A great example from David Clow’s book is the transcendent smile on the face of the Buddha. And how can you help but wonder about the health and happiness on the inside creating such an expressive result on the outside? Turns out, some traditional Eastern meditation exercises are designed to cultivate an inner smile. Buddhists and Taoists teach smiling is good medicine (I’d like to see some of those exercises turn up as Continuing Ed for dental school faculty.)

Clow quotes Buddhist master Thich Nhat Hanh, explaining, “Sometimes your joy is the source of your smile and sometimes your smile can be the source of your joy.”

About a month ago when I met new patient Martha, she was upset, depressed, and frustrated. And she was sobbing. Martha was basically being held captive by a smile she wouldn’t, or couldn’t, share. I remember sitting down and having a conversation. Martha did most of the talking; I did most of the listening. Seemed like the best care we could offer that first day was a friendly ear and equal doses of understanding and reassurance. Martha could have been my daughter.

So I’ve yet to experience an official endorphin that I know of during spin class. And shucks, if I could restore smiles like Martha’s every other day and not even twice on Sunday I probably wouldn’t have to exercise at all.

Martha later shared that on leaving the office with her new smile she pulled over to the side of Las Tunas, glanced up into the rear view mirror and cried…from relief and joy. And the smile we get to see today is a great match for the beautiful person we met on Day One.

I also used to wonder about “Family” dentistry. Like, was the alternative “Hot Singles” dentistry or even worse, “Disco” dentistry? But today, I think I finally understand; I get it. And what is family dentistry if not a loving network of smiles from within?

For those who are fortunate enough to be uninitiated regarding the crown experience, here’s how it usually goes. The patient comes in for appointment #1 and has the tooth in question shaped; in the process, tooth decay and existing restorations get removed. When the shaping is done and everything’s clean and there’s enough space for a crown to fit over the tooth without sticking out too far or wide, the dentist takes an impression. When poured up in plaster, the impression will show the technician exactly what the tooth looks like after the shaping. The technician then builds the crown to fit the model poured from the impression. The next appointment is for cementing the crown to the tooth. Between appointments I and II, the patient wears a temporary crown.

Everyone confused yet?

Here’s my big problem. I have issues with the words “temporary” and “permanent”. There! Feels better just sharing that with y’all

When I come up with some bonehead remark like “What an awesome looking temporary!” or “It’ll only take 5 minutes or so to make your temporary” or I start reminiscing about temporaries past (sadly, it happens) or I give you a piece of paper explaining how you should eat, chew, brush, and floss with your “temporary” what’s the message?

You absolutely know the message is, “Next visit we’ll be cementing your permanent crown”. Even though I never use the word “permanent”, it’s implied by my using “temporary” all the time to describe the nifty little creation I made that protected your tooth for 2-3 weeks.

I learned the terminology I’ve been ranting about way back when I was a student and I’ve suffered from it ever since. “Permanent” was probably some early 1900s holdover more easily achieved when basic average males could expect to blow out no more than 47 or so candles on their birthday cake.

I guess defining permanent depends some on your perspective. If a Rhodes Scholar, 2-term U.S. President (The scholar part rules out the current office-holder) doesn’t know what the definition of “is” is, I’m not going to beat myself up over “permanent”. I mean, permanent is as permanent does, right?

In dental school, permanent meant until I graduated. Most of my crowns only had to endure a maximum 2 years (Although most of the ones I did for my gutsier friends and relatives are still standing). I think my patients were so dang happy to be rid of some seriously ugly temps they just sort of lived in the moment, celebrating the retirement of some “not permanent” tooth forms that ranged in looks from upside-down aluminum/tin trash cans to acrylic imitating rubbery Tupperware gone bad.

I’ll pause here just for a moment to honor today’s “provisional crowns” (that even sounds better) that can look like a million bucks. With the impression materials and the non-distorting beautiful acrylics we have at our disposal these days, provisional crowns often way more cosmetic than the real deal restorations I used to place 10-12 years ago. I’ve actually had patients cry when they first glimpsed a new smile comprised of temporarily placed acrylic (It’s not what you think; they were really touched, moved, and very happy). In fact, that first glimpse moment is probably my all-time favorite recurring cosmetic clinical experience.

Most insurance programs will pay benefits to replace existing crowns after five years. Usually, five years is a short life expectancy. Sometimes, however, for patients who are at high risk for tooth decay owing to a standing history of weak bio-mechanical resistance and/or poor oral hygiene or lack of compliance or perhaps a history of dry mouth, five years might be a victory.

Patients have always asked me if their new crowns will last a lifetime. Since I’m half Sicilian, sometimes I’ll come back with the stock Blandino answer, “That can be arranged.”

Truth is, teeth restored with crowns inevitably have a history of multiple tooth decay episodes and multiple fillings or even fractures. Consider teeth all start out as something pristine, designed by nature to last. Does it make sense that any modifications that follow, provided by me, even on my best day, are going to require something of an upgrade in attention and maintenance?

The good news is cosmetic crowns are getting smaller and procedures less invasive. The materials we use today mimic natural tooth structure more and more closely.

If I slip up in the future and use the word “temporary” and you get to thinking about stuff like “permanent”, let’s have a conversation.

Teeth are really a lot like E. Las Tunas Dr. We use ‘em every day and they wear down over time. Periodically, some maintenance might be required but with today’s technology the resurfacing stands to be less frequent and less inconvenient.