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Transcript of DPH Core Doctrine
Dental Public Health Web Resource Area
FOR PATIENTS THE DENTAL TEAM
Dental Public Health Web Resource Area
[Blank Template Slide]MainMenu
The DDS Dental Public Health Web
Resource Area contains materials
relevant to military dentistry,
health promotion and upcoming
events
• The DPH Team• News
• MCAM
• Smile Month
• NSD
• Research
• Policy
• OHP Reports
• ROHC TORs
• DDS Reports
• Free CPD
• DN Extended Duties
• ROHC
• Web Links
• Samples
• Newsletters
• Army HP
• Service Guide to OH
• Health Fairs
Dental Public Health Web Resource Area
Research Resources Events Documents ContactsTraining/CPD
Help
Achievements
• Achievements
Top tips for deploymentCommon Dental Problems
Tell me about fluoride varnish
Health Fairs
Dental Public Health Web Resource Area
PATIENT RESOURCEMainMenu
BDHF ‘Tell me about’ Link
This area contains useful information and resources for dental patients
Free Stuff
Help
Dental Public Health Web Resource Area
Help
The DDS DPH website runs within a MS PowerPoint presentation. Some features present in the full version of the site on the Defence Intranet have been disabled on this site.
Navigate around the site by hovering over and then clicking on the available links.
Use the return arrows in the bottom right corner to return to the previous or home page. Alternatively, the menu button to the right of the title will return users to the main menu page.
MainMenu
Dental Public Health Web Resource Area
The DPH Team
If you have an idea for how this site could be developed or an OHP resource you would like to share then please contact WO2 Lowe or the SO2 DPH:
WO2 Jane Lowe - [email protected]
SO2 DPH - [email protected]
Examples include locally produced posters, event reports and sharing of useful web resources.
Please note: We can only accept photos when the subjects have all provided written consent to the photo being included.
MainMenu
Dental Public Health Web Resource Area
NEWS
Relevant news and announcements will be placed here
MainMenu
Dental Public Health Web Resource Area
Regional Oral Health coordinators
West Midlands & Wales
Scotland
Northern England & Northern Ireland
East Midlands & Anglia
Home Counties
London & South East
PortsmouthWessex
South West
Select a region to see contact details for the nominated ROHC
Overseas
Germany
Cyprus
MainMenu
Dental Public Health Web Resource Area
Regional Oral Health coordinators
DDS Cyprus
ROHC – Cpl Cat Warhurst
Dental Centre - Dhekelia
Mil Tel – 94 120 3553
Civ Tel - 00357 25963553
Email – DDS (CYP)-DHK-DHYG
BFPO - 58
MainMenu
Dental Public Health Web Resource Area
Regional Oral Health coordinators
DDS Germany
ROHC – SSgt Alicia Gowans
Mil Tel – 94 8772008
Civ Tel – 004 9505196 2008
Email - DDS(G)-HOH DHyg
Address – Haig Barracks, Hohne, BFPO 30
MainMenu
Dental Public Health Web Resource Area
Regional Oral Health coordinators
DDS East Midlands & Anglia
ROHC – SAC Jenny Briggs
Mil Tel – 95 751 7390
Civ Tel – 01400 261201
Email – DDS (EMA)-CRN-DN04
Address – RAF Cranwell, Sleaford, NG34 8HB
MainMenu
Dental Public Health Web Resource Area
Regional Oral Health coordinators
DDS London & South East
ROHC – Lt Col Ian McDicken
Dental Centre – Baird
Mil Tel –
Civ Tel – 0207 4143371
Email -DDS(LSE)-BAI SDO
Address – The Baird Dental Centre, Birdcage walk, Wellington Bks, LONDON, SW1E 6HQ
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Dental Public Health Web Resource Area
Regional Oral Health coordinators
DDS Scotland
ROHC – PO Jo Harris
Dental Centre – HMS Neptune
