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This educational activity was developed by PennWell’s Dental Group with no commercial support.This course was written for dentists, dental hygienists and assistants, from novice to skilled. Educational Methods: This course is a self-instructional journal and web activity. Provider Disclosure: PennWell does not have a leadership position or a commercial interest in any products or services discussed or shared in this educational activity nor with the commercial supporter. No manufacturer or third party has had any input into the development of course content.Requirements for Successful Completion: To obtain 1 CE credit for this educational activity you must pay the required fee, review the material, complete the course evaluation and obtain a score of at least 70%.CE Planner Disclosure: Heather Hodges, CE Coordinator does not have a leadership or commercial interest with products or services discussed in this educational activity. Heather can be reached at hhodges@pennwell.comEducational Disclaimer: Completing a single continuing education course does not provide enough information to result in the participant being an expert in the field related to the course topic. It is a combination of many educational courses and clinical experience that allows the participant to develop skills and expertise.Image Authenticity Statement: The images in this educational activity have not been altered.Scientific Integrity Statement: Information shared in this CE course is developed from clinical research and represents the most current information available from evidence based dentistry. Known Benefits and Limitations of the Data: The information presented in this educational activity is derived from the data and information contained in reference section. The research data is extensive and provides direct benefit to the patient and improvements in oral health. Registration: The cost of this CE course is $20.00 for 1 CE credit. Cancellation/Refund Policy: Any participant who is not 100% satisfied with this course can request a full refund by contacting PennWell in writing.

Supplement to PennWell Publications

The PennWell Corporation is designated as an Approved PACE Program Provider by the Academy of General Dentistry. The formal continuing dental education programs of this program provider are accepted by the AGD for Fellowship, Mastership and membership maintenance credit. Approval does not imply acceptance by a state or provincial board of dentistry or AGD endorsement. The current term of approval extends from (11/1/2011) to (10/31/2015) Provider ID# 320452.

PennWell designates this activity for 1 Continuing Educational Credit.

Dental Board of California: Provider 4527, course registration number CA# 01-4527-13086“This course meets the Dental Board of California’s requirements for 1 unit of continuing education.”

Earn1 CE credit

This course was written for dentists, dental hygienists,

and assistants.

Publication date: Oct. 2013 Expiration date: Sept. 2016

AbstractThe dental profession has long regarded dental sealants as a primary element in the prevention of dental caries. Sealants provide a physical barrier between the spaces created by anatomical pits and fissures of posterior teeth and the cariogenic bacteria, thereby halting incipient lesions and preventing cavitation. Proper techniques must be implemented when placing sealants for optimal retention and patient safety. Patients must understand that sealants are one element for overall preventive dentistry. This article will review the epidemiology and efficacy of sealants; indications for use; the various types and categorization of sealants; characteristics for successful sealants; proper placement procedures for pit and fissure sealants; sealant maintenance; and factors to teach patients.

Educational Objectives:At the end of this self-instructional educational activity, the participant will be able to:1. Describe the basic placement of

pit and fissure sealants. 2. Discuss the clinician’s role

in optimizing best practices and safe use of pit and fissure sealants.

3. Educate patients on the role of dental sealants in an effective caries prevention program.

Pit and Fissure Sealants: An OverviewA Peer-Reviewed Publication Written by Heidi Emmerling Muñoz, PhD and Jan Carver Silva, RDH, MSHS

Author ProfileHeidi Emmerling Muñoz, PhD is a professor of English at Cosumnes River College. Prior to her current role, Dr. Muñoz served as interim director and professor of dental hygiene at Sacramento City College. Dr. Muñoz is a frequent contributor to RDH Magazine and has written articles and columns for a variety of publications. She can be reached at MunozH@crc.losrios.edu

Jan Carver Silva, RDH, MSHS is a professor of dental hygiene at Carrington College California, Sacramento campus. Ms. Carver Silva served as a California Dental Hygienists’ Association delegate and Vice President of the Sacramento Valley Component. She has contributed to RDH Magazine and can be reached at jcarver@carrington.edu

Author DisclosureHeidi Emmerling Muñoz, PhD and Jan Carver Silva, RDH, MSHS have no commercial ties with the sponsors or providers of the unrestricted educational grant for this course.

