Is Your Mouth Making You Sick?

Is your mouth making you sick?

How Oral Health Impacts Systemic Health

At our Dental Centers in Freeman, Parkston and Viborg, we take healthcare seriously.  While we are specifically concerned with our patients’ oral health, we acknowledge its role in a person’s overall health.  Unfortunately, the mouth has always been treated by a realm of healthcare (dentistry), which has historically been kept separate from general medicine.  For this reason, some people are under the impression that the mouth is therefore independent and unrelated to the rest of the body. 

This is a dangerous myth!

What systemic issues are connected with the mouth?

In 2000, the surgeon general released a report called “Oral Health in America”.  The purpose of this report was to inform and educate the nation about oral health, its prevalence in our nation, and how it affects a person’s overall health.  This report was based on a review of published scientific literature and is still considered the authority on the link between oral health and systemic health.

There are many links between the mouth and the rest of the body.  In this article, we will limit the discussion to the most harmful health conditions that are affected by the health of your mouth.

  • Osteoporosis – Osteoporosis is a condition of decreased bone density and often brings to mind a picture of a frail old lady whose bones break easily.  Osteoporosis can affect any bone in the body, even the jawbones.  This is especially important in patients who have lost teeth and wear dentures.  The jawbones in a patient with osteoporosis will diminish much more rapidly than in a patient with healthy bones, causing the denture to become loose and uncomfortable.  
  • In a patient with all of their teeth, osteoporosis causes an increased risk for periodontal bone loss.  It has even been suggested that bone loss around the teeth could be a warning sign of osteoporosis.
  • Immunosuppression – There are many different diseases, disorders, and conditions that suppress the immune system, including HIV, autoimmune diseases, organ transplants and cancer treatments.  A suppressed immune system makes any type of infection worse because your body cannot fight it naturally.  This puts a person at higher risk for periodontal disease and dental abscesses.  Because these infections also affect other areas of the body, the impact on the overall health is much greater in an immunocompromised patient.  
  • Anyone who has a problem with their immune system should keep to a strict oral hygiene routine and continuing care schedule with their  dentist.
  • Some people with a weakened immune system will suffer from persistent mouth sores and ulcers that do not heal.  Often a dentist is the first  person to catch these signs of a suppressed immune system.
  • Pulmonary Disease – Because the bacteria in the mouth have a quick pathway to the lungs, there is a link between oral disease and pulmonary disease.  COPD (chronic obstructive pulmonary disease) is associated with poor oral health, and patients with periodontal disease are at a higher risk of developing bacterial pneumonia.
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  • Diabetes – The link between periodontal disease and diabetes is considered a two-way connection: meaning diabetes makes periodontal disease worse, and periodontal disease makes diabetes worse.  Diabetes worsens periodontal disease through its affect on blood flow, inflammation and healing ability.  Periodontal disease worsens diabetes by contributing to hyperglycemia and complicated metabolic controls.  This association is thought to be true of diabetes with any chronic infection in the body
  • Heart Disease – The bacteria present in the mouth of a patient with periodontal disease can contribute to heart disease through a few different mechanisms of action: 1) small localized infections of blood vessel walls, which leads to plaque formation, atherosclerosis, and in severe cases, a heart attack,  2) an influence on platelets causing them to aggregate and form clots in the bloodstream, which could block a coronary artery, leading to heart attack.  People with periodontal disease have a 25% higher risk of heart disease than people with healthy gums.

 

  • Stroke – The increased risk of a stroke in patients with periodontal disease is based on the same mechanism of action noted above: increased risk for clot formation, which can travel to the brain and occlude a cerebral artery, blocking blood flow to brain tissues.
  • Adverse Pregnancy Outcomes – There is a correlation between periodontal disease and low birth weight infants.  The mechanism is in need of more scientific research.  At this time, it is thought to arise from two possible consequences of periodontal disease:  1) The bacteria present in periodontal disease produce toxins that could enter the blood stream, cross the placenta, and cause damage to the fetus.  2) The maternal inflammatory response to these toxins could interfere with fetal growth.

 

How do I reduce my risk of health problems?

All people should be aware of the health risks associated with dental diseases.  Because most oral health problems are preventable, you can be instrumental in lowering your risk for systemic health problems.

