Dr. Mark W. Evans looks oral health in the mouth every day as a dentist. Sometimes he fills cavities, other times he treats gum disease and on occasion he has found what turned out to be malignancies.
Dr. Mark W. Evans looks oral health in the mouth every day as a dentist. Sometimes he fills cavities, other times he treats gum disease and on occasion he has found what turned out to be malignancies in tissue within the body's craniofacial complex that houses the organs of taste, vision, hearing and smell.
"Oral health is more than just teeth," said Evans whose Longmeadow-based practice, with Dr. Derrick F. Ziemba, is Pioneer Valley Dental Arts.
"A big part of oral health would be the condition of the gum, supporting bones around the teeth as well as the soft tissue - tongue, pharynx, cheek, palate."
Evans adds, "When a patient comes in for an examination, whether a new patient or a patient of record for a revisit, the examination always reviews those areas of the mouth."
"We do a complete assessment of head and neck including all the teeth and gum, soft tissue as well as an extraoral exam of jaws and lymph nodes. We also take the necessary radiographs to help us look at the areas that we can't see in the teeth and jaw," said Evans of X-rays for a first-time patient.
"From there, we determine whether the patient has periodontal (gum) problems or not. Those who do need to go through some therapy of very specific scaling and cleanings with the hygienist. Those who don't go into a regular routine cleaning and are usually seen twice a year. The cleaning gets rid of the plaque (thin layer of bacteria) and accumulated stains and any tartar (mineral) buildup that is around the teeth."
He added X-rays help dentists "look for the amount of bone or bone loss, cavities between the teeth, and any other anomalies - cysts in the jaw - and other pathology that we just can't see on examination of the patient."
Dr. Mark W. Evans of Pioneer Valley Dental Arts in Longmeadow.Anne-Gerard Flynn photo
Evans said how often X-rays are done depends on such factors as diagnosis and age of the patient. He said a complete series of X-rays might be done "between five or 15 years, with a panoramic X-ray showing all the jaw structures every 10 years and the bitewings (of the molars) from every year to every three years per patient."
"You can see in-between the teeth, the crest of the bone and if anything is leaky or faulty around a restoration. A lot is obtained from those small bitewing X-rays," Evans said.
Evans enjoys all aspects of the work, treating patients from the very young to seniors of advanced age, and likes to say, "Overall a tooth is meant to stay in a person's jaw for the life of a patient and can be maintained."
"Most patients, when we detect cavity, don't even know they have a cavity. I had a patient this morning say, 'It is not hurting me.' It doesn't need to hurt to have a problem there," said Evans during a recent break in his work day.
"Cavity is basically the enamel cap on the tooth is dissolved by the acid attack of the bacteria that penetrate deeper into the tooth. Once it is in the secondary layer of the dentin, the bacteria spreads rapidly based on the anatomy of the dentin. The therapy is the removal of the disease, enamel and dentin sealing, cleansing and disinfecting of the dentin and then the placement of a filling restoration."
He added, "Most of our fillings today are adhesively bonded composite resins which have no metal and are very aesthetic."
"There is some call for silver amalgam fillings and they have been around for decades, but in the U.S. most of the dentists are using less and less of that material every year. The newer material is adhesively bonded to the tooth, whereas the amalgam was just placed in a cavity hole," Evans said.
"You can be more conservative in your preparation and restoration design with the composite, removing less tooth structure then with a silver amalgam and it blends it with the shade of your tooth. There is no unsightly gray, silver, black fillings there."
How long a filling lasts, Evans said, correlates to the "size (of the filling) and diet of the patient."
"I have seen fillings fail as early as five years, others in 25 years," Evans said.
He noted the importance of good nutrition, daily brushing and flossing in the prevention of cavities.
"One of the biggest things is the nutrition. Yes, sugary foods, high fructose, sucrose containing foods are higher in cavity producing abilities. So, things like raisins, iced tea, sports drink, obviously soda, in an excess amount gives the teeth a sugar bath all day," Evans said.
He called brushing and flossing "very, very important."
"Contrary to some media reports saying it is not worth it, flossing is definitely beneficial for removing plaque between the teeth where the bristles of a brush can't obtain the removal," Evans said.
He recommends "a minimum of twice a day for brushing" and says "once a day for flossing is ideal."
"Some patients will do more, and there is nothing wrong with that. Those patients who may be brushing but not flossing, sometimes - as they get older - we will see a site that will develop some inflammation. Obviously they get a pep talk every time they see the hygienist in this office and that is all good," Evans said.
Evans also stressed regular dental checkups for all ages.
"Just like any preventive appointment, whether medical or dental, we are able to pick up disease states at an early part of the process," Evans said.
"A lot of the intervention is very conservative. This is one of the advantages of going on a regular basis for preventative re-care visits."
Evans said "pediatric societies recommend that children be screened by the age of one."
"We usually have the child in the lap of the parent with the dental hygienist," Evans said.
"There is an educational process going on for the parent on how to maintain the primary teeth, but also what to look for as the child gets older. This gives the parent and the child the opportunity of going to a nice place. It is fun, and takes away that sense of fear if you get a child at that young age because they are used to going on a regular basis."
