All posts by Dr Harden

Why is Modern Dental Technology Changing the Face of Dentistry?

July 2009

By: Dr. Scott R. Harden

Just last month, at Dobbin’s Air Force Base, I had the privilege and honor to relive a great moment in our United Stated history, which commemorated the 60th anniversary of the Berlin Airlift, a truly heroic conquest for many millions of people in need of “hope” and food to survive Soviet domination. This event, well timed for Memorial Day, also permitted me to reconnect with an old acquaintance, Mr. Pat Epps of Epps aviation. Mr. Epps is an icon in Georgia and his father further made Georgia aviation history by having built and flown the first airplane in Georgia, only 4 years after the Wright Brother’s amazing solo flight at Kitty Hawk. While standing on the airfield at Dobbin’s Air Force Base, recounting such great history and the technology of that time as compared to today’s USAF F-22 Raptor stealth air superiority fighter, it was clear how far our technology has advanced.

Amazing breakthroughs have also followed in dental technology, which have kept my excitement and enthusiasm as a dentist at its peak for the last twenty-five years. I am thoroughly pleased with the wonderful opportunities the dental profession can offer our patients today.
The primary goal of dentistry today is to reverse the negative experiences carried forward from generations past. Thanks to modern dental technology, this is easily achieved in many areas:

  • Communication
  • Education
  • Smile enhancements
  • Replacing missing teeth
  • Treatment of Periodontal Disease
  • Treatment of Dental Abscesses

Communication and Education occurs on many levels, Dental Office-Patient, Dentist/Staff-Patient and Dental Office-Dental Lab. Dental Office-Patient communication has improved tremendously from just a few years ago thanks to technology permitting our office to communicate via telephone, text, email and voicemail, more importantly reaching our patients while they are on the go anywhere, anytime. Dentist/Staff-Patient communication and education is greatly improved by intra-oral cameras allowing us to demonstrate cavities and fractures seen in your teeth directly to you at that instant on our computer monitors. “A picture is worth a thousand words”. Similarly, new digital x-rays let you also see your teeth on the computer monitor the size of a baseball so the patient is clear on their diagnostic problems. Other diagnostic equipment permits open communication at a very comfortable level with all patients so they can be apart of the dental experience and clearly understand their dental needs, ultimately equating to patient satisfaction. Dental Office-Dental Lab communication has been greatly improved by the use of digital photographs that can now be emailed through the Internet and enhances detailed transfer of information (i.e. shape of teeth, smile, color, lip line, etc.) with tremendous accuracy, all that benefit the patient directly.

At the forefront of inspiring dental relationships is the trust developed from providing a patient with an award-winning smile yielding confidence and improving self worth. New technology utilizing tooth-whitening products, new porcelain technology that is stronger, natural looking, and securely bonded to your teeth permits artistry that adds a smile to the face of the patient and dental staff alike.

Implants have become a standard that has revolutionized dental care by replacing missing teeth in a way that does not require a plastic denture sitting on your skin. Implants stimulate and preserve the bone in the jaw so that the patient’s facial appearance and muscle tone also does not change. Implants replace missing teeth with 100% of the function and chewing capacity as compared to dentures that feign in comparison by only replacing 20% of the chewing capacity at best. Patients now have an unknown freedom they never new before and another great dental benefit awaiting them.

Periodontal Disease is now diagnosed and directly recorded into our computers by voice recognition software making the detailed analysis efficient, thorough and easier for the patient. The use of ultrasonic technology can vibrate the tartar off your teeth much easier and more gently and is coupled with safe localized placement of antibiotics at the source of infection so they can render the harmful bacteria harmless.

Dental Abscesses can be diagnosed with amazing new technology so the patient remains comfortable and calm during a difficult time. Patients really appreciate this. The ability to eliminate decay in the tooth and infection in the roots is easily accomplished with state-of-the-art procedures that make historically dreaded procedures painless and rewarding for the patient. The patient transitions from pain to comfort, benefiting from a positive experience through the entire process. This is dentistry at it’s finest.

Technology often equates to impersonal and uncaring interactions between people. Our technology in dentistry is a gift to patients that breaks down barriers and opens up long-lasting relationships. It is the key to unlock doors of anxiety and procrastination. Patients need to embrace dental care as a new experience that offers pain-free quality care like never before imagined. Visit your dentist soon!

