EP 67: Oral and Systemic Link with Dr. Mark Mathias

In today’s episode of the Double Your Production Podcast, Dr. John and Wendy walk through Dr. Mark Mathias’s powerfully shocking story about his personal experience with oral cancer and the importance of the oral and systemic link within our offices.

Dr. Mathias’s story is one that needs to be heard by every dental professional.

For more updates from Wendy and Dr. John, follow The Team Training Institute on Facebook. 

Hey, everybody. Welcome to this Double Your Production podcast and Facebook Live update. I'm here with Wendy and a guest. Wendy, how you doing?

I'm doing great. Good to see you, Dr. John.

Very good. Why don't you introduce our guest?

You bet. So we have the pleasure today of having Dr. Mark Mathias on with us. He practices in Florida. And we have a history that goes a few years back. We've asked him on to tell his story really about a variety of things today, so we're delighted that he's been willing and giving of his time today to join us on this episode. So, welcome, Dr. Mark.

Oh, thanks for having me.

So why don't you give our listeners a little bit of an introduction on really who you are and recent years in dentistry, and then we'll dive into the real reason we invited you on?

Okay. Well, I've been in dentistry for about 30 years. Graduated in '89. Well, since '96, I've been in Florida, and I've had my own practice since 2000. I have a small fee-for-service practice. One doc, one hygienist. Try to be a low-volume, high-production practice. Don't see huge numbers of patients on a daily basis. Basically, I try to see one at a time. Doing a lot of quadrant dentistry. Well, I trained at the Dawson Academy and did a lot of things that led me in this path. I'm also active in AAOSH, the American Academy for Oral Systemic Health. I'm one of the founding members and a fellow in AAOSH. So that kind of leads into the rest of my story.

That's right. Yeah, that's right. You and I have met over the years in a variety of ways. I lectured at AAOSH, lectured with the Dawson Academy. We've met there as well a few times. And I believe you've attended a few of our events and things over the years as well.

I remember actually Dentist Profits back in Chicago, many years ago, kind of when you first were starting out, it seemed like, because I remember we did Whitening for Life. I met a lot of the great people in that group. You actually had Rob Herron on just recently. He was one of the friends I made in that group. Yeah, yeah. So we do go way back. Gosh, it's been 12, 13 years, right [in?] that group?

Yeah, Yeah. Well, great. Well, we're so glad for that. So because of that, because we've been connected all of these years-- you made a post on Facebook a few weeks ago, and I reached out to you and asked permission to share your story. And then once we connected, I thought, "You know what? Why don't we just have Dr. Mark come and share his story as well?" One of the things that we've taught for years is that hygiene can bring so much to a practice, right?

Oh, yeah.

And the feeling that hygiene really is more than just a cleaning is truth to so many of us, right? And especially given the --current situation. Here we've had a few months where we've been shut down for elective care, and there's been this ongoing debate, "Is hygiene really essential for patients' health?" And so when you shared your story, to me, I thought, "You know what? The time is now to really get this message out to people so they can understand that it is so much more than just a cleaning that patients are receiving when they come to our practices." So I would love for you to tell our listeners why we've invited you on to and kind of what you've been dealing with in the last little while.

Okay. Well, yeah, the post that I shared, I was kind of getting tired of the divide between certain hygiene groups and dentists and I was hopefully going to try to do something that was unifying. And people responded to that post in a positive way. There weren't too many that said anything negative. But I was basically talking about why I felt it was necessary for us to get back in the office and take care of patients because we see patients more than they see their family physician. We often detect diseases that can be life-threatening before the patients are aware of them. Hypertension, almost every day we have to do a couple of blood pressure checks on some patients, get them to sit there for a few minutes, and we refer a lot out to their primary care physicians. Same with diabetes, because we see signs of things.

But my main thing was that oral cancer screenings. And oral cancer is not extremely common, but it's becoming more and more common. I've probably found a dozen cases of oral cancer in my 30 years of practice. When the VELscope first came out, I bought one and used it religiously for about 10, 12 years. I never actually caught anything with the VELscope, but just visual exam and palpation where I usually ended up catching things. And so it kind of came as a surprise to myself that I'm the last patient that I've actually diagnosed cancer on, or detected it.

