Not Necessarily Permanent
Webster’s defines the word temporary as meaning “not permanent”. Seems my Webster’s trouble started way back in dental school.
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.
