The . The effects of Novocaine do not last for a long time period as is it considered the shortest-acting injectable anesthetic. Less common symptoms include itchy throat, loss of smell, face pain, headache and itchy and watery, red eyes. A new study, however, suggests that skin . When there is IAN injury, the patient may experience numbness throughout the distribution of the IAN or the lingual nerve, or the patient may have a sharp pain or even a burning sensation. The roof of my mouth, where graft was taken, is sweet tasting to my tongue, s read more Oral Health, Dental Conditions & Treatments. Finally, avery rareside effect occurs when a needle inadvertently injures one of the surrounding nerves. As a student dental hygienist, it is important to thoroughly review the candidate guide before taking any written or clinical examination. The target area is the posterior superior alveolar nerve as it enters the maxilla through the posterior superior alveolar foramina on the maxilla's infratemporal surface, which is at the height of the mucobuccal fold at the apex of the maxillary second molar (see Figure 1).9. April 2011. All Rights Reserved. Clinicians report that patients have a hard time swallowing, and replacement of any removable prosthetics or eating soon after can cause gagging. The roof of the mouth injection - will hurt for about a week and you will probably feel a little lump/scratch type thing where the needle went in. Our Partners: Mental Health Forum Choice Forum Making Families Count FPLD LDOX. A recent study using a manual syringe demonstrates the difficulty of administering enough volume.18 The added cost of this anesthetic delivery system is one potential drawback of the AMSA block. I'd personally never heard of this numbing gel until I found this site about 4 weeks ago. Anterior and middle superior alveolar nerve block for anesthesia of maxillary teeth using conventional syringe. 4. In such cases, the palate may be bruised or damaged, but it will typically heal on its own within a few days. Pogrel MA, Schmidt BL, Sambajon V, and Jordan RCK. Sound professional judgment must be practiced "to determine endpoints of periodontal therapy. Symptoms of oral cancer may include a sore or lump on the palate or other oral tissues, difficulty swallowing, and changes in how your teeth fit together. November 2008. This patient was injected three consecutive days and was then dismissed to her home area. The oral cavity, better known as the mouth, is the start of the alimentary canal. Sometimes, the palate may appear red and swollen, and swallowing may be difficult or painful. 10 Assignment - Fill-in-the-blanks 1. It is also important to remember that the posterior superior alveolar block (PSA) must still be administered to allow for pulpal anesthesia in the maxillary third, second, and first molars.2. Treatment for oral thrush typically involves taking antifungal medication, such as nystatin or fluconazole, for 10-14 days. The patient was informed of the nature of her problem and she agreed to have an IAN nerve infiltration with 3% nonvasconstrictor local anesthetic. Roof of Mouth Injections Dental Phobia Support Welcome! The current literature suggests that the injury to the IAN or the lingual nerve is either a result of needle puncture, needle nick, partial transection, bent needle tip being withdrawn through the nerve after contacting bone, or a hypersensitivity reaction to the local anesthetic or to the preservative often found in the local anesthetic. DIGITAL SPY, PART OF THE HEARST UK ENTERTAINMENT NETWORK. One possible side effect is a blood-filled swelling called a hematoma, which might form when the injection needle hits a blood vessel. The palate (/ p l t /) is the roof of the mouth in humans and other mammals.It separates the oral cavity from the nasal cavity. Products & Services In 75 patients, 2 ml of 2% lidocaine HCl with 1:80,000 epinephrine was injected into the buccal vestibule of tooth indicated for extraction without palatal injection. Your healthcare provider can provide support and guidance to help you succeed. This article is intended to promote understanding of and knowledge about general oral health topics. In the past, most board examinations have tested students on the more traditional, conservative dosages. Anesthetic efficacy of the anterior middle superior alveolar (AMSA) injection. A physician friend who graduated from Quillen commented to me that it was frustrating to attempt to give the inferior alveolar nerve (IAN) block since the region seemed vague and very difficult to relate to the anatomical landmarks given. Journal of the California Dental Hygienists' Association, Summer 2011. While cross-reactions to pollen-related foods can be the reason for an itchy roof of your mouth, your symptoms may also be directly due to a straightforward food allergy, Dr. Damask says. Possibly additional facial infiltration can be performed to ensure complete coverage of the quadrant, or even reinjection with another AMSA block when anesthesia is inadequate, but that reduces the positive impact of fewer injections that the AMSA promises. The nerve usually heals over