Why are Teenagers Cavity Prone?

June 2009

By: Dr. Scott R. Harden

Teenagers. They are the wonderful age that spans from childhood innocence to the complexities of adulthood. Teens endure peer pressure, social and sexuality challenges, modern technology, historical standards, family values, moral issues and school demands to name a few. All these untoward factors require an unprecedented balance and must overshadow nature’s curveball of hormonal and physiologic growth coupled with apathy, confusion and a generalized sense of “being awkward”.

It is no wonder teenagers, under the constant guidance of adults directing them toward the better good, trend toward reclusion (disguised as iPods and other electronics) and often become withdrawn in order to take time and figure out themselves during this metamorphosis. A butterfly does this relatively fast; a teenager must endure this for years.
Teenagers have a tremendous challenge coping with all the responsibilities and new demands awaiting them every day. In the mix of many important concerns for teens and moreover for their parents is their dental health. During the teen years, many fundamental things change rapidly and consequently impact the teen, the teen-parent relationship and the quality standards that have been in place through the pre-teen years.

TEEN DENTAL FACTS:
Fact #1. According to the Centers for Disease Control, dental decay is the most common chronic disease of children in their teen and pre-teens.
Fact #2. More than 51 million school hours are lost each year due to dental-related illnesses.
Fact #3. Regular dental check ups are not maintained for a high majority of teenagers and for many are even non-existent.
Fact #4. The average male teen drinks 868 cans of soda a year, equating to 540 Cups of sugar per year (a 12oz soda has 10 tsp of sugar).
Fact #5. Soft drink purchases by teen in schools have increased 1100% in the last 20 years, while the intake of calcium rich drinks have decreased by 30%.
Fact #6. Nationally, 22% (or approximately one in five) of high school students smoke cigarettes.

Let’s briefly explore the title of this article, WHY Are TEENS Cavity Prone? Mother nature is our first problem. As molars (the most cavity prone teeth) erupt slowly through the gum tissue, two problems arise. First, the flap of tissue over them restricts effective tooth brushing of the molar surface and decay can occur by the time the molar fully erupts into the mouth. Second, tissue areas over erupting molars are typically very sore, especially to brushing, and this creates a negative reinforcement to children’s brushing habits, especially their back teeth. Once molars do erupt into the mouth, children are programmed to avoid these areas, making these teeth very prone to decay. Third, molars vary with large and small grooves on the surface that put them in high cavity prone or low cavity prone categories.
During this most important but independent stage of dental development, teens often become disconnected from their parents about their oral hygiene habits. The ongoing question “did you brush your teeth?” fluctuates and feigns over time. A dry toothbrush immediately after a child has gone to bed is always a bad sign. At a time when coaching from parents is most needed, regarding the importance of brushing and the technique of flossing all their new teeth and utilizing their new level of dexterity, teens discourage our help.

Another factor toward teens getting cavities is snacking habits that develop when they are old enough to choose the type and frequency of their munchies. Snacking throughout the day can increase the risk of developing tooth decay. Each time we eat, the bacteria in plaque produce harmful acids that attack our teeth for up to twenty minutes after you eat. Over time these acids can wear down tooth enamel putting them at a higher risk to decay.

Bottled water has taken away a lot of the fluoride intake that children and teens would receive from our regular water supply. This reduces the ability of enamel to resist bacteria as well and increases the risk of tooth decay.
Add braces to a teen’s already compromised brushing and flossing process and we now have insult to injury. Imagine the additional surface area and hiding places for plaque to accumulate. This translates to an increased concentration of bacteria in the oral cavity that greatly increases the risk of tooth decay, extending to areas that normally would not develop decay.

TEEN TIPS for better Dental Health:
Eat healthy snacks rather than sweets and chips. Learn to drink water rather than soda, which helps remove excess bacteria and food debris. Limit snacks to avoid increased bacterial activity on your teeth. Eat nutritious well- balanced meals made of foods from the five food groups. Teens can keep travel-size brushes in lockers or back packs to brush at school. Chewing sugarless gum after meals or snacks can also help cleanse the mouth.

