The Midnight Drill

On call with an eleventh-hour savior for supermodels, Secret Service agents and anyone else with a late-night toothache.

The Midnight Drill

On the late-December day the Mayans predicted the world would end, thirty-four-year-old, six-foot-four-inch Dr. Isaac Datikashvili is going about business as usual, looming over a reclining sixty-something tax attorney with a handlebar mustache. Datikashvili prepares to perform an emergency wisdom tooth extraction on the crumpled patient.

“Looking forward to this?” a confident Datikashvili asks, smiling.

“Like the plague,” the man grunts in reply.

From behind my splatter-proof face-gear provided by dental assistant Gladys Montalvo who is Lilliputian next to the towering dentist, I observe as Datikashvili wiggles the problem tooth with sundry metal instruments. Blood leaks from the surrounding gums. Things don’t seem to be moving, but the dentist is undaunted, motioning me closer for a better view.

Dr. Isaac Datikashvili monitors an x-ray and writes a prescription
Dr. Isaac Datikashvili monitors an x-ray and writes a prescription

It’s late in the afternoon on the Friday before Christmas, but it might as well be the middle of the night. The small Gramercy office that Datikashvili (pronounced Dah-te-ka-shve-lee) operates out of is always open. He shares it with a colleague who works typical dentist hours, but Datikashvili has a less forgiving schedule—he’s always on call.  While there may be other emergency dentistry options in the city—Datikashvili says he cannot provide an exact figure on the number of practices like his—you’re hard-pressed to find another free agent who offers emergency care any hour of the day or night. Datikashvili is perhaps something of a big city luxury. Many patients wind up in his office because they put off getting help until the last minute, when the pain becomes unbearable. According to Datikashvili, this phenomenon stems from a deeply ingrained dental phobia, a fear that’s implanted during childhood when kids typically experience some sort of traumatic—and occasionally anesthesia-free—procedure. This is especially true for people from foreign countries, Datikashvili says.

On this particular afternoon, the intimate, tranquil office, adorned with menorahs, zealous thank-you cards and an Otis Spunkmeyer cookie oven, is empty except for the dentist, his assistant, the patient and the patient’s wife, who shows up mid-procedure for harried moral support. The calming water fountain that usually runs in the office throughout the day has been shut off. Datikashvili tells me many other dental care centers in the city are shutting down for the holidays, but not his one-man operation.

I hear the tax attorney’s tooth make a cracking noise against the backdrop of CNN playing softly on the TV affixed to his dental seat—a beige-brown ErgoSoothe massage chair. No one in the room is paying attention to the gentle chatter of the news. Datikashvili hums sporadically. A small fragment of tooth is ejected and lands on the patient’s chest; he writhes, but offers a thumbs-up.

It’s just another day on the job for Datikashvili, who’s been a practicing dentist for seven years.

Once out of high school in Philadelphia, he immediately began working as an EMT, and he grew accustomed then to a sporadic schedule that has given him a unique advantage over other dental care providers.

Dr. Datikashvili, on the job
Dr. Datikashvili, on the job

“I have to stay sharp,” he says, noting that his alertness “can be a real safety issue.” Now in a swanky Gramercy office, where, constantly in motion, he seems almost out of place, Datikashvili recalls rotations at King’s County Hospital, which he describes as something of a madhouse.

“When it was time to start applying to graduate schools I could go to medical or dental school,” he explains. “My uncle was a dentist and I followed in his footsteps. I realized I didn’t want to be a general dentist and just do cleanings, though, so I put together the two things I knew how to do.” By this, he means dentistry and emergency care. Datikashvili, who had no idea whether there was a market for his planned endeavor, now exclusively practices emergency dentistry.

When in a later conversation I quote a statistic about the high suicide rate among dentists who tend to feel eschewed by society, or a general sense of being hated and under extreme pressure on the job, Datikashvili says the correlation, while perhaps accurate to some degree, is not applicable to him as he exclusively offers relief. Further, he points out, dentists have been surpassed by psychiatrists when it comes to suicide rates.

“Patients are happy to see me because I take away their pain,” he says. “My job is rewarding compared to others’.” Datikashvili’s office also provides IV sedation for the oppressively afraid. I ask him if he’s seen the mid-nineties horror flick The Dentist; he says it’s in his Netflix queue.

Datikashvili likely fulfills no one’s stereotype of the garden variety “dentist.” Rather, he epitomizes a “larger-than-life” persona, the sort you often hear described but rarely encounter in the flesh. At the same time, though, he remains relatable. Datikashvili seamlessly blends a necessary gentleness with animated banter and quick wit when interacting with his eclectic collection of patients.

“This one’s on the house,” he says, massaging the tax attorney’s face with his tremendous hands to get the anesthetic moving prior to the procedure. I see the anxious patient physically relax between his hands. “You’re a hard one to numb, my friend!” the dentist chuckles. He smiles at me. When it comes to Datikasvhili’s patients, “It’s about them and me,” he says.