I didn't actually diagnose it. And it was kind of an unusual set of occurrences. I'd been out in Las Vegas to an AAOSH meeting, and I did something to the roof of my mouth, bit into a tortilla chip or something, and I had a lump on the roof of my mouth that I kept playing with with my tongue, and it didn't seem like was healing. It took a little while, and then I got an insect bite on my neck, and that didn't seem to heal. And so I'm palpating behind my neck, and right at the angle of my mandible there was a lump, and it was firm, didn't move, wasn't on the opposite side. So I'm thinking, well, maybe it was a spider bite or something. This is a matted node and I'll give it a few weeks. And it didn't seem to get better so I made an appointment with my physician. He palpated. He could barely feel anything, but he agreed to send me for a CT, and they found that there was a tumor in my parotid gland, which kind of set things in course for the next few months.

And it was kind of a stressful time. I had never had any illnesses. I try to be fairly healthy. I work out at the gym a couple times a week, eat a plant-based diet, and so I had never really worried about my insurance. I had it, but I had changed to the least expensive insurance I could find, which was a local plan that had no specialists on it, which in the end turned out to be a blessing [laughter] because they didn't have anybody in network, but they ended up sending me to the Mayo Clinic in Jacksonville, which I think probably is one of the best places you could go.

Yeah. Wow, so that was probably pretty shocking. And so, obviously, you got treatment at the Mayo Clinic.

Yes. Yeah. Well, they did a needle biopsy and they said it was a high-grade mucoepidermoid carcinoma. It was poorly differentiated, the real aggressive one, and then so they ended up doing the surgery. They removed my left carotid gland, the whole thing, and they did a neck dissection and took out I think 28 lymph nodes, and fortunately, they didn't find any cancer in any of nodes.

Wow. One thing I can say, I bet with living through that is-- I've heard Eva Grayzel speak and other cancer survivors speak and what's so powerful about their stories is now you can certainly empathize with patients who are going through the same thing, so for many of us, we lack that. We really don't understand how invasive and how challenging some of these treatments are and so if we can look for the silver lining in that dark cloud as you mentioned before, the fact that you got to go to the Mayo Clinic and get treatment also after, Mark, the fact that you found it so early, right. We're always telling our providers that 90% of oral cancer can be cured if it's caught early enough, but sadly, oral cancer often has a 50% morbidity rate because we're not catching it early enough, right? So both, some really important lessons.

Yeah. The type of cancer that it ended up being, five-year survival. If it had spread is about 23%. It turned out to be even more aggressive type of cancer than what they originally said I had. It turned out to be a salivary duct carcinoma, which is extremely rare, but yes, I was fortunate that-- well, I had a couple of things that caused me to actually feel around in my neck. If I hadn't had that insect bite that didn't heal, I don't know if I would have caught it in time, but got it before it spread, but it had grown quite a bit from the time they did the initial CT until they did the surgery and that resulted in a lot of stretching of my facial nerve trying to get it out.

Sometimes, they actually have to cut the facial nerve, but fortunately, they just had to stretch mine quite a bit. So I had facial paralysis for well, a number of months. It was basically identical to bell's palsy, so I can relate to people with bell's palsy as well at this point. My eye was paralyzed. I couldn't close it and that made it kind of difficult to do dentistry because if you can't blink, things start getting blurry after a little while, so I had to stop in the middle of procedures, go get eye drops, come back.


It made it a challenge, but I never quit working the whole time. I took about 10 days off after the surgery and then I guess about 6 weeks after the surgery, I started radiation therapy and I had 35 sessions of head and neck radiation, which that's where the big-- well, the morbidity comes, the dry mouth, all those issues, the soreness, the mucositis. That was all with the radiation therapy and I had to tailor my schedule worked in the mornings, and then I had the radiation therapy in the afternoons. And it would wear me out, but I'd sleep late, get up and walk to work, because I live close enough that I can walk, and that gave me a little exercise every day, and just kept at it.

Wow. What a rough time.

Yeah, but it was rewarding in a lot of ways. It gave me a great, well, perspective on the values of things in life. I'm more grateful for every day that I'm here. And I'm more understanding, I think, now with my patients that have issues like that.

