Category: Family Health

What Is Body Dysmorphic Disorder?

Body dysmorphic disorder causes people to feel worried that parts of their body are flawed in some way. It’s related to obsessive-compulsive disorder (OCD). 

People with this mental health condition spend hours concerned that something is wrong with their looks. For example, they may see “flaws” that others wouldn’t notice. These thoughts and worries take up time and drain energy. As a result, people often miss out on being with friends, going to school or work, or doing normal activities. This can make them feel alone, sad, or depressed. But with treatment, people with the condition can learn coping skills and feel less upset by negative thoughts.

What Causes Body Dysmorphic Disorder?

There’s still much to learn about the exact causes of body dysmorphic disorder. But experts believe these things play a role in causing it:

Genes. The disorder may be partly inherited, and tends to run in families.

Serotonin. The brain needs serotonin (a brain chemical linked to mood and energy) to work correctly. A low level of it helps explain why the disorder happens.

Brain differences. Studies have shown that some areas of the brain look and work differently in people with the disorder.

Body dysmorphic disorder isn’t caused by anything the person or a parent did. It’s not anyone’s fault.

What Are Signs & Symptoms of Body Dysmorphic Disorder?

People with body dysmorphic disorder:

Focus on their looks to an extreme. They find it hard to stop thinking about the parts of their looks that they dislike. They focus on specific things — like a pimple or the shape or look of their nose, eyes, lips, ears, teeth, or hands. They may seek out extreme treatments like plastic surgery.

Feel upset about their appearance. They feel worried, stressed, and anxious about their looks almost all the time. They may get angry and be easily irritated.

Check or fix their body part often. People with the disorder feel the strong need to check their appearance over and over. For example, they may look in a mirror, ask others how they look, or “fix” their appearance many times a day. 

Try not to be seen. Some people feel so bad about their looks that they don’t want to be seen. They may stay home; keep to themselves; or use makeup, hats, or clothes to cover up. They may also avoid looking in mirrors because it’s so stressful.

Have false ideas about their looks. Someone with body dysmorphic disorder doesn’t see their body as it really is or as others see it. The “flaws” they focus on are things that others can hardly notice. They exaggerate them, so things seem worse in their minds.

How Is Body Dysmorphic Disorder Diagnosed?

If your doctor thinks you have body dysmorphic disorder, you’ll likely need to see a mental health provider who understands it and can diagnose it. This person will ask questions and listen carefully to the answers to figure out if you have the disorder or something else.

How Is Body Dysmorphic Disorder Treated?

Body dysmorphic disorder treatment can include cognitive behavioral therapy (CBT). This type of talk therapy helps you learn to manage worry, fear, and anxiety. CBT teaches you that what you think and do affects how you feel. You’ll learn that when you face a fear, the fear gets weak and goes away. You’ll find out how to change the way you see your body. Slowly, and with lots of support, you can focus less on flaws. You’ll learn to stop checking and fixing your looks.

Medicines that help serotonin work well are used to treat body dysmorphic disorder. These are sometimes called SSRI medicines. They can help people obsess less about their looks and feel less distress. 

Most of the time, CBT and medicine are used together to treat body dysmorphic disorder.

What Else Should I Know About Body Dysmorphic Disorder?

It can be hard for people with body dysmorphic disorder to understand that it makes them see themselves in a false way. It takes time and effort for CBT and medicines to work, so be patient. Go to all your care visits, work hard in therapy, and don’t give up. Be honest and open with your mental health provider. Say if you feel depressed, and let others help you. 

Learn more about it. You can find more information about body dysmorphic disorder and support online at:

Pain that involves more than just one joint is called polyarticular joint pain. A joint may simply be painful (arthralgia) or may also be inflamed (arthritis).

Pain that seems to be coming from joints can sometimes be coming from structures outside the joints, such as ligaments, tendons, or muscles (see Introduction to the Biology of the Musculoskeletal System). Examples of such disorders are bursitis and tendinitis.

True joint pain (arthralgia) may or not be accompanied by joint inflammation (arthritis). The most common symptom of joint inflammation is pain. Inflamed joints may also be warm and swollen, and less often the overlying skin may be red. Arthritis may involve only joints of the limbs or also joints of the central part of the skeleton, such as the spine or pelvis. Pain may occur only when a joint is moved or may be present at rest. Other symptoms, such as rash, fever, eye pain, or mouth sores, may be present depending on the cause of the joint pain.

Different disorders tend to affect different numbers of joints. Because of this, doctors consider different causes of pain when the pain affects one joint (see Joint Pain: Single Joint) than when it affects more than one joint. When multiple joints are involved, some disorders are more likely to affect the same joint on both sides of the body (for example, both knees or both hands) than other disorders. This is termed symmetric arthritis. Also, in some disorders, an attack of arthritis remains in the same joints throughout the attack. In other disorders, the arthritis moves from joint to joint (migratory arthritis).

