Traduccion Minima Invasiva

The Ultimate Prevention Plan ~ Conception to College

Sweetwater Dental Hygienists’ Association 2004

The Ultimate Prevention Plan Conception to College Shirley Gutkowski, RDH, BSDH Sponsored by Xlear, Inc and Dreir Pharmaceuticals

Operative Dentistry for Children Not filling teeth but preserving the necessity for filling teeth should be the dentist’s work. Let him consider himself successful who can show a clientele where his patients boast that never from babyhood to the grave have they had a stain or hole in any tooth. That is true dentistry, not this tiresome, painful plugging of holes. It is an ideal possible for the majority of people. Why is our profession permitting sixty percent to suffer needlessly?

Operative Dentistry for Children M. Evangeline Jordan, DDS Operative Dentistry for Children Chapter III Oral Prophylaxis

Copyright,

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The Ultimate Prevention Plan ~ Conception to College • Study on pregnant women with periodontal disease • All measurements for a given woman were performed by the same examiner • Carious lesions were treated and all teeth indicated for extractions were extracted from both groups

The Ultimate Prevention Plan ~ Conception to College

163 Women Treatment Group

188 Women Control Group

2 PTB

1.10%

12 PTB

6.38%

1 LBW

0.55%

7 LBW

3.72%

3 PLBW

1.63%

19 PLBW

10.11%

J Perio August 2002

J Perio August 2002

The Ultimate Prevention Plan ~ Conception to College

The Cavity Connection

Decay Four Ingredients

The tooth

Germs Lacto Strep mutans Strep

Germ Food fermentable carbs sugar acid

Time Exposure pH

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The Cavity Connection Decay Four Ingredients

Germs Lacto Strep mutans Strep

The tooth

Germ Food fermentable carbs sugar acid

Time Exposure pH

Rebuilding Fluoride

Recaldent

Xylitol

Saliva

The Ultimate Prevention Plan ~ Conception to College • Fluoride – Works on the surface – Doesn’t need super clean surface to work – It’s in municipal water supply – It’s in toothpaste – Office treatments

Both decay at the same rate

1000 ppm Fluoride incorporated into the tooth as it forms

100 ppm Fluoride incorporated into the tooth as it forms

• • • • •

4 minute gel 1 minute rinse 1 minute gel 1 minute foam Fluoride varnish

„

Home fluoride rinse

„

Home fluoride gels Rx

„

Fluoride Lozenges

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The Tooth ~ Rebuilding with Fluoride

The Tooth ~ Rebuilding with Fluoride • J Public Health Dent. 1992 Winter;52(2):111-6. –

Works in the pits and fissures too!

The Tooth ~ Rebuilding with Fluoride Disease Prevention Section, National Institute of Dental Research, National Institute of Health, Bethesda, MD 20816.

The pattern of these findings is similar to that

This paper presents finaltwo results of an eight-year clinical trial designed to compare the found on the interim examinations. Even caries-preventive benefits of two self-administered fluoride procedures when used though combined regimen showed an and first separately andthe in combination with one another. Children in kindergarten grade residing in Springfield, Ohio, a nonfluoridated community, were assigned additional caries-preventive benefit compared randomly within school to one of three groups that either (a) rinsed once a week in with the considerations of cost school with a 0.2rinse, percent neutral NaF solution; (b) chewed, rinsed with, and then swallowed daily in schooland a neutral 2.2 mg NaF tablet; or (c)support carried out both effectiveness feasibility do not procedures. At baseline (1981), 1,640 participants were examined clinically using the changing an ongoing rinse remaining program DMF surface index. Findings for 640 children after to eightone years show that subjects the combination group experienced a mean caries increment of 2.40 that inemploys both procedures. For new DMFS, 15.2 percent lower than the mean score of 2.83 DMFS for children in the tablet programs the lower bestthan choice appears toin be thegroup. Only group and 32.8 percent the 3.57 DMFS for those the rinse thetablet difference in incremental caries scores between the combined fluoride procedure procedure alone. and the fluoride rinse was statistically significant (P less than .05).

