I just had a discussion with a patient who had seen another dentist for upper and lower full-coverage ceramic restorations. She was struggling with her gums being red, irritated, bleeding when brushing and generally not feeling good. However, we determined the cause is not bacterial; she has great home care and frequent hygiene visits. There are several possible causes for her chronic gingival inflation. I'll discuss some of the possible causes in her case and how we'll figure out what is really going on.