Is There a Treatment Plan for Halitosis?

My daughter has good dental hygiene and brushes her teeth two to three times a day but has always had a problem with halitosis. Should I consider talking to other specialists besides dental?... Read more

Oral Hygiene

The practice of proper oral hygiene is the most important thing you can do for your teeth and gums. In Part One, you learned that brushing alone is not sufficient to care for your teeth. In addition to brushing, your daily routine should include flossing and, depending on your particular need, the use of balsa-wood tooth-picks, gum stimulators, or water-irrigating devices.


Brushing

Proper brushing involves choosing and caring for your toothbrush as well as using it correctly. There are many different types of toothbrushes available, with a variety of sizes, shapes, and lengths. No single type is best for everyone, but soft bristles are recommended whether you use an electric or manual toothbrush.

Although electric toothbrushes are effective in plaque removal and gum stimulation, they have no proven advantage over manual toothbrushes. Some people, however, simply prefer them. Handicapped individuals, those who wear braces, and lazy children may also benefit from using electric toothbrushes. Continue Reading >>

Despite Dentists' Urging, Many Don't Take Proper Care of Teeth

(HealthDay News) -- There's limited evidence that so-called behavior management techniques help dentists convince patients to brush and floss their teeth properly.

That's the conclusion of British researchers who reviewed four previous studies that included a total of 344 people with periodontal (gum) disease.

In one study, patients attended five 90-minute groups sessions about proper care of their teeth and gums, while two other studies required patients to meet with psychologists to discuss periodontal care. In the fourth study, patients called or visited a periodontist twice a week.
The review authors noted that there were flaws in how these studies were conducted, which made it difficult to draw any firm conclusions.

"We need better-quality trials assessing the effects of psychological interventions to improve people's oral health. I also think we need broader research on the benefits of the application of psychological theory to dentistry, as I believe it has a great deal to offer," review co-author Dr. Peter Robinson, professor of dental public health at the University of Sheffield in England, said in a prepared statement.

"Dentistry has worked really hard at trying to educate patients to get them to change behaviors, but we have been a bit old-fashioned. We have tended to think that if we give people information, their attitudes and behaviors should change. In fact, people can change a little, but those new behaviors are difficult to sustain. We have a lot to learn from psychologists and other experts in the field if we really want to help people," Robinson said.

The findings are in the journal The Cochrane Library, published by The Cochrane Collaboration, an international organization that evaluates medical research.

More information
The American Dental Association has more about oral hygiene.

No Clear Winner in Fight Against Bad Breath

(HealthDay News) -- There's no conclusive evidence to indicate which approach -- mouthwash, breath mint, spray, chewing gum or mechanical tongue cleaning -- is most effective for treating bad breath (halitosis), says a new review of previous clinical studies.
"From the results of some low-powered trials, tongue cleaning, scraping and brushing do appear to have some benefit at reducing halitosis, and the effects appear to be short-lived," review co-investigator Zbys Fedorowicz, a periodontist at the Ministry of Health in Bahrain, said in a prepared statement. "But we were unable to find any reliable evidence confirming any benefits of using tongue-scraping over mouthwash, or vice-versa, at reducing halitosis."
Halitosis is caused by accumulated bacteria and the decay of food particles and other debris in the mouth.
Currently, there are no standard and accepted methods for treating halitosis. Mouthwashes, sprays, mints and gums provide a competing and temporary smell that masks bad breath. Some mouth rinses have ingredients that neutralize the odor or the bacteria that produce it.
Tongue brushing and scraping dislodge trapped food and bacteria, which can also be reduced by improving oral hygiene.
The findings appear in the latest issue of the journal The Cochrane Library.

More information
The American Dental Association has more about halitosis.

Fresh Mouth $22.95 [ learn more ] Fresh Mouth - is our newly formulated treatment spray to which we have added Coenzyme Q-10, Xylitol, and Colloidal Silver. When Fresh Mouth was first put together some years ago, we advised our customer base that the formula would grow as new biological dental information was brought forth.

Flossing a Quick Fix for Gum Disease, Bad Breath

(HealthDay News) -- Just two weeks of flossing, added to regular tooth brushing, can significantly reduce bleeding gums and bad breath, a U.S. study finds.

The study included 51 sets of twins, aged 12 to 21, divided into two groups. One group brushed their teeth and tongue twice a day, while the other group did the same, along with flossing twice a day.