A comparison of the caries-preventive effects of fluoride mouthrinsing, fluoride tablets, and both procedures combined: final results after eight years. Driscoll WS, Nowjack-Raymer R, Selwitz RH, Li SH, Heifetz SB.

Bacterial Redistribution ~ at home The key to the development of a more acid-resistant tooth is not the amount of fluoride applied to the tooth, but the frequency of its application.

www.drierpharmaceuticals.com

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Saliva

Saliva

Unstimulated and stimulated salivary pH and flow rate in patients with and without caries With Caries Without caries Unstimulated 6.55 +/- 0.07* 7.12 +/- 0.05 salivary pH Stimulated salivary 7.72 +/- 0.09* 7.21 +/- 0.06 ph Unstimulated salivary flow (ml/min)

0.43 +/- 0.03*

0.73 +/-0.09

Stimulated salivary flow (ml/min)

0.60 +/- 0.05

1.12 +/- 0.10

• “Salivary pH changes during soft drinks consumption in children” • International Journal of Paediatric Dentistry 2003: 13: 251-227 Coke pH 3.18 Sprite pH 2.23 ADES N pH 3.20 Chocolate milk pH 7.1

¾ One drink per week ¾ No straw ¾ pH 9x first hour ¾ Results averaged per child

Recaldent • Supply Calcium and Phosphorus • Casein Hydroxyapatite dissolves Fluorohydroxyapatite dissolves

– From dairy products – Available form – Not for people with milk allergies – OK for lactose intolerant

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Minimally Invasive Dentistry the saving of enamel

HOW RECALDENT WORKS H+ H+

From GC America Slide Series

From GC America Slide Series

HOW RECALDENT WORKS

From GC America Slide Series

Dr. E Reynolds

H+ H+

Dr. E Reynolds

HOW RECALDENT WORKS

From GC America Slide Series

Dr. E Reynolds

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The Cavity Connection

The Cavity Connection Decay Four Ingredients

Decay Four Ingredients

Germs Lacto Strep mutans

The tooth Germs Lacto Strep mutans Strep

The tooth

Killing

Chlorhexidine Rembrandt Xylitol

Germ Food fermentable carbs sugar acid

Time Exposure pH

Time Exposure pH

Kill Them Chlorhexidine Rembrandt

Re-Distribution At home Floss Brush

Germ Food fermentable carbs sugar acid

Xylitol Arginine

metabolic

At the Office Handpiece polish

Starving

Ecology

The Ultimate Prevention Plan ~ Conception to College

Illustration by Keith Kasnot, Scientific American, July 2001

http://www.altcorp.com/AffinityLaboratory/biofilms.htm P. Dirckx ‘00

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Published in: Science, 21 May 1999, VOL 284

P. Dirckx ’99 MSU–CBE

The Ultimate Prevention Plan ~ Conception to College

The Ultimate Prevention Plan ~ Conception to College •

• Xylitol – Disrupts bacterial metabolism – Decreases lactic acid output – Best in Gum

Xylitol 1. 2. 3. 4. 5.

Interferes with MS metabolism Effects oral ecology Oral biology homeostasis Stimulates saliva flow Shifts equilibrium to enhance remineralization

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The Ultimate Prevention Plan ~ Conception to College

The Ultimate Prevention Plan ~ Conception to College • Xylitol

• Inoculation of Streptococcus Mutans • Window of Infectivity – median 26 months of age – Mohan 20% by 14 months – Milgrom 6 months and predentate

The Ultimate Prevention Plan ~ Conception to College

– Start with the mothers • Soderling March 2000 • 195 mothers • 127 study group 2-3 times per day • At 2 years of age 9.7% colonized with MS – 28.6% in CHX – 48.5 in Fl group

The Ultimate Prevention Plan ~ Conception to College • Xylitol – Start with the mothers