After treating all forms of a teenagers cavity for over twenty years, my advise to parents is to realize teens need independence when brushing and flossing their teeth. From the moment they take control of the toothbrush, they are in control of their dental care. Education and positive reinforcement is the most important tool for teens. Do not hold them to perfect standards because they will not achieve them any better than a lot of adults. Do not scold them if they get cavities because as we learned above there are a lot of reasons for teens to get cavities.

Instead, as parents, realize it is very important during a teenager’s dental development to bring them to the dentist for regular professional check ups twice a year. All the problems discussed above that increase the likelihood of tooth decay in teenagers, can be professionally evaluated and corrected if properly assessed and addressed by the dentist. The use of sealants and other preventive measures can establish a lifetime of happiness from healthy teeth.

During a teen’s dental visit, the dentist and hygienist will take great strides to discuss brushing and flossing techniques, eating habits and apply this information to their individual needs utilizing benefit statements and education that gives teens the basis to make changes and develop good habits for the right reasons. Teamwork from teenagers, parents and the dentist is essential to allow our teenagers to mature into happy healthy adults.

Why Are Bacteria So Destructive To Your Teeth?

May 2009

By: Dr. Scott R. Harden

It is amazing to me that the tiniest little microorganisms that reside in our mouths can create such substantial destruction to our teeth, especially considering that our teeth are armor-coated with enamel. A bacteria measures about one micrometer or “micron”. There are 1000 microns in 1mm and 25.4 mm per inch. The wall of enamel on a tooth is about 1mm thick. Thus, a single bacterium must effectively penetrate 1000 times it’s size to enter into the soft middle area of our teeth known as “dentin”.

Our mouths set the stage for a battlefield, which remains a blazing 95 degrees Fahrenheit and a grueling 100% humidity. The offensive comes from bacterial armies that have been amassed by numerous militant factions. Intel reports from microbiologists estimate the militant factions are comprised of more than 400 species of bacteria, and hundreds of species of fungi, protozoa, and viruses that have taken up residence in our mouths. Some of these enemy factions have been identified as: streptococci, staphylococci, corynebacteria, neisseria, lactobacilli, and candida. The most impressive and unnerving statistic of all is there are more bacteria in our mouths than the entire world’s population and saliva may contain up to 1 billion bacteria per milliliter.

These militant factions are supplied by an endless supply of ammunition, primarily in the form of sugar and carbohydrates, which the bacteria use to convert into their ultimate weapon; a very strong acid that will dissolve enamel and prove a “bacterial knife” for attacking and stripping the gum tissue off the roots of our teeth. These armies become deeply entrenched and the ammunition supply appears to be endless and impossible to cut off. The enemy has two defined targets; our teeth and supporting gum tissue. Further, these armies are unique in that they can launch a 24/7 non-stop invasion that proves to be relentless and formidable. These armies repopulate at an amazing level.

The strategic defensive for our mouths that occur on a natural level includes our primary barrier of enamel, our long-range attack from our immune system, our awaiting battalion of saliva offering neutralizing affects against bacterial acid, and the stringent force of our tongue to swipe bacteria off our teeth. These defensive units combine to fortify and immobilize the enemy stronghold. Secondary defensive units command a toothbrush, toothpaste, fluoride, floss, water irrigation, sealants and regular professional dental visits to sabotage and otherwise affect a full retreat of the bacterial armies.

The enemy battle plan is to take up a stronghold inside the poorly defensible areas of our teeth and gums, and upon reaching their target, unleash their acid and launch their biological attack. The weakest points of our teeth are the deep grooves on the top and the pits located on various surfaces. Once embedded into these fortified strongholds, despite all countermeasures, it will only prove a matter of time before the ongoing assault of the 1,000 to 100,000 bacterial armies found on each tooth will conclude in a certain victory, known as a cavity or “caries”. The weakest point of our gums is the space around our teeth, called a “sulcus”, and is a prime location for trench warfare. The unyielding incursion of these bacteria can lower defenses of the gum attachment regretfully from a 2 or 3mm depth that is normal to a 5mm or greater depth that effectively severs defensive forces from engaging the enemy and allows gum disease to progress from “gingivitis” to “periodontitis” ultimately compromising bone support and tooth retention.