 

  1. See your dentist and dental hygienist at their recommended intervals for cleanings and oral evaluations.
  2. Practice good oral home care with regular brushing, flossing, and rinsing with the proper mouthwash.
  3. Treat dental problems as they arise.  Do not wait until something hurts!  Periodontal disease is often called a “silent” disease because it rarely causes pain.
  4. See your medical doctor to be as preventive as possible with conditions like diabetes and cardiovascular diseases.

 

I am concerned that my mouth is affecting my overall health.  What now?

Call our office at 605-925-4999 (Freeman) or (605) 928-3363 (Parkston) to schedule your appointment today with Dr. Jason Aanenson, Dr. Alex Whitesell or Dr. Serena Whitesell!They will discuss your medical history with you and outline how it can affect your oral health and vice versa.  

Oral Cancer

Oral Cancer

Cancer is a disease caused by uncontrolled growth of abnormal cells in a part of the body.  Oral cancer is a type of cancer in which these abnormal cells originate in the mouth.  Cancer is classified by the original site of abnormal cells.  Oral cancer kills approximately one person every hour in the United States.  About 50,000 new cases of oral cancer are diagnosed each year. 

What are the different types of oral cancer?

The most common type of oral cancer is squamous cell carcinoma, and it occurs in the tissues lining the inside of the mouth or on the lips.  Squamous cell carcinoma makes up over 90% of all oral cancer.  A much smaller percentage of oral cancers develop in other types of tissue in the mouth, like the salivary glands causing adenocarcinoma, the lymph nodes or lymph tissue like tonsils causing lymphoma, or in pigmented tissue causing melanoma.

What are the risk factors for oral cancer?

The risk factors most closely associated with oral cancer are:

  • Tobacco use of any kind

  • Alcohol consumption

  • Infection with human papilloma virus (HPV)

  • Chronic oral infections

  • Persistent trauma to oral tissues

  • Poor oral hygiene, lack of dental care

  • Poor nutrition

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Who is most likely to get oral cancer?

  • People who work outdoors and have a large amount of sun exposure on their lips are at a high risk for developing cancer on their lips.

  • People who smoke, use smokeless tobacco and/or drink alcohol have a high risk for oral cancer inside the mouth. Tobacco use combined with alcohol consumption creates a risk level that is higher than either one alone because they act synergistically together.

  • People infected with the human papilloma virus (HPV) have a higher risk for developing oral cancers at the back of the throat and base of the tongue. Certain strains of the virus have a higher risk than others. HPV is the newest known cause of oral cancers and accounts for the changing demographics of oral cancer. Historically, oral cancer was a disease of old men who smoked and drank alcohol a lot. The average age of oral cancer has dropped in the last two decades, and it now affects more women than in the past.

  • People with chronic infections and persistent trauma in their mouths have an increased risk for developing oral cancers.

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What can I do to lower my risk for oral cancer?

  • Limit sun exposure and use SPF chapstick!

  • Stop ALL tobacco use, both smoking and smokeless tobacco!

  • Limit alcohol consumption.

  • Practice good oral hygiene. Treat any persistent infections in the oral cavity including cavities and periodontal disease.

  • If you have an area of your mouth that is prone to trauma (cheek biting, a sharp tooth cutting your tongue), see your dentist to discuss treatment options to reduce the occurrence of this trauma.

  • See your dentist for regular oral cancer screenings. At the Dental Centers in Freeman, Parkston, and Viborg, this is included in every comprehensive and periodic oral evaluation you have with Dr. Jason, Dr. Alex and Dr. Serena. In its initial stages, oral cancer is typically painless and easily goes unnoticed without a visual evaluation. This is why consistent oral cancer screenings are so important. Early detection is key!

  • Perform a self-screening exam once every month.

 

What should I look for in my mouth?

Any ulcer, sore, blister, lump or abnormal tissue that does not heal within 14 days needs professional evaluation by a dentist.  A very common presentation for oral cancer is an overgrowth of white tissue on the sides of the tongue or the floor of the mouth.  Cancerous lesions can also be bright red in color.  As you are screening yourself, simply search for anything that does not blend in with the surrounding tissue both by look and by feel.  Because of some locations in your mouth being difficult to see, you may be able to feel something unusual without seeing it.  Remember, oral cancer rarely causes any discomfort or pain in its early stages, so you have to be looking on a consistent basis to catch it early.