Mil Tel – 93 255 6971
Civ Tel – 01436 674321 6971
Email – DDS(SCO)-CLY D Hyg
Address – Dental Centre, HMNB Clyde, Helensburgh, Argylle & Bude, G84 8HL
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Dental Public Health Web Resource Area
Regional Oral Health coordinators
DDS Portsmouth
ROHC – LDH Jody Hill
Dental Centre – HMS Excellent
Mil Tel – 9380 24270
Civ Tel - 02392 724270
Email - DDS(POR)-NEL DHyg2 (Hill, Jody Able Rate)
Address – HMS Nelson, Queen St Site, PORTSMOUTH, PO1 3HH
MainMenu
Dental Public Health Web Resource Area
Regional Oral Health coordinators
DDS Wessex
ROHC – SSgt Darren Hutchinson
Mil Tel – 94342 2499
Civ Tel - 01980 650499
Email – DDS(WX)-TID DHyg
Address – Dental Centre, Kirkee Rd, TIDWORTH, SP9 7BQ
MainMenu
Dental Public Health Web Resource Area
Regional Oral Health coordinators
DDS South West
ROHC – LDH Lesley Higgs
Dental Centre – Lympstone
Mil Tel – 935105512
Civ Tel - 01935 455049
Email – DDS(SW)-CTCRM-TDG-DENT-HYG
Address – Dental Centre Lympstone, CTC RM, Exmouth, Devon, EX8 5AR
MainMenu
Dental Public Health Web Resource Area
Regional Oral Health coordinators
DDS West Midlands & Wales
ROHC – Sgt Greg Wilshaw
Dental Centre – Stafford
Mil Tel – 95551 7220
Civ Tel – 01785 787220
Email – DDS(WMW)-STF HYG
Address – Dental Centre Stafford, Beaconside, Stafford, ST18 0AQ
MainMenu
Dental Public Health Web Resource Area
Regional Oral Health coordinators
DDS Northern England & Northern Ireland
ROHC – SSgt Alan Hutchinson
Dental Centre - Catterick
Mil Tel – 94731 2132
Civ Tel - 01748872132
Email - DDS(NE)-CAT-ScRd-Dhyg
Address – Scotton Rd, Catterick Garrison, North Yorks, DL9 3LD
MainMenu
Dental Public Health Web Resource Area
Regional Oral Health coordinators
DDS Home Counties
ROHC – SSgt Liza Longworth
Dental Centre – Pirbright
Mil Tel – 94 211 5586
Civ Tel – 01483 798258
Email - DDS(HC)-PIR-HYGIENIST
Address – Dental Centre Pirbright, Woking, Surrey, GU24 0DT
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Dental Public Health Web Resource Area
Useful Web Resources• British Dental Associationhttp://www.bda.org/
• British Dental Health Foundationhttp://www.dentalhealth.org/
• Evidence Based Toolkit for Preventionhttp://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_102331
• Mouth Cancer Awareness Monthhttp://www.mouthcancer.org/
• National Smile Monthhttp://www.nationalsmilemonth.org/
• NICE Guidelines on Wisdom Teethhttp://guidance.nice.org.uk/TA1
• No Smoking Dayhttp://www.nosmokingday.org.uk/
MainMenu
Dental Public Health Web Resource Area
DDS Research
The DDS carries out research in a number of areas, adding to the oral health evidence base and supporting patient care. Two recent papers of note are listed below. Copies can be accessed from the Dii based web portal version of this site:
MainMenu
Third Molar related morbidity in deployed Service personnel - J Combes, E
McColl, B Cross & R J McCormick
Is there a differential in the Dental Health of new recruits to the British Armed Forces. A Pilot Study. T B Elmer, J Langford, R McCormick & J Morris
Dental Public Health Web Resource Area
Common Dental ProblemsMainMenu
Click an image to see more
Common Dental ProblemsMainMenu
Eating sugar-containing foods more than 3-4 times per day WILL cause tooth decay
Fillings fill a hole, they do NOT prevent further decay
Keeping sugary foods to mealtimes (Less than 4 times per day)Is the ONLY way to prevent decay
Early decay forms UNDER the surface and may not be obvious until a cavity forms late on
Dental Decay
Watch out for ‘hidden sugars’ in baked beans, ketchup, coffee whiteners etc.