50 45 40 35 30 25 20 15 10 5 0

• Isokangas Nov 2000 • 143 mothers still available • Chewed Xylitol until children age 24 months • Kids at age 5 Xylitol

Chlorhex

Fl Varnish

Percent of Children Colonized at age 2

– 71% less dmf than fluoride group – 74% less dmf than CHX group

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The Ultimate Prevention Plan ~ Conception to College

The Ultimate Prevention Plan ~ Conception to College Caries prevention by xylitol compared to a control group

• Xylitol – Soderling May 2001 – 147 mother/child pairs – Kids are 6 years old • Children showed reduced MS counts 4 years after mothers quit chewing xylitol • Concludes MS counts were still less in children at age 6

% Reduction in Caries for Xylitol vs. Control 0 -10 -20 -30 -40 -50 -60 -70 -80

The Ultimate Prevention Plan ~ Conception to College

E st on ia

D ay to n

C re ek

B el iz e

St an n

Y liv ie sk a

M on tr ea l

H un ga ry

ne sia

ni on

Po ly

2

Fr en ch

So vi et U

T ur ku

T ur ku

1

-90

The Ultimate Prevention Plan ~ Conception to College

• Xylitol • Hujoel 1999 – Only half the likelihood of decay 5 years after chewing the experimental gum – Long-term caries risk is down 93% in teeth erupting during the second year of habitual use

Second Window of Infectivity Occurs when first molars are erupting

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The Ultimate Prevention Plan ~ Conception to College

The Ultimate Prevention Plan ~ Conception to College • Xylitol

20% higher incidence of caries in second molars [over first molars] Featherstone reported in the 1980’s 75% of children aged 5-11 years were caries-free and about 70% of the 12-17 year olds had caries.

• Hujoel 1999

…data suggest that xylitol gum-chewing should start at least 1 year prior to [permanent] tooth eruption.

JADA May 2000 Dennison

The Ultimate Prevention Plan ~ Conception to College Alanine Arginine Asparagine Aspartic Acid Cysteine Glutamic Acid Glutamine Glycine Histidine

Minimally Invasive Dentistry the saving of enamel

Isoleucine Leucine Lysine Methionine Phenylalanine Proline Serine Threonine Tryptophan Tyrosine Valine

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The Ultimate Prevention Plan ~ Conception to College – Other methods to kill germs •

OTC mouthwashes – Listerine » Alcohol » Artificial colors – Rembrandt Dazzling Fresh Mouth and Age Defying » No Alcohol » No Colors – Tea Tree Oil

•

Assessing risk • • • • • • •

Recent decay Family history Past decay history Diet Caries Activity Test Home care X-rays

• Fluoride sources – – – –

Water Toothpaste Soft drinks Tea

• DIAGNOdent • QLF • Saliva quality

Prescription mouthwashes – Chlorhexidine

Assessing risk

Assessing risk • X-rays

• Disclosing solution – not just for kids • IO camera

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Assessing risk – x-rays • • • • •

Quality of film Readability Reproducibility Good Contrast Low radiation dose

Assessing risk • White spot lesions can remin. Completely provided no mechanical damage occurred. • Occlusal caries is over ½ total caries experience • Occlusal surfaces accounts for only 13% of tooth surfaces

Assessing risk – x-rays • High contrast and high max density support diagnosis • Extra soft, smooth corners/edges, disinfectable • Short exposure times • Firm/flexible • Archival quality – ensured for 30 years • Agfa Film

Assessing risk • Probing tests show probing pressure increases during the day • Save to infer increased explorer pressure as well

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Bacterial Redistribution ~ the office

Assessing risk – QLF

• Misdiagnosis

These areas may not be decalcified, and a explorer won’t stick

– 20-80% of true enamel caries called sound – 5-20% of sound fissures are called carious