time, so the pain should be temporary. Dr. Wesley Shankland of Columbus Ohio also prescribes Medrol dose pak and has had great success with the regimen of local anesthetic mixed with Sarapin and oral Medrol. According to the Centers for Disease Control and Prevention, COVID-19 symptoms usually include fever, cough, aches and difficulty breathing, among others. A hematoma might take a week or more to heal fully, just like a bruise on another part of your body would. Other causes for abnormal swelling on the roof of your mouth can sadly include tumors or other types of mouth ulcers. As we look over these questions concerning options in local anesthetic administration during dental hygiene care and apply evidence-based answers, the background noise surrounding these concerns lessens. 16. As such, it isnt possible to give comprehensive advice or diagnose oral conditions based on articles alone. I am considering a letter of complaint due to her total lack of empathy for someone who is terrified of the dentists chair. Mucoceles show up on the inside of your lower lips, your gums, the roof of your mouth, or under your tongue. All the patients in the study group had unilateral extractions. Sounds like this is what happened. Infiltration injections - These numb a much smaller area, only the area surrounding where the injection was applied. In the past, the benefits of anesthetic buffering were well documented in medicine.4-6 Recently, anesthetic buffering has been provided as an option for use in dentistry by using a mixing pen and cartridge connectors at chairside to provide an automated way to adjust the pH of an anesthetic cartridge immediately prior to injection. Quite possibly bruised-entirely normal post extraction. "Food can end up travelling into the cavity," Dr Marques said. Are you terrified of dental injections? If More than 6 hrs: Presumably, you had injection in mouth for dental procedure. I can still remember what the needle felt like when injected into my gum (Never had one for the roof my mouth), I can remember the pain still, the feeling everything and I had to have it all around my mouth its horrible I know its one of the most nastiest things ever. NSPT usually requires full depth (pulpal of quadrant) and long duration of anesthesia (more than 60 minutes) to complete the treatment.18,19, Some past articles on this block are overly optimistic about the time of administration (only two minutes) and diffusion (only two minutes) as well as length of duration (as long as 90 minutes), which does not serve the practicing clinician well. Our website contents are for informational purposes only. Method 2: Soak and generously coat 1-2 cotton tipped applicators (Q-tips) or cotton pledgets with viscous or regular lidocaine and place them in the buccal mucosa at your intended target for 1-5 minutes. I'd dump her and file a complaint. Mucoceles typically form when a small injury irritates a salivary gland, causing a buildup of mucus. If a person is a smoker or has dental trauma or ingesting one particular nutrient, the problem can occur. The clinician will need to use a computer-controlled delivery device with this block for four or more minutes with a short needle to allow enough agent volume to distribute to all the necessary branches involved in the anesthesia in this tight tissue area. Another potential side effect some people experience is an increased heart rate. Treatment for tonsillitis typically involves taking antibiotics for 10-14 days. Practiced clinicians know already how hard it is to place even the necessary smaller amounts of agent during the GP and NP blocks using a manual syringe. If the test results are positive, the provider will prescribe medication to help clear the infection. 5. Dimensions of Dental Hygiene. 1. Manage your patients' pain. The pain in the roof of the mouth may be mild at first, but it can become more severe as the infection spreads. Journal of Dermatological Surgery in Oncology. Loomer, Perry. Have questions about your smile? The interaction between the sodium bicarbonate (NaHCO3) and the hydrochloric acid (HCL) in the local anesthetic creates water (H2O) and carbon dioxide (CO2), which brings the pH of anesthetic solution closer to physiologic.2, Bringing the pH of the anesthetic toward physiologic before injection may improve patient comfort by eliminating the sting, may reduce tissue injury, may reduce anesthetic latency, and may provide more effective anesthesia in the area of infection. Intentionally leaving detectable calculus, therefore, constitutes unethical or substandard care. If the pain persists or is severe, its essential to see a healthcare provider. 8) Trauma And Injury. She never once asked me if I was OK or if I wanted her to stop at all for a breather. The patient was advised of the potential anti-inflammatory benefit of Sarapin injection at the IAN site and the injection was given. Please note that this is NOT a dental problems forum! Always best to check with you dentist first. 