What do I do when I find something in my mouth that could be oral cancer?

Monitor it closely, noting what date you first saw or noticed the lesion.  Take photos of it, if possible.  Any sore, ulcer, or bump that does not heal within 14 days needs professional evaluation by a dentist.  Make an appointment with Dr. Jason, Dr. Alex and Dr. Serena for an evaluation as soon as possible.

What is the treatment for oral cancer?

Treatment for oral cancer depends on the stage of cancer diagnosed.  Early detection is the most important factor in beating oral cancer!  The first step is always a biopsy of the abnormal tissue.  Depending on the location of the tissue, this will be done either by a periodontist (gum specialist), oral and maxillofacial surgeon, or an ENT (for lesions on the tonsils or throat).  Once biopsy results confirm a diagnosis of cancer, treatment will commence with the surgeon working in coordination with an oncologist and can include surgical removal of cancerous tissue, chemotherapy and radiation.  Dr. Jason, Dr. Alex and Dr. Serena will work in cooperation with your doctors to ensure that the rest of your mouth stays as healthy as possible throughout treatment.

More information on oral cancer can be found online at The Oral Cancer Foundation and the

 

Call our office at 605-925-4999 (Freeman) or (605) 928-3363 (Parkston) to schedule your appointment today with Dr. Jason Aanenson, Dr. Alex Whitesell or Dr. Serena Whitesell!

Hormone-Induced Gingivitis

Hormone-Induced Gingivitis

What is hormone-induced gingivitis?

Hormone-induced gingivitis is a type of gingivitis that occurs specifically during changes in hormonal levels .  It is a very common condition that we see frequently in our office.  Hormone-induced gingivitis causes a patient to have gums that are swollen, red, tender, and bleed easily.   The tenderness and bleeding often make oral hygiene routines uncomfortable, and patients sometimes avoid proper brushing and flossing techniques because it hurts.  Healthy, natural gum tissues are light pink, relatively flat and tightly adhered to the teeth.  The appearance of bright red, puffy gums is unsightly, giving a diseased look to the mouth, and may cause embarrassment. 

What causes hormone-induced gingivitis?  

The name says it all: it is induced by hormones.  Rapid swings in hormone levels (most notably estrogen, progesterone, and chorionic gonadotropin) can have a profound effect on gum tissues.  Research has shown that these hormone levels cause two important changes to occur:

  1. Hormone changes affect the tiny blood vessels in the gum tissue, increasing the blood flow in this area (which can cause swelling) and changing the permeability of the blood vessels (which makes the tissue bleed more easily).

  2. Hormone changes also affect the types of bacteria present in gum tissues. Research shows that gum tissues in patients with hormone changes such as pregnancy or taking birth control pills have more dangerous bacteria than patients without hormone changes. By “more dangerous”, we mean stronger and more likely to cause gum disease.


Who is at risk for hormone-induced gingivitis?  

Hormone-induced gingivitis is common in children going through puberty, both girls and boys.  It is also prevalent in women at various stages of hormone changes, including menstrual cycles, the use of birth control pills, pregnancy, and menopause.  This higher risk for gum disease makes oral hygiene even more important than it already is.  People with poor oral hygiene are more likely to experience hormone-induced gingivitis than those with good plaque control and consistent oral hygiene habits.  People who have infrequent and inconsistent dental cleanings are also at an increased risk.

 

What can you do about hormone-induced gingivitis?

 

  • Practice perfect oral hygiene. Do not miss a single day of flossing! Use an electric toothbrush; they are shown to effectively remove more plaque than a manual toothbrush.

  • Add a mouthwash to your oral hygiene routine, and use it twice daily. In addition to an over-the-counter alcohol-free mouthwash, you can swish with warm salt water throughout the day. Some patients require a prescription mouthwash to get the inflammation under control.

  • Stay on schedule with professional dental cleanings. Your dental hygienist is able to remove bacterial buildup from areas you might be missing, even with good oral hygiene.

  • Consider increasing the frequency of professional dental cleanings. Many of our patients with severe gingivitis during puberty or pregnancy have their teeth cleaned every 3 months, instead of every 6 months. This reduces the severity of gingivitis by reducing the amount of bacterial buildup accumulated between cleanings.