Causes of Pain in Many Joints

In most cases, the cause of pain originating inside multiple joints is arthritis. Disorders that cause arthritis may differ from each other in certain tendencies, such as the following:

• How many and which joints they usually involve

• Whether the central part of the skeleton, such as the spine or pelvis, is typically involved

• Whether arthritis is sudden (acute) or longstanding (chronic)

Acute arthritis affecting multiple joints is most often due to

Less common causes of acute arthritis in multiple joints include Lyme disease and gout (disorders that also may affect only one joint), gonorrhea and streptococcal bacterial infections, and reactive arthritis (arthritis that develops after an infection of the digestive or urinary tract).

Chronic arthritis affecting multiple joints is most often due to

Some chronic inflammatory disorders can affect the spine as well as the limb joints (called the peripheral joints). Some affect certain parts of the spine more frequently. For example, ankylosing spondylitis more commonly affects the lower (lumbar) part of the spine, whereas rheumatoid arthritis more typically affects the upper (cervical) part of the spine in the neck.

The most common disorders outside the joints that cause pain around the joints are

Bursitis and tendinitis often result from injury, usually affecting only one joint. However, certain disorders cause bursitis or tendinitis in many joints.

Evaluation of Pain in Many Joints

In evaluating joint pain, doctors first try to decide whether joint pain is caused by a disorder of the joints or a serious bodywide (systemic) illness. Serious bodywide disorders may need specific immediate treatment. The following information can help people decide when to see a doctor and know what to expect during the evaluation.

In people with pain in more than one joint, symptoms that should prompt rapid evaluation include

• Joint swelling, warmth, and redness

• New skin rashes, spots, purple blotches, or nail pitting

• Sores in the mouth or nose or on the genitals

• Chest pain, shortness of breath, or new or severe cough

• Abdominal pain

• Fever, sweats, weight loss, or chills

• Eye redness or pain

People with warning signs should see a doctor right away. People without warning signs should call a doctor. The doctor decides how quickly they need to be seen based on the severity and location of pain, whether joints are swollen, whether the cause has been diagnosed previously, and other factors. Typically, a delay of several days or so is not harmful for people without warning signs.

Doctors first ask questions about the person’s symptoms and medical history. Then they do a physical examination. What doctors find during the history and physical examination often suggests a cause for joint pain and guides the tests that may need to be done (see table Some Causes and Features of Pain in More Than One Joint).

Doctors ask about pain severity, onset (sudden or gradual), how symptoms vary over time, and what increases or decreases pain (for example, rest or movement or time of day when the symptoms worsen or abate). They ask about joint stiffness and swelling, previously diagnosed joint disorders, and risk of exposure to sexually transmitted infections and Lyme disease.

Doctors then do a complete physical examination. They check all joints (including those of the spine) for swelling, redness, warmth, tenderness, and noises that are made when the joints are moved (called crepitus). The joints are moved through their full range of motion, first by the person without assistance (called active range of motion) and then by the doctor (called passive range of motion). This examination helps determine which structure is causing the pain and if inflammation is present. They also check the eyes, mouth, nose, and genital area for sores or other signs of inflammation. The skin is examined for rashes. Lymph nodes are felt and the lungs and heart examined. Doctors usually test function of the nervous system so that they can detect disorders of the muscles or nerves.

Some findings give helpful clues as to the cause. For example, if the tenderness is around the joint but not over the joint, bursitis or tendinitis is likely the cause. If tenderness is present in many areas besides the joints, fibromyalgia is possible. If the spine is tender as well as the joints, possible causes include osteoarthritis, reactive arthritis, ankylosing spondylitis, and psoriatic arthritis. Findings in the hand can help doctors differentiate between rheumatoid arthritis and osteoarthritis, two particularly common types of arthritis. For example, rheumatoid arthritis is more likely to involve the large knuckle joints (those that join the fingers with the hand) and wrist. Osteoarthritis is more likely to involve the finger joint near the fingernail. The wrist is unlikely to be affected in osteoarthritis, except at the base of the thumb.

The following tests are the most important overall:

If joints are swollen, doctors usually insert a needle into the joint to take a sample of the fluid in the joint for testing (a procedure called joint aspiration or arthrocentesis). Doctors numb the area before taking a sample, so people experience little or no pain during the procedure. Doctors generally do a culture on the fluid to see whether infection is present. They look under a microscope for crystals in the fluid, which indicate gout or related disorders. The numbers of white blood cells in the fluid indicate whether the joint is inflamed.

Doctors also often do blood tests for autoantibodies. Examples of such tests are antinuclear antibodies, anti–double-stranded DNA, anticyclic citrullinated peptide, and rheumatoid factor. Autoantibodies in the blood may indicate an autoimmune disorder such as rheumatoid arthritis or systemic lupus erythematosus.