Caries process

Pulpal lesion Dentin lesion Enamel lesion

Cavity No Cavity

White spot

De- & Re- mineralization Colonization Adhesion

Slide from KaVo DIAGNOdent series

Time

Possible Course of Action Preventive Therapy

Record and Monitor

DIAGNOdent reading

No Action

0-5

h

5-10

h

h

10-15

h

h

h

h

15-20

h

h

h

20-25

h

h

h

h

25-30

h

h

h

h

30+

h

Sealant

Preparation

Assessing risk – QLF Plaque Assessment • Plaque: – Can we detect plaque with QLF and is it possible to assess the threat this plaque poses?

h

Non-stained plaque in a caries Stained plaque in the same Non-stained plaque in a caries inactive person after 5 days of Dr.patient. person. All pictures courtesy R. Heinrich-Weltzien and Dr.prone J. Künisch, abstaining from brushing.

Friedrich-Schiller University of Jena, Erfurt, Germany

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The Ultimate Prevention Plan ~ Conception to College

The Cavity Connection Decay Four Ingredients

• Evolution in Dentistry

Germs Lacto Strep mutans Strep

The tooth

– Advancements in Patient Care – Advancements in Technology – Philosophy shift from extraction to prevention

Time Exposure pH

Redistribution

Mechanical at Home

Manual Toothbrush Cross Action Crest Tess

The Cavity Connection

Germ Food fermentable carbs sugar acid

Power brush Sonicare Crest Spin Oral Giene

Interdental Stim U Dents Prox a brush End tuft brush

Bacterial Redistribution ~ the office

Decay Four Ingredients

The tooth

Germs Lacto Strep mutans

Germ Food fermentable carbs sugar acid

Redistribution

Time Exposure pH

The American Academy of Pediatric Dentistry Position on Sealants

Mechanical At the Office Polishing Paste Clinpro Polish Air Polish

Handpiece Ergonomic Midwest RDH NSK America

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Bacterial Redistribution ~ the office 1. Bonded resin seals, effectiveness increased with good technique 2. Benefit increased sealing high risk teeth 3. Best risk eval done by experienced clinician (tooth morphology, clinical diag., past history of caries/fluoride/oral hyg. 4. Caries risk may exist in any tooth with a pit or fissure at any age

5.

6.

7.

8.

Placement methods should include careful cleaning of the pits and fissures without removal of any appreciable enamel. Low viscosity, hydrophilic material bonding layer has been shown to enhance the long term retention Glass ionomer are ineffective as sealants, but could be used as transitional seals Profession must be alert to new preventive methods…

The Ultimate Prevention Plan ~ Conception to College • S. Mutans prefers to live in pits and fissures • Saliva and neighboring teeth are believed to be the main source of infection • 50% of decay is on 13% of tooth surfaces

American Academy of Pediatric Dentists

Bacterial Redistribution ~ the office • Sealant facts – Fluoridated community – molars scored initially sound becae carious at a rate of 13% if not sealed – Fluoridated community – molars scored initially sound became carious at a rate of 8% if sealed

Bacterial Redistribution ~ the office • Sealant facts – Fluoridated community – molars scored as incipient or questionable became carious at a rate of 52% if not sealed – Fluoridated community – molars scored as incipient or questionable became carious at a rate of 11% if sealed.

Ped Dent 24:5; 2002 Use of Fissure sealants

Feigal reporting on Heller 1995 J Pub Health Dent

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Bacterial Redistribution ~ the office

Bacterial Redistribution ~ the office

• Sealant Facts – The last remnants of caries in a fissure should be inconsequential to the success of the sealant. – Surface cleaning is all that is appropriate, unless one judges a fissure to contain caries that has progressed to the dentin. Thus, caries-detecting dyes hold no therapeutic value.

