A Story That Ends in a Smile

SPECIAL TO THE TIMES; Kerry Madden-Lunsford is the author of "Offsides" (William Morrow Co., 1996)

When a dentist keeps his surgical mask on and talks to the ceiling while advising you, you begin to suspect that maybe you don't have his full attention. It didn't take long for me to surmise that my dental debacle (lack of a front tooth and a misaligned crown) was merely a kink in this particular dentist's Monday morning schedule.

"How did this happen?" he inquired.

"I bit into a very soft bagel in London and out it popped."

He stared at my X-rays briefly. "Hmmm. Well, it looks like you could have an infection, which could have caused your tooth to break inside the crown. Maybe you need to go to a specialist for a root canal." He said all this without removing his mask.

"But I had a root canal on this tooth when I was 11. It was knocked out when I was 8 and the root died at age 11."

He said something else, but I couldn't understand him through the surgical mask.

"But can't you put it back on straight, at least temporarily, so it fits in my mouth?" I persisted.

"No. I'm not sure if I can put it back on at all. I don't know what that dentist did in London, but this crown is ruined," he mumbled, looking out the window.

"But what should I do?"

As he garbled more incomprehensible words, I lost it. "Would you please take that surgical mask off? I can't understand a word you're saying."

He yanked it down and replied, "I said I could give you a bridge."

"What would that entail?"

"Shaving the two teeth on either side to hang a bridge."

Now there's a thought. The idea of him whittling away the good front teeth I had left to hitch even more fake ones made the tears rise, but I refused to give into them. "But won't people be able to tell?" I asked.

"Only dentists. Not regular people. I could give you another crown, but it might fall off again. Maybe an implant, but that's expensive, and it might not take to the bone. It would also take up to six months."

*

There was a tense silence in the room. The only reason I'd replaced this crown in the first place was because a fine black line had been showing at the gum line on the previous one (for years) and, call it vanity, I wanted a clean white crown that didn't look fake. Finally, I said, "Doctor, I paid you $300 for this crown 18 months ago on the school district's dental plan. Why did it come off?"

"Your tooth is brittle. It just broke."

"What would you do in my situation?"

"I don't know," he said, glancing out the window. Again.

I turned to the assistant. "What would you do?"

"Maybe a bridge," she said with a shrug. "They don't look too bad. Yeah. Get a bridge."

The dentist added, "But any route you take is irreversible, so you have to decide. Right now, I have other patients, so just call when you know what you want to do."

Irreversible. I let my tongue play over the empty socket, hand clamped over my mouth. What was I going to do? My greatest horror was having the thing pop out in public again and being forced to gum apologies as I escaped.

"Wait." I pleaded, "If you were me sitting in this chair, what would you do?"

He and his assistant exchanged glances, and he replied, "I don't know. I never thought about it."

"You're a dentist and you've never thought about it? But this is a front tooth."

"Yeah, I know." He looked at his watch and at the ceiling again.

"Get a bridge," the assistant insisted. "It looks almost the same."

Almost. I'd had enough of these two. They didn't give a damn. They wanted me to get out of their office and quit messing up their Monday schedule. Before I left, he managed to shove the crown back on, only this time it was hanging by a thread, literally.

*

I fled the office and called my husband, Kiffen, wailing. "I hate that dentist, and I hate all the team dentists who carved away at this tooth for years. I'm furious with my football coach father for knocking it out in the first place. I'm a freak. I look like a boxer."

Kiffen said, "Call your cousin, the dentist. Call him now. It doesn't matter what it costs. This is your front tooth."

My cousin is president of the Washington, D.C., Dental Society. Yet, I couldn't call him because I was afraid I would burst into tears over the phone with a relative I only see at weddings and funerals, so I e-mailed him instead, detailing the nightmare.

His response, which explained my options quite clearly, made me think that maybe I wouldn't be destined to go through life looking like someone who'd just stepped out of Appalachia, circa 1930.

He advised me to go to one of his colleagues in the Valley, Dr. Myron "Mike" Bromberg, and without hesitation, I did. After examining me, he said, "Jesus, what did that guy in London do to you? What did your Los Angeles dentist do to you?"

"Is there any hope at all?" I asked.