Oral Cancer can occur ANYWHERE in the mouth. Over 6,000 cases are diagnosed in the UK each year
The further back in the mouth it occurs, the HARDER it may be to detect, the LATER it may be diagnosed
SMOKING is a MAJOR risk factor for oral cancer
ALCOHOL can increase the risk when combined with smoking
White or red patches, lumps and ulcers can all occur commonly in the mouth BUT if in doubt GET IT CHECKED by a dentist
Unexplained symptoms present for over 3 weeks SHOULD be checked by a dentist
For more information visit:
http://www.mouthcancer.org/page/about-mouth-cancer
Oral cancer sufferers are more likely to die than those with cervical cancer or melanoma
Oral Cancer
Common Dental ProblemsMainMenu
Dental Trauma Falls, sports injuries, fighting and accidents can all result in damage to the teeth
Injuries can involve the lips and other ‘soft’ tissues and/or the teeth
Baby teeth should NEVER be re-inserted into the child’s mouth as this can damage the unerupted permanent tooth
Any injury involving suspected loss of consciousness should be seen by a medical professional
Teeth that are displaced (moved) will require further investigation by a dentist
Adult teeth that are knocked out can sometimes be successfully re-inserted: Time is important, further treatment will be required:
- Gently reinsert tooth into socket if practical
- If dirty, gently rinse tooth with clean water, don’t touch the root
- Alternatively transport tooth to dentist in milk, saline, saliva, or, as last resort, waterWearing a custom fitted MOUTHGUARD
for all contact sports can significantly reduce the risk of dental injuries. Contact your dental centre to make an appointment if required
Common Dental ProblemsMainMenu
Acid Tooth Erosion Juices and sports drinks, even sugar-free ones, contain acids
The longer the acids are in contact with the teeth, the greater the rate of erosion
Acid dissolves the tooth enamel, making it thinner and more prone to fracture over time
Top Tips:
Avoid frequent / prolonged sipping of fruit juices, fizzy drinks and sports drinks
Use a straw to minimise drink contact with the teeth
Avoid ‘swilling’ the drink around the mouth and against the teeth
Don’t brush teeth straight after the drink – this brushes away the softened enamel
Instead use a fluoride rinse to strengthen enamel
WATER provides adequate hydration during sports and does not damage the teeth!
Saliva and fluoride provide some limited repair to early / infrequent damage
Common Dental ProblemsMainMenu
Smoking and dental health
Thinking about Quitting?
- Book a smoking cessation appt at Med Centre
- Make a plan
- Tell others you are quitting
- Find out about Nicotine Replacement Therapy (NRT) or other drugs
-Avoid areas where you may be tempted to light up e.g. smoker’s shelters
- NHS Smoking Helpline 0800 169 0169 (Provide some free material
Smoking causes:
- Increased mouth cancer risk
- Increased gum disease and future tooth loss risk
- Greater risk of and slower healing mouth infections
- Faster loss of muscle tone around the mouth and premature ageing
- Stained teeth and tongue
- Bad breath
- On top of ALL the general health risks (cancers, lung & heart disease…)
Visit:http://www.nosmokingday.org.uk/
For further information
Common Dental ProblemsMainMenu
Oral Hygiene and gum disease
The gums around the teeth are vulnerable to disease
If your gums bleed after you brush then you are likely to be at risk – they need more attention from the brush not less!
Gum disease over years can lead to permanently receding gums, ugly gaps, loose teeth and is the biggest cause of losing teeth
Poor cleanliness and untreated gum disease can leave teeth prone to infections and abscesses
1. Brush twice daily for 2 mins – brushing all areas carefully
2. Spit but don’t rinse out the toothpaste
3. Use an interdental aid – floss / flossettes / tepes each day
Common Dental ProblemsMainMenu
Dental Public Health Web Resource Area
Top Tips for DeploymentMainMenu
1 Arrange a pre-deployment dental inspection well in advance of your deployment date.
2 Limit the frequency of sugar-containing foods to 3-4 times per day MAX.
3 Avoid frequent intake of sports drinks & squash which cause both tooth decay and acid erosion. - Drink water: it rehydrates, is healthy, safe for teeth and best of all it’s free!
4 If you are told you are at risk for dental decay;- Discuss your diet with the dental officer – try to keep sugars solely to main meals- Request protective fluoride varnish from the dental officer (applied 6 monthly).- Take a high strength fluoride toothpaste on deployment- Consider using an alcohol-free fluoride mouth rinse between brushings- Spit out, but don’t rinse away toothpaste after brushing, to increase the dose
5 Read the short booklet: The Service Guide to Oral Health:
Dental Public Health Web Resource Area
Health FairsMainMenu
Health Fairs are an excellent way to find out more about important health issues that you may or may not have considered.