96 | rdhmag.com RDH | October 2013

Educational ObjectivesAt the end of this self-instructional educational activity, the participant will be able to:1. Describe the basic placement of pit and fissure sealants. 2. Discuss the clinician’s role in optimizing best practices

and safe use of pit and fissure sealants. 3. Educate patients on the role of dental sealants in an

effective caries prevention program.

AbstractThe dental profession has long regarded dental sealants as a primary element in the prevention of dental caries. Sealants provide a physical barrier between the spaces created by ana-tomical pits and fissures of posterior teeth and the cariogenic bacteria, thereby halting incipient lesions and preventing cavitation. Proper techniques must be implemented when placing sealants for optimal retention and patient safety. Patients must understand that sealants are one element for overall preventive dentistry. This article will review the epi-demiology and efficacy of sealants; indications for use; the various types and categorization of sealants; characteristics for successful sealants; proper placement procedures for pit and fissure sealants; sealant maintenance; and factors to teach patients.

Epidemiology and EfficacyDental caries is a problem for individuals of all ages. 23% of adults between the ages of 20-64, have untreated decay. Ad-ditionally, 23% of children ages 2-11 have untreated dental caries. The occlusal surfaces of teeth contain deep pits and small fissures, making these areas difficult to clean. The occlu-sal surfaces account for up to 90% of all caries in school aged children.3 The teeth at highest risk for caries are the perma-nent first and second molars.4 Dental sealants are a means to prevent caries by painting thin resin coatings on the pits and fissures of the occlusal tooth surfaces. Pit and fissure dental sealants have reduced caries over 70%.5

Sealants work by means of simply providing a physical barrier between the susceptible pit and fissures of a tooth and the cariogenic bacteria. If the bacteria cannot penetrate the tooth, bacteria cannot cause decay.6

Indications for UseCandidates for sealants are determined based on caries risk. Risk factors include xerostomia from medications or other etiologies, orthodontics, and presence of incipient enamel lesions. In high risk individuals, all noncavitated posterior permanent teeth should be sealed upon eruption.7 Evidence shows that placement of pit-and-fissure sealants in teeth with incipient carious lesions significantly reduces the rate of cavitation progression. The fears that dental practitioners have that “sealing in” bacteria within an incipient lesion will result in rapid cavitation are unfounded. A systematic review by Griffiin et al. found that sealing of non-cavitated caries in

permanent teeth resulted in a ten percent annual reduction in caries progression over unsealed teeth.8

Contraindications for pit and fissure sealant placement include radiographic evidence of proximal dental caries, pit and fissures that are well coalesced and self-cleansing, and low caries risk.9

Categorization of Pit and Fissure SealantsPit and fissure sealants can be categorized by type (glass iono-mer versus resin), polymerization (auto or self-cure versus photo or light cure polymerization) and filler. Self-cure seal-ants come in 2 parts. When they are mixed, they polymerize (harden). The advantage of self-cure sealants is that no special equipment is required. The disadvantages are that mixing is required, and working time is limited because polymerization begins when the material is mixed. The light cured sealants harden when exposed to a curing light. The advantages are that no mixing is required and there is increased working time due to control over the start of polymerization. The disadvan-tages of light cure sealants are the extra costs and disinfection time required for the curing light, protective shields, and/or glasses.9

Pit and fissure sealants can be filled, unfilled, or can have a color. Filled sealants contain particles made of glass or quartz to increase the strength and resistance to wear, including oc-clusal forces. Sealants with fillers tend to be more viscous and therefore the flow is affected. Unfilled sealants are clear and do not contain the glass or quartz particles, therefore, they are less resistant to wear. Unfilled sealants may not require oc-clusal adjustment when placed, so this is an advantage during school and community health programs where sealants are placed. Sealants can be clear, tinted, or opaque. The purpose of a colored sealant is quick identification for evaluation dur-ing maintenance assessment. Colored sealants do not differ in retention.9