The ESR is a test that measures the rate at which red blood cells settle to the bottom of a test tube containing a blood sample. Blood that settles quickly typically means that bodywide (systemic) inflammation is likely, but many factors can affect the ESR test including age and anemia, so the test is sometimes inaccurate. To help determine whether bodywide inflammation is present, doctors sometimes do another blood test called C-reactive protein (a protein that circulates in the blood and dramatically increases in level when there is inflammation).

Imaging tests are sometimes necessary, especially if there is a possibility of bone or joint tumors. X-rays are done first, but sometimes computed tomography (CT) or magnetic resonance imaging (MRI) is needed.

If a particular disorder is suspected, other tests may be required (see table Some Causes and Features of Pain in More Than One Joint).

Treatment of Pain in Many Joints

The underlying disorder is treated. For example, people with an autoimmune disorder (such as systemic lupus erythematosus) may need a drug that suppresses the immune system. People with a gonorrhea infection in the joint need antibiotics.

Symptoms can usually be relieved before the diagnosis is known. Inflammation can usually be relieved with nonsteroidal anti-inflammatory drugs (NSAIDs). Pain without inflammation is usually treated more safely with . Immobilizing the joint with a splint or sling can sometimes relieve pain. Applying heat (for example, with a heating pad) may decrease pain by relieving spasm in the muscles around joints (for example, after an injury). Applying cold (for example, with ice) may help relieve pain caused by joint inflammation. Heat or cold should be applied for at least 15 minutes at a time to allow deep penetration. The skin must be protected from extremes of heat and cold. For example, ice should be put in a plastic bag and wrapped in a towel.

After the acute pain and inflammation have lessened, physical therapy may be useful to regain or maintain range of motion and strengthen surrounding muscles. In people with chronic arthritis, continued physical activity is important to prevent permanent joint stiffness (contractures) and muscle loss (atrophy).

Essentials for Older People: Joint Pain

Osteoarthritis is the most common cause of multiple joint pains in older people.

Although more common among younger adults (those aged 30 to 40), rheumatoid arthritis can also begin later in life (after age 60).

People over age 55 who have hip and shoulder stiffness and pain that is usually worse in the morning may have polymyalgia rheumatica. Recognizing polymyalgia rheumatica is important because treating it can help prevent other problems.

Gout in older women tends to affect the distal interphalangeal (DIP) joints of the hands (the first knuckles from the tip of the fingers).

Key Points

• Acute pain in multiple joints is most often due to inflammation, gout, or the beginning or flare up of a chronic joint disorder.

• Chronic pain in multiple joints is usually due to osteoarthritis or an inflammatory disorder (such as rheumatoid arthritis) or, in children, juvenile idiopathic arthritis.

• When significant fluid accumulates inside of a joint, a fluid sample usually must be withdrawn and tested.

• Lifelong physical activity helps maintain range of motion in people with chronic arthritis.

Everyone is anxious to get back into their home after a disaster. If you evacuated, you may be worried about what you will find when you get back. But, don’t rush in when you arrive. There are certain precautions to follow if you find your home had damage. Be aware that your house may be weakened, or contaminated with mold or sewage, which can cause health risks for your family.

Be aware of hazards

Outside the home

• Before entering your home, look outside for damaged power lines, gas lines, foundation cracks and other exterior damage. It may be too dangerous to enter the home until an inspector checks it out.
• Turn the main electrical power and water systems off until you or a professional can ensure that they are safe. NEVER turn the power on or off or use an electrical tool or appliance while standing in water.
• Smell for gas. If you smell natural gas or propane, or hear a hissing noise, leave immediately and contact the fire department.
• Check the ceiling and floor for signs of sagging. Water may be trapped in the ceiling or floors may be unsafe to walk on.
• Beware of rodents, snakes, insects and other animals that may be on your property or in your home.

Inside the home

Mold 

• If your home was flooded or had high humidity due to the disaster, assume there is mold growth. Exposure to mold may increase health risks for survivors with asthma, allergies or other breathing conditions.
• Open doors and windows. Let the house air out before staying inside for any length of time if the house was closed for more than 48 hours.
• For instructions on how to clean mold-infested areas, see resources from the U.S. Centers for Disease Control and Prevention (CDC).
• Wear protective clothing, including rubber gloves and rubber boots.

When in doubt, throw it out

• Throw out items that absorb water and cannot be cleaned or disinfected (e.g., mattresses, carpeting, cosmetics, stuffed animals and baby toys).
• Remove all drywall and insulation that has been in contact with flood waters.
• Be careful when moving furnishings or debris since they may be waterlogged and heavier.
• Throw out all food, beverages and medicine exposed to flood waters and mud, including canned goods and containers with food or liquid that have been sealed shut.

