Dr. James Eisdorfer

December 18, 2013

Dr. Eisdorfer is the least scary dentist that we’ve ever met, and that’s a compliment, given that one of us (we won’t name names) refused to see a dentist for an embarrassing number of years because she was too afraid of what might happen. It’s no exaggeration to say that Dr. E is something of a tooth whisperer, capable of eradicating decay AND making one’s teeth look beautiful and natural. That he uses a ceramicist was an interesting discovery, given that when we think of ceramics we think of mugs and pots and vases, not teeth. His ability to look dapper in both a lab coat and a pinstriped suit never fails to impress us, and we like that he referred to appearance as “packaging.” Obviously, that word was music to our ears, given that we’re in the branding business, and we know a thing or two about the importance of packaging.


Are teeth the first thing you notice when you meet someone?

Yes. 100 percent. You can tell somebody’s age by their teeth. First thing you notice is their smile.


Meaning if they have one?

If they have one, or if they’re trying to hide one, or if they’re trying to hide their teeth.


I’m now trying to hide my teeth. But I normally have a huge smile, and I’m usually not self-conscious about it at all.

I see that—I saw that in the waiting room. I noticed one tooth could use a little touch-up. I don’t like the material that they used. Yes, I notice people’s teeth. You can tell a person’s age by their teeth and by their hands.


Hands I knew. But what do you look for in teeth?

You look for length, because as you get older your teeth get shorter from wear.


So long in the tooth, that expression, is not actually accurate. 

That is the gum receding. A lot of people don’t have a normal smile line, so your lip hides 40% of the upper part of your upper teeth going to the gum. You really see just the bottom 60%. As the gum recedes, it doesn’t show that. That’s fortunate.



So you look for a long tooth, you look for a translucent tooth, you look for a natural shades.


What’s a translucent tooth a sign of?

Good enamel. Youth. If you notice somebody very young, you look at the edges of their teeth—I call it “blue ice.” The enamel is so pure the light actually transmits right through it, actually penetrates it.


Like a diamond.

Exactly. And we try to reproduce this with our porcelain. We’re getting better and better; we no longer use metal on any of our teeth. They’re coming out with newer porcelains, but newer porcelains also have issues. They’re selling the strength of the porcelain instead of the aesthetics of the porcelain. We just had a case that was done beautifully, with the latest material out, and it was dead white.


So it didn’t look real, it looked white?

Right. And that’s one of the issues.


Do you work on inventing your own porcelain here?

Yes, we have a ceramicist in the office. Both of us work together. Sixty percent of it is listening to the patient, and what they want. Forty percent is giving it to them.


When you say sixty percent, how does that work? Because I’ve noticed that in a lot of service professions, you end up becoming the person’s therapist, in whatever field you’re in. Is it the same with teeth? Do you end up hearing personal stories that have nothing to do with teeth?

Eventually, if it’s a long treatment. I’m going to have an initial visit in a few minutes, and what I’m going to do is sit down with a pad and pen and ask questions: What brought you here? What do you like? What don’t you like? Do you have any issues with your smile? Then you try to sit back and listen, and not force your opinion. The ceramicist and I go in separately, and then we come out and try to put our thoughts together, what we each perceived. It’s amazing. Sometimes we’re not on the same page.


What’s a story where that was the case, and how did you come to an agreement?

We both went back in alone, and tried it a second time, and tried to listen to the other side of the coin and see who was right. We ended up compromising.


What is the number one concern patients have? Is there one, or are there a couple?

Patients are torn between having an ultra-youthful smile and a natural smile. You have to see the patient, and then you have to combine different modalities to give somebody a lighter shade than they used to have, and to add some other characters into the structure that will make it more natural. You don’t want, for example, to have one shade of tooth. The other thing is texture. Do you make something flat and shiny, or do you stipple it, make it a little wavy, and if so, how much? Everybody makes up these rules, so for some reason if it’s a male, I’ll give him more texture than a female. I don’t know if it’s true, but it’s something you acquire, I think. With the different shades, we can use ten different shades to grade an upper tooth, from the edge to the neck of the tooth, and that’s very important.


Where is the neck?

The gumline.


My dentist when I lived in San Francisco told me that I must floss, so I’m pretty obsessed with flossing. So I wanted to ask you how important is flossing? Is it really important?

It’s the most important thing.


Why is that?

There have been some studies that if you eat a white bread sandwich, grilled cheese sandwich, you’re cleaning your teeth.



The bread just goes up against your teeth, and it’s cleaning.


Wonder Bread needs to get on that.

(Laughs.) White bread may clean the teeth, but nothing gets in between the teeth except for the floss. It makes a big difference. It’s the most difficult thing to get somebody to do. They really don’t start flossing until they get out of college.


That’s because flossing is labor intensive!

Yes, that’s it. That’s the thing. It’s very difficult to get a 22-year-old to start flossing.


How many times a day do you suggest it, and at which times of day?

Ideally twice a day. I know I do it in the morning and at night, which doesn’t really make that much sense. I should space it differently. Twice a day is ideal, but at least at night before you go to sleep, so the food isn’t staying in between your teeth at night, when you’re sleeping.


Why is “do you like your smile?” one of the intake questions you ask your patients?

Most of the patients come here for that reason. That’s why they’re walking in the door.


They want cosmetic help.

Yes. We were just discussing this with somebody who had decay and whose teeth needed to be restored. That was about 60 percent of his smile. I said well, don’t you want to do the other 40 percent and make it blend better and gain a few years while you’re at it? And he asked me how light I wanted to go, and I said I wanted to keep a natural smile.


And then you need to diagnose what that is for a given mouth.



What’s the worst case you’ve ever seen?

I never look at it that way. I may not come up with a solution immediately, but within 24 hours or so I’ll come up with a solution. It may take a long time, it may take a year and a half. I did a case where it was a whole thing: He was losing his teeth. He was a little heavyset at that time, and he had trouble breathing, so besides restoring his teeth, I also had to increase the teeth height so it would be easier for him to breathe. That was a difficult case. It combined everything.


And when you say everything, you mean…

Function, aesthetics, breathing.


Right. Pretty much everything.

If he’s not breathing, that’s it.


That would be the real worst case scenario.



So when you said that you go home and within 24 hours come up with a solution, is it the same way that for me, with taking a photograph or writing a sentence just clicks? Does the answer just dawn on you?

It’s the same idea. You can look at a photograph or a shot you’re setting up, and there’s something that’s bothering you about it, and you’ll walk away and come back in an hour and it will just hit you right in the face. It’s the same thing here.


Part of the Wednesday Wisdom is to get three tips about something. What are the three easiest things a person can change that will have the greatest impact on their, and why do they have such impact?

  1. For bleaching, I suggest Crest White Strips. It doesn’t remove any enamel. Unfortunately, it’s out there, and most patients don’t have the patience to use it.
  2. As I said before, flossing is essential. I like Glide, the thicker version that’s still not the full tape.
  3. For bad breath, the easiest thing is to brush your tongue.
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