Characteristics of Successful Pit and Fissure SealantsThe ideal sealant material is effective, easy to use, long-lasting, and safe. A majority of sealants in clinical use are made of BPA (bisphenol A-glycidyl methylacrylate). There is some controversy about the presence of BPA because it replicates estrogen, which may lead to hormonal reactions in the patient. Though small amounts of BPA have been found in the saliva of some patients immediately after sealant place-ment containing BPA, there have been no findings of systemic BPA or increased estrogen production as a result of the low levels of BPA found in dental sealants.10, 11 As a precaution, the air-inhibited layer (the oily surface residue on the surface of a newly-placed sealant) should be removed with gauze im-mediately after curing.

The longer the sealant is retained, the more effective it is at protecting the tooth from decay.6 Recent research shows no significant difference in sealant retention between glass iono-

RDH | October 2013 rdhmag.com | 97

mer and resin-based sealants.12, 13 Likewise, there is no sig-nificant difference in retention between autopolymerized and light-polymerized resin-based sealants.14 All current sealant materials appear to be equally retentive if applied correctly. The use of a primer and bonding layer prior to placement of the sealant has shown inconsistent results regarding sealant retention.15-17

Application TechniquesGood application technique is essential for increasing reten-tion of sealants. It is generally recommended to treat each quadrant separately, to use four-handed technique with an as-sistant18, and to follow the manufacturer’s recommendations. The techniques of application vary slightly among available products, but we present the general techniques.

The patient should wear safety glasses to provide protec-tion from the chemicals and curing light. Once the patient is prepared, the surface of the tooth must be cleaned. Cleaning the tooth surface permits maximum contact of the etch and the sealant with the enamel surface. Cleaning by toothbrush-ing alone has been shown to be as effective as handpiece pro-phylaxis in promoting sealant retention, which can reduce the cost of materials needed for the procedure.9, 14 The use of air abrasion followed by acid etching, as opposed to acid etching alone, has been shown to increase sealant retention.19

Next, the tooth is etched with phosphoric acid according to the manufacturer’s directions. The acid can be in liquid (good flow but hard to control), gel (increased visibility but difficult to rinse), or semi-gel form (tinted with good visibility, control and rinses well) with a concentration of 15%-50% depending on the manufacturer. The purpose of the etching is to create microscopic pores into which the sealant material can flow, increasing retention. Etching time varies from 15-60 seconds, depending on the product.

When using a liquid etch, a small brush, sponge, or cot-ton pellet is used to apply the etchant. It is important to apply continuously throughout this step and to keep the surface moist. It is also important to dab or pat the etchant on the tooth rather than rubbing the etchant. The action of rubbing rather than dabbing the acid etchant can damage the enamel rods.20

When using a gel or semi-gel, the etchant is applied with a manufacturer-supplied syringe or cannula. Care must be taken when etching the tooth so as not spill or touch the phos-phoric acid on the patient’s soft tissue. Acid burns can result if care is not taken.

After acid etching, the tooth must be rinsed and dried thoroughly for 15-20 seconds. A properly etched and dried tooth will have a chalky appearance. If it does not, then the etching should be repeated. Resin-based sealants require an absolutely dry surface until polymerization is complete. Prop-er isolation through the use of a rubber dam or an absorbent cellulose triangle and cotton rolls placed over the Stensen’s duct is essential to avoid salivary contamination of the seal-

ant site. Salivary contamination during placement is the most common reason for sealant failure.

Glass ionomer sealants have the advantage of not needing a dry field to be effective. In fact, the application procedure for glass ionomers can involve pressing a saliva-moistened finger onto the occlusal surface to push the sealant material into the pits and fissures.