Cleaning

• Clean hard surfaces (e.g., flooring, countertops and appliances) thoroughly with hot water and soap or a detergent.
• Some cleaning solutions can cause toxic fumes and other hazards if mixed. If you smell a strong odor or your eyes water from the fumes or mixed chemicals, open a window and get out of your home.
• Financial assistance up to $300 may be available to help prevent additional losses and protect the health and safety of your household if your home has damage but is livable.

Before making repairs or rebuilding, check with your local building department to see if a permit is required. For an in-depth look at safety precautions and clean-up methods, see the CDC website at Clean Up Safely After a Disaster.

 

 

For the latest information on Hurricane Ida visit fema.gov/disaster/4611. Follow us on Twitter at twitter.com/FEMARegion6 and like us on Facebook at facebook.com/FEMARegion6/.

Sjögren’s Disease 

Exercise and Physical Activity from the National Institute on Aging 

VIDEO
Liliana’s Story (SLE)
In this video, Liliana shares her experience living with lupus and how participating in clinical research at the National Institutes of Health has helped her. *Note: English is spoken in this video. Spanish captioning is available.

VIDEO
Shirley’s Story (SLE)
In this video, Shirley talks about her lupus diagnosis and treatment at the National Institutes of Health.*Note: English is spoken in this video. Spanish captioning is available.

VIDEO
Nicole’s Story (SLE)
In this video, Nicole talks about her lupus diagnosis and treatment at the National Institutes of Health.*Note: English is spoken in this video. Spanish captioning is available.

Anthrax is a potentially fatal infection with Bacillus anthracis, a gram-positive, rod-shaped bacteria (see figure ). Anthrax may affect the skin, the lungs, or, rarely, the digestive (gastrointestinal) tract.

• Anthrax rarely occurs in people; when it does, it usually results from skin contact but can result from inhaling anthrax spores, eating contaminated meat, or rarely by injecting contaminated illicit drugs.

• Anthrax spores are a potential biological weapon.

• Anthrax bacteria produce several toxins, which cause many of the symptoms.

• Symptoms include bumps and blisters (after skin contact), difficulty breathing and chest pain (after inhaling spores), and abdominal pain and bloody diarrhea (after eating contaminated meat).

• Symptoms suggest the infection, and identifying the bacteria in samples taken from infected tissue confirms the diagnosis.

• People at high risk of being exposed to anthrax are vaccinated.

• Antibiotics and the vaccine must be given soon after exposure to reduce the risk of severe illness or death.

(See also Overview of Bacteria.)

Anthrax can occur in wild and domestic animals that graze, such as cattle, sheep, and goats, and in other animals such as horses, hippos, elephants, and Cape buffalo.

Anthrax bacteria produce spores that can live for years in soil. Grazing animals become infected when they have contact with or consume the spores. Usually, anthrax is transmitted to people when they have contact with infected animals or animal products (such as wool, hides, and hair). Spores may remain in animal products for decades and are not easily killed by cold or heat. Even minimal contact is likely to result in infection.

Although infection in people usually occurs through the skin, it can also result from inhaling spores (inhalation anthrax), eating contaminated, undercooked meat (gastrointestinal anthrax), or rarely by injecting contaminated illicit drugs.

Anthrax is rare in humans and is not contagious from person to person. However, in rare cases, skin anthrax (cutaneous anthrax) may be spread from person to person by direct contact with an infected person or an object contaminated by an infected person. Inhalation anthrax, gastrointestinal anthrax, and injection anthrax are not spread from person to person.

Anthrax is a potential biological weapon because anthrax spores can be spread through the air and inhaled. In the anthrax bioattacks of 2001, spores were spread in envelopes mailed via the United States Postal Service.

Recently, injection anthrax has developed in people in northern Europe who inject contaminated heroin. Anthrax that is spread in this way has not been seen in the United States.

Anthrax bacteria produce several toxins, which cause many of the symptoms.

Symptoms of Anthrax

Anthrax symptoms vary depending on how the infection is acquired:

• Through the skin (most cases)

• Through inhalation (most serious)

• Through the gastrointestinal tract (rare)

• Through injection (rare)

Most anthrax cases involve the skin.

A painless, itchy, red-brown bump appears 1 to 10 days after exposure. The bump forms a blister, which eventually breaks open and forms a black scab (eschar), with swelling around it. Nearby lymph nodes may swell, and people may feel ill—sometimes with muscle aches, headache, fever, nausea, and vomiting. It may take several weeks for the bump to heal and the swelling to go down.

About 10 to 20% of untreated people die, but with treatment, death is rare.

Inhalation anthrax is the most serious. It results from inhaling anthrax spores, almost always when people are working with contaminated animal products (such as hides).