After two weeks, the group that brushed and flossed had a 38 percent reduction in gingival bleeding and also had less halitosis (bad breath). In contrast, participants who just brushed experienced a 4 percent increase in gingival bleeding.

The study was published in the current issue of the Journal of Periodontology.

"Gingival bleeding and halitosis is often the first sign of poor oral hygiene that may eventually lead to further periodontal problems. A good way to prevent periodontal disease and tooth decay is through at-home oral hygiene care and routine dental visits," study mentor Walter Bretz, of the department of Cariology and Comprehensive Care, New York University College of Dentistry, said in a prepared statement.

More information
The American Dental Association has more about oral hygiene.

Fresh Mouth $22.95 [ learn more ] Fresh Mouth - is our newly formulated treatment spray to which we have added Coenzyme Q-10, Xylitol, and Colloidal Silver. When Fresh Mouth was first put together some years ago, we advised our customer base that the formula would grow as new biological dental information was brought forth.

Red Wine May Ward Off Gum Disease

(HealthDay News) -- Raising a glass to a new weapon against periodontal disease, researchers say red wine may help keep gums healthy and strong.
Though the results have so far only been borne out in the test tube, a team of Canadian scientists believe antioxidant components in red wine and grape seeds have anti-inflammatory effects that may ward off periodontal troubles.
"Our findings demonstrate that red wine polyphenols have potent antioxidant properties," conclude researchers led by Dr. Fatiah Chandad from the Universite Laval in Quebec City. Her team presented its findings Friday at the American Association for Dental Research (AADR) annual meeting, in Orlando.
Experts believe that upwards of 80 percent of Americans are estimated to have some form of gum disease, either in the relatively mild form known as gingivitis or in a more serious form, known as periodontitis. Periodontitis (meaning "around the tooth") is linked to poor oral hygiene. It is a chronic infection involving bacteria present in plaque that persistently coats teeth.
"I am optimistic that components in red wine can limit the effect of this oral bacteria," Chandad said.
According to the AADR, approximately 15 percent of Americans between the ages of 21 and 50 suffer from this harshest form of gum disease. Among adults over the age of 50, 65 percent are affected.
Smokers, diabetics and those taking steroids, oral contraceptives and certain cancer drugs are a higher risk for developing periodontitis, often in the absence of any obvious warning signs.
And gum disease's effect may extend beyond the mouth: Recent research has indicated that the inflammation and immune responses which accompany serious gum infection may also provoke an increased risk for diabetes, heart disease and birthing abnormalities among periodontal patients.
However, the Quebec researchers say laboratory tests conducted on mouse cell samples revealed that antioxidants found in red wine known as polyphenols may help limit the severity of bacteria-linked gum inflammation.
They note that inflammation is the immune system's natural response to the presence of such bacteria, Unfortunately, that response also involves the accelerated production of unhealthy molecules called "free radicals."
The production of too many free radicals can lead to a further weakening of gums. The result is inflammation, bleeding, and a gradual tissue and bone decay that can ultimately result in the loss of one or more affected teeth.
But Houde and her colleagues found that -- in the test tube, at least -- red wine polyphenols inhibit key proteins at the cellular level to slow free radical production. They speculate that red wine's antioxidant punch could be a useful weapon in the fight against gum disease.
Not everyone is ready to gulp down a glass of Cabernet to fight gum disease, however. Robert Genco, a distinguished professor of oral biology with the School of Dental Medicine at the State University of New York at Buffalo, stressed the findings are very preliminary.
"I would say that in general these experiments with antioxidants in test tubes give variable results when they are later tested in animals or humans," Genco noted.
He pointed to recent studies that found that the consumption of popular antioxidants such as vitamin E, vitamin C and beta carotene does not appear to provide the health benefits that had been anticipated by the medical community.
"Many antioxidants have been tested in humans, and they have not been too effective," Genco stressed. "We've been very disappointed, so we have to be very careful. So, while this study is an interesting first start, the key now is clinical trials in humans."
Chandad agreed that further studies are needed, but said she's optimistic that these early results will be replicated in animals and humans. Her team has already begun such work, she said -- first with animals, then soon after with human trials.
More information
For more on periodontal disease, visit the