"We'll get you fixed up. But, look, I'll be honest. I don't know if this tooth can be saved. There is a black spot at the root, but I'll send you to a specialist, and we'll find out what he says. I do know that your other dentist did not put in a dowel underneath the crown, which anchors the crown. Did the guy take an impression of your teeth?"

"No."

"Then your bite put strain on it as well. We always take an impression to avoid occlusion."

"Can you fix this temporary just so it matches my bite?"

"Of course I can."

*

I must have looked nervous, for one by one his dental hygienists came in to reassure me. "He does great work." "He's had patients for 35 years who still have their original crowns and teeth." "You're in good hands." I was so grateful for these women and for a dentist who looked me in the eye and was full of empathy.

Before I left, he shaped the ruined crown to match my front teeth and cemented it back on with a warning to be incredibly careful. Then he sent me to a specialist the following day, an endodontist, who said, "Yes, there is a black spot at the root, but you're asymptomatic, so we'll monitor it. If my wife or daughter was sitting where you are right now, I would tell them to go down swinging. Your best implant is your original tooth. You have a good strong root. Why shouldn't you try another crown?"

So on my fifth trip to a dentist in seven days, Dr. Bromberg began the first stage of preparing for the permanent crown. He took "before" pictures, making me smile wide. While he worked, he said, "That poor dentist in London was in so over his head. He was just glad you were leaving the country. When you showed up, he thought, 'I knew I shoulda gone to Blackpool today.' But the real culprit is the one who put this crown on 18 months ago. It never should have come off."

At various stages, he would call his assistants in saying, "You gotta see this," or "Look at that." He said to me, "I almost called another dentist in to watch this procedure. Your tooth has really been through hell."

After he was finished with Stage One, he re-cemented the temporary, and I made an appointment to come the following week for the permanent crown. I made the first down payment on the $875 bill, not including the $95 I had paid for X-rays and reattachment, but I didn't care. No, this dentist was not on my coverage. No, we couldn't really afford this expense. But what was the alternative? A crappy bridge from the masked, window-gazing dentist on the school plan? I dug out the checkbook and paid.

When I told my friend whose teeth had been knocked out by her brother with an iron skillet at the age of 16, she said, "When it's your front teeth, you have to be a princess. I go to a dentist for the stars, and I don't care. It's my front teeth."

*

A week later, I went in for the final procedure. It had been two weeks to the day that the tooth had "gone missing" near the Tower of London, and this was to be the permanent "coronation." I was worried. The gum above my temporary had become blistery and tender, so I felt sure it wasn't going to work.

Still, I'd become somewhat "Zen" about the problem, because maintaining an accelerated state of panic for two weeks demanded more energy than I had. Even more significantly, I had learned that the mother of one of my daughter's friends had died very suddenly. I didn't know her well, but when I learned of her death a week after returning from London, I began to see my "tragedy of the tooth" in a different light. There are degrees of disaster, and yes, losing a front tooth at 36 is undesirable, but then there is complete devastation.

After an hour in Dr. Bromberg's chair, it was finished. He gave me a mirror and declared, "perfect."

"You will never have to smile or talk again with your hand over your mouth. You've got a beautiful smile." Then he snapped the "after" picture and added it to my file.

I inspected his work. He was right. It was beautiful. I hadn't had such a pretty tooth since my own real tooth before the accident at 8. I did smile. It shined. It matched. Best of all, it fit in completely with my other teeth. Miraculous.

I drove home in a deluge of rain as the sun burst through the clouds; a rainbow shone down over the Hollywood Freeway. I thought of the young mother I knew who had died, and a wave of horrible sadness washed over me. I thought of my new tooth, and I felt a stab of joy. I thought of my respect for a dentist who knew what he was doing. I turned on the radio and went to the bus stop to pick up my children.

When I smiled at them, my daughter said, "Mama, you got a new tooth! Just like me. Look." She laughed and pointed to her gum where a permanent tooth was growing in. I made a wish for her teeth then. Let them grow in and stay in. Let them be strong. Let them meet no untimely accidents. Please, let them live. Then we drove home together to celebrate our new smiles.

*

* Kerry Madden-Lunsford is the author of "Offsides" (William Morrow Co., 1996).

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