented with an ethical dilemma. Generally best not to incriminate another practitioner without knowing the circumstances at the time the crowns were designed and placed. However, each clinician would need to determine how he/she ethically wishes to answer.