Datikashvili’s not afraid to be vulnerable either—“I’m nervous about this article,” he tells me repeatedly. Despite his playfulness, it’s clear how important his practice is to him, how dearly he cares about what he does.

Datikashvili’s late-night patients aren’t just dental phobics; many have succumbed to some form of trauma requiring immediate, careful attention. He describes bar-fight antagonists and carousing partiers who’ve wound up face-down on the sidewalk, their teeth none the better.

“One couple was walking down the street and a Santa started harassing the girlfriend,” Datikashvili says of a fight that happened the previous weekend during SantaCon, a yearly event in which people dress up like Santa Claus and tromp boisterously through New York City streets and bars.“Santa punched the boyfriend in the face. [The couple] came in Saturday night and on Monday he got a brand new tooth.”

He proudly scrolls through the before-and-after photos for me on his iPad. The images of the reconstruction are indeed impressive.

Dr. Datikashvilli shows before-and-after photos on his iPad.
Dr. Datikashvilli shows before-and-after photos on his iPad.

Datikashvili tells me in detail how getting punched in the face is a “numbing kind of pain.” He’s never experienced this personally, but he’s seen enough assault victims to be well-versed in the subject.

While the late-night demographic is predominantly male, Datikashvili describes another instance in which a heavyset woman went out partying in high heels and met a similarly unfortunate fate.

“She slipped and missed a step and her front tooth went across the street,” he says. “She came in right away, wearing her high heels, all scratched up. We had to build her a tooth from scratch.”

“In a couple hours she walked out with a front tooth,” Datikashvili adds.

Patients also call him on the holidays, when no other dentist can be reached. “We get very busy around Thanksgiving, Christmas, New Years, Labor Day, Memorial Day… ” he says, noting that he’s on call  364 days a year; Datikashvili’s only day off is Yom Kippur , when he’ll refer emergency callers to colleagues.

In general, Datikashvili avoids performing procedures in the middle of the night, using that time instead to stabilize and diagnose patients. Procedures, when necessary, are carried out the following day.

Datikashvili has also snatched up the SEO-friendly domain name and acquired an unforgettable phone number–646-DENTIST–to which he attributes at least some of his practice’s success.

To be sure, late night dental services are pricier than their daylight counterparts, averaging about $650 for a visit, though Datikashvili says his daytime rates are competitive with other dentists’ and he offers free follow-up care, as well as accepting some forms of insurance. Datikashvili’s patient schedule varies vastly, though in my short time with him it seems the phone rings continuously.

I ask him if patients ever worry about his presence of mind, particularly with his erratic schedule that does not allow much time for restful sleep. He seems surprised by my question. Suffering patients, he says, couldn’t care less about state of mind. They want relief and they want it fast.

Datikashvili sends me a text message at 10 p.m. the following day: “Are you on standby?” it reads. “We might have one.” It turns out to be a false alarm. Datikashvili continues to notify me of similar calls until just after midnight. When it’s that late, he says, many patients opt to come in the next day. Still, I sense that he’s not giving me the full picture, in order to spare me a night’s worth of chaotic uncertainty. The following day I discover he received similar calls all throughout the night.

“You never know who’s going to walk in the door,” he says later. “Sometimes it’s big thugs, sometimes it’s supermodels, sometimes it’s diplomats or dignitaries…it’s a melting pot.”

A major part of Datikashvili’s job, like any dentist’s, is patient management, and he performs well under the pressure.

When patients call at night, Datikashvili assesses the situation over the phone, brings them in to stabilize them if necessary and then provides follow-up care the next day.

His time in and out of the office is punctuated by these phone conversations. Most issues can be diagnosed from the initial phone call. If Datikashvili suspects a middle-of-the-night patient is intoxicated, for instance, he’ll urge him to sleep it off first.

“Don’t worry,” I hear him repeat into the phone, as though coaxing a child, demonstrating the same relaxed demeanor as when a patient tenses up in the chair. “We do it all the time.”

Datikashvili calmly runs down the standard list of questions: “Is there swelling? Do you have a fever? What’s your pain like on a scale of one to ten?”

“We’ve got an emergency coming in right now,” he tells me once he’s hung up.

Datikashvili admits that he doesn’t have much of a social life. In his free time he gets whatever rest he can. Emergency calls can vary from a few a week to several a night. He says you get used to the irregular sleep schedule; you “develop certain rhythms.” Perpetually on call, Datikashvili abstains from alcohol and any kind of drug, including herbal supplements, but drinks “tons and tons of coffee.” (A Keurig instant coffeemaker sits prominently next to the intake desk, and I’m offered a cup on more than one occasion while I linger around the office.) His girlfriend, who sometimes accompanies him on jobs to provide comfort to patients, gets frustrated by the spontaneity of his lifestyle but understands well the demands of the job, he says, as do his friends and colleagues.

A recent late night with Dr. Datikashvilli.
A recent late night with Dr. Datikashvilli.

*   *   *

I first met Datikashvili in the middle of a weekend night some months back, in one of the typical situations he describes. I ignored a toothache for a week, hoping the pain would eventually subside. It did not.