Official statistics have come in estimating 30% of the U.S. population does not clean their teeth. 80% (8 out of 10) of all people demonstrate some level of gingival inflammation or damaging periodontal disease. 30% of people in the U.S. over the age of 65 years old have no teeth.
Bacterial armies are on the full offensive every day waging war and explicitly attacking your teeth and gums. Keep up your offensive by brushing and flossing 2-3 times per day. See your dentist regularly for professional check ups and cleanings. If your seeking a new dentist, find an office that has a doctor and staff that make you feel welcome, educate you about your mouth and meet your dental needs so dental health remains a strong focus throughout your life.

What is the Domino Effect Involving Your Teeth?

April 2009

By: Dr. Scott R. Harden

In nature, for every action there is a reaction. This is Newton’s Third Law of Motion. A force is a push or a pull upon an object that results from its interaction with another object. In summary, forces result from inter-actions!

In life, for every action there is often a reaction as well, and this is especially true in dentistry. I like to refer to this phenomenon as the domino effect, which interrelates the actions we take or otherwise avoid to our dental health.

Healthy mouths statistically remain healthy because of implementing good habits and avoiding bad habits. People with healthy mouths have routine daily habits, which includes good oral hygiene and a healthy diet. They thoroughly brush and floss at least two times daily to remove harmful plaque that contributes to tooth decay and gum disease. Their routine also incorporates regular dental check-ups, so if problem areas do arise, they are promptly diagnosed and corrected. People with healthy mouths do not typically eat a lot of candy or drink a lot of sodas, and if they do, they are diligent about brushing soon after. People with healthy mouths are pro-active about their dental health and have created clear guidelines, which they strictly adhere to and maintain. Their dental health is an achieved result and not based upon luck.

Unhealthy mouths result from not implementing good habits and adopting bad habits. People with unhealthy mouths possess tooth decay and or gum disease because they often eat candy, drink soda, smoke, have irregular brushing and flossing habits, and they do not keep routine professional dental check-ups. They will seek out dental help when they are in pain. Therefore, not only do their bad habits produce dental problems, but also their infrequent dental check-ups promote delayed diagnosis and more severe problems.

Many people feel they have bad teeth because their parents did. “My mom and dad lost all their teeth by the time they were 30 and they had full dentures” is a common statement. Genetics is a factor in dentistry, but there is virtually no basis for anyone to lose their teeth in this day and time, despite their parent’s history. Good habits with regular dental check-ups permits anyone to keep their teeth throughout their entire life.

Below are several scenarios illustrating the Domino Effects we have seen involving patients in the last several days.

Scenario #1. An infant is put to bed every night with a bottle of juice or milk.
The infant develops “bottle caries”; decay of baby teeth that especially affect the upper front teeth. The teeth become brown and have cavities that may be confused by the parent as staining. The parent brushes the teeth but maintains the bad habit. The baby begins to cry frequently, which may be confused with colic. Babies are typically not brought to the dentist.

A man had a lower tooth extracted between located between several other teeth many years ago.

Scenario #2. A man in his 40’s brushes twice daily and smokes 1 pack of cigarettes per day, has severe pain in his gums and they start to bleed when he brushes. He has not been to the dentist in four years. In addition to the heavy black tar and nicotine stains on the inside of his lower front teeth, his gums have become red and swollen and begun to pull away from his teeth allowing food debris to collect down into the pockets that have opened up around the teeth. This man has developed periodontal disease and has formed pus down in the gum pockets causing bad breath and bone loss that may ultimately progress to lost teeth.

Scenario #3. A woman is at lunch and while eating feels her tooth break. She is 65 years old, brushes regularly, flosses occasionally, and considers herself to have good dental homecare. She has not been to the dentist in six years. She is concerned about her broken tooth, but since it does not hurt, dismisses the tooth fracture as not important enough to visit a dentist. In several months, the tooth begins to hurt. The dentist tells her advanced decay has spread so deep in the tooth that it needs to be extracted. This all began years prior with a large filling that ultimately caused small tooth fractures around the filling and allowed bacteria to enter into the tooth. This could have been easily detected with x-rays and regular dental visits, and permitted more ideal treatment.

Healthy mouths result from good homecare, preventive and routine dental care, all coupled with healthy eating and drinking. “Be true to your teeth or they’ll be false to you” is a funny old saying that has merit. If you ignore your teeth, the domino effect is always lurking in the background to amplify simple problems into complex problems. The best thing you can do for yourself is to make a dental appointment today and have a comprehensive dental examination. Avoid big problems later by catching your dental problems early through routine care. If your in your 20’s, 30’s, 40’s, 50’s, 60’s, 70’s, 80’s or 90’s, don’t ignore your teeth, because they make life better.