Anti-Inflammatory Drug Might Ease Gum Disease

(HealthDay News) -- In tests on rabbits, a byproduct of omega-3 fatty acids helped protect the animals from the unhealthy effects of gum disease.
Boston University researchers say topical application of the eicosapentanoic acid-derived Resolvin E1 (RvE1) helped prevent soft tissue inflammation and destruction, as well as bone loss associated with periodontal disease.
The team was to present the findings Friday at the annual meeting of the American Association for Dental Research in Orlando.
The finding suggest that inflammation may be a good target in the treatment of gum disease, the researchers said.
Resolvins are a new family of biologically active products of omega-3 fatty acids and natural regulators of the inflammatory process.
The Boston group pointed out that gum disease is similar to other chronic inflammatory diseases, such as arthritis, where inflammation causes tissue damage.
Currently, oral hygiene and regular dental care are used to control plaque and prevent gum disease. However, plaque control may not be enough to prevent gum disease in susceptible people with a high inflammatory response, according to the study authors.
More information
The American Dental Association offers advice about oral hygiene.

Gum Disease Can Harm Much More Than Your Teeth

(HealthDay News) -- Proper oral hygiene may do a lot more than keep your teeth bright and cavity-free -- it could be a boon to your overall health.
A growing body of research suggests that periodontal disease may exacerbate a variety of health problems as wide-ranging as diabetes, heart disease, respiratory disease -- even premature births, experts say.
For instance, several promising studies have found that blood-sugar levels in diabetics with periodontal disease were reduced to normal when the patients' gum disease was treated. Other research revealed that the incidence of respiratory diseases among nursing-home residents was cut when they were treated for gum disease, said Dr. Robert Genco, distinguished professor of oral biology at the School of Dental Medicine at the State University of New York at Buffalo.
"All of these are pilot studies, and whether [the periodontal disease] is causal, we cannot say, but we can't ignore these associations," Genco said. "Further, from a practical standpoint, there is no harm in treating periodontal disease in these patients."
Gum disease is very common, Genco explained. Approximately 80 percent of Americans have some form of the condition, which is a bacterial infection of the gums surrounding the teeth.
Gingivitis is the mildest and most common form of gum disease, causing inflammation of the tissues around the teeth. More serious is periodontitis, when the inflammation affects the connective tissue supporting the teeth and, eventually, the bone. An estimated 20 percent of Americans have periodontitis, making it the primary cause of tooth loss in adults.
Because periodontal disease is so common, Genco said, treating the condition successfully could have a significant impact on public health, even if it's associated with only a small portion of other ailments.
One reason gum disease could contribute to other ailments, researchers say, may be that oral bacteria get into the bloodstream and cause inflammation of other body tissues. Another possibility is that an oral infection could trigger inflammatory responses from the immune system, adversely affecting the rest of the body.
Dr. Steven Offenbacher, distinguished professor at the Department of Periodontics at the University of North Carolina School of Dentistry, is studying the link between periodontal disease and preterm birth, and thinks inflammation could play an important part in the connection.
"Organisms are capable of invading the bloodstream and challenging the fetus by inflammation of the fetal and placenta unit, thus promoting premature birth," he said.
In monitoring the dental health of 1,020 pregnant women, Offenbacher and his colleagues found that those who suffered moderate-to-serious periodontal disease (14 percent of the women) were twice as likely to give birth to premature babies, than women with healthy gums. This difference held up even when the results were adjusted to reflect factors such age of the mother, prior preterm births and socioeconomic differences.
Offenbacher is now the lead investigator of a five-year, multi-center study that's enrolling 1,800 pregnant women and treating their periodontal disease, to see if the treatment reduces the risk of premature delivery. Within three years, he said, there will be good data showing whether or not treating gum disease can reduce preterm birth risk.
"We have not yet proven [a link] but the data suggests that treating the mother is safe and can improve dental health," he said.
Meanwhile, growing interest in the possible links between periodontal disease and other illnesses has prompted study into more aggressive treatment of gum disease.
"Periodontal disease is a silent disease. The signs are not that obvious, and people really don't know they have problem," Genco said.
Doctors with patients with diabetes, respiratory illnesses, heart disease as well as pregnant women would all benefit from awareness of the possible effects of periodontal disease on the conditions they're treating, he said.
To help them and their patients recognize the signs of periodontal disease, Genco is one of several health professionals working with the U.S. Centers for Disease Control and Prevention. The goal: To develop a simple questionnaire for doctors to give their patients that would suggest when a patient should be seen by a dentist.
Answering "yes" to questions like whether their gums bleed or if their teeth look different could indicate which patients might have gum disease and should be referred to a dentist.
"People know when their gums recede -- there can be discoloration. Or if there is a difference in the spacing of their teeth or if their teeth look different," he said.
More information
To learn more about periodontal disease, visit the American Dental Association.