  • Talk to Dr. Jason, Dr. Alex or Dr. Serena about other recommendations they may have to improve your gingivitis. There are many additional oral hygiene products available to help reduce gum inflammation. They will determine which one will be most beneficial for your unique situation.

 

Think you or your child may have hormone-induced gingivitis?

Call our office at 605-925-4999 (Freeman) or (605) 928-3363 (Parkston) to schedule your appointment today with Dr. Jason Aanenson, Dr. Alex Whitesell or Dr. Serena Whitesell!

Aphthous Ulcers (Canker Sores)

Aphthous Ulcers (Canker Sores)

If you have never had a mouth ulcer, thank your lucky stars!  They are terribly painful and interfere with eating, speaking, and brushing your teeth.  The most prevalent type of mouth ulcer is an aphthous ulcer, and it is commonly referred to as a canker sore.  Aphthous ulcers are unusual in that, even now in 2017, we still do not know exactly what causes them.  There are many studies showing correlation between certain diets, vitamin deficiencies, hormone changes, and stress levels with the occurrence of aphthous ulcers.  But correlation is not the same as causation. 

What are aphthous ulcers?

There are three main types of aphthous ulcers: 1) minor, 2) major, and 3) herpetiform.  They all the share similar appearance of a round or oval-shaped ulcer with an inflamed red border around a yellowish-white film that covers the deeper ulceration.

  1. Minor aphthous ulcers are the most common and least painful. They typically are less than 1 cm in diameter and last for 7-14 days.

  2. Major aphthous ulcers are much larger, up to 3 cm, and can last over a month. Due to their increased size and duration, they are much more painful.

  3. Herpetiform aphthous ulcers take their name from herpes lesions (also called cold sores) caused by a Herpes Simplex Virus, which occur in clusters. Herpetiform aphthous ulcers also occur in clusters and can easily be misdiagnosed as viral sores. Herpes viral sores and aphthous ulcers differ in cause and location. There is no virus associated with aphthous ulcers, and they only occur on freely movable mucosa. This includes the inner lining of the lips, cheeks, tongue, floor of mouth and the soft palate. Herpes lesions, or cold sores, occur on the outside of the lips or any attached gum tissue like the hard palate or gums covering the teeth. When herpetiform aphthous ulcers form in a cluster, the ulcers often coalesce or blend together to form one very large, very painful ulcer.

 

What causes aphthous ulcers?

There is currently no scientific data identifying one specific cause of these ulcers.  The research studies have shown a correlation in the occurrence of aphthous ulcers with certain predisposing factors, listed here.

  • Genetics – Some studies suggest a genetic component because children are much more likely (90%) to experience aphthous ulcers if both of their parents have had them.

  • Certain GI problems – There is a high correlation between patients who experience aphthous ulcers and those with gastrointestinal issues like ulcerative colitis, Crohn’s disease and Celiac Disease.

  • Vitamin deficiencies – Some studies show a correlation between patients with aphthous ulcers and low levels of iron, vitamin B12, and folic acid.

  • Hormone levels – Many women experience aphthous ulcers at regular intervals correlating to their menstrual cycle.

  • Stress – Because stress cannot be quantitatively measured, this one is difficult to prove scientifically. But it’s no surprise to people who suffer with these ulcers that stress can make them more likely to appear.

  • Trauma – This is likely the most common cause of aphthous ulcers. Trauma can range from anything as simple as accidentally biting the inside of your lip or hitting your gums with the toothbrush to routine dental treatment or a complicated oral surgery procedure.

 

How are aphthous ulcers treated?

There are many ways to treat the painful symptoms of aphthous ulcers, but there is no cure to prevent them from recurring.  There are many options available, and it is best to discuss them with Dr. Jason, Dr. Alex and Dr. Serena to figure out which one is best for your specific ulcers.  Some of the possible treatment options are listed here.

  • A topical gel or paste – Usually a prescription product, this is applied to the ulcer with a Q-tip or clean fingertip multiple times a day. It typically contains a steroid, which reduces the severity and duration of the ulcer, but does not change the frequency of occurrence.

