My wife Debi in perfect form.
Dental exam on a Ski Lift
My wife Debi and I have been skiing together for over 42 years, it is one of our shared passions that began years ago when we lived in Mammoth lakes and worked in a ski shop. Actually it began when we first met and she told me that if we were going to be together I had better learn to ski, hence the move to Mammoth lakes. To put it more correctly I have been trying to catch up with her for over 42 years. Not long ago we were skiing in Mammoth and a young man who worked as a ski lift operator joined us on the chair as we were riding up. Lift operators are a source of very valuable information; where the snow is good so I attempted to start a conversation but he related he could barely talk as he had painful mouth sores. Many of you know that I am very direct and have every few filters when it comes to my interest in people or their dental problems. I knew I only had a four minute chair lift ride to satisfy my interest and figure this out.
Dental Differential Diagnosis on a Ski Lift
Debi, my wife was mortified when I started my differential diagnosis questioning into the history of his symptoms and previous treatments. Wyatt, the lift operator related numerous bouts with the sores and visits to doctors and dentists. He had been given numerous lab tests and varying antibiotics without answers or relief. When I asked him to open his mouth so I could examine the lesions Debi was so embarrassed she almost jumped out of the chair. This is not Wyatt but this is what a single ulcer looks like and he had them throughout his mouth. I asked him how he was currently treating the sores and he related he was drinking lots of Emergen C and orange juice. At the top when we got off the chair I gave him my best four minute guess as to the diagnosis: Recurrent apthous ulcers and advice on treatments. First stop drinking EmergenC and any other acidic drinks or foods, those containing vitamin c (citric acid). Both Brandon and I know from personal experience that highly acidic foods can trigger apthous ulcers; for us it is fresh pineapple. I explained he was just burning off the fragile skin and making his ulcers worse.
Treatment:
I recommended two over the counter medicines he could purchase at the pharmacy in town to rinse his mouth with that would provide relief and help healing : canker x and ricinol. Debi and I went on skiing and he went back to work in the lift control shack.
Follow up
Two weeks later we returned to ski and were greeted by a smiling Wyatt who thanked me profusely as his sores had completely gone away. He even wrote a Yelp review thanking me for my advice even though he in not a patient. He asked me why all those other doctors and dentist couldn’t figure it out. I told him probably because they didn’t have Dr. Christensen at UCLA making them think, question and memorize everything when they were in dental school. I did not cure Wyatt I just helped him to understand that what he was doing, exposing his mouth to acid was not helping. Given that we do not really understand the cause of apthous ulcers palliative treatments like the over the counter rinses I recommended or cortisone creams to reduce the inflammation are about all that can be offered. Recurrent apthous ulcers recur hence the name. For Wyatt they did come back and when we last saw him I gave him additional advice including encouraging him to try and figure out what triggers them. I also related newer technologies like laser treatments that Brandon and I have performed on each other that have also seemed effective in reducing the pain and frequency. The good news for Wyatt is that recurrent apthous ulcers usually reduce in severity and frequency with age. I will write a complete blog on mouth sores at a later date.