Datikashvili was the first and possibly only result when I Googled local emergency dentists and, while a bit skeptical of his flashy website, I was instantly comforted by the reasonable, human voice on the other end of the line. “Talk to me,” he said, upbeat. His formidable reviews on sites like Yelp helped sway me.

He explained my options on the phone and said he could see me then, or the next morning for a lesser fee. He didn’t seem worried about my situation. It felt a bit like a pep talk from a sport’s coach. I agreed to see him in the morning. After we hung up, though, I was overcome with pain and I became frantic. I called Datikashvili back. “I need to see you now,” I said.

I paced around outside his office building at around 11 p.m. Eventually, a man and woman glided up the sidewalk out of the darkness—passersby, I presumed. Inordinately tall and sharply-dressed, as though he’d just left a posh dinner party (he probably had), Datikashvili didn’t exactly look the part of a “dentist.”

“You look like you’re in pain,” he said cheerfully. In my now fading memory, he gracefully released the smiling woman from his arm and unlocked the door. How good can this guy possibly be, I wondered.

After Datikashvili diagnosed my problem—a plethora of micro-fractures in my tooth—and sent me off into the waning night saddled with a prescription for painkillers, I felt like I’d just gotten done shooting the breeze with an old friend. The whole experience cost me $650, excluding cab fare and the meal of solid food I treated myself to afterward.

It’s 11:20 p.m. two days before Christmas when I get another text message from Datikashvili. He has an emergency patient—a police officer. I envision squad cars screeching up to his office, revealing a scene of bloody disfigurement and gore. I relay these fantasies to the 24-hour dentist. “He’s not in uniform, he’s just a man with a bad toothache,” Datikashvili tells me. “I’ll handle it. Follow my lead.”

Datikashvili says he’s seen between fifty and fifty-five police officers in 2012 alone. Two officers from Manhattan’s “robbery squad” are regulars, he says. “They work vicious hours.” Still, he attributes the frequent visits to the fact that “police, like anyone else, experience emergencies after-hours.”

When I arrive at the office, Datikashvili is drinking black coffee from a Dunkin’ Donuts cup. He is thrilled that they just opened a location across the street. I notice tiny bits of sweat on his forehead as he paces eagerly, stopping momentarily to loom in doorways and chat. I’m glad the office is empty; it seems too small to contain just him.

Officer Kenneth Flores at Dr. Datikashvili’s office
Officer Kenneth Flores at Dr. Datikashvili’s office

Thirty-three-year-old Kenneth Flores of Brooklyn’s 68th Precinct walks in timidly, wearing faded jeans and a t-shirt emblazoned with the logo for Rock Band—the musical video game. He’s shorter than I predicted, husky, calm and limping slightly. He tells us later that he’s been a cop in South Brooklyn for the past eleven years.

“How bad is the pain on a scale of one to ten?” Datikashvili asks him immediately. Flores initially offers a seven, and Datikashvili repeats the question about ten more times throughout the night.

“You’ll be out of pain in a minute, my brother,” the dentist says. “You’ll be smiling ear-to-ear.” Datikashvili continues to stride around the office, emptying his cup. I wonder when he’ll sleep next. As Flores fills out his intake forms, Datikashvili’s phone buzzes with more emergency calls.

“I told you we get busy right before Christmas,” he says to me.

Datikashvili makes small talk with Flores about football. I understand by now to what extent he can read his patients. He immediately, and with ebullience, homes in on their interests. The dentist establishes common ground.

Once in the chair, Flores is reluctant to vocally address the pain, but his feet tense noticeably as Datikashvili taps away at his teeth. Datikashvili expertly moves a gloved hand around inside the man’s mouth, his own eyes focused on the ceiling.

“Don’t worry about her,” says Datikashvili, indicating me, when Flores becomes tightlipped about the pain.

After a few shots of local anesthesia, Flores is indeed smiling from ear-to-ear. “Now it’s zero!” he says, almost childlike. “Zero!”

Flores, like me, has micro-fractures resulting from at least ten years of clenching and grinding his teeth.

As Flores walks out the door sometime after midnight, Datikashvili’s phone continues to buzz persistently. He tells me he’s sure Flores had a gun in his coat. “I just know it,” he says eagerly. Datikashvili, perhaps unsurprisingly, has a fondness for high tension, for anything that gets your adrenaline pumping.

“I had a patient from the Discovery Channel once,” he says. “He wanted to do a reality series on me. He said they could get at least ten shows…I was too nervous then.”

How long can one possibly go on living like this, I finally ask Datikashvili. Will his corner on the late-night dentistry market eventually fade as others catch on?

He concedes that the practice eventually begins to take a toll. “We’re in the process of training other doctors,” he explains. “It’s just me right now, but I teach part time at the NYU dental school. I’m going to start recruiting and training former students.”

However, Datikashvili strongly believes practices like his will not become more prevalent. To him, the particular marriage of dentistry and emergency care is a unique one. “I spent five years building this,” he says, without missing a single beat. It occurs to me I’ve still never once seen him look tired. “Dentists become dentists to do something different.”