  • A prescription mouthwash – Also used to alleviate symptoms only, this can contain an antibiotic, antifungal, steroid anti-inflammatory, antihistamine (like Benadryl), and antacid (which creates a thick coating over the oral lining). When used 4-6 times per day, it can reduce the symptoms of the painful ulcers.

  • Laser treatments – A laser can be used to treat the ulcer, which reduces inflammation and speeds up the healing process by making changes to the surface of the ulcer.

  • Dietary changes – Patients who are afflicted with frequent or multiple aphthous ulcers and have celiac disease or a

  • gluten intolerance show a marked reduction in ulcer occurrence when gluten is eliminated from their diet. A very recent study has also shown an improvement in occurrence of ulcers when a dairy-free diet is observed. This is based on a new study showing a higher level of antibodies to cow’s milk proteins in patients who have aphthous ulcers.

  • Vitamin therapy – In patients who do show deficiencies in iron, vitamin B12, and folic acid and experienced frequent aphthous ulcers, the ulcer occurrence rate decreased after vitamin therapy to treat those deficiencies.

 

What can I do about aphthous ulcers?

The most important step you can take is contacting your dentist as soon as you notice the lesion.  All of the above treatment modalities are most effective when started early in the life of the ulcer.

Ulcers are aggravated by acidic foods, spicy foods, and hot temperatures, so avoid them in order to reduce your painful symptoms.  Use caution when eating and talking so that you do not reinjure the area and cause the ulcer to last longer.  Cold can temporarily alleviate symptoms, so we do recommend drinking ice water and holding a piece of ice against the ulcer until you see the dentist for other treatment options.

Do you think you have an aphthous ulcer?

Call our office at 605-925-4999 (Freeman) or (605) 928-3363 (Parkston) to schedule your appointment today with Dr. Jason Aanenson, Dr. Alex Whitesell or Dr. Serena Whitesell!  They will help you get started on the best treatment to reduce the pain and length of your ulcer.  

Periodontal Disease: What Does it Mean to be High Risk?

Periodontal disease: What does it mean to be high risk?

What is periodontal disease? 

Periodontal disease is a disease that affects the structures supporting the teeth, including both the gums and the jawbone.  Its primary cause is bacterial buildup on the teeth, and some people have a higher risk due to genetic factors, systemic disorders (such as diabetes), and habits (such as smoking or oral tobacco use). 

What are the stages of periodontal disease?

The earliest stage of periodontal disease is called gingivitis, which means inflammation of the gums.  Inflammation can involve one or more of the following:

  • A bright red color to the gums

  • Swollen or puffy gums

  • Gums that bleed easily when brushing, flossing or having teeth professionally cleaned

 How does periodontal disease happen?

Periodontal disease begins with the accumulation of bacteria and plaque on the teeth.  This can be due to poor oral hygiene, and it can also be due to the presence of very difficult-to-clean areas on your teeth.  When teeth are crooked or rotated, they collect more bacteria.  We all have different types of bacteria in our mouths, and some types are more destructive than others, meaning they are more likely to cause disease.  Research studies show that the types of bacteria that gather on crooked teeth are more likely to cause periodontal disease than the types of bacteria that collect on straight teeth.  Periodontal disease progresses as the bacteria and plaque harden on the teeth into tartar, which can only be removed with a professional cleaning.  If no professional dental care is completed, the tartar accumulation will grow, causing more inflammation and more serious damage to the gum and bone.  In severe periodontal disease, the supporting structures have become so damaged that they can no longer hold the teeth, which become loose and have to be extracted.

What does it mean if I am high risk?

If, during your evaluation, you presented with some signs of gingivitis, you would be classified as high risk for periodontal disease.  As stated earlier, gingivitis is the first step to periodontal disease, and if left untreated, it can lead to a progression of disease.  The good news is that in the early stages, periodontal disease is completely reversible!

Risk factors noted during a clinical evaluation:

  • Pockets measuring ›3mm

  • Poor oral hygiene

  • Crowded teeth

  • Prior periodontal disease

  • Bone loss

  • Mobility (loose teeth)

  • Gum recession

  • Mucogingival defect (gum tissue that is not attached to the bone underneath it)

  • Abnormal frenum attachments

What can I do about it?

  1. Have a professional dental cleaning. This removes the bacterial accumulation from the teeth, essentially giving you a “clean slate”.

