Thursday, November 21, 2013

Lifetime Dentistry-Crystal Lake Dentist

Lifetime Dentistry



Importance of Regular and Preventive care


Today regular and preventive dental care is more important than  ever. almost daily researchers are finding strong links between dental disease and systemic diseases. Periodontal disease bacteria have been linked to Alzheimer disease, colon cancer, diabetes, stroke, and coronary heart disease. Obstructive Sleep Apnea  a disease of airway blockage at night) is linked to snoring, ADHD, poor grades in school, behavior problems, ear infections, malocclusion, facial deformity, allergies, tonsillitis, failure to thrive, poor growth  and others in children. In adults, this condition leads to diabetes, overweight, daytime drowsiness (#1 cause of vehicle accidents), heart disease, stroke, headaches, nighttime bruxing (tooth grinding), snoring, poor sleep for bed partners, and other systemic conditions. Tooth Decay is the most common communicable disease on earth.
Abscesses from tooth decay cause loss of time from work and school. Abscessed teeth have lead to death, and other abscesses in the body.

These Three Huge Diseases are Controllable or Preventable by Dentists. 


1 Airway problems


Normal developing children should have adequate room for the teeth, a normal swallow pattern and no thumb or finger habits. In addition, they should be able to easily breath through their nose, normal sized tonsils and adenoids. and have no snoring at night. Early diagnosis of enlarged tonsils, abnormal swallow habits, allergies, improper bite and tooth position and altered breathing in children are signs of impending problems with airway development. This can be treated early by dentists with interceptive orthodontics, and recommendations for clearing the airway by and ENT. If these problems are not corrected early, a lifetime of problems await including an average loss of 8 to 12 years of life.

2 Gum Disease


Gum disease is a contagious disease  Most adults have some form of periodontal disease. Periodontal (gum) disease is usually caused by  a combination of biology (inflammatory response), trauma, bacteria, food wedging around teeth, and poor oral hygiene. The ability of a person's biology to resist gum disease varies greatly. Left untreated one gum pocket can spread to the entire mouth causing loss of all teeth. Gum disease drags down the immune system making a person susceptible to many other life threatening diseases including diabetes,  heart disease stroke, cancer, and others.  Gum disease can be controlled but remains chronic in most cases. Treatment often involves correcting the bite, improved oral hygiene, and cleaning out the bacterial pockets.

3 Tooth Decay (caries)


Tooth decay is a contagious disease as well as a bacterial infection. It is the most common disease in the modern world.  Many patient's worst fear when visiting the dentist is having a cavity, yet they often will avoid the dentist till something hurts. Left untreated tooth decay can lead to extremely painful cavities, abscessed teeth, and expensive treatment. Pain is not a good indicator of early decay which is easily treated. Tooth decay is on the rise in young children partly due to the high intake of sweets and carbohydrates. Fluoride has helped fight decay by making the teeth more resistant to bacterial acid attack. New advances in decay detection including digital x-rays, DIAGNOdent laser detection, and the use of magnification are helping catch decay earlier. The use of dental sealants, and topical fluoride also help to reduce the chance of decay in the future. Flossing and adequate brushing as well as controlling the amount of sugar and carbohydrate intake can greatly reduce decay.

How to manage the Big Three


Prevention, and early detection and early treatment. Going to a preventive oriented dentist who prescribes Lifetime Dentistry early and regularly is the key.When caught early and corrected, orthodontic problems, airway issues, gum disease, and tooth decay can be kept is check. The benefit is a healthier, happier, better looking, longer lasting body and life. A side benefit is less ultimate cost for dental and health care.

Why would you not want this for yourself and your loved ones?

Call Today



815 459 2202

 





 Dr. Neal answers all of your questions about Lifetime Dentistry at Crystal Lake Dental Associates.


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Sunday, November 17, 2013

Sensitive Teeth-cCrystal Lake Dentist

Sentitive Teeth


What causes sensitive teeth?


Teeth are composed of 3 layers:

1) Enamel...the hard white outer layer
2) Dentine the softer yellow layer with nerve endings
3) Pulp (nerve) the pink fleshy layer


Imagine a tooth like the M & M candy with the enamel layer which covers the tooth to the gum line as a hard outer shell, and the dentine as the soft inner layer. The hard enamel layer has no nerves in it. It protects the inner layers from most sensitivity to stimuli like hot and cold. Likewise the gum tissue protects the tooth from sensitivity. 


