STANDING OVATION

"The best and most beautiful things
in the world cannot be seen, nor
touched ...but are felt in the heart."

-- Helen Keller


I was preparing a tooth for a new gold crown during my dental school clinical requirements and felt in the zone. I had carefully sculpted the patient's mouth with the perfect crown preparation in mind, a design as pictured in text books. The taper was barely over six degrees as desired and the maximum amount of tooth structure was preserved. With immense pride and confidence, I was anxiously waiting my clinical instructor to verify my perceived talent.

He looked into my patient's mouth, thoroughly inspecting the tooth with high powered magnification loupes, tilting the mirror in several different angles. At last, he told the patient, "That is the most perfect crown preparation I have seen in years. Dr. Foy has really done you a great service."

My pride and ego soared. I completed the impression and cemented the temporary crown. After my patient left, the instructor came over and said, "That was a nice job. But when you are out in the real world don't expect a standing ovation from your patients. Most people value quickness and lack of pain, not line angles and perfect margins. They will never see or appreciate that type of quality. You’ll have to motivate yourself to continue to maintain it, and break your own arm slapping yourself on the back.”

One of my patients, a maintenance man in his early sixties, had volunteered to go with a group of medical missionaries to the poor areas of Guyana, Africa. Larry had a full head of wavy hair, snow-white with age, and the Guyanese people exalted him as possessing great powers, looking up to him in a godlike manner.

During his stay he met and married a young African woman named Lily. My dental journey with her was one of the most surprising and gratifying of my career.

Our American emphasis on personal esthetics can be extreme to someone from an impoverished country. Larry’s new bride had a hard time adapting. She was extremely self-conscious, but at least she could speak a little English.

As with many immigrants Lily had little or no previous dental care, but she was free of any fillings. First, we treated some gum disease and instructed her on proper oral hygiene techniques. After she mastered a self-care routine, we were able to restore minor decay. In the beginning we were simply trying to build the foundation for cosmetic dental care. Lily was compliant and eager to fix her anterior teeth.

She had grown up in an area of Africa where the water supply was rich with fluoride at a level so extreme that all of the people had severe fluorosis. This condition caused their teeth to take on a reddish-brown color.

When everyone around you has similar teeth you do not stand out, but in America the prominence of white teeth made Lily ashamed of her smile. She covered her mouth when she spoke, and this was crippling her ability to adapt. Larry asked for our help.

After a consultation, Lily decided to cosmetically enhance her smile. Diagnostic casts were made to plan for size, function and space management. Despite all the discussions and pre-planning, it was still difficult for her to completely appreciate and comprehend the result.

The day of final delivery was a day that I will never forget. Local anesthetic was used and Lily was cooperative through out the procedure. When everything was cemented, cleaned and polished, I handed her a mirror. At first, she remained expressionless, and tears began to roll down her face.

I was confused by her reaction. Were these tears of joy, tears of shock or disappointment? I waited nervously for her opinion.

Lily remained stoic as she peered into the mirror. Suddenly her face lit up with a beautiful grin. She leaped out of the chair and started doing a little jig, dancing in circles around the small room. Then she dropped down on her knees and began kissing my feet.

I quickly bent over, grabbing her arms, trying to lift her up, protesting, "No, no, no, no, no...." when Larry walked into the room.

It is odd to have a husband witnessing his wife on her knees kissing your shoes.
Larry laughed, and as Lily jumped up and showed him her new teeth, he exclaimed, "Wow! I cannot believe it." She shrieked and ran into the waiting room, going from chair to chair to show her new smile.

Some things are better than a standing ovation.