Mark Egbert, DDS

Date of Interview: August 13, 2019 @ Seattle Children’s Hospital

Why the mouth? 

When you want to become an oral and maxillofacial surgeon, you have to become a dentist first. When I was in college, I studied two things — science and art. And I still enjoy art — drawing, painting, carving. When reality sets in, you start to think about how you’re going to feed your family. You do a little better monetarily out of the STEM field than with a paint brush and an easel. So, I decided to focus on the sciences and ultimately, I applied to dental school. That’s how I got into the mouth. I didn’t want to, at that time in my thinking, take care of people who were possibly going to die. I wanted to help people, to contribute to their overall health. Additionally, I had some dentist-mentor people in my life who influenced my decision making. That’s kind of simplistic, but that’s what got me into dentistry and dental school. 

How does art play a role in your career as an oral surgeon?

I feel like I’m an artist. I apply facial art every week. We take patients who have significant challenges and dysplasia. We rearrange things so they have better proportions and function. Understanding facial anatomy, facial proportions, and the art of what constitutes an attractive or normal appearing and functioning face is part of what I do. Instead of clay or stone or wood, my media is flesh, bone and living tissue. That is really a blessing for me, to be able to improve the quality of life for patients. 

What does an average week look like for you?

Monday is a special day I spend it in what’s called our craniofacial clinic. That’s where we see patients with different varieties of congenital, developmental, and genetic problems. Patients with syndromes that affect their face, oral health and function, and how the world perceives them. That gets back to this art thing. If I can change a child or a young person’s face so the world perceives them as normal, they will have a better life. They won’t have as many challenges. Maybe they can get a job. If you don’t look normal, people tend to not pay as much attention, or not hire you, or not give you the opportunity to go to school and do what you want to do.  Tuesday is when I do a lot of paperwork, and on most Tuesday afternoons I have a clinic where I see a dozen patients or so. Wednesday, I’m in the operating room, where I’m really at home. As an oral and maxillofacial surgeon that’s what I do, that’s who I am. Thursday all day is a clinic.  When you do surgery for patients, you always see them beforehand to diagnose and develop a treatment plan. You also see them afterwards as many times as it takes for them to be whole, healed, and happy. Friday is another day in the operating room. Again, that’s where I’m at home. 

What advice would you give to high schoolers who may be hoping to pursue a career in healthcare or the STEM field?

Study hard, listen to your counselors, get good grades, and do things that show your interest in people’s wellbeing. Volunteering is a big part of a successful application to a health-sciences field — whether it’s medicine, dentistry, nursing, or pharmacy. Build a resume, build a curriculum vitae. Just be involved and active and show that you’re out there. Once you’re into college, be involved in research at some level with one of your professors. We have dental students who do lots of research with their professors. Medical students, the same. 

How has the introduction of technology affected the way surgery is done for you?

Practice has changed dramatically in my surgical lifetime, which is now 33 years. When I first finished training, we did everything pretty low-tech. We had x-rays that are like a photograph — a picture of the bone or face. Now, we use CT scans routinely, which gives us a 3D picture of the skeleton. The 3D CT images are then used in a virtual planning process which provides us the templates that we then use to translate the treatment plan from the computer to the patient in the operating room. The end result of the virtual planning is a plastic splint — just like the one that I used to make that took me 4 hours in the laboratory. Now, in 10 minutes, I have a much better product, and far more accuracy. 

Does this new technology allow you to treat more patients?

It does — it allows higher volume throughput because it takes less of my time. My staff takes photographs, radiologists gets CT scans — it all comes together. Nancy, my care coordinator, helps me collect it all. It’s a very efficient process. And that’s just one thing in technology that has changed. There are so many others. The plates and screws we use have dramatically improved from when I first started. When I was first starting, we wired people shut when they had jaw surgery because that provided another bit of stability for healing the bone and the wound. Now, the plates and screws we use are stable enough that people don’t have to be wired shut. That’s a huge improvement. There are also advances in radiology, 3D CT scanning, MRI, nuclear medicine scanning — all of those things have happened in my lifetime. Those are all amazing advances. In medicine, there are so many that you can’t count them. It’s going to be a very different world. If you pursue medicine or dentistry from today, when you finish school, it will be dramatically different. Another area of rapid advancement is dental materials. Many of the materials that your dentist uses now didn’t exist when I started dental school. And they’re fantastically better. Everything has changed and change continues. Mostly for the better. 

Have you personally had a role in developing these new technologies? 