It the enamel wears away, or the gum recedes, the dentine which is filled with nerve endings is exposed. These nerve endings can transmit pain when touched (tooth brushing), heated or cooled (hot/cold foods) or coated with acid (from bacteria metabolizing carbohydrates {sweets}).  Cavities can cause tooth sensitivity. Gum disease can also cause sensitivity. Severe wear or teeth not fitting together properly can cause sensitivity.


How Can I Stop  Sensitivity?



 See your dentist to make sure there are no cavities, or other problems causing the sensitivity.
If the cause is eased dentine on the root of the tooth, there are a few things you can do at home. You can try desensitizing toothpastes, and avoid whitening toothpastes which can be overly aggressive. Be careful to brush properly and gently near thegum line. Make sure you are brushing after eating sweets.

What Can The Dentist Do For Sensitivity?


A cavity or a notch in the root can be filled in.  Gum disease can be treated as well as a poor bite. A mouth guard can be fitted to reduce tooth wear. Some areas of receding gum tissue can be corrected by recovering the roots with a graft.
Fluoride treatments and special high fluoride toothpastes can be prescribed by your dentist. In addition, a new treatment is available called "Seal and Protect". This simple procedure that is applied by a dental hygienist can protect sensitive roots for up to 3 years per application. Results are immediate and no shots or drilling is needed.

Call Today



815 459 2202


 Dr. Neal answers all of your questions about Root Canals at Crystal Lake Dental Associates.


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Monday, September 23, 2013

Root Canals Update-Crystal Lake Dentist

Root Canal Treatment Has Evolved

Root canal treatment is many centuries old. Root canal treatment in text books goes back to the 17th Century.  Many methods of treating and filling the canals have been tried with mixed success.The first use of Gutta Percha ( a rubbery filling material goes back to 1847). Over the centuries, many discoveries have been made in the field of Endodontics (Root Canals). As with all of the other healing sciences, time, study, and experimentation brings improvements in understanding and methods of treatment.

What has changed in in Root Canal Treatment Lately?

A lot has changed since I graduated form dental school. Root Canal treatment in particular has gone through several revolutions in the past few decades.Though the basic concept of cleaning, shaping, disinfecting  and sealing the Root Canal System is unchanged, the methods have improved tremendously.  New materials, techniques, and research has led to many recent breakthroughs. Some portions of the technique I am describing below did not exist as recently as two years ago.


State of the Art Techniques for Cleaning and Shaping Root Canals

The use of Magnification, and improved materials the improves the comfort, safety, and predictability of root canal treatment. Electronic Apex locators, and Digital x-rays greatly improve our ability to determine the length and configuration of root canal systems. Ultrasonic diamond coated shaping tips help to quickly identify the top of the canal system. The recent reintroduction of extremely sensitive computer driven reciprocating handpiece improves the treatment. By incorporating  a new generation of Nickle Titanium files called the Wave One System and M-wire, we have a more accurate shaping or the canals. The use of several cleaning and disinfecting agents including  NaOCl, EDTA, Chlorhexadine, and  Surfactants that are sonically activated lead to a much better cleaning and sterilization of the complete root canal system. This system removes debris, and bacteria from the tooth more efficiently, throughly and safely that possible in the past.

Filling the Root Canal  System

First we thoroughly dry the root canal system using sterile Paper points.Following this, small amount of sealer which is CaOH based (disinfects and helps healing) and warmed 100 % Gutta Percha is placed in the canal system space. (Warmed Gutta Percha has been found to penetrate the canal system more thoroughly providing the best possible seal.)

Core Buildup and Crown
No root Canal treatment is considered complete until the tooth has been restored to function. This means that a core buildup is placed in the root canal Chamber (the top portion leading the the canal system). This tooth can now function for a short period of time like this. The tooth will need a crown if it is not in the very front of the mouth (it may still need a crown if there has been much damage to it from wear, caries or fracture).

We use the Wave One Endodontic System at Crystal Lake Dental Associates


Call Today



815 459 2202


 Dr. Neal answers all of your questions about Root Canals at Crystal Lake Dental Associates.


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Wednesday, September 4, 2013

Tooth Whitening For Life-Crystal Lake Dentist




What Is Free White For Life?