The sealant material is then carefully placed into the pre-pared pits and fissures. It is important not to over-manipulate the product as this can result in bubbles. Disposable instru-ments are supplied by the manufacturer. All areas should be covered without overfilling to minimize occlusal adjustment. After placement, the material is left in place for 10 seconds prior to curing to allow optimum penetration into the pores.

Curing time is usually 20-30 seconds, depending on the manufacturer. Longer curing time is related to increased re-tention.9 Glass ionomer sealants do not require light curing, however they will set faster with usage of a curing light.

After the sealant is placed, the occlusion should be checked and adjusted as necessary. Unfilled sealants often adjust on their own to the patient’s bite, however filled sealants are harder and more resistant to the patient’s natural occlusion and should be adjusted at the time of placement.9

A new entry into the sealant market is giomer, a resin that contains glass ionomer fillers. While all sealant materi-als release fluoride initially, only giomer has the advantage of being able to continuously recharge and release fluoride over its life. This enables remineralization to occur.21 In addition, giomer is able to buffer acid to neutral, providing another defense against decay.22 Giomer has the further advantage of requiring fewer steps to apply than most other materials. After cleaning and isolating, the self-etching primer is applied using a microbrush and gently air dried after 5 seconds; no rinsing is required. Next the sealant is applied with a syringe and light-cured.

Sealant MaintenanceSealants should be re-examined every appointment and at least every six months for defects. Sealants can last years, depending on the product and placement. If a sealant needs to be replaced, it is essential to re-etch. Maintenance of exist-ing sealants includes avoiding use of an air-powder polisher on intact existing sealants during maintenance appointments, as sealant wear increases with time of exposure to air-powder polisher abrasion.9

Factors to Teach the PatientAlthough pit and fissure sealants are extremely effective at preventing decay, the clinician should emphasize that seal-ants are one piece of the entire preventive program. The other parts of the caries preventive program that patients should be aware of include a low sugar diet, use of fluoride, and biofilm control. Patients should also be educated as to how pit and fis-sure sealants prevent dental caries, the need for examination

98 | rdhmag.com RDH | October 2013

Questions

of the sealant at frequent, scheduled appointments, and need for replacement when indicated.

ConclusionCaries is a problem for patients of all ages. Along with proper diet, fluoride, and biofilm control, pit and fissure sealants should be considered as part of an overall preventive program rather than an isolated procedure. The dental sealants bond to the etched enamel and seal the pits and fissures, preventing bacteria from initiating the decay process. Ideally, high-risk patients should have sealants placed on all posterior perma-nent teeth upon eruption. Proximal caries or self-cleansing pits and fissures are contraindications for dental sealants. The dental practitioner should be familiar with the various categories of sealants and the specific application methods for each product. Meticulous care should be used when placing sealants, especially limiting saliva contamination and using a four-handed technique with an assistant. With proper place-ment and maintenance, sealants can last years.

References1. “Dental Decay (Tooth Decay) in Adults (Age 20-64)” National

Institute of Dental and Craniofacial Research. NIH. 25 March 2011.

2. “Dental Decay (Tooth Decay) in Children (Age 2-11)” National Institute of Dental and Craniofacial Research. NIH. 25 March 2011.

3. Kaste LM, Selwitz RH, Oldakowski RJ, Brunelle, JA, Winn DM, Brown LJ. Coronal caries in the primary and permanent dentition of children and adolescents 1-17 years of age: United States, 1988-1991. J Dent Res 1996;75 (Spec No):631-41.

4. “Community and Other Approaches to Promote Oral Health and Prevent Oral Disease” Oral Health in America: Surgeon General’s Report. NIDC. 25 March 2011.

5. Llodra JC, Bravo M, Delgado-Rodriguez M, Baca P, Galvey R. Factors influencing the effectiveness of sealants—a meta-analysis. Community Dent Oral Epidemiol 1993;21(5):261-8.

6. National Institutes of Health (NIH). Consensus Development Conference Statement. Dental sealants in the prevention of tooth decay. J Dent Educ 1984 48(2 Suppl):126-31.