Poor Gums Take Big Bite Out of Health

(HealthDay News) -- Problem gums are nothing to smile about.
In fact, experts gathered at a periodontal disease conference Thursday said chronic gum infection can pose risks for diabetes, heart disease, and even premature delivery.
"There is increasing evidence that disease in the mouth has implications elsewhere in the body," said Samantha Cramoy, a member of the Board of Trustees of the American Medical Association, and a pediatric resident at Children's Hospital in Boston, Mass.
Cramoy was the first speaker at the New York City conference, sponsored by the American Dental Association and the American Medical Association and underwritten by the Colgate Palmolive Company.
Cramoy and other doctors reporting on recent research emphasized that scientists haven't yet found definitive proof that gum disease ups risks for more serious illness. But the evidence is mounting.
"The evidence is increasingly strong and deserves the attention of both the medical and dental professions," added Robert Genco, a distinguished professor of oral biology at the School of Dental Medicine at SUNY Buffalo. Genco has researched the origins of oral disease for more than 30 years.
What's unfortuunate is that periodontal disease is treatable and "represents a modifiable risk factor to moderate or reduce other illnesses," Genco said. "Also, periodontal disease is so common that even if it accounts for a small portion of conditions, the public health consequences would be great."
Genco noted that about 80 percent of Americans have some form of periodontal disease, a bacterial infection of the gums surrounding the teeth. Gingivitis is the most common and mildest form of periodontal disease, causing an inflammation of the tissues around the teeth. More serious is periodontitis, when the inflammation affects connective tissue supporting the teeth and underlying bone. Approximately 10 percent of the general population suffers from well-established periodontal disease, Genco said, with people over 65 having a 30 percent prevalence of the disease.
Chronic gum disease may affect other health conditions for several reasons, the experts said. Oral bacteria can make their way into the bloodstream, causing inflammation of other body tissues. Oral infections may also trigger inflammatory immune responses, adversely affecting the rest of the body.
Researchers are also beginning to study how periodontal disease interacts with other illnesses, noted conference moderator Michael Glick, editor of the Journal of the American Dental Association and chairman of the department of diagnostic sciences at the University of Medicine and Dentistry of New Jersey.
"Does periodontal disease initiate other illnesses, or exacerbate them?" he asked. And, if it does impact on other illnesses, he added, "does [gum disease] treatment improve systemic health?"
Among the most provocative research at the conference was the finding that poor oral health was associated with premature delivery.
A team led by Dr. Steven Offenbacher, distinguished professor of periodontics at the University of North Carolina School of Dentistry in Chapel Hill, monitored the dental health of more than a thousand pregnant women. Each of the women received dental examinations early in their pregnancies and then once again after giving birth.
Fourteen percent of the women were found to have moderate to serious periodontal disease. According to Offenbacher, this group was twice as likely to deliver early (before 37 weeks of gestation) compared to women with healthy gums. This difference held even when the researchers controlled for factors such as maternal age, prior preterm birth and socioeconomic differences.
Women whose gum disease worsened over the course of their pregnancy were almost 2.5 times more likely to deliver very early -- before 32 weeks of gestation. Babies born this early are at high risk of serious disability and even death, Offenbacher noted.
Two large, multi-centered trials are now underway to examine whether treating a mom-to-be's gums during pregnancy can reduce the risk for premature births, Offenbach said. In the meantime, these preliminary findings should encourage women to practice good dental hygiene during pregnancy, he said.
"Good dental care doesn't appear to be a threat [to a woman's pregnancy] and is an effective way to improve the mother's health," he added.
Research suggests poor gum health raises risks for other problems, too.
Diabetics may need take special care of their smile, noted Dr. Louis Rose, professor of surgery at Drexel University School of Medicine and clinical professor of periodontics at the University of Pennsylvania School of Dental Medicine. That's because untreated periodontal disease seems to exacerbate diabetes and vice-versa. It may even speed periodontal bone loss in diabetics, he said.
Healthy gums do a heart good, too, added Moise Desvarieux, an infectious disease epidemiologist at Columbia University's Mailman School of Public Health in New York City. He said the evidence for a solid link between heart disease and problem gums is growing. "We should know within five years the relationship between cardiovascular and periodontal disease," he said.
It is important, said Genco, that physicians recognize gum disease as a potentially potent contributor to poor health generally. To that end, he's one of a group of health professionals working with the U.S. Centers for Disease Control (CDC) to develop a simple questionnaire that doctors can hand out to patients to identify those with periodontal disease.
More information
For more on periodontal disease, head to the American Dental Association.