The dental team will be in attendance and can discuss topics such as:
-Improving diet to prevent dental problems
-Sports drinks and acid erosion of teeth
-Smoking cessation
-Dental problems on deployment
-Correct brushing techniques
-Fluoride supplements
-Types of toothbrush, floss and other aids to oral hygiene
Additionally, health fairs can offer:
-Friendly advice and direction to further services across all aspects of health
-General smoking cessation advice and services
-Children’s and dependants health (where applicable)
-Trade stalls for sports equipment
-Handouts, freebies, information leaflets and competitions
Click here to see a list of upcoming
health fairs
Dental Public Health Web Resource Area
Free StuffMainMenu
dentalcare.com - Patient Information site
BDHF - Patient Information site
Dental Public Health Web Resource Area
Children’s Oral HealthMainMenu
A list of available documents and their links is available on the Defence Intranet
version of this website.
This can be accessed from the DDS HQ MOSS Homepage or via the Defence Intranet link:
1. Select menu option: Organisations & Locations
2. Select: Surgeon General
3. DDS is under the section ‘DMS Pages and links’
4. DPH Portal is in the box on the RHS
Dental Public Health Web Resource Area
Free Cpd
Wrigleys Orbit CPD
Colgate CPD
MainMenu
Dental Public Health Web Resource Area
Free Samples
GSK Dental Professionals
Colgate Free Samples
Colgate FluoriGard Alcohol-Free Sample
Wrigleys Orbit Free Samples/Factsheets
GSK Sensodyne Free Samples
MainMenu
Dental Public Health Web Resource Area
Useful Web Links
British Dental Association
British Dental Health Foundation
DOH Evidence Based Toolkit for Prevention
Mouth Cancer Awareness Month
National Smile Month
NICE Guidelines on Wisdom Teeth
No Smoking Day
MainMenu
Dental Public Health Web Resource Area
No Smoking Day
Click below to link to the latest news about NSD 2013BHF Military No Smoking Day Web Page
MainMenu
Dental Public Health Web Resource Area
Mouth Cancer Action Month
Click below to link to the latest news about MCAM
Mouth Cancer Action Month BDHF Website
MainMenu
Dental Public Health Web Resource Area
Smile MonthMainMenu
Smile Month runs from 20th May to 20thJune:
BDHF Link to National Smile Month
• One of the longest running health campaigns in UK
• Established 1977
• Based on simple oral health promoting messages
• Click on the link to find out more
Dental Public Health Web Resource Area
Dental Nurse Extended DutiesMainMenu
Reference Documents
•Fluoride varnish product and aftercare information
•Delivering Better Oral Health (Publication)
Update on DN Fluoride Varnish Training
Whilst the DDS is keen to resume the DN fluoride varnish training course, the course format is currently being looked at by JMTRA. Once formally approved, it is hoped that selection for future courses can be offered at the Training Establishment.
Any DN who have undergone the training, either through the DDS or externally, must ensure that copies of their certificates are forwarded to RHQ in order for a record to be maintained at DDS HQ.
Only formally trained DN are authorised to apply fluoride varnish and give associated preventive advice, which must then be recorded on DMICP.
Dental Public Health Web Resource Area
List of Upcoming Health FairsMainMenu
Portsmouth 17 Feb 13
Marham 19 Feb 13
Dental Public Health Web Resource Area
ROHC TORsMainMenu
A list of available documents and their links is available on the Defence Intranet
version of this website.
This can be accessed from the DDS HQ MOSS Homepage or via the Defence Intranet link:
1. Select menu option: Organisations & Locations
2. Select: Surgeon General
3. DDS is under the section ‘DMS Pages and links’
4. DPH Portal is in the box on the RHS
Dental Public Health Web Resource Area
DDS ReportsMainMenu
A list of available documents and their links is available on the Defence Intranet
version of this website.
This can be accessed from the DDS HQ MOSS Homepage or via the Defence Intranet link:
1. Select menu option: Organisations & Locations
2. Select: Surgeon General
3. DDS is under the section ‘DMS Pages and links’
4. DPH Portal is in the box on the RHS
Dental Public Health Web Resource Area
OHP NewslettersMainMenu
Cyprus
WM&W
Wessex
Several Regions are now producing regular OHP newsletters. To see their content, access this site through Dii.