White for life is a program we have developed to thank our loyal patients. Regular dental check ups are essential for healthy living. As I have reported here, there are are several serious medical conditions associated with poor dental health. In addition, a beautiful healthy smile has a very positive effect on a persons relationships and self 
image.

 How Does This Program Work?


At your first checkup visit, or anytime you desire to whiten your teeth, we offer an initial whitening series for $49.00 (a $350.00 value). At this time we take impressions of your teeth and make custom whitening trays and set a time to deliver the trays with enough whitening gel to brighten your smile. Usually a two week supply is all that is needed, but if you desire, we can give you additional gel. At each professional check-up visit, we give you an additional tube of touch-up whitening gel for free.

Do You Whiten Teeth Before Cosmetic Dentistry?


In fact that is one of the first things I recommend when considering any major changes in your smile. After whitening, we match any new dental work to the new tooth shade after they have been whitened. I will often include the white for life program for free to encourage patients to have the best result in a cosmetic or functional change to their smile.

Are There Any Restrictions?


This program is for regulate patients of our practice who plan on having us provide their routine care and check-ups. Some degree os tooth sensitivity can be expected by most people for the main portion of the two week whitening procedure. In addition, I need to make sure you are a candidate for whitening. For instance, if you have very sensitive teeth or unfilled cavities, they would need addressing. Also, if you have several fillings or other  restorations in front teeth, I would discuss how these may be affected by whitening.

Is Whitening Safe For Teeth?


Yes, the same chemical used in whitening, is also made and used by the body. The chemical (Hydrogen Peroxide) is deactivated by the body fairly quickly. I do not recommend whitening during pregnancy or while nursing however. Though whitening is very safe, some people can become addicted to whitening like many other things in life, and this can weaken the teeth in time.


How Do I Get Started?




Just call our office for an appointment or a free evaluation.



Dr. Neal answers all of your questions about Intercepotive Orthodontics at Crystal Lake Dental Associates.


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Monday, August 26, 2013

Sleep Apnea And Our Diet-Cystal Lake Dentist


What is Obstructive Sleep Apnea?


It is a condition where our airway is restricted or blocked  for 10 or more seconds to the point that we are aroused from our sleep in order to force our airway open. It is measured by a variety of statistics including , heart rate, chest and abdominal contortions, limb movement, snoring, brain wave activity, air flow, oxygen levels etc, in a sleep lab or with a take home monitor.

Why do Humans get Obstructive Sleep Apnea?


The human airway is unique in many ways. The ability to speak requires a special arrangement of the vocal cords, a large brain and very specialized tongue, and lip movements. This arrangement or the airway however, puts humans at risk of obstructed breathing. The tongue can fall back into the airway, the soft palate, tonsils and adenoids (if enlarged) can also clog the airway. Except for a few breeds of short faced dogs, Humans are the only species that snores.  If a human has a c old or allergies, these airway passages become swollen and clogged with mucus further decreasing the passage of air to the lungs. So in effect humans are "predisposed" for sleep related breathing obstructions we call Sleep Apnea.

What does diet have to do with Sleep Apnea?


There are two main reasons:

One


 Our ancestors nursed their young much longer ans often for as long as 2 years. This nursing forced the infant to work harder to receive nutrition which helped develop the hard palate lip tongue muscles. This development enlarged the hard palate of the upper jaw making it larger. In addition our ancestors ate more raw foods, and they did not have many sharp utensils like knives, forks etc to cut food into nice little bite sized chunks. Their food had no refined starches, and sugars so they had to eat more to get energy. This eating exercise helped to continue developing the jaws as they had to tear the food with their teeth and chew much harder and longer to break it down. Our jaws and in particular our upper jaw fail to grow to their full potential. the net result is malocclusion (improper bite), impacted teeth (wisdom teeth etc.), speech problems, reverse swallows, plugged eustation tupes resulting in earaches, mouth breathing, enlarged tonsils, upper airway infections including sinus problems, allergies, swollen inflamed tonsils and adenoids, and the tongue forced to take a more rearward position in the throat pinching off the airway.

Two

  Our "modern" diets are very high in calories  which leads to a larger frame and more weight. In addition, our "modern" lifestyle of convenience and fast food that tastes great  tends to cause obesity. Obese people have more fat deposits in their tongue, neck, and every other body tissue. These fatty tissues encroach on the airway when lying down further decrease the airway when sleeping.