Spores may stay in the lungs for weeks but eventually enter white blood cells called macrophages, where they germinate, and the resulting bacteria multiply and spread to lymph nodes in the chest. The bacteria produce toxins that make the lymph nodes swell, break down, and bleed, spreading the infection to nearby structures. Infected fluid accumulates in the space between the lungs and the chest wall.

Symptoms develop 1 day to 6 weeks after exposure. Initially, they are vague and similar to those of influenza (flu), with mild muscle aches, a low fever, chest discomfort, and a dry cough. After a few days, breathing suddenly becomes very difficult, and people have chest pain and a high fever with sweating. Blood pressure rapidly becomes dangerously low (causing shock), followed by coma. These severe symptoms probably result from a massive release of toxins.

Gastrointestinal anthrax or an infection of the brain and the tissues covering the brain and spinal cord (meninges)—an infection called meningoencephalitis—may develop.

Many people die 24 to 36 hours after severe symptoms start, even with early treatment. Without treatment, all people with inhalation anthrax die. In the 2001 outbreak in the United States, 45% of people treated for inhalation anthrax died.

Gastrointestinal anthrax is rare. When people eat contaminated meat, the bacteria grow in the mouth, throat, or intestine and release toxins that cause extensive bleeding and tissue death. People have a fever, a sore throat, a swollen neck, abdominal pain, and bloody diarrhea. They also vomit blood.

Even with treatment, about 40% of infected people die, probably because they have already become very ill before the diagnosis is made.

Injection anthrax is rare. Symptoms may be similar to those of skin anthrax, such as fever and an itchy bump or bumps that appear where the heroin was injected. The bump develops into a painless sore that forms a black scab (eschar) with swelling around it. A pocket of pus (abscess) may develop deep under the skin or in the muscle where the heroin was injected.

Injection anthrax can spread throughout the body faster than skin anthrax and can be harder for doctors to diagnose and treat than skin anthrax.

Diagnosis of Anthrax

Doctors suspect skin anthrax based on its typical appearance. Knowing that people have had contact with animals or animal products or were in an area where other people developed anthrax supports the diagnosis.

If inhalation anthrax is suspected, chest x-ray or computed tomography (CT) is done.

Samples of blood, infected skin, fluids around the lungs, or stool are removed and examined with a microscope or cultured (enabling bacteria, if present, to multiply). Anthrax bacteria, if present, can be readily identified.

If people have inhalation anthrax and symptoms (such as confusion) suggesting that the brain may be affected, doctors may also do a spinal tap (lumbar puncture) to obtain a sample of the fluid that surrounds the brain and spinal cord (cerebrospinal fluid). The sample is examined and analyzed. People undergo imaging of the brain and spine, such as with a CT scan or magnetic resonance imaging (MRI), when a spinal tap cannot be done.

Blood tests may be done to check for fragments of the bacteria’s genetic material or antibodies to the toxins produced by the bacteria.

Treatment of Anthrax

The longer anthrax treatment is delayed, the greater the risk of death. Thus, treatment is usually started as soon as doctors suspect that people have anthrax.

Skin anthrax (cutaneous anthrax)

Inhalation, gastrointestinal, and other anthrax infections including severe skin anthrax are treated with a combination of three antibiotics given by vein (intravenously). Once the intravenous antibiotics are done, people are given an antibiotic by mouth for 60 days to kill any remaining spores in the lungs.

If the brain and meninges are affected or if fluid has accumulated around the lungs, corticosteroids may help. A chest tube is used to continuously drain fluid around the lungs.

Other treatments may include mechanical ventilation to help with breathing and fluids and medications to increase blood pressure.

Prevention of Anthrax

biological weapon, most members of the armed forces have been vaccinated. To be effective, the vaccine must be given in five doses. A booster shot, given yearly, is also recommended. All of the shots are injected into a muscle. Animals can be given an animal vaccine as well.

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Your dentist tells you that you need braces, bringing back not-so-fond memories of kids being called “metal mouth.”

Take heart. Braces have evolved and new alternatives in both look and materials are available. The FDA is responsible for reviewing these devices for safety and effectiveness and, as appropriate, granting marketing authorization for the devices before they can be sold.

Some Common Questions

Q: I thought braces were just for kids. Not so?

A: Not anymore. Orthodontics is a branch of dentistry dedicated to straightening misaligned teeth. According to the American Association of Orthodontists, 1-in-3 orthodontic patients today are adults. So, while you may not have worn braces as a kid, you may still choose to investigate teeth straightening as an adult.

Q: Why do I need to wear braces?

A: Simply put, braces will straighten your teeth. Not only will you have a straighter smile, but they will also help you maintain good dental hygiene. Crooked or crowded teeth can be hard to clean, causing inflamed and infected gums and other forms of dental disease. Wearing braces now can go a long way toward helping you maintain healthy teeth and gums down the road.