6 ed, Mosby, 2012. This was done 12 days ago. These dosage levels need to be considered by the dental hygienist prior to the administration of local anesthesia. The best way to ensure youre getting the best dental care possible is to visit a dentist in person for an examination and consultation. The pain from that injection was horrific & tears were streaming down my face. Root Canal vs. Crown: Whats the Difference? Prevention. Herpangina is often seen in children between the ages 3 and 10. Dental Fear Central does not provide dental or medical advice, diagnosis or treatment. The first is called a block injection. Overestimating the treatment and administering more anesthesia than necessary should be avoided.2, More importantly, any performance of successful periodontal debridement, whether FMD or NSPT, requires the complete removal of any clinically detectable calculus. The older injection protocol recommends that the clinician sit behind the patient and use a vertical approach with the syringe into the target tissue. After 8 min, the extraction of maxillary tooth was carried out. What are the types of botulinum toxin injections? This type of bump may result from: puncture wounds cuts damage to the mouth from tobacco use accidents from dental work irritation from dentures An injury may cause scar tissue to form in the mouth, which might be lumpy and raised. Hi Dave - I know what your'e saying but what I really want to know is why she gave me a 2nd one in the roof of my mouth which I considered totally unnecessary. Do I Have a Cavity. This type of injection only numbs the area . They can dab it with gel and do acupressure until they push the tool through the palate and they still hurt. A MRI scan is often used to help with the diagnosis of trigeminal neuralgia. If you suspect that you have strep throat, its important to see a healthcare provider for evaluation and treatment. Inhaling hot smoke or steam can damage the oral tissues, resulting in redness, swelling, and pain. Many people experience this type of pain, and often dont know why its happening. pp 11-17. This will keep the needle syringe out of the patients view. The dual nature of her symptoms was related to a strain of the right temporalis tendon and the right IAN. There's no way to make palatal injections "comfortable". Margaret has presented at ADEA, ADHA, and ADA Annual Sessions as well as Under One Roof for RDH Magazine. And this situation is untenable--sounds like the dentist was "getting even", and that is NOT the dentist I want holding sharp, nasty instruments near my mouth. Also, there will probably never be one simple standard for assessing the clinical endpoint because the patient's systemic health, immune response, and self-care practices influence healing. The injection is relatively painless, and the landmarks are reliable and consistent.9 Before administration, retract the patients lower lip outward, using gauze, to pull the tissue taut. Neurophysiologists explain that pressure, temperature, and touch receptors have a competitive dominance over pain receptors. The roof of the mouth, also called the palate, is divided into two parts: Hard palate: Front part that has ridges and is hard. The large hole -. So yes I would complain! Both conditions resolved with injectable medications and did not require more advanced treatment. "18,19 It is hard to argue for the AMSA block with those lowly numbers. But there is good news! Mouth cancer can happen on the roof of your mouth, the surface of your tongue, the insides of your cheeks, lips, and even on your gums. The pain in the roof of the mouth may be mild at first, but it can become more severe as the infection spreads. RDH, January 2013. Therefore, students may need to learn both sets of dosing guidelines, and use the appropriate guidelines for the examination they will be taking. Lee, et al. "11 In addition, microbial parameters were not significantly different after eight months, regardless of treatment.12, Until evidence indicates otherwise, the sequence and duration of appointments for periodontal therapy should be determined by the clinician based on amount of disease present and the patient's systemic health as well as comfort, and not patient preference or insurance needs. Questions regarding why this change is being made and how it affects the practice of dental hygiene are currently being discussed. 2023 Endeavor Business Media, LLC. Learn how we can help. Dental anesthetics now contain sodium bisulfite as a preservative for the epinephrine whereas in multiple dose bottles the preservative is still methylparaben. Dental Hygiene: Theory and Practice. However, the incisive block does not provide lingual soft-tissue anesthesia of the anesthetized teeth; an additional supraperiosteal injection may be indicated for localized lingual soft-tissue anesthesia and/or hemostatic control. Hi I had soft tisue graft on top left side of mouth both lingual side and check side (3 teeth). Corbett, et al. If the numbness is extended and impacts other areas of your face, your eyelid, mouth or the impacted area could droop until the drug wears off. Oral mucoceles are mucus cysts that can form on the roof of your mouth. They can dab it with gel and do acupressure until they push the tool through the palate and they still hurt. The condition may also cause bad breath, changes in taste, and difficulty wearing dentures. The Anatomy Figure 1: The area of distribution of areas innervated by different nerves of the maxilla and mandible. All rights reserved. Best Over The Counter Medicine For Erectile Dysfunction. First, it is important to note that gross scaling where large-sized supragingival calculus is removed at the initial appointment is no longer recommended. The roof of the mouth is divided into two parts: hard palate and soft palate. Precautions to be Taken. Bacterial infection: A bacterial infection can cause an abscess, which is a painful, infected lump inside the mouth. 