What has changed? - Much about dentistry and much about how we see dentistry has changed.

What has changed? - Much about dentistry and much about how we see dentistry has changed. Thirty years ago I was treating teeth that had people attached. Today I am treating people that are appropriately attached to the realization that their oral health is intimately connected to their overall health and well-being. Every tooth is a vital organ with its own innervations, circulation, and special function.
Holistic practitioners have long appreciated the connection of disease in one part of the body intimately affecting all parts. Conventional dentistry and medicine has rediscovered, after about 80 years of denial, the bidirectional role of periodontal disease (bleeding gum tissue and retreating gum tissue and boney support). Thirty years ago I was not taught that regular hygiene visits were so instrumental in preventing heart attacks, strokes, diabetes and premature and low birth-weight babies. That truth is universally accepted now. The role, of home care and of hygiene visits to detect problems early and to coach optimal home-care, has risen from a good idea to one of the most important things we can do for our patients. Who knew hygiene visits could save lives?

Information Sheet on Dental Implants

What does it try to accomplish

Dental Implants are replacement “roots” to replace a lost tooth (teeth), or help retain a denture. They can be used in your upper and lower jaws.

How is it done
Local anaesthetic is used to make the proposed implant site numb. A special site is prepared in the jaws. The implant is then placed in this site with its attachments.

What medicines / supplements do I need to take
You will have been given a list of supplements and medicines that you need to obtain from your local chemist. It is very important that you take these as requested for your long-term successful result.

How long does the operation take
From 1 hour, upwards, depending on how many implants are planned to be placed.

How many appointments are needed
At least two. One to place the implant(s), and another at 10 to 15 days time to remove the stitches.

Type of stitches
We use PTFE sutures. These will reduce the possibility of infection, and need to be removed at a later appointment.

How long are the stitches left in
From 10 to 15 days.

Type of dressing
Usually, no dressing is needed.

Bruising
We find that as each person reacts differently to surgery, and you may have very little bruising. However, we have had a few patients with significant facial bruising, and you should be prepared for this.

Swelling
We find that as each person reacts differently to surgery, and you may have very little swelling. However, we have had a few patients with significant facial swelling, and you should be prepared for this. We will give you medication to control this swelling for you.

Pain
We find that as each person reacts differently to surgery, and you may have very little pain. However, we have had a few patients with significant facial pain, and you should be prepared for this. We will give you medication to control this pain for you.

Where are the scars and how bad are they
Any scars will be confined to your gum tissue only. We try to place these at the back of your mouth. Usually, any residual scars will be difficult to see after 6 to 8 months.

How long does it take to recover
You may want to plan to take a few days off work, or remain at home. The majority of our patients are back at work within 24 hours or so.

When is the final result
This depends on the implant system we have recommended for your dental treatment, and this will be detailed on your treatment plan.

How long will it last
Dental Implants should last you for the remainder of your life. There are a few patients where the implants have become infected, and have needed to be removed. This is a rare complication, and is detailed in your treatment plan report.

Common complications
Common complications are swelling and bruising. Occasionally patients may have pain. These can be controlled by modern medicines. You may bleed from the surgery site and you should follow the instructions given. It is very important that you maintain your oral care and hygiene, as this will determine how well you heal and the success of your treatment. We always recommend that you stop all smoking or chewing of tobacco. Your co-operation and compliance is essential for a successful outcome.