Q: Do I have to have a mouth full of metal?

A: Your dentist or orthodontist will need to make that determination based on your dental exam. Traditional braces can be composed of metal, plastic, or ceramic brackets and can be colored to match the color of your teeth. And if you’re feeling expressive, the rubber bands connecting the brackets come in different colors.

Additionally, there are now alternatives called dental aligners that are clear and removable. However, they may not work for everyone’s teeth. Ask your dentist or orthodontist if they are right for you.

Q: How do traditional braces work?

A: Braces move teeth by applying pressure and usually consist of small metal, ceramic, or plastic brackets cemented to your teeth, connected by a wire, and held to the brackets by rubber bands. The wire is regularly tightened by the dentist or orthodontist, gradually shifting your teeth and jaw.

Q: How do clear aligners work?

A: Aligners are made of clear plastic material and are worn over your teeth to straighten them. You’ll get a series of custom-made aligners and wear each one for 1-2 weeks, as directed by your dentist or orthodontist. This stage of treatment can take anywhere from six to 18 months. In the next stage of treatment, you will wear a retainer, also as directed by your dentist or orthodontist. This way, your teeth are gradually moved into the correct position according to your personal treatment plan.

Aligners are removable and need to be taken out before you eat, brush, and floss, allowing you to maintain good oral hygiene. Because they are removable, you must be sure to follow your dentist or orthodontist’s instructions on how long to wear them each day, typically about 22 hours daily. After your aligner treatment is complete, your dentist or orthodontist will instruct you on using a retainer to maintain your orthodontic treatment.

Q: How long will I have to wear braces?

A: That depends on how much tooth correction your dentist or orthodontist thinks you need. An average treatment time period is two years; it may take more time or less.

There really is no “faster” method of straightening teeth. Orthodontics works by applying slow pressure that affects the bone surrounding a tooth to allow it to move. If movement is too rapid, tooth loss or a breakdown of the bone can occur.

Q: Isn’t it hard to clean teeth when you have metal braces?

A: Yes. It’s easy for food to get stuck in the braces, so you should be extra careful to keep your teeth clean and free of food material. Not cleaning your teeth carefully can cause dental decay, swollen or bleeding gums, and may affect your overall oral health. Your dentist or orthodontist may recommend more frequent dental cleanings to maintain good oral hygiene while wearing your braces, rather than the usual twice a year.

Q: Now my orthodontist says I need to wear a retainer. What’s that for?

A: Retainers, worn nightly after you’re done with the braces, help maintain tooth position so the bone in the tooth can solidify in the new position.

Q: Are there certain types of food I should avoid eating when I have braces?

A: Yes. You should avoid eating anything chewy or sticky, like gummy bears or chewing gum, and should try not to eat hard candies or popcorn, as these can damage the braces and prolong the time you must wear them.

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Fewer teens today
smoke cigarettes than twenty years ago, but more are discovering new—and old—ways to use tobacco, including hookah, that are no less harmful to their health. 

What is hookah?

Hookah (also called argilah, nargile, and hitboo) is the traditional name for waterpipes that were first used centuries ago in South Asia and the Middle East. A social and often shared form of tobacco use, hookah smoking has been gaining popularity among teens and young adults in the United States.

How does it work?

Typically, groups of people sit around a hookah to smoke a shredded tobacco mixture known as
sisha, which is usually sweetened with fruity or candy flavors. The hookah’s vase-like tower is heated near the top by lighting charcoal or bits of wood. Smoke and vapor from the combusted tobacco bubble through the hookah’s water chamber and into one or more attached hoses from which users inhale before passing it to the next person in the group. 

Smoking hookah is not safe.

Because smoke from the tobacco passes through water, many people mistakenly believe hookahs are safer than cigarettes. However, studies show hookah does not effectively filter out harmful substances from the smoke. Hookah smokers may end up breathing in higher amounts of nicotine, metals, and toxic chemicals. Germs are also spread on the hoses’ shared mouthpieces.

Here are some important facts about hookah:

• One hookah session is the same as smoking 100 or more cigarettes. Hookah sessions can last half an hour or more, and the amount of smoke typically inhaled during this time is 100-200 times greater than the smoke inhaled from smoking one cigarette. Many of the same toxins that are inhaled in a cigarette are also breathed in through a hookah. Individuals may experience a rapid heart rate, increased blood pressure, or even irregular heartbeats. In the long term, it also puts you at increased risk for several types of tobacco-related cancers that strike the lungs, bladder and other organs, as well as respiratory diseases.

• Poisonous and addictive chemicals are in hookah smoke. Carbon monoxide, arsenic, selenium, mercury, lead, benzene, and other chemicals in hookah smoke can reach dangerous levels during a single session. These chemicals have been shown to be especially dangerous for pregnant women and children.