Evans added that as a young patient grows "we look for developmental problems in the jaw and tooth arrangement which might trigger some early intervention with orthodontic appliances or braces."
"Looking at a child developing, sometimes, we can intervene to redirect growth of the skeletal structure and alleviate the need for more orthodontic treatment down the line and lessen the amount of therapy needed there," Evans said.
With adults, he said dentists "get concerned with periodontal disease."
"This is silent, insidious and pain free in its early stages, but can be picked up by the dental professional on a regular routine re-care visit," said Evans of disease that affects the gum.
He called gum disease a "very complex entity."
"It is not just that you are not brushing properly or flossing. There is a strong genetic component to who will be at risk and there are certain assessments that we do here to find out what patients are at risk and then cultivate that treatment plan or re-care visit to handle that," Evans said.
Offering a "simplified explanation" of gum disease, Evans said "plaque bacteria build up on everybody's teeth everyday." The body's response to this in individuals with certain immune systems can put them at particular risk for advanced gum disease if the issue is not addressed.
"That plaque stimulates an inflammatory response in the body where your white blood cells will rush to the area of inflammation in an attempt to wall off and destroy the bacteria. In that process, those white blood cells are releasing enzymes to destroy those bacteria," Evans said.
He added the process is "destructive to the connective tissue in the bone," particularly in individuals "where their autoimmune system has gone haywire."
"As the bone is loss, gum tissue falls and recedes with it and the tooth develops mobility and ultimately will be loss if no treatment is done," Evans said.
"The focus today in a lot of periodontal specialty is not necessarily saving the tooth at all cost but to save the bone. If the tooth has to be loss and we have bone that is fairly well preserved we can rebuild it and place in a dental implant to replace that tooth. If we don't have the foundation of good bone, then we can't put in an implant."
He added, "In early stages of bone loss we use aggressive debridement and scaling and placing antibiotics in that localized site."
"Obviously, if it is more involved, the therapy might mean referral to a periodontal specialist for some surgery," Evans said.
With senior citizens, Evans said the concern is for "root cavities."
"A lot of seniors are on medications that cause dry mouth and this dry mouth condition usually results in a high amount of cavities on the roots. Some patients may have missing teeth in that age group and we can discuss replacements, but it is interesting to note that most of the aging population is retaining more of their teeth than ever before," Evans said.
"Hence, the rate of cavities increasing on the whole because they are maintaining those teeth."
Evans said his office may spend time "reviewing home care measures and increasing the frequency of professional care" for seniors.
"We have them coming in not just every six months, but maybe every four or even three months for professional maintenance. Fluoride treatments at home, as well as professionally, help reduce that cavity risk by strengthening those roots as well as some dietary nutrition counseling in terms of what foods to look out for that can cause more cavities," Evans said.
Evans is also very aware that dentistry can impact the social health of patients as well.
"Health of the dentition (condition of teeth) and the gums is paramount, but also the first thing that you see after looking at the patient's eyes is their smile. Studies have shown the smile is a very important social aspect," said Evans of the popularity of procedures as teeth whitening or straightening.
"We can actually take a person's full facial portrait smile and image it and show what we can do within the mouth," said Evans of the use of digital photography by dentists.
"It is called cosmetic imaging and this can give the patient a preview of what they have the potential to change whether it is color, shape, arrangement or straightening of teeth. A lot of cases that we do combine therapies. Orthodontic before we actually go on to the aesthetic component which may include tooth whitening, veneering, bonding or even replacement of teeth with some dental implants."
He added in his practice, "We see a lot of senior citizens coming in and asking to have a lot of these cosmetic procedures because they are maintaining the teeth and they tend to discolor and something conservative can be done."
Dentistry runs in the family for Evans as he took over from his dad, Dr. William T. Evans, who died suddenly at the age of 58 in 1987. Evans was 28 at the time, working in Connecticut and three years out of school. He eventually moved what was his dad's practice from downtown Springfield to Longmeadow, and his patients today include fourth generation ones from his late father.
"My dad started the practice in the 1950s, so I know the families, they know my family. They know my background, my history and it is nice. It is part of a long-term dental family. Those who stayed in the area always referred their family members here," said Evans who holds degrees from Springfield College and the University of Pennsylvania Dental School of Medicine.
Pioneer Valley Dental has grown through mergers and acquisitions, with Ziemba, a graduate of Providence College and Tufts University School of Dental Medicine, joining in 1997.
"I always liked to work with my hands, and I love science. Dentistry provided a great opportunity to use both. I used to fix bikes when I was a kid," Evans said.
He added his greatest professional satisfaction is in "seeing the result of a beautiful restoration," such as replacing damaged or decayed teeth with dental implants, and how that can impact a patient's appearance.
"The emotional satisfaction to me is we, as a team, have created that and the patient is very emotional. It has changed their whole appearance and that is very rewarding to me," Evans said.
"I like to think every component of restoration restores function but also has an aesthetic component, even if its as simple as a filling. It has to look and blend in with the tooth seamlessly, but it has to restore the function of that tooth back to its original state. The same with a single crown or tooth replacement whether it be a removal, partial dental, or fixed dental implant."