Ped Dentistry 24:5 2002 Feigal

Bacterial Redistribution ~ the office • • • • • • • •

Defects in the fissure walls can lead to dentin caries with

NO enamel decalcification

Can’t diagnose this with a explorer or Caries Detection Dye (CDD)

Announcing Triage White

Fluoride Releasing Fluoride Recharging Transitional Sealant Transitional Restoration No etching Moisture friendly Acts as a physical barrier Surface protectant

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The Ultimate Prevention Plan ~ Boomers and Beyond

The Ultimate Prevention Plan ~ Boomers and Beyond

Decay Four Ingredients

The tooth

Germs Lacto Strep mutans Strep

Germ Food fermentable carbs sugar acid

Time Exposure pH

The Ultimate Prevention Plan ~ Boomers and Beyond Journal of Public Health Dentistry 2003 Spring

Atraumatic restorative treatment (ART): a three-year clinical study in Malawi—comparison of conventional amalgam and ART restorations • Results: The survival rates of ART restorations after three years were lower than those of amalgam restorations. 81% vs 90% p= 0.067 • Conclusions: ART class I restorations is competitive with that of conventional amalgam restorations

The Ultimate Prevention Plan ~ Boomers and Beyond Caries Research 2003 Jul-Aug

Six-year success rates of occlusal amalgam and glass-ionomer restorations placed using three minimal intervention approaches. • Secondary caries observed for 2% of glass-ionomer and 10% of amalgam restorations. p=0.001 • ART approach using glass-ionomer performed equally well as conventional restorative approaches using electrically driven equipment and amalgam for tx dentinal lesions in occlusal surfaces after 5 years

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The Ultimate Prevention Plan ~ Boomers and Beyond

Patient

The Ultimate Prevention Plan ~ Conception to College • Drink it fast • Drink it with a straw • Rinse with tap water after (source of fl) • Chew gum with Recaldent in it • Brush your teeth twice a day until all the stuff that looks like paste is off

• Rinse with ACT before bed • Have a dental check up 4x/yr • Get a power brush • Use Lozi-flur as directed • Don’t rinse out the toothpaste

First InterReading vention

Time lapse

Second reading

Derek

#12 DP 30

#28 MP 66

F Varnish

4 mo

#12 DP 15

#28 MP 55

Mike

#3 B 50

#18 B 35

F Varnish

2 mo

#3 B 35

#18 B 22

The Ultimate Prevention Plan ~ Conception to College • • • •

Summary of Remineralization plan Assess Offer options Take more clinical responsibility

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The Ultimate Prevention Plan ~ Boomers and Beyond

The Cavity Connection

• Advancements in dentistry today – Technological advancements • For Patients

Decay Four Ingredients

The tooth

Germs Lacto Strep mutans Strep

Germ Food fermentable carbs sugar acid

Time Exposure pH

Meal frequency

Acid Reflux

– – – – – – –

Chewing Gum

Sugar free Aspertame sorbitol

xylitol

The Ultimate Prevention Plan ~ Boomers and Beyond • Advancements in dentistry today – Preventive Philosophy – Medical view – Physicians of the mouth – Bacterial nature of decay and perio – Technological advancements

Xylitol Home fluoride Power brushes Recaldent® Municipal water fluoride Fluoride toothpaste Educated clinicians

The Ultimate Prevention Plan ~ Boomers and Beyond • Advancements in dentistry today – Preventive Philosophy • • • •

Prevent decay Prevent perio Prevent tooth loss Prevent systemic diseases

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The Ultimate Prevention Plan ~ Boomers and Beyond • Advancements in dentistry today – Medical view • • • •

Generalists Treating disease without surgery Treating diseases Referring advanced cases

The Ultimate Prevention Plan ~ Boomers and Beyond • Advancements in dentistry today – Bacterial nature of decay and perio • • • •

means medicines as well as debridement understanding bacteria understanding biofilms no longer surgical basis to treatments

The Ultimate Prevention Plan ~ Boomers and Beyond • Advancements in dentistry today – Physicians of the mouth • • • • • •

Not acting as a carpenter Acting as a physician Looking for potential diseases Treating diseases early Asking questions Treating the Whole family