Source: Adentec & UKSmiles
3 Old Row Court, Rose Street, Wokingham, RG40 1XZ
http://www.uksmiles.co.uk/

Cavity Cops Dis 'Drill and Fill'

Cavity Cops Dis 'Drill and Fill'

By Sean MartinWebMD Medical News

March 28, 2001 (Bethesda, Md.) -- To significantly improve dental health in the U.S., we need to develop more sophisticated strategies than to simply "drill and fill" cavities when they appear.

That's the gist of a consensus statement released today by an expert panel of dental experts convened by the National Institutes of Health.

Dental caries -- tooth disease -- may not be killing anyone, and it may be diminishing as a threat, but it remains a serious public health problem. Nearly 20% of children between the ages of 2 and 4 have experienced the disease, and just 5% of adults are free of the disease.

"[There is] the potential to bring your child to the dentist to prevent the disease ... rather than filling the holes that develop when we wait too long," says Michael Alfano, DMD, chairman of the expert panel. "But in order to do that, we need better diagnostic techniques. The problem is that right now, our techniques are really not sensitive enough to pick up these early [infections] before they actually cavitate the tooth."

X-rays can be helpful in diagnosing early disease, says Alfano, dean of New York University College of Dentistry in New York City, but better methods need to be tested. "There are some exciting new developments that suggest the dentist may soon be armed with ways to know ... and then intercede to prevent [teeth] from ultimately requiring a filling.

"Filling a tooth is expensive, invasive, and weakens the tooth," he says. "Other than restoring the tooth to function, which is necessary when it does have a hole in it, it's not necessarily a good result."

Remineralization, which can restore tooth enamel if disease is caught at an early enough stage, is a promising option. "Identification of early caries lesions and treatment with nonsurgical methods, including remineralization, represents the next era in dental care," the report states.

"We think it is just a higher standard of care that ultimately should result in fewer repeat visits," Alfano says. "One of the things that keeps dentists busy today is they are replacing old fillings."

"The next breaking area of dental technology has to do with remineralization, and we are looking at the possibilities of regrowing dental or natural tooth material as a filling material," Matthew Messina, DDS, a practicing dentist and spokesman for the American Dental Association, tells WebMD. "But that is not in the everyday toolbox of the average dentist right now."

Eliminating the need for dental crowns, bridges, and moldings could cut dental expenses, but major perception changes are crucial, the report stresses. Dentists lack reimbursement incentives to keep their patients from getting to the point of needing cavity fixes.
"The tendency is to compensate dentists only for doing fillings, and the reality is that a dentist can do so much more to prevent these conditions," Alfano says.

"The insurance companies are not, as a whole, as interested in preventive techniques, and that's one of the areas that's going to have to be adjusted," Messina tells WebMD.

Panel member Alan Lurie, DDS, of the University of Connecticut School of Dental Medicine, pointed out that controlling the amount of sugar that children eat is important in preventing disease. And according to the report, sugarless chewing gum with xylitol (a type of sugar that doesn't seem to promote tooth decay) also is effective in preventing caries. However, the gum is not yet widely available in the U.S.

The panel did note that brushing teeth with fluoridated toothpaste and widespread community water fluoridation have made significant dents in dental caries in recent decades. Moreover, dentists have been effective in preventing some disease by "sealing" teeth with plastic film.
"The awareness with parents of the value of taking their kids to the dentist on a regular basis and starting at a young age has really grown, along with proper brushing," Messina tells WebMD. "We're producing a generation of kids that has had very little experience at the dentist, and a very low decay rate."

"The reduction in dental caries is as much as two-thirds in the past 30 years," Alfano says, "so we've been doing something right as a society."
At the same time, he says, "We've got pockets of disease in economically underprivileged and minority individuals that need to be addressed."

The panel noted that low socioeconomic status is linked to a higher risk of tooth disease. For adults and the elderly, it said that risk factors include poor oral hygiene, a lack of adequate salivary flow, and gum recession.
The expert panel also lamented that scientific research on tooth disease often has been flawed. Future dental care advances may be dependent on higher standards, it warned, calling for a new focus on tooth decay research.

"Despite the fact that it just about affects everybody in this room, caries is not life threatening, so in terms of garnishing a lot of attention both public and in terms of funding for research, it is at a slight disadvantage," says panel member Ian Coulter, PhD, from the University of California Los Angeles School of Dentistry.

The panel's consensus statement can be found online via http://www.webmd.com/click?url=http://consensus.nih.gov.

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