Personalized Dental Care for Adults

April 2009

Dr. Scott Harden

The benefit of relationships goes far beyond our professional daily existence. The ability to improve our patient’s dental health is a small part of what we can do to enrich their lives and carry forward a valuable sense of self-esteem. Possessing this privilege and further realizing that this opportunity exists allows Dr. Harden, his entire staff at Fountain View Family Dentistry and his patients to experience this special gift every day.
After nearly a quarter century of devotion and professional commitment to dentistry, Dr. Scott Harden has performed hundreds of extensive dental reconstructions, cosmetic smile enhancements, gum surgeries, root canals and general procedures for adults and children alike. He admits in a recent interview that although his passion for dentistry is as strong today as it was in the eighties, and he still appreciates all areas of dentistry, his favorite aspect of dental care is helping senior adults. It is this specialized group of adults over fifty that cumulatively beckons all of his professional talent and allows Dr. Harden to provide them dental care that sets a benchmark for their needs and expectations.

“There are many aspects of dentistry for patients 50 and older that offers unique dental challenges”, says Dr. Scott Harden, and are discussed below. “The key to dental care for adults, however, has more to do with the entire patient experience than strictly the treatment itself.”
Dr. Harden’s success is founded on several cornerstones: open communication, excellent patient care, educated staff and a tremendous focus on patient comfort. In a time when most healthcare professionals spend less time with patients, Dr. Harden has formulated a unique approach to ensure he focuses more time with his patients while utilizing state-of-the-art diagnostic technology. Camera images and digital photographs of the patient’s mouth, support the adage, “a picture is worth a thousand words”, and provides unparalleled communication between the doctor and patient. Their office also has CONSULT ROOMS that are great for patients and their spouses to have one-on-one time with Dr. Harden and staff and to facilitate a thorough discussion regarding care before, during and after treatment. In direct contrast to feeling like a number in many healthcare offices, they offer a refreshing approach to healthcare that we observed during this interview.

Quality of care, compassion, relationships, friendly staff, a knowledgeable and personable doctor and an amazing modern spa-style office all translate to a caring approach at Fountain View Family Dentistry, and these values that they have cultivated mean as much to the doctor and staff as it does to their patients — and it shows.

In this challenging economic time, Dr. Harden is very aware of the costs of dentistry and their office has very competitive fees and easy financial arrangements to ensure their patients receive tremendous value coupled with Dr. Harden’s vast amount of experience.

“There are many specific and unique dental concerns associated with patients fifty and over”, states Dr. Harden. A typical example involves a person with gum recession and therefore root exposure, commonly found in adults over fifty. Root exposure often leads to root decay and is enhanced by medications, reduced salivary flow and decreased immune response, which are also age-related. The root decay often goes undetected by the patient because of decreased nerve sensation common in adults over 50, and creates a similar problem for decay under and around old crowns, bridges and fillings. Plaque-induced decay is caused from lack of dexterity associated with age possibly including arthritis, and also due to infrequent dental check-ups. Plaque build up on your teeth also contributes to gum disease or “periodontal disease”. Teeth associated with periodontal disease can develop spaces, collect food and make the periodontal condition worse. Infected teeth and infected gums can lead to tooth abscesses, gum abscesses and can result in the very harmful bacteria circulating through your system to your heart, lungs, kidneys, liver, pancreas, and other organs, creating the potential for much more serious health problems later in life.

Other dental problems associated with senior adults include, extensive tooth wear over the years from tooth grinding leading to broken teeth and dental restorations, improper function, and the potential for TMJ or jaw joint problems. Teeth from ill-fitting and old dentures become loose and often require extractions.

Dr. Harden is well aware of all these issues, having treated thousands of patients with similar problems, and believes in a very personalized approach to dental care. “Regular visits are at the heart of this program and permits personalized diagnosis, treatment planning and instruction. The key to helping any patient, especially patients fifty and over first begins with relationships.” It was clear to observe that patients have a special connection with their wonderful dental staff and Dr. Harden that offers them a value far beyond dentistry. “Leave it to me to think like a dentist and believe it had to all be about their teeth”, stated Dr. Harden referring to his earlier years in dentistry. “It is way beyond this. They are seeking a sense of belonging, a person who can listen, understand, and comfort them in a time of need. In dentistry, we maintain a continued relationship every six months that has translated into decades with many of our patients. A routine of taking care of their teeth maintains a state of normalcy in their lives, and establishes a friend who is happy to listen. We extend the opportunity to let them feel good about their dental health and themselves, which may include a new smile, eliminating their tooth decay or gum disease, and ultimately they find a spark of happiness in another realm of their lives, and it all happens at the dental office — believe it or not.”