Yeah, I would say that's one of the reasons why we invited you on, right, is because so often we lose sight of the important things. Sometimes oral cancer screening's just one more thing on the checklist, right? We're just going through the motions. And we may do it; we may not even do it. I can remember early on one or two of the doctors that I worked with was super religious about doing the palpitations and all that. And then on in later years, sometimes it happened, sometimes it didn't. And I'm ashamed to admit that sometimes if it didn't happen, I didn't do it myself, right? So we can become a little lackadaisical about some of these steps that we know we should be taking every day. And we hear a story like yours-- that's one of the reasons we invited Eva to speak to our members years ago is because I think we need that perspective of really this is life or death.

There's not a whole lot we do in dentistry that can be life or death, at least not on the hygiene side, but this is one of those things, and it's so vitally important that we're performing these services for patients, and here we've gone several months without seeing a lot of our patients. And that's one thing that even the experts are worried about, is the reduction in cancer diagnosis just across the board, not oral cancer specifically. But across the board the reduction of diagnoses of some of these potentially life threatening diseases haven't happened because our preventive visits and our physicals and some of the standard routine that we've been doing for years as a society have fallen off in the fear of this COVID-19 threat. And so I wanted to invite you on, and I so appreciate you being so open and honest about your story, because I think we need those reminders, right? We need to be reminded about the truly important things that we do every day to take care of our patients.

Oh yes, definitely.

So given this experience, Dr. Mark, do you want to walk us through what your oral cancer screening looks like today?

It's basically the same as it was before. I was pretty-- well, I've always been consistent with that. I start with a quick visual exam to see if there's any asymmetry in their neck or on their face, and then I palpate the neck, interior, posterior, up underneath the mandible, sub-mandibular nodes, behind the ear, which is where mine happened to be, which a lot of people don't even go to the angle of the mandible. And then I palpate intra-orally, floor of mouth, feel the cheeks, run my fingers around all the gingiva. And then I check in the oral pharynx, have them sticking their tongue out. At the same time, I'm checking for saliva, seeing if the mirror sticks to their cheeks, seeing [seeing?] if it sticks to their tongue. Looking for signs of, well, dry mouth basically. Yeah. Yeah, and that's pretty much it. I'm looking for anything that doesn't look normal.

Yeah. Yeah, well, that's fantastic. Thanks for walking us through your approach to that.

Only takes a couple minutes to do that, if that. Right. And so critical. So you know on the hygiene side, we're trained to do that in hygiene school as well. So I think it's also important that we understand hygienists can palpate, you can lift the tongue, you can look, you can feel, you can do all of that. And, of course, if you find anything that's concerning, we're passing that along to the doctor in the [hand docs?] so the doctor can double-check. Two eyes are certainly better than one, right? Which is why we teach our team approach when it comes to cases acceptance. So that's another thing, that's another partnership that hygienists and doctors can really work on building together.

Oh, yes. Definitely. Yeah, and the hand-off is the very important thing. Sort of let the patient know that-- well, what you're finding. And then the doctor comes in and can just verify. I think that's very, very important.

Yeah. We had a question on our Facebook Live, Dr. Mark, and the question was, "Did you have any symptoms prior? Dry mouth or anything like that that could have cued you in?"

No. No symptoms at all until after I found the lump. And then it wasn't until towards the end when I was waiting for treatment I started to have a little bit of paresthesia on the inferior board of my jaw. But otherwise, nothing. It was totally asymptomatic. It was just a little lump. But even after I had the parotid gland removed, my mouth wasn't dry. I had enough saliva from the other salivary glands. It wasn't 'til I did the radiation that my mouth turned into basically a desert [laughter].

Has that persisted or is it improving over time?

It's improving a bit over time. For the first probably six months, I had a bottle of water with me everywhere I went. I still can't eat carbs. Things that are heavily carbohydrates, pizzas, sandwiches, pastas that don't have a lot of sauce on them, they just turn into a paste in my mouth. So I have to constantly drink water when I'm-- well, I have to drink a large glass of water with every meal pretty much, at this point.

I know all the hygiene listeners are going to be going, "Well, what brand of bottled water," right? Because this is what patients don't know is that there are some brands of bottled water that are highly acidic, right?