In small ways I have. For example, we now commonly use a technique called distraction osteogenesis where you cut a bone, allow it to start to heal, and then slowly pull the wound apart. This process forms new bone in between the cut ends where the bone wound is continuing to heal. By this mechanism, without bone grafting, you can make a bone larger or change its position. Distraction involves the use of devices that actually do those movements. I’ve designed one or two of those to fit unique situations. When something new comes down the pipe, it has to be proven to me that it’s better, and that it’s going to better serve my patients before I say, “Yeah, I’ll use that.” 

How do you decide on what to do when you come upon a difficult or unusual case?

That’s a complex question. In all of your training as a health professional, you learn to take in information, collect data, analyze the data. Then, you interpret those and create a diagnosis. For every diagnosis, there is a certain set of treatments that might be applicable. So you decide which treatment is appropriate. If there are options, patients and families are involved in choosing the option that they want. While everyone’s a little different, the problems that patients present with fit into different categories. Whether it’s pathology, deformity, trauma — they fit into a category. In each category, you have common and uncommon diagnosis. You deal with the common ones in a very routine way. The ones that are uncommon require some research. So, I might see a child or a person with a new tumor that I haven’t seen in a long time or a deformity I haven’t seen before. I figure out what it is, and then I do the research on what’s the best treatment. Those kinds of things are changing — we talked about advancements. There are tumors that I treat now that used to require, by the textbooks, excision with a wide margin. That can mean, taking out the tumor, but also a portion of normal tissue around the tumor. That’s a big deal. Now, with some aggressive tumors, we can treat that tumor by removing them conservatively and then using chemotherapy.  This approach has been developed through continual research in medicine and surgery to improve how we are able to treat disease. If the child hasn’t lost the jaw or the teeth in it, or the nerves that give feeling to the face, because we have been able to be conservative with the tumor removal, that is a huge deal. 

Where do you see the field going in the future?

We’re already seeing robotics play a big role in medicine and surgery. And I expect that to continue to develop. I foresee a time when a patient who is remote, like on an aircraft carrier or in a spaceship, might have a surgeon somewhere else sitting at a computer to do their operation with a robot. This is the ultimate kind of tele-medicine. The use of lasers in surgery and dentistry is rising. There are many kinds of examples of things like that. The exponential expansion of knowledge and data on the human genome will have an ever increasing impact on medicine and surgery. Instead of managing a disease, we will get to the root cause and cure. For example, a large portion of my practice is taking care of young people and children with rheumatoid arthritis (JIA). Patients get sore joints, limited movement, bony erosions, and deformity related to both damage and growth effects of the disease. There are many medicines that help us control JIA, but we don’t have any medicine or treatment that cures it. But eventually, through continued research and our increasing understanding of the genetic basis of disease, I think we will.

Do you think the process and research speed is adequate?

I think one of the biggest challenges in medicine and research in any field is data management, communication, and collaboration. I often wonder how many things are done by multiple people, sometimes at the same time on different sides of the world.  Eventually you end up with people recognizing the importance of work that was done and the advancements that were produced, but better communication and data sharing might make it faster and better. Someone gets the Nobel Prize, and someone else doesn’t, and they did the same things. It’s hard to keep track of everything. The application of computerization and artificial intelligence is going to help is pull all of that together. Advances will be more dramatic and rapid because of improved data analysis and management. 

Why Seattle Children’s and the pediatric side?

When I finished my training, I worked at Harborview, a level 1 trauma center. I was the chief of 

 oral and maxillofacial surgery there for 15 years. My life consisted mostly of caring for people who were involved in motor vehicle accidents, or who got shot, or who suffered other injuries to their jaws and face. A lot of the people were drug addicts or alcoholics, and for the most part they had some responsibility for how they came to be injured. Over the 15 years of taking care of those people who created their own problems, you get a little jaded. You begin to have a less than generous outlook of life, humanity, and your fellow man. During those 15 years, I spent a day each week at the Seattle Children’s Hospital, caring for children. It was always a breath of fresh air to care for the children and deal with innocent people — people who didn’t have a hand in creating the problems you were treating. In 2000, my previous partner here at Seattle Children’s moved to Oregon and became the chairman of the oral and maxillofacial surgery (OMS) program there. When he left, I moved full time to Children’s and became the division chief of pediatric OMS here.

Why did you end up going to a trauma clinic if you didn’t want to deal with people dying? 