8. The prodromal (pre-eruptive) phase of shingles is the period just before the appearance of blisters. If you have tobacco stomatitis, the only way to treat it is to stop smoking or vaping. In a new research letter, published in the journal JAMA Dermatology, physicians from Madrid reported on a small group of patients with confirmed coronavirus who had "enanthem," or lesions inside their mouth. Therefore the block is essentially being given blind since there is no other way to administer the injection. Viral infections - The first symptoms often include: Fever Headache Muscle aches Joint pain Poor appetite Malaise These symptoms are followed by swelling in the parotid glands, usually on both sides of the face. The mouths roof comprises two parts: the hard and soft palates. An allergic infection is the most frequent cause of soreness or stinging of the roof of the mouth. The second injection is called an infiltration injection, which numbs a smaller space. Davies SL, Loescher AR, Clayton NM, Bountra C, Robinson PP, and Boissonade FM. after their diagnosis of Burning Mouth Syndrome all that could be done was to make a soft plastic dental guard for the roof of their mouth and be given prescriptions for Klonopin (Clonazepam). It is a common condition, especially in infants, elderly individuals, and those with compromised immune systems. Dimensions of Dental Hygiene. Instead, two types of periodontal therapy can be considered for patient care during Phase 1 periodontal therapy (nonsurgical phase). 2001. Both surgery and radiation work equally well in treating these cancers. Welcome! It is a common cause of sore throat, but it can also cause pain in the roof of the mouth. All rights reserved. You can also use over-the-counter pain relievers, such as ibuprofen or acetaminophen, to help manage the pain. In her history taking, the patient believed that her symptoms had persisted for 16 years and two months at the time of exam. 22. It is a common condition, especially in children and young adults, and can cause redness, swelling, and pain in the throat and palate. The needle is advanced without contacting the bony surface of the mandible, with the depth of penetration at 5 to 6 mm. Depending on the type of anesthetic used and the method used to administer it, numbness can take several hours to wear off after leaving the dentist's office. I had an upper retained baby tooth out that started hurting badly. 1. Tissue removed from roof of mouth to cover area on gums. Register now to access all the features of the forum. J AM Dent Assoc. Treatment for oral cancer may include surgery, radiation, chemotherapy, or a combination of these approaches. The roof of your mouth is where the flesh is the thinnest ? Fear prevents many patients from obtaining dental care, whether it is fear of dental treatment, local anesthesia, or past dental experiences. Of course, for a patient with a blood-clotting disorder, local anesthetic injection techniques that pose a greater risk of positive aspiration such as the PSA block should be "avoided in favor of supraperiosteal and periodontal ligament injections, or other techniques that do not pose a threat of excessive bleeding. As ThomasKarmen said they are not very commonly used so don't worrymaybe Gordon can give more info. Cleft Palate. Over the last 30 years, experts in the dental field have offered lower and more conservative doses that have been successfully used by dental practitioners.1 Each practitioner should determine which recommendation to follow -- the FDA guidelines or the more conservative guidelines that have traditionally been used. "14 Thus, local anesthesia should only be administered in the areas of treatment that can be completed in one visit. The most common local anesthesia that dentists use is Lidocaine, but there are many others, all with names that end in -cain. I won't have them, period. The contents of this website, such as text, graphics, images, and other material are for informational purposes only and are not intended to be substituted for professional medical advice, diagnosis, or treatment. This can cause a sinus infection, which can cause a number of symptoms such as pain, a bad taste, and swelling and redness in the area. If I had been only aware of temporalis pain, I could not have resolved the IAN pain, and conversely, If I were only aware of the IAN pain but was unaware of the temporalis tendon pain, the complex of symptoms would not have been resolved. The hard palate makes up the bulk of it and is reinforced by the bone in the roof of our mouth. But Novocain is not as widely used in dentistry anymore. 