• Hookah leads to addiction. Research shows that over 95% of the nicotine is still available when using hookah and is not filtered out by the water chamber. This is more than enough to cause addiction. People who smoke hookah are much more likely to begin smoking cigarettes. One
  study using Centers for Disease Control and Prevention (CDC) data found that young adult hookah smokers were more than twice as likely to try cigarettes than nonsmokers. Hookah also has been linked to increased alcohol and marijuana use.

• Sharing more than smoke. Because hookahs come into direct contact with the mouth and are shared by multiple smokers, infectious diseases of the lungs, mouth, lips, and gums can be spread to other people during a session. Contagious diseases ranging from oral herpes to the flu might be passed along, and more dangerous illnesses such as tuberculosis and hepatitis have been linked to Hookah use.

Discuss the dangers of hookah.

According to the CDC, tobacco use remains our country’s leading cause of preventable disease and death. Tobacco use almost always begins during youth and young adulthood. It’s important to consider the health risks associated with hookah and other forms of tobacco smoking and to have a discussion with your family about it.

Additional Information & Resources:

The overwhelming majority of adult smokers began smoking before age 18, and many were addicted before they even finished high school. So, why do kids pick up that cigarette in the first place?

• Their parents are smokers.
• Peer pressure—their friends encourage them to try cigarettes and to keep smoking.
• They see smoking as a way of rebelling and showing independence.
• They think that everyone else is smoking and that they should, too.
• The tobacco industry has used clever marketing tactics to specifically target teenagers.
• The price is right—in places where low tobacco taxes have kept the price down, it is easier for kids to afford cigarettes.
• Most teenagers simply like to try new things, but they aren’t mature enough to think of the long-term consequences.
• Nicotine is a “feel-good” drug without intoxication.

The majority of children in elementary school and the early part of middle school have never tried a cigarette. Most will tell you that they never will smoke cigarettes and they mean what they’re saying. But as they get older, some will become more open to the idea of smoking.

Tobacco companies shape their marketing campaigns to portray smokers as cool, sexy, independent, fun, attractive and living on the edge—images that appeal to many teens. As a result, they try smoking and don’t understand that they can become addicted after smoking as few as 100 cigarettes (five packs). Only 5 percent of high-school-age smokers believe they’ll still be smoking five years after graduation, but they don’t understand how difficult quitting can be. Research shows that after eight years, 75 percent of those smokers still will use some form of tobacco.

Know a teen who is ready to quit smoking? The American Lung Association’s Not-On-Tobacco (N-O-T) program is designed for 14 to 19-year-old smokers who want to quit. Contact your local American Lung Association office to find out if N-O-T is available in your area.

Most teens are aware that people who have smoked for a while can get lung cancer and various life threatening lung disorders, eventually leading to death, but many don’t know about all of the bad things that smoking can do to them right now. If you smoke, you owe it to yourself to find out about the effects of smoking on your life now.

Facts about smoking:

Even small amounts of the poisonous chemicals in cigarettes can do bad things to your body.

• Smoking stains teeth, and causes bad breath and wrinkles.
• Smokers get 3 times more cavities than non-smokers.
• Smoking lowers hormone levels.
• When smokers catch a cold, they are more likely than non-smokers to have a cough that lasts a long time. They are also more likely than non-smokers to get bronchitis and pneumonia.

Why is smoking unhealthy for me?

According to research done by the CDC (Center for Disease Control), there are more deaths caused by smoking than by all of the following combined: HIV, illegal drug use, alcohol use, car accidents, and firearm-related incidents.

Each day about 4,000 youth under the age of 18 years old smoke their first cigarette, 1,000 of those teens, become daily cigarette smokers. More than 16 million Americans live with a serious illness caused by smoking and on average, smokers die 10 years earlier than nonsmokers.

Each cigarette contains about 7000 chemicals, many of which are poisonous and about 70 cause cancer. Some of the worst ones are:

• Nicotine: a deadly poison
• Arsenic: used in rat poison
• Methane: a component of rocket fuel
• Ammonia: found in floor cleaner
• Cadmium: used in batteries
• Carbon Monoxide: part of car exhaust
• Formaldehyde: used to preserve body tissue
• Butane: lighter fluid
• Hydrogen Cyanide: the poison used in gas chambers
• Acetone – used to remove nail polish
• Tar –used to pave roads

Every time a person inhales smoke from a cigarette, small amounts of these chemicals get into their blood through their lungs. The chemicals are then transported by the blood to different parts of the body and cause harm. So it is important not to start smoking, and if you have already started smoking then you should quit as soon as possible. It is understandably hard to quit smoking, but there are nicotine replacement products that could be helpful to you. If you are over the age of 18 years old, you can buy nicotine replacement products which come in a variety of forms such as patches, gum, and lozenges. Under the age of 18 years old? A prescription will be needed from your health care provider.