Dental Public Health Web Resource Area
Army HP WebsiteMainMenu
The Army health promotion team are in the process of updating their site. Links will be provided from the Dii
version of this site in future.
Dental Public Health Web Resource Area
The Service Guide to Oral HealthMainMenu
This resource is only available via the MOD Dii Intranet site.
This can be accessed from the DDS HQ MOSS Homepage or via the Defence Intranet link:
1. Select menu option: Organisations & Locations
2. Select: Surgeon General
3. DDS is under the section ‘DMS Pages and links’
4. DPH Portal is in the box on the RHS
Dental Public Health Web Resource Area
Health FairsMainMenu
How to Order OHP Products
A list of available documents and their links is available on the Defence Intranet
version of this website.
This can be accessed from the DDS HQ MOSS Homepage or via the Defence Intranet link:
1. Select menu option: Organisations & Locations
2. Select: Surgeon General
3. DDS is under the section ‘DMS Pages and links’
4. DPH Portal is in the box on the RHS
Dental Public Health Web Resource Area
Oral CancerMainMenu
A list of available documents and their links is available on the Defence Intranet
version of this website.
This can be accessed from the DDS HQ MOSS Homepage or via the Defence Intranet link:
1. Select menu option: Organisations & Locations
2. Select: Surgeon General
3. DDS is under the section ‘DMS Pages and links’
4. DPH Portal is in the box on the RHS
Dental Public Health Web Resource Area
DDS Research PolicyMainMenu
A list of available documents and their links is available on the Defence Intranet
version of this website.
This can be accessed from the DDS HQ MOSS Homepage or via the Defence Intranet link:
1. Select menu option: Organisations & Locations
2. Select: Surgeon General
3. DDS is under the section ‘DMS Pages and links’
4. DPH Portal is in the box on the RHS
The DDS is committed to undertaking and supporting research in order to build the evidence base and to support a shift towards more preventive focussed
oral healthcare.
The 2011 DDS Oral Health strategic Plan sets out the organisation’s strategic intent over a 5 year period. Research forms one of the core pillars of this
document.
Dental Public Health Web Resource Area
Fluoride Varnish - Patient InformationMainMenu
What is it?A concentrated fluoride gel applied to teeth by the dental team at your appointment – painless and completed in minutes.
Why?Studies show that when applied twice-yearly it can reduce dental decay by up to 50% (Effectiveness is increased with dietary changes).
How?Fluoride absorbed by tooth enamel increases resistance against tooth decay. It helps protect against bacterial acids released after sugar is eaten.
Is that it?No…don’t forget, the best way to prevent decay is to cut down how many times a day you eat sugar-containing foods
Dental Public Health Web Resource Area
How to Order OHP ProductsMainMenu
Background. 1. There are three major Oral Health Promotion (OHP) campaigns supported by the DDS - No Smoking Day, National Smile Month and Mouth Cancer Action Month.
2. In addition, the DDS has a budget that can be used by dental centres to purchase products to supplement these packs or at any other point throughout the year to promote oral health. 3. There is a collection of pooled electronic resources that can be accessed on this website (Dii version only)
Criteria for funding. 4. As the budget is limited, it is important to concentrate these limited resources on our patients so there are certain criteria for approval of funding:
a. Dental Centres that do not treat children are not entitled to funding for child OHP products. However, there are child OHP products held centrally at HQ DDS that are available for loan.
b. Everything needs to have an OHP message. A picture of a tooth and no message is not considered to be value for money. c. The maximum levels of funding for a single OHI orders is £200 and giveaways are limited to £30.
OHP suppliers.5. There are 2 companies that can be used:
British Dental Health Foundation. Their website is www.dentalhealth.org and all dental centres are eligible for the members’ prices.GASP. Their website is www.gasp.org.uk and as their name suggest this company concentrates on stop smoking merchandise.
Procedure for application of funding.6. Send an email to Polly Harrison [email protected] by using the template below. Please copy your Regional Oral Health
Coordinator into the email ROHC7. An email from Polly Harrison approving the order will be sent to you and copied directly to the OHP company. This email constitutes the order and therefore there is nothing that you will need to do until you have received your items. 8. The invoice will be sent directly to Polly. Therefore, it is imperative that on receiving your items you email Polly to confirm that you have received the order. HQ can then settle the bill.