Can't the Orthodontist help with the tooth crowding?


Your typical orthodontist has likely been trained in the style of Dr Begg. Dr Begg did some studies that had erroneous facts and came to the conclusion that the best way to correct tooth crowding was to take out bicuspids. His philosophy was to wait till about age 12 and take out bicuspids and then close the spaces.
This  made the teeth look straight but further forced the teeth back into the face leading to a dished in face and a tongue position even further back in the throat. In essence this treatment of the teeth can lead to TMJ symptoms and makes Sleep Apnea even worse.

What can be done?


Nursing infants  for up to 2 years is not impracticable for most mothers. In addition having the family resort to eating raw foods without modern utensils may not be possible as well for people living in cities and suburbs 9 (though today's grocery stores are full of healthy raw foods).



We recommend evaluating a child as early as possible and developing a program or interceptive orthodontic care. The goal is to help get the child's jaws "growing normally as early as possible" We take necessary records, and recommend a series of oral guides "that the child can easily wear to encourage proper growth and development of the face and jaws.  In addition, these appliances can reduce or eliminate the need for braces later on. The appliances lower the overall cost of orthodontic care by as much as 66 percent.


What are other health the advantages of these devices?

The use of these devices not only contributes to proper tooth placement, but can help eliminate several bad oral habits, improve behavior (reduce ADHD" by up to 50 percent) lessen earaches, and upper respiratory infections. They also  improve sleep and reduce or eliminate snoring, eliminate bed wetting, improve self image, improve performance in school. When the jaws develop fully, the tongue position is improved and the likelihood of obesity, diabetes, heart attach, stoke go down which adds 12 years to a person's life expectancy not to mention a better quality of life.

What do I do?


815 459 2202

Make an appointment today to have your child screened. The initial screening is free.  If your child shows signs of poor oral development, we would recommend taking the needed records to develop a customized course of interceptive treatment.

Call Today



815 459 2202


 Dr. Neal answers all of your questions about Intercepotive Orthodontics at Crystal Lake Dental Associates.


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Saturday, August 17, 2013

Gum Disease and Colon Cancer- Crystal Lake Dentist



Colon Cancer is Common and Deadly
It is the second leading cause of death by cancer in the United States. . In 2009, the most recent year data was available, 136,717 people in the United States were diagnosed with the disease. Overall, the lifetime risk of developing colorectal cancer is about 1 in 20 (5%). 

 Gum Disease and Fusobacteruim nucleatum
The connection is Fusobacterium nucleatum. Fusobacterium nucleatum is an oral bacteria, common to the human oral cavity, that plays a role in periodontal disease. This organism is commonly recovered from different  infections in humans and animals. It is a key component of periodontal plaque due to its abundance and its ability to live in community with other bacteria in the oral cavity 
Other conditions caused by Fusobacterium nucleatum 
Dr. Yiping Han has been tracking this bacteria for years. Research has shown that this  bacteria  travels  through the body and attaches itself to blood vessels  Dr Han has and implicated it in low birth weight, amniotic fluid sepsis, and fetal death. 

The Colon Cancer Connection
According to Dr. Yipping Han, it has been reported that there were a striking number of the bacteria in colon cancer tumor samples, published concurrently by separate research groups in the journal Genome Research.“There were huge numbers of [the bacteria] in the tumor tissues,” Han said. “But we didn't know if it was a cause or a consequence of the cancer. Using a test-tube experiment with samples of colon cancer tumors, Han’s lab mixed in Fusobacterium, and found that the cancer cells grew faster. “But if we knocked out [FadA] ( a component of the bacteria's metabolism), it didn't stimulate the growth anymore,” Han said. Dr Han's lab took their experiments in vivo, and injected Fusobacterium into mice who had colon cancer tumors. As expected, the bacteria increased the tumor growth rate.

Now What?
Dr. Han believes that there are markers for Fusobacterium nucleatum that doctors can track to help in early diagnosis of tumors and Colorectal Cancer. More research needs to be done to develop this testing procedure.

What Can You Do?
Go to the dentist regularly and have your teeth professionally cleaned. In addition, In addition if you are told you have gum disease, you need to get it treated. Also adults over age 40 should have routine colonoscopy done every 5 years.