  2. Change your oral hygiene routine as directed by your dentist or hygienist. This may involve different toothbrushing techniques, an electric toothbrush, consistent flossing, interdental brushes, etc . . .

  3. If prescribed by your dentist, begin an antibiotic mouthrinse daily. The more bacteria you kill, the less there are to accumulate on your teeth.

  4. Return for a follow-up professional cleaning in 6-8 weeks. This allows us to assess the home care, suggest any positive changes to be made, and again remove bacteria that have accumulated.

What if I don’t do anything?

Without treatment, bacterial levels will increase, causing more accumulation of plaque and tartar.  More plaque and tartar causes more inflammation and response from the gums and bone.  As the bone migrates away from the tartar buildup, which it considers a foreign substance, the support for the teeth is slowly lost.  In a worst case scenario, untreated periodontal disease eventually leads to loss of all teeth and loss of the underlying jawbone, which makes future treatment with either dentures or dental implants less predictable.

Need more information?

Call our office at 605-925-4999 (Freeman) or (605) 928-3363 (Parkston) to schedule your appointment today with Dr. Jason Aanenson, Dr. Alex Whitesell or Dr. Serena Whitesell!

Why do they check my blood pressure at the dentist?

Why do they check my blood pressure at the dentist?

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If you have visited our practice, you are not surprised that your blood pressure may be checked by our dental assistants, dental hygienists or dentists.  If the measurement is nor “normal”, we will point this out to you.  Sometimes we are questioned about this, and we always want to be able to adequately answer our patients’ questions.  There are three main reasons we regularly take your blood pressure, which are listed and elaborated on below. 

  1. It protects you! The medications and procedures involved in dental visits can cause in increase in blood pressure and heart rate. We know that going to the dentist can be very stressful for some people. Fear or anxiety may cause a patient’s blood pressure to be elevated before he or she even walks in our doors. The sensations of something as straightforward as a dental cleaning can increase the stress on an already-anxious patient. The ingredients in the local anesthetic used to numb your teeth and gums for dental work can cause the heart rate and blood pressure to go up even more. All of these factors could be the perfect storm for a medical emergency. We always keep our patients’ safety as our highest priority. For this reason, we commit to be diligent in measuring and recording your blood pressure before, and sometimes even throughout, a dental procedure.

  2. We genuinely care about you! Our second reason implies that we don’t want you having a heart attack or stroke on our watch, and we don’t! We don’t want you having a heart attack or stroke anywhere. Emergencies are not always preventable, so we want to take advantage of every preventive opportunity we are given. If your blood pressure is recorded as consistently high when you visit our office, we will recommend that you see your physician. The American Heart Association outlines exactly which blood pressure measurements are considered dangerous. Don’t wait until you have a crisis to do something about your high blood pressure!

 

White Coat Syndrome

Many patients exhibit white coat syndrome.  This is a phenomenon in which patients exhibit a blood pressure level above the normal range, in a clinical setting, and normal blood pressure levels at home or in other settings.  The key to white coat syndrome is that the blood pressure is only high at the doctor or dentist and measures normal in another setting.  This requires the measurement of your blood pressure in multiple different settings.  Unfortunately, we can’t just take your word for it because we are held to account by the measurements recorded in our dental records. 

If you find yourself in this situation, please discuss your concerns with us and be open to working with your physician.  We have had great success in reducing white coat syndrome with a wide variety of therapies and medications, including meditation, breathing techniques, laughing gas, or anti-anxiety medications prescribed by your physician. 

Our goal is always to take the best possible care of you in our offices and alert you to anything that could be a concern when you are not in our office. 

Have you put off dental work because of your high blood pressure?

Due to the links between heart disease and problems with your teeth and gums, it is not safe for you to put off needed dental work.  The dental problems actually make your risk for heart problems go up! 

Schedule a consultation with our dentists to discuss what dental treatment you need and how we can help you manage your blood pressure.  It may require a consultation with your medical doctor in order to get started. 

Call our office at 605-925-4999 (Freeman) or (605) 928-3363 (Parkston) to schedule your appointment today with Dr. Jason Aanenson, Dr. Alex Whitesell or Dr. Serena Whitesell!  Our kind and caring staff will put you at ease and help you get started on the path back to good health.