People can change their minds in life. You have that right, and you have that autonomy. When I first decided on dentistry, I was in this mode of not wanting to care for people who might die, and I have continued with that goal. I think the bigger picture is that I found something that I’m good at, that I love, that improves quality of life for people, and is appreciated. I get more out of that than I get out of my paycheck. 

Did you ever consider going into the research area rather than the clinical area? 

The short answer is no. That said, I do clinical research and write papers which is part of being an academic surgeon. It’s part of being a professional. When you learn something, you write it down, and you contribute it to the developing knowledge that’s out there. That is not my favorite part of what I do — I’d rather be in the operating room caring for children, but it’s an obligation. It’s something that as a healthcare professional, you do to advance your profession and for the greater good.

Least favorite part of your job?

Least favorite part is getting up at 3 a.m. when I am on-call at Harborview. That’s my least favorite — getting out of bed. Once I’m there, awake and taking care of someone, then it’s okay. Another part of professionalism is having a responsibility to the people you care for. These are the commitments you make to be a professional and to have the job. Being responsible, active, and involved — those are the things that you have to do. Sometimes, they’re not so pleasant. Also, paperwork — dealing with insurances and documentation of everything that you do. That gets to be a bit of a burden and not the most fun part of what we do, but it’s important too. If you do a surgery for someone, it must be documented.

Do you have a memorable surgery that you have done?

I remember the first case that I did as an attending, you know, when the buck stops here, where no one else has more authority or responsibility. You remember those kinds of things. You remember when you have a particularly bad outcome — when something doesn’t go right and you feel horrible for the patient and how it went. And you think about all of the decision making that went into that and what you might have done differently. You remember the surgeries that turn out particularly well — the ones that you are proud of. Those that have the biggest impact on the person’s health and wellbeing. I remember the patient I was caring for, who had a cardiac arrest under an anesthesia while I was working on her, and what we did to save that life. There are children that I knew and helped when they were 6 weeks old, and who I know now, when they are 30, and you are taking care of their children. You get to know people, and the things you did that changed their lives. You remember those. 

How do you calm your nerves and stay grounded?

Through your training — in medicine or dentistry or surgery — you learn to compartmentalize. You learn to separate what you have to do from how you feel about it. It’s okay for me to have feelings of connection with a patient. But when that patient is asleep in the operating room and having a surgery, they are not that human being with whom I have a connection. They are a patient and I know what I need to do to help them. You’re trained to be able to do that. You have empathy and you have to have a connection, but you also have to be separated so that you can do what is right and what is needed. I never take care of my own child, because I can’t have that objective separation with them. 

What’s the collaboration between the doctors and nurses and surgeons like when you’re working with a patient?

We have a team, and each member of the team has a role. We work together for the best interest of the patient, and always with the patient’s benefit and best interest in mind. Nancy is part of my team. She helps me in many, many ways. I have a nurse, and she helps me with other things. We all have the same goal of providing the best possible care. Members of the team help us by pointing out things that we might have missed. Like, “Hey Dr., did you see this?” Radiology is a good example. I feel pretty comfortable looking at any x-ray or study that has to do with the head or neck. But I will always go back and read what the radiologist had to say because they’re part of the team. They have knowledge and training. What they say is valuable, and I make sure it matches with what I saw and that I didn’t miss anything they may have seen. I work collaboratively with surgeons of different disciplines. I work with the ENT surgeons routinely. I work with craniofacial plastic surgeons and neurosurgeons. I will consult with general surgeons. It’s all focused on the patients and what they need. If there’s an area of expertise that I don’t have, then I will call in someone to help. We’re all there for each other that way. Sometimes there’s a territorial conflict between surgeons, sort of like a protection of your turf. But, that’s not in the patient’s best interest. And that’s always got to be the guiding light — “What’s best for the patients?” 

How do you feel about preventative medicine? 

I think it’s tremendously important. I think that’s the future of mankind on the planet — to have ever-improving health for all. In dentistry, prevention is huge. For example, having fluoride in the community water supply where you live prevents cavities. Dentistry is a profession continually trying to put itself out of business!

Can you tell us about any procedures that you believe has changed or will change the future of the dental field?

There are people who are growing teeth from stem cells in the laboratory. I envision a day where instead of putting in a titanium implant to replace a missing tooth your dentist will drill a hole in your bone and put a little magic stem cell concoction in there, and you watch the tooth grow. And the tooth that needs to be there will be selected from a palette of stem cells. “That stem cell will form a molar”, or, “That stem cell grows a front tooth”. Things like that — if you can imagine it. It’s amazing and it is coming.