The Ultimate Prevention Plan ~ Boomers and Beyond • Advancements in dentistry today – Technological advancements • For Clinicians – – – – – – – –

Clinpro paste Weightless handpieces NSK cordless Fluoride varnishes Fluoride lozenges DIAGNOdent Intraoral cameras Lasers X-ray film and digital x-rays

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• • • • • • •

The Ultimate Prevention Plan ~ Boomers and Beyond

The Ultimate Prevention Plan ~ Boomers and Beyond

Preventing Injury

Preventing Injury • • • • • •

field hockey, football, gymnastics, handball, ice hockey, in-line skating, • lacrosse,

acrobatics, baseball, basketball, bicycling, boxing, equestrian events, field events,

• • • • •

martial arts, racquetball, rugby, shot put, skateboardi ng, • skiing, • skydiving,

• • • • • • • •

soccer, softball, squash, surfing, volleyball, water polo, weight lifting, and wrestling

The Ultimate Prevention Plan ~ Conception to College • O-pro

• Prevent dental phobes using music or other distractions

– Impressions – Lab molded – Under $50 – www.Opro.com

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The Ultimate Prevention Plan ~ Conception to College • Visual distractions work better than auditory • Deep breathing • Modeling

The Ultimate Prevention Plan ~ Conception to College • Retaining control – General Anesthesia v Local w/N2O – Less anxiety with Local w/N2O

– Siblings – Parents – Peers/video

JDHA Fall 2000 Behav Manag Instruct of Anxious Clients...

• Muscle moves bone • The lip exerts 100 grams of pressure • Teeth need 1.7 grams of pressure to move • The tongue exerts 500 grams of pressure • Relapse

JDHA Fall 2000 Behav Manag Instruct of Anxious Clients...

• Fixed appliances don’t affect muscle • Myofunctional appliances that create biofeedback

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Myoresearch.com • MRC Positioner acts as a protectant against the brackets and bands • Opens the occlusion decreasing fixed appliance time by up to 15% • Can be for children and adults • 6 months for the first soft appliance • Finish when the lips are competent.

The Ultimate Prevention Plan ~ Conception to College Tobacco users who dip or chew 8 to 10 times a day may be receiving the nicotine equivalent of 30 to 40 cigarettes a day. The risk of developing oral cancer for long-term spit tobacco users is approximately six times greater than for non-users. Children who use spit tobacco products are 4 to 6 times more likely to develop oral cancer than nonusers. http://www.agd.org/

Moulded into the anterior section (similar to orthodontic archwire). 1. Tooth Channels. 2. Labial Bows impart a light force on misaligned anterior teeth as they are developing.. 3. Tongue Tag actively trains the positioning of the tongue tip as in myofunctional and speech therapies. 4. Tongue Guard stops tongue thrusting when in place and forces child to breathe through the nose. 5. Lip Bumpers to discourage over-active mentalis muscle activity. 6. Edge to Edge Class I Jaw Position is produced when in place (same as most functional appliances). Combined with prevention of tongue thrusting and forcing the child to nose breathe, Class II correction in particular, is achieved.

The Ultimate Prevention Plan ~ Conception to College id you know that: •More than 5 million children alive today will die prematurely from smoking-related illnesses? •Nearly every adult who smokes (almost 90 percent) took his or her first puff at or before the age of 18? •Or, that increasing tobacco taxes is an effective way to prevent and reduce smoking, especially among kids? www.tobaccofreekids.org

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The Ultimate Prevention Plan ~ Conception to College Oral Cancer facts: Increase in people under forty Largest increase in people with no risk factors Oral cancer survival is 50% due to late diagnosis Most Oral cancer is detected in the Physicians office

The Ultimate Prevention Plan ~ Conception to College

www.oralcancer.org

The Ultimate Prevention Plan ~ Conception to College • Chemotherapy • Radiation therapy • Caries reduction

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