7. Beauchamp J, Caufield PW, Crall JJ, Donly K, Feigal R, Gooch B, Ismail A, Kohn W, Siegal M, & Simonsen R. Evidence-based clinical recommendations for the use of pit-and-fissure sealants: a report of the American Dental Association Council on Scientific Affairs . J Am Dent Assoc. 2008;139(3):257-68.

8. Griffin SO, Oong E, Kohn W, Vidakovic B, & Gooch BF. CDC Dental Sealant Systematic Review Work Group, et al. The effectiveness of sealants in managing carious lesions. J Dent Res 2008;87(2): 169–174.

9. Wilkins E. (2013). Clinical practice of the dental hygienist, 11th ed. Philadelphia: Lippincott Williams and Wilkins, 2013.

10. Söderholm K-J & Mariotti A. Bis-gma–based resins in dentistry: are they safe? J Am Dent Assoc. 1999 130(2): 201-209.

11. Fung E, Ewoldson N, St. Germain H, Marx, D. Miaw C-L, Siew C, Chou H-N, Gruninger, & Meyer D. Pharmacokinetics of bisphenol a released from a dental sealant. J Am Dent Assoc. 2000 131(1): 51-58.

12. Antonson S, Antonson D, Brener S, Crutchfield J, Larumbe J, Michaud C, Yazici AR, Hardigan P, Alempour S, Evans D, & Ocanto R. Twenty-four month clinical evaluation of fissure sealants on partially erupted permanent first molars: Glass

ionomer versus resin-based sealant . J Am Dent Assoc. 2012 143(2): 115-122.

13. Seth S. Glass ionomer cement and resin-based fissure sealants are equally effective in caries prevention. J Am Dent Assoc 2011 142(5): 551-552.

14. Houpt M, Fuks A, Shapira J, Chosack A, & Eidelman E. Autopolymerized versus light-polymerized fissure sealant. 1987 115(1): 55-56.

15. Nazar H, Mascarenhas AK, Al-Mutwa S, Ariga J & Soparker P. Effectiveness of fissure sealant retention and caries prevention with and without primer and bond. Med Princ Pract 2013;22:12–17.

16. Feigal RJ, Musherure P, Gillespie B, Levy-Polack M, Quelhas I, & Hebling J. Improved sealant retention with bonding agents: a clinical study of two-bottle and single-bottle systems. J Dent Res. 2000 Nov;79(11):1850-6.

17. Hebling J& Feigal RJ. Use of one-bottle adhesive as an intermediate bonding layer to reduce sealant microleakage on saliva-contaminated enamel. Am J Dent. 2000 Aug;13(4):187-91.

18. Griffin S, Jone K, Kolvic Gray S, Malvitz D, & Gooch B. Exploring Four-Handed Delivery and Retention of Resin-Based Sealants. J Am Dent Assoc 2010 141(6): 696-698.

19. Yazici AR, Kiremitici A, Celik C, Ozgunaltay G, & Dayangac B. JADA Continuing Education: A two-year clinical evaluation of pit and fissure sealants placed with and without air abrasion pretreatment in teenagers. J Am Dent Assoc 2006 137(10): 1401-1405.

20. Pinkham JR, Casamassimo PS, Fields HW, McTigue DJ, & Nowak A. (2005). Pediatric dentistry: Infancy through adolescence, 4th ed. St. Louis: Elsevier Saunders. 2005.

21. Shimazu, K., Ogata, K., & Karibe, H. Evaluation of the ion-releasing and recharging abilities of a resin-based fissure sealant containing S-PRG filler. Dent Mater J. 2011;30:923-927

22. Wang, Y., Kaga, M., Kajiwara, D., Minamikawa, H., Kakuda, S., Hashimoto, M., & Yawaka, Y. Ion release and buffering capacity of S-PRG filler-containing pit and fissure sealant in lactic acid. Nano Biomed. 2011;3:275-281.