Why Go Through Life Without An Attractive Smile?

March 2009

By: Dr. Scott R. Harden

Almost everyone wants straight, white teeth and an attractive smile. Patients with crooked teeth or discolored teeth often cover their mouth with their hand or simply refrain from showing their teeth at all when they smile.

Patients from 18 to 90 present to my office looking for answers on creating the smile they always wanted. This particular smile is of a senior that was very involved in the process and thrilled about her attractive new smile.

Why go through life without an attractive smile? There are choices that we make in life that are more time consuming and more costly than achieving a nice smile. Further, a nice smile will last you a lifetime, and adds confidence all along the way.

  • Cosmetic procedures in dentistry include:
  • Composite “white” Fillings
  • Dental Whitening
  • Composite Veneers
  • Porcelain Veneers and All Ceramic Crowns
  • Orthodontics

Composite “White” Fillings
The most common every day cosmetic procedure that is performed in dentistry today, is the replacement of amalgam “silver” fillings with white composite fillings. This is overlooked today as a cosmetic procedure simply because it has become a standard of dental care which is performed so routinely. When a patient comes in with old silver fillings that have decay present, there is nothing that looks more wonderful than seeing the conversion of silver fillings to the white composite fillings. It rejuvenates the entire appearance of the person’s teeth.

Dental Whitening
Whitening teeth is seemingly a basic procedure, now offered as an over-the-counter product or professionally by a dentist. A dental diagnosis to evaluate for gum disease or deep cavities is important because they could pose complications for the patient. For this reason, over-the-counter whitening systems are sold at much weaker concentrations of only 4%, providing 2 or 3 shades of improvement, and are therefore much less effective than professional concentrations. Professional Dental Whitening is designed for either take-home delivery in whitening trays at 10-15% and can get teeth 8 shades whiter, or as in-office delivery in 1-2 hours utilizing up to 35% getting teeth 12 -14 shades whiter.
Dental Whitening is very safe for you and your teeth, and is performed by carbamide peroxide. It works on the basis of oxygenation by attaching to proteins inside the pores of your teeth, classified as extrinsic stain, and removing them to result in white tooth enamel. Extrinsic stain is a cumulative effect from our diets of coffee, tea, food colorings, colas, and everyday items we eat, as well as smoking.

Tooth Whitening is ideal for a large majority of people, with enamel that demonstrates mild to moderate yellow or gray discoloration. Results for these patients are very satisfactory. Patients that present with a severe discoloration or simply want very white teeth, require more than basic tooth whitening, and possess the need for other cosmetic options as noted below.

Composite Veneers
Composite Veneers (also called “direct bonding” or just “bonding”) is the application of a very thin coating of white filling material, “composite”, bonded to the smile surfaces of your teeth. They have the advantage of being accomplished in one dental visit. Composite Veneers create dramatic changes in your smile, are often compared to receiving “instant orthodontics”, and can be used to close spaces between teeth, create an ideal appearance for poorly shaped or crooked teeth and for restoring broken or chipped teeth.

Porcelain Veneers
Porcelain Veneers are used to create that Hollywood smile. Porcelain Veneers are thin tooth-colored porcelain restorations (0.3mm) that are custom designed for the smile surface of your teeth and improve color, shape, function and overall appearance. Porcelain Veneers, typically considered a cosmetic procedure, are designed to be very conservative and require little if any tooth reduction. They dramatically improve your smile and appearance and provide you a great quality of life.

Porcelain Veneers treatment must follow carefully designed and scientifically integrated dental principles. Careful planning between the dentist and the lab with input from the patient on overall style, shape and color of their teeth means that happiness meets expectations.
Why wait for a smile you have always dreamed of? Make the step toward a whiter brighter smile that carries the balance of confidence and esthetics you will benefit from for years to come.