Beautiful teeth get the attention, but according to Dr. Jamar McKay, a general and cosmetic dentist at Express Smile in Atlanta, the real story starts at the gumline.
“Gum and bone are the foundation of everything for the teeth,” he says. “You could have beautiful teeth, teeth that don’t have any cavities, but you start to lose them because you’re losing the foundation.”
McKay, 36, who began practicing dentistry in 2018, is among the 3.9% of dentists in the United States who are Black; nearly 13% of the U.S. population is Black. He has worked with professional athletes, including Atlanta Falcons wide receiver Zachariah Branch, Indianapolis Colts linebacker Christian Jamar Allen and University of North Carolina tight end Jelani Thurman.
He also reflects the industry’s trend showing an increasingly younger and more diverse workforce. That trend also finds dentists settling more into urban counties rather than rural locales.Word In Black asked Dr. McKay about common misconceptions regarding dental health, the effect of tobacco and marijuana use on oral health, and how oral health connects to the rest of the body.
This interview has been edited for length and clarity.
Word In Black: What is the greatest misconception people have about dental health?
McKay: People think that if they’re not in pain, they don’t have any dental issues. Puffy gums and bleeding gums sometimes don’t hurt, so we just keep it moving. [But] like high blood pressure, a problem in the gums can [signal] a silent issue. The pain comes later. It only starts when things are much further along. Then you’re told, “Well, we’ve got to remove this tooth,” and you’re like, “What? I wasn’t in pain.” That’s one of the biggest misconceptions we have today versus going in for regular [dental] visits.
WIB: Gingivitis is regularly mentioned in commercials for dental hygiene products. Why is it still an issue?
McKay: Education is the most important factor here. You could have all the fancy stuff going on — toothpastes, fancy mouthwashes — but if people aren’t educated and don’t know they need to take care of this, it’s futile.
Gingivitis is the precursor, the starter, to more problematic gum disease. It’s like the gums are screaming out to you, “Hey, something is going on here.” Red and puffy gums are reversible if you get care early on and get regular cleanings.
If it’s prolonged without regular cleanings and maintenance, or there are underlying health issues, it progresses from gingivitis to periodontitis. Now, instead of the gums being inflamed or receding, the actual bone is inflamed and receding. We start having bone loss and the teeth become mobile. At that stage, it’s irreversible, meaning you can’t bring back that bone level. However, with care, we can hopefully stop the damage from progressing.
WIB: What can be done, and why is brushing alone not enough?
McKay: Brushing [your teeth] is mechanical removal of food particles and the biofilm we call plaque from the teeth. When you’re brushing, you’re removing what you can physically see, which is the front part of your teeth. However, food also gets stuck in between the gums. That’s why flossing is important. Flossing removes the plaque in between the teeth since it also sits on the gums and starts to inflame the tissue. Water flossing is also important as an additional option because it helps to stimulate the gums as well. Sometimes you can put a little diluted mouthwash in it to help flush it, and it just feels much, much fresher. And remember to be careful with brushing because we want to make sure the toothbrush has soft or medium bristles because we tend to scrub at the teeth. Over time, issues such as wearing away enamel can occur. And you definitely don’t want that.
WIB: How does tobacco and marijuana use affect dental health?
McKay: With smoking, the burning of the tobacco can affect the mucous lining inside the mouth. That’s where we start to worry about cancer risks or more keratinized tissue, where the tissue becomes wider and whiter as a protective mechanism. The heat you take in lowers blood vessel flow, which delays healing, damages the gum tissue and stains the teeth. With chewing tobacco, again, there’s the risk of cancer, and it makes the gum tissues a lot more sensitive than they need to be.
It’s not only smoking. It’s also what you’re putting in your mouth— chewing tobacco, people who dip. Vaping is a newer trend, and a lot of people think, “Well, I’m not smoking. I’m just vaping,” not knowing there are also issues with that.
Smoking also lowers your salivary flow. Saliva helps wash plaque and bacteria away from the teeth. It carries enzymes and is part of your immune system, which helps fight the bacteria in the mouth. Smoking makes saliva thicker, so it can’t wash things away as well. Saliva also acts as a buffer. The fluoride, phosphate and calcium in your teeth are also in your saliva, so it helps replenish [these substances] when they’re missing from the teeth. That’s something that’s overlooked, and I find that a lot with people who smoke marijuana as well.
WIB: How does dental health relate to overall physical health?
McKay: Let’s take diabetes. A person can be diabetic and have healthy gums and healthy teeth, but not if their diabetes is uncontrolled. Day-to-day blood glucose checks don’t give you the best indication of the status of your teeth. If uncontrolled, diabetes can contribute to the further breakdown of the gum and the bones because there’s active inflammation occurring. Also, when your A1C is out of whack, your wound-healing properties are reduced. If you need dental work and your A1C levels aren’t in a good range, we’re going to tell you, “You’ve got to get this under control, because if I’m going to pull this tooth, you’re not going to heal properly.” We also find that poor oral health or gum disease can, in turn, affect diabetes, because it can spike your A1C level.
WIB: Can medications affect your gums, too?
McKay: The mouth is a gateway into the body for everything, so a lot of times we can detect systemic health issues by examining the mouth. Sometimes it’s medications. A big one I’ve noticed is amlodipine, a high blood pressure medication that is a calcium channel blocker. For some people, this medication causes the gums to overgrow. Pair that with someone who isn’t already taking care of their gums, and we’re going to start to have puffy gums. Poor oral health, being on that medication and smoking on top of that is a double, triple whammy. I can look at a patient right away and know, “Hey, you’re taking amlodipine.” The gums just have a certain look.
WIB: What can people do if they don’t have dental insurance, or their insurance doesn’t cover enough procedures?
McKay: A lot of offices offer an exam at a set price just to get you in. That’s a starting point because once you see a dentist and they take your X-rays and look at everything, at least you know your baseline. Whether or not you can afford the treatment there, you know what’s going on, and from there you can shop around for better pricing. Also, most offices offer third-party financing like Sunbit, Cherry and CareCredit. Those are ways of getting [treatment] done.
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