Gateway To The Body.
The mouth is truly the gateway to your body and it is important to keep it healthy.In my previous blog, I listed several other conditions related to gum disease including Alzheimer's, heart attack, stroke, diabetes, osteoporosis and respiratory disease. Now you can include low birth weight, fetal sepsis, fetal death, and colon cancer.
Call for an appointment today!

815 459 2202


 Dr. Neal answers all of your questions about Gum Disease at Crystal Lake Dental Associates.


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Saturday, August 10, 2013

Gum Disease and Alzheimer's Crystal Lake Dentist

GUM DISEASE AND Alzheimer's

A new report found a link to Alzheimer's and a protein from a specific bacteria called P gingivalis which is common in gum disease . This laboratory study showed that gum disease bacteria lipopolysaccharides were found in the brain tissue of 4 out of 10 recently deceased people diagnosed with Alzheimer’s, and 0 out of 10 people without the condition.
This provides some, very limited, evidence to support the theory that in some people with Alzheimer’s, the bacteria responsible for gum disease may be playing a role in the disease.

 

 

GUM DISEASE AND HEART DISEASE*

HEART DISEASE


Several studies have shown that periodontal disease is associated with heart disease. While a cause-and-effect relationship has not yet been proven, research has indicated that periodontal disease increases the risk of heart disease.
Scientists believe that inflammation caused by periodontal disease may be responsible for the association.
Periodontal disease can also exacerbate existing heart conditions. Patients at risk for infective endocarditis may require antibiotics prior to dental procedures. Your periodontist and cardiologist will be able to determine if your heart condition requires use of antibiotics prior to dental procedures.

STROKE

Additional studies have pointed to a relationship between periodontal disease and stroke. In one study that looked at the causal relationship of oral infection as a risk factor for stroke, people diagnosed with acute cerebrovascular ischemia were found more likely to have an oral infection when compared to those in the control group.
DIABETES AND PERIODONTAL DISEASE*
Diabetic patients are more likely to develop periodontal disease, which in turn can increase blood sugar and diabetic complications.
People with diabetes are more likely to have periodontal disease than people without diabetes, probably because people with diabetes are more susceptible to contracting infections. In fact, periodontal disease is often considered a complication of diabetes. Those people who don't have their diabetes under control are especially at risk.
Research has suggested that the relationship between diabetes and periodontal disease goes both ways - periodontal disease may make it more difficult for people who have diabetes to control their blood sugar.
Severe periodontal disease can increase blood sugar, contributing to increased periods of time when the body functions with a high blood sugar. This puts people with diabetes at increased risk for diabetic complications.
GUM DISEASE AND OTHER SYSTEMIC DISEASES*
OSTEOPOROSIS
Researchers have suggested that a link between osteoporosis and bone loss in the jaw. Studies suggest that osteoporosis may lead to tooth loss because the density of the bone that supports the teeth may be decreased, which means the teeth no longer have a solid foundation.
RESPIRATORY DISEASE

Research has found that bacteria that grow in the oral cavity can be aspirated into the lungs to cause respiratory diseases such as pneumonia, especially in people with periodontal disease.
*(This information reprinted from web page information on the website of the American Academy of Periodontology)

Call for an appointment today!

815 459 2202


 Dr. Neal answers all of your questions about Gum Disease at Crystal Lake Dental Associates.


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Monday, August 5, 2013

Gum Recession-Crystal Lake Dentist


Gum Recession 




Is it normal for gums to recede?

No.

What Causes Gum Recession?

It is thought to be caused by a combination of improper tooth brushing and stress on the tooth from hard biting or tooth clenching.Other causes can be attributed to crooked  teeth out of position. There is a genetic tendency as well causing some people to have less attached gingiva (the gum tissue at the base of the tooth most resistant to receding). In addition some areas of the mouth may have muscle attachments from the lips that pull on the gum tissue during certain movements causing recession.

Is Gum Recession Bad?

yes, recession of the pink gum tissue means that the bone is also receding at least 3 mm more below the tissue. The bone is the foundation for the tooth root and when a sufficient  amount is lost, the tooth can be lost as well. In addition to this, recession can lead to severe tooth sensitivity, wear or the root and cavities.A tooth root exposed by recession is also esthetically ugly as well.