Click Here for template
Dental Public Health Web Resource Area
TemplateMainMenu
Application for funding from DDS OHP budget. To: Polly Harrison [email protected] Dental centre delivery details: Name: Address: Mil tel no: Civ tel no: Email:
Catalogue Page Code Item description No of items Total price (BDHF use member’s price)
The page number is not essential but it is very useful if there is a query as to whether the item should be funded. Who will use the products? Are the items for a specific event e.g. Smile Month? Will the items be used by a single Dental Centre or a whole region? Invoice to be sent to: Ms Polly Harrison PS to Dir DDS HQ DDS DMS Whittington LICHFIELD Staffs WS14 9PY Tel: 94422 4302 or 01543 434302
Dental Public Health Web Resource Area
OHP ReportsMainMenu
A list of available documents and their links is available on the Defence Intranet
version of this website.
This can be accessed from the DDS HQ MOSS Homepage or via the Defence Intranet link:
1. Select menu option: Organisations & Locations
2. Select: Surgeon General
3. DDS is under the section ‘DMS Pages and links’
4. DPH Portal is in the box on the RHS
Dental Public Health Web Resource Area
Achievements & InitiativesMainMenu
Health Promotion campaigns
‘Spit Don’t Rinse’
Regional Oral Health coordinators
Oral Health Conference
Research
Ongoing Initiatives
Health Promotion Campaigns
Through DPH, the DDS participates in 3 funded major oral
health campaigns:
- Mouth Cancer Action Month
- Smile Month
- No Smoking Day
These campaigns reach thousands of military patients and
their families, delivering key oral health messages through a
variety of settings and media including:
- Attendance at Health Fairs & Unit events
- Displays in dental centres
- BFBS TV and Radio spots
- Local and National Publications
• Select a topic to view more
• Click again to close tab.Ongoing Initiatives
DDS DPH are actively engaging with the chain of command
to investigate modifications to operational ration packs in
order to reduce cariogenic components, ensuring they are
optimised to prevent dental diseases in those on operations
or training exercises
Targeted OHP:
DPH are producing a number of targeted oral health
promotion resources aimed at recruits, those on operations
and those attending health fairs.
Resources will include branded products such as
toothbrushes with clear oral health messages, posters and
information leaflets.
Research
DPH continue to support a number of individuals conducting
research for publication.
Recent examples included research on the health
differentials of Armed Forces recruits, the effects of
peripatetic clinics in reducing dental morbidity on operations
and the effects of third molar management on dental
morbidity.
Additionally, the DPH team support dental officers in the
undertaking of routine clinical audit as part of CPD and
quality assurance.
‘Spit Don’t Rinse’
Started in 2012, ‘Spit Don’t Rinse’ was conceived to
provide simple, memorable oral health advice that could be
easily adopted by patients to make a difference. The concept
is simple; after brushing with fluoride toothpaste, spit but do
not rinse out the mouth. This allows a greater concentration
of fluoride to remain on the teeth for longer and, particularly
at night time, can be an effective adjunct in the fight against
tooth decay. Posters, branded toothpastes and wide use of
media ensured maximum visibility whilst incorporation of the
health message into Phase I recruit training as part of a DPH
Consultant-led research project has helped to demonstrate
that lasting behavioural change is possible.
Oral Health Conference
With over 200 attendees and a variety of esteemed
speakers, the 2012 Oral Health Conference held at Keogh
Barracks, showcased the best of preventive practice in the
DDS. Open to all, particularly DCPs, it provided an
opportunity for dental health promoters to share knowledge.
Highlights included prizes for outstanding efforts in oral
health promotion which were presented by Nigel Carter Chief
Exec of the BDHF.
The 2013 event on 4 July will build on this success. The
theme is Oral Health Promotion for the Dental Team.
Regional Oral Health Coordinators
The implementation of a regional and international network
of Oral Health Coordinators (ROHC) provides a unique
opportunity to channel oral health promotion activities
through a subject matter expert. Highly motivated and
proactive, 11 selected ROHCs help ensure preventive best
practice is standard business and that dental teams are
resourced to improve the health of their populations.
ROHC hold a selection of regional resources that can be
loaned out to dental centres.