What happens to a person’s lungs when they smoke?

Every time a smoker inhales a cigarette, some of the alveoli (air sacks in the lungs) die. Alveoli are important because they transfer oxygen from the lungs into the blood which then carries oxygen to other organs in the body. This is dangerous because the alveoli won’t grow back so when they are destroyed, part of a person’s lungs will not function anymore. People with lung disease have problems doing physical activities such as sports, dancing, or singing.

Smoking paralyzes the cilia that line the lungs. Cilia are little hair like structures that move back and forth to sweep particles out of the lungs. When a person smokes, the cilia can’t move and thus can’t do their job. So dust, pollen, and other things that are inhaled just sit in the lungs and build up. Also, there are a lot of particles in smoke that get into the lungs. If the cilia can’t move, the particles stay in the lungs and form tar.

Why do people smoke if it’s so bad for them?

Some people like the feeling that smoking gives them. This temporary feeling is from the nicotine in the cigarettes. Some teens think smoking will help them lose weight or stay thin, but this isn’t true.

Facts:

• Smokers get sick more often. They are also at risk for developing life threatening lung diseases and cancer.. Most people agree that the temporary feeling from nicotine isn’t worth the risk of getting serious health problems.
• Smoking doesn’t really help people lose weight. If that were true, every smoker would be thin.

How do tobacco companies get teens to start smoking?

Think about it this way: When a person decides to start smoking, the tobacco companies are happy because millions of dollars are spent every year on advertising to try to get new people, especially teens, to smoke. Once a person is hooked on smoking, they are forced to buy cigarettes to support their addiction. Ask yourself: Do I really want a big corporation controlling my life and telling me how to spend my money?

Can a person stop smoking if they’re addicted to cigarettes?

Many people don’t realize they are addicted to smoking. They think they can easily quit any time they want. But when they try, they forget it is extremely hard. Unfortunately, it is very easy to become addicted. Cigarettes are just as addictive as cocaine or heroin. Even if you only smoke one or two cigarettes a day and even if you’ve never bought a pack of cigarettes yourself, you are at risk. Stressful situations or hanging out with friends who smoke might cause a person to smoke more and become addicted. If you smoke, try going a whole week without smoking at all. If you find this challenge to be very hard, you are probably addicted to cigarettes.

When is the best time to quit smoking?

A lot of people put off quitting smoking, thinking that they’ll do it when the time is right. However, about 80% of teens who begin smoking now, will continue smoking into adulthood. If you smoke, it will never seem like the right time to quit and quitting will never be easy. The longer you smoke, the harder it will be to stop and the more damage you will do to your body.

Here are some reasons to quit sooner rather than later:

• Most teens would rather date a non-smoker.
• You’ll save money if you quit smoking. A pack of cigarettes in the U.S. costs over $9.00. Even if you only smoke a couple packs a week, you’re spending about $100 per month and $1200 per year on smoking. Think of all the other things you could use that money for.
• You only have one pair of lungs. Any damage you do to them now will be with you for the rest of your life.
• The longer you smoke, the better your chances are of dying from it. One out of 3 smokers die from smoking and many more become very sick. Think about your friends who smoke. 1/3 of them will die from smoking if none of you quit.

What are ENDS?

ENDS is short for “electronic delivery system” which includes smoking or “vaping” products such as electronic cigarettes (e-cigarettes), e-pipes, hookah pens, and vape pens. They are made to look like cigarettes, cigars, pipes and/or pens and they typically use liquid nicotine (the same chemical in regular cigarettes) or “e-juice,” and a battery to make a vapor which is then inhaled. Other chemicals including propyleneglycol, glycerin, flavorings, etc. may also be added to the “e-juice.”

It is important to know that the Federal Food and Drug Administration (FDA) (the government organization that tests the safety of cigarettes, medicine, and food) has not studied the safety or efficiency of e-cigarettes, therefore E-cigarettes are NOT safer than regular cigarettes and should not be used for to quit smoking. This new ruling will allow the FDA to test all new tobacco products, identify possible risks, and explain any confusing advertising. All new tobacco products must print the following statement on the product:

WARNING: This product contains nicotine. Nicotine is an addictive chemical.

Additionally, no one under the age of 18 may purchase tobacco products including ENDS.

Since the summer of 2019, nearly 1400 cases of E-cigarette and vaping product related lung injuries (EVALI) have been reported by the Center for Disease Control (CDC). This alarming number has caused permanent and temporary bans on the sale of E-cigarettes and vaping products across the United States.

Smoking has serious effects on a person’s life. The longer a person smokes the more risk for serious health problems. Most people who begin smoking as teens say that they wish they had never started. No one can actually make a person stop smoking, but getting support from friends and family help a lot. If you smoke, just think about how much healthier you’ll feel when you kick the habit!