Can Gum Recession be Corrected?

yes. there are several grafting techniques to recover the tooth root today. These graft techniques help protect the tooth root from the return of recession and can eliminate sensitivity and improve the appearance.

Gum Recession before                     After treatment


When Should Gum Recession be Treated?

In our office, we recommend treatment when:

  •  there is 2 mm or more of gum recession and less than 2 mm of attached gingiva
  • when there is a definite frenum attachment causing the recession, the frenum needs to be treated and any recession  corrected
  • when the gum tissue is so thin that you can see through it
  • when the recession is causing tooth root sensitivity

Is Gum Recession treatment Painful?


No .Recently new membrane technology has changed the way this procedure is done. In the past a donor site was needed which meant an area of the palate was used to take a piece of tissue from. this piece of tissue was placed on the site needing the graft. Today we use a special safe donor membrane as the basis of this procedure and the graft site heals with almost no discomfort.

Where can I go for this procedure?

We have been providing this procedure for several years. We are excited to offer an improved technique  utilizing a great new product called Perioderm. Call us for a consultation or an appointment to get started.

 815 459 2202


Call us today to find out more about this great service

815 459 2202

 Dr. Neal answers all of your questions about Gum Recession at Crystal Lake Dental Associates.


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Monday, July 15, 2013

Interceptive Orthodontics Crystal Lake Dentist

Why do so many people need braces?


Answer in a nutshell OUR DIET! 

Change in the way we collect, store, and serve food.


Our diets have changed drastically since humans began farming and organizing into a more "civilized society". The industrial revolution and other "improvements" in farming, food processing, cooking, manufacturing,  refrigeration, etc  have taken us in a new direction when it comes to our diets. Over time we have become addicted to FAST FOOD from birth on. The highly processed, high calorie foods are put in our bodies begins with baby formula.

Problem.

High calorie manufactured and processed foods are responsible for rapid growth in children except for one area ... the MID and LOWER  FACE where the nose, tongue, and teeth reside. 

Old way... (our ancestor's diet). 

Nursing for at least 12 months helps develop the tongue and other muscles. After weaning the act of chewing hard unprocessed foods continues the development of the chewing muscles. Raw unprocessed foods requires more time, energy,  chewing effort to get the same calorie content. The harder working  muscles in turn guide greater jaw development and there is now room for all of the teeth including the wisdom teeth. 

New way (our modern convenience diet). 

Bottle feeding early and formula use leads to a poor tongue muscle tone and improper swallow habits. The high calorie content of these artificial foods leads to larger babies in all areas except the mid face. The continuation of high calorie "Fast Food" (easy to chew or drink) through the growing years leads to continued fast growth in all areas except the mid and lower face. 

Result. 

End result from a dental standpoint is crowded teeth, open bite, deep bite, crossbite, TMJ disorders, mouth breathing, gum disease, cavities, and tongue thrust swallowing. From a medical standpoint, there are a host of disorders arising from poor mid and lower face development. These can lead to a poorer quality of life, many doctor visits, and even shorten a person's life by up to 12 years. 

Difficult to go back to the way our ancestors ate.

Today it is impractical for many Americans to change their children's diets from birth on. Starting am infant with 12 months of  breastfeeding exclusively does not fit into the lifestyle of most families. Finding and feeding of the  roughage that our ancestors ate to our growing children though ideal is also impractical if not impossible for most families. 

Good News!!! We can correct the problem. 

The growth problem is correctable at an early age with interceptive orthodontics.
Using of specialized orthotic appliances, we correct the growth and save the family a lot of money normally spent on extractions and 2 or more years of conventional braces. 

More Good News!!!Added Benefits. 

The added benefits or Interceptive Orthodontics... Reduction or elimination of:

·        need for braces and oral surgery
·        cavities
·        clogged nasal airways
·        mouth breathing
·        speech problems
·        gum disease
·        clenching and grinding
·        headaches
·        neck and back problems from poor head posture
·        TMJ disorders
·        tonsillitis
·        ear infections
·        allergies
·        impacted wisdom teeth
·        snoring
·        Sleep Apnea
·        ADHD, ADD
·        poor self image from an ugly smile


Call us today to find out more about this great service

815 459 2202
 Dr. Neal answers all of your questions Invisalign, conventional orthodontics and Interceptive Orthodontics  and dental care at Crystal Lake Dental Associates.


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