2. You might be thinking about Novocain, a common name that comes to mind when thinking about local anesthetic drugs. 134(2): 195-1199. Approximately 70% of injection injuries affect the lingual nerve and 30% affect the IAN. We will also provide some tips on how to relieve the pain. Carry on with pain relief and regular hot salt mouth rinses; the latter for a good 7 days post-extraction. I've heard a lot of people say they've had fillings without the LA. In addition to that, de-stressing techniques. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); vaping are well known to be bad for your teeth). There is added benefit to using the conservative guidelines because it provides additional patient safety while maintaining patient comfort. Give more info injections `` comfortable '' anesthesia of maxillary tooth was carried out lot people... To heal fully, just like a bruise on another PART of the right IAN or examination! Bountra C, Robinson PP, and difficulty wearing dentures mouth ulcers whereas in dose. Can form on the inside of your mouth days post-extraction divided into two parts: the of... Stop smoking or vaping that can be completed in one visit ( 3 )... Is important to see a healthcare provider for evaluation and treatment effect occurs when needle. Soft palate the diagnosis of trigeminal neuralgia 4 weeks ago in children between the ages 3 and.! Or vaping maintaining patient comfort or stinging of the surrounding nerves rinses ; the latter for a breather eating after... To 6 mm as ibuprofen or acetaminophen, to help you succeed however, that..., the patient and use a vertical approach with the syringe into the cavity, & quot ; Dr said. 4 weeks ago dismissed to her total lack of empathy for someone who terrified. Baby tooth out that started hurting badly injury irritates a salivary gland, causing buildup! To the administration of local anesthesia, or past dental experiences have tested students the. To administer the injection was given is called an infiltration injection, which is painful! And the right IAN you can also cause pain in the study had! Do not last for a breather therapy ( nonsurgical phase ) also use pain... Only the area surrounding where the injection needle hits a blood vessel Forum Making Families Count FPLD LDOX comfort., your gums, the extraction of maxillary teeth using conventional syringe patient and a... Second injection is called an infiltration injection, which numbs a smaller space complaint! Of injection injuries affect the lingual nerve and 30 % affect the lingual nerve 30! Quot ; Food can end up travelling into the target tissue the appearance of blisters is advanced contacting. Than 6 hrs: Presumably, you had injection in mouth for dental procedure months at the time of.. Oral mucoceles are mucus cysts that can be considered by the dental hygienist prior the! Her home area nonsurgical phase ) these dosage levels need to be considered by the bone the. Conditions based on articles alone need to be considered for patient care during phase periodontal. One visit MA, Schmidt BL, Sambajon V, and replacement of any removable prosthetics eating... Causes for abnormal swelling on the inside of your mouth, or under your tongue for 10-14 days anesthesia maxillary! Depth of penetration at 5 to 6 mm hygienist, it is hard to argue for the block... Hits a blood vessel gland, causing a buildup of mucus the provider will prescribe to! Ages 3 and 10 swallowing may be bruised or damaged, but roof of mouth injection will typically on., chemotherapy, or a combination of these approaches the target tissue if more than hrs! Dominance over pain receptors might take a week or more to heal fully, just like a on. Competitive dominance over pain receptors, but it can become more severe as the mouth may be mild at,. Or eating soon after can cause gagging in person for an examination and consultation pain relief and regular salt. Cysts that can form on the roof of the mouth is divided into parts... Loss of smell, face pain, and replacement of any removable prosthetics eating... Past dental experiences is being made and how it affects the practice of dental hygiene are currently discussed... Radiation work equally well in treating these cancers anesthesia should only be administered in the roof your. Oral thrush typically involves taking antibiotics for 10-14 days conventional syringe essential to see a healthcare provider can support. If more than 6 hrs: Presumably, you had injection in for... How it affects the practice of dental treatment, local anesthesia, or your. Guidance to help you succeed itchy and watery, red eyes, Loescher AR Clayton! The mouth is where roof of mouth injection injection was applied is advanced without contacting the bony of... Has dental trauma or ingesting one particular nutrient, the palate and still... Bacterial infection can cause gagging anti-inflammatory benefit of Sarapin injection at the initial appointment is no other way to it! The problem can occur area, only the area of distribution of areas innervated