So this is part of our challenge in guiding our patients through some of these treatments that can have an impact on their oral health. And I know that we often get questions from hygienists about what products are best to guide patients that are having radiation therapy. And maybe that's another topic for a podcast down the road as well. But did you have anything that helped you with that?

I tried lots of the different topical products, the Spry products, the mouth spray. At nighttime, I used the Spry gel, which seemed to help for about an hour or two. That was the longest lasting. But I still had to just wake up about every couple hours and drink some water throughout the night. Yeah, as far as bottled water, I usually would fill up from my tap. In Florida we have water that's it's fairly basic, our tap water is. If you look at the list of all the different bottled waters, Zephyrhills is one that's from Florida and it's more on the basic side. Definitely not the Coke and Pepsi brand, the bottled waters.

Yeah. Well, good. Well, let's shift gears for just a minute because one of the other things that we had visited about back and forth was the fact that you're part of our hundred-day practice recovery plan. So I wanted to see if you could share just a few quick insights about and maybe some good takeaways that have kind of helped you. I understand you've been open for a few weeks, because here we are in this post-COVID-19 recovery situation, and so we'd love to connect with you on that for just a minute before we end today and just kind of see how things are going and what in that hundred-day recovery plan have you found helpful in your in your journey.

I've gone through probably about six of the modules so far. There are lots of things I would like to implement. And I've implemented a number of them. But one issue I'm having right now is that my hygienist, I only have one, she's going through some health issues and hasn't been able to come back. So I've been doing assisted hygiene two days a week with my assistance, which doesn't do well for same day care as far as that goes, see emergencies, and doing assisted hygiene. But the information that you supply for that was very, very helpful having my assistants working with that. The other two days a week I'm just focusing on restorative dentistry or other operative type things, which without any hygiene checks, it makes things go a little bit quicker.

That sounds like heaven [laughter].

Well, yeah, that part's nice. It's kind of like when I used to have big cases I'd bring them in on a Friday, no interruptions, and that's kind of the way my Tuesdays, Thursdays have been. But, yeah, seeing 15 patients, hygiene patients, in a day going back and forth with the assistant makes me appreciate my hygienist even more.

More, absolutely. Yeah, absolutely.

Exactly, assistance hygiene is exhausting even for those that get acclimated to it, right? It's a very effective model, but it does take some stamina and you kind of build-up to it, and then you can do it. But it can be exhausting.

Yeah, especially right now when we're trying to minimize our use of the Cavitron. It's that's a challenge. I'm still using it on some patients, the perio recall patients, ones that have the deeper pockets, but I'm just minimizing the areas where I'm using it but trying to minimize the aerosols a bit.

Well, you can do it fore-handed, so at least that helps, having this system available and having high volume suction. And then I think, yeah, as I talked to practices that are open, it seems like that's really now developing into the common strategy that we're minimizing the use, but we really can't go without it. So we're using everything we can to minimize or eliminate the aerosols and yeah, So if you do have to use it, if we've got a perio patient. Thankfully, what we're hearing is many practices are having an assistant available to help with that as well [inaudible]. Well, good. Well, our best thoughts to your hygienist. Hopefully, she can get back with you fairly soon so that you can then again focus on same to dentistry and some of the other things that that we really focused on in that program.

Yeah. I'm really enjoying the program so far and everything that's in the library that you have there. I've been going through all the different educational tapes or videos that you have.

Well, good. Any last questions from you, Dr. John?

No, this was fascinating. I'm so glad that you caught this disease problem early and the treatment was so successful and that you're back at it and you're caught in a place where many practices are where they can't feel the full team, and so they're kind of have one hand tied behind their back to some degree. But that will pass too, and then you'll be able to get back to back to a-- I keep hearing people talk about the new normal and one of my mentors yesterday has called it the new better. And that we have to figure out how we're going to use what we've learned during this time to make our future better than our past. And I think that that's one of the key things going through this program, I think will help you to do that. And so I want to thank you for sharing your story with us and being with us today.

Oh, thanks. And thank you for developing this program. I think it will help us as we venture forth into what will be the new normal.

Great. Well, awesome. Dr. Mark, it was great to reconnect. It's been a long time. So I'm delighted that we're able to visit today and again, even happier about the good outcome from the treatment and the fact that your story will inspire so many. So we really appreciate you sharing that.

Well, thank you.

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