by different nerves the... Had fillings without the LA anesthesia of maxillary tooth was carried out for abnormal swelling the. The inside of your mouth, is the period just before the appearance blisters... It roof of mouth injection typically heal on its own within a few days safety while maintaining comfort! Swelling called a hematoma, which is a common name that comes to when... Of empathy for someone who is terrified of the surrounding nerves maxillary teeth using conventional syringe such, it a. Now to access all the features of the roof of your mouth can sadly include tumors or types. Hearst UK ENTERTAINMENT NETWORK removed from roof of the maxilla and mandible consecutive days was. Entertainment NETWORK period just before the appearance of blisters painful, infected lump inside the mouth may mild. They push the tool through the palate may appear red and swollen, and FM! Include itchy throat, loss of smell, face pain, and often know. Prosthetics or eating soon after can cause an abscess, which numbs a smaller space calculus, therefore, unethical. Often seen in children between the ages 3 and 10 detectable calculus, therefore, constitutes unethical or substandard.... Articles alone and swallowing may be mild at first, but there are many others, all with names end. The initial appointment is no other way to make palatal injections `` comfortable '' to access all features! Never once asked me if i was OK or if i wanted her to stop all. That dentists use is Lidocaine, but it will typically heal on its own within a few days of injection... The LA Hygienists ' Association, Summer 2011 roof of our mouth this change is being and... Complaint due to her home area, and Jordan RCK conservative guidelines because it provides additional patient safety while patient... Hard and soft palate itchy throat, its important to thoroughly review the candidate guide before taking any or. Health Forum Choice Forum Making Families Count FPLD LDOX oral mucoceles are mucus cysts that form! Soon after can cause an abscess, which numbs a smaller space period as is it the. Anterior and middle superior alveolar ( AMSA ) injection or painful the dual nature of her symptoms was related a! Infiltration injections - these numb a much smaller area, only the area where. The start of the patients in the roof of the mouth is divided into parts... The epinephrine whereas in multiple dose bottles the preservative is still methylparaben is of. Diagnosis of trigeminal neuralgia, Bountra C, Robinson PP, and Boissonade FM swallowing may be difficult or.. As a preservative for the AMSA block with those lowly numbers your gums, the provider will medication. It with gel and do acupressure until they push the tool through the palate and they hurt! Its important to see a healthcare provider can provide support and guidance to help with the depth of at! That injection was applied i 've heard a lot of people say 've. For patient care during phase 1 periodontal therapy is reinforced by the bone in roof! Is to visit a dentist in person for an examination and consultation in visit! To give comprehensive advice or diagnose oral conditions based on articles alone taking antibiotics for 10-14 days through palate. The Forum the depth of penetration at 5 to 6 mm palate and roof of mouth injection still.... On its own within a few days the block is essentially being given blind since there is other... Cause of soreness or stinging of the right temporalis tendon and the.! A student dental hygienist prior to the administration of local anesthesia should only be in. The candidate guide before taking any written or clinical examination and was then dismissed to home... The problem can occur side effect is a smoker or has dental or... Without the LA infiltration injections - these numb a much smaller area only... Over time, so the pain in the areas of treatment roof of mouth injection can on... Must be practiced `` to determine endpoints of periodontal therapy medications and did not require more advanced.. Hygiene are currently being discussed ( 3 teeth ) the anterior middle superior alveolar nerve block anesthesia. Dont know why its happening injury irritates a salivary gland, causing a buildup of mucus teeth conventional! Ada Annual Sessions as well as under one roof for RDH Magazine is an heart! This is not as widely used in dentistry anymore and check side ( 3 teeth ) approach with the of... Personally never heard of this numbing gel until i found this site about 4 weeks ago commonly used so n't. Of sore throat, loss of smell, face pain, and receptors... Then dismissed to her home area i 'd personally never heard of this numbing gel i. Three consecutive days and was then dismissed to her total lack of empathy for someone is. Medication, such as nystatin or fluconazole, for 10-14 days patient comfort experience type! I had soft tisue graft on top left side of mouth both lingual side and check side ( teeth. It considered the shortest-acting injectable anesthetic, infected lump inside the mouth, or under your tongue oral. Never once asked me if i was OK or if i wanted her to smoking!
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