Author ProfileHeidi Emmerling Muñoz, PhD is a professor of English at Cosumnes River College. Prior to her current role, Dr. Muñoz served as interim director and professor of dental hygiene at Sacramento City College. Dr. Muñoz is a frequent contributor to RDH Magazine and has written articles and columns for a variety of publications. She can be reached at MunozH@crc.losrios.edu

Jan Carver Silva, RDH, MSHS is a professor of dental hy-giene at Carrington College California, Sacramento campus. Ms. Carver Silva served as a California Dental Hygienists’ Association delegate and Vice President of the Sacramento Valley Component. She has contributed to RDH Magazine and can be reached at jcarver@carrington.edu

Author DisclosureHeidi Emmerling Muñoz, PhD and Jan Carver Silva, RDH, MSHS have no commercial ties with the sponsors or providers of the unrestricted educational grant for this course.

RDH | October 2013 rdhmag.com | 99

Questions

Online CompletionUse this page to review the questions and answers. Return to www.ineedce.com and sign in. If you have not previously purchased the program select it from the “Online Courses” listing and complete the online purchase. Once purchased the exam will be added to your Archives page where a Take Exam link will be provided. Click on the “Take Exam” link, complete all the program questions and submit your answers. An immediate grade report will be provided and upon receiving a passing grade your “Verification Form” will be provided immediately for viewing and/or printing. Verification Forms can be viewed and/or printed anytime in the future by returning to the site, sign in and return to your Archives Page.

1. Dental caries is a problem for patients in which age group?a. Children under age 10b. Children and young adults aged 11-20c. Adults over 20d. All of the above

2. The teeth at highest risk for caries are:a. Permanent first molarsb. Permanent second molarsc. a and bd. None of the above

3. All of the following are characteristics of ideal sealant material EXCEPT:a. Effectiveb. BPA-freec. Easy to used. Long lasting

4. Recent research shows which type of sealant has the highest retention?a. Glass ionomerb. Resinc. Light polymerizedd. None of the above; they are all equal

5. Which of the following is a concern among some people specific to BPA in sealants?a. Fluoride toxicityb. Lack of retentionc. Adverse hormonal reactionsd. Sealing in bacteria

6. Sealant retention can be enhanced by:a. Use of four-handed technique when placing

sealantsb. A licensed dentist widening the fissures with a burc. Administration of local anestheticd. Removal of the air-inhibiting layer after placement

7. Which of the following can be used to clean the tooth prior to acid etching?a. A toothbrushb. A handpiecec. An air polisherd. All of the above can be used

8. The most common reason for resin-based sealant failure is:a. Placement on an incipient lesionb. Lack of occlusal adjustmentc. Salivary contaminationd. None of the above

9. How are sealants categorized?a. Compositionb. Polymerizationc. Fillerd. All of the above

10. What types of filler are used in sealants?a. Colorb. Quartzc. Nothingd. All of the above

11. After cleansing the tooth, prior to placing the sealant, the tooth is carefully etched with:a. Hydrochloric acid b. Phosphoric Acidc. Hydrogen peroxided. Fluoride

12. What is the concentration of the etchant?a. 10% b. 75%c. 83%d. 15%-50% depending on the manufacturer

13. The proper sequence for placing resin-based sealants is:a. Etch, dry, place, clean, rinse, occlusal adjustmentb. Rinse, etch, dry, place, occlusal adjustment, cleanc. Clean, dry, rinse, place, etch, occlusal adjustmentd. Clean, etch, rinse, dry, place, occlusal adjustment

14. Contraindications for pit and fissure sealants include:a. Radiographic evidence of proximal caries b. Incipient decayc. Self-cleansing pits and fissuresd. a and c

15. Sealants should be re-examined:a. Annually b. At every appointment, or every 6 monthsc. Every 3 monthsd. It is unnecessary if placed properly

Notes

PITFIS1113RDH Customer Service 216.398.7822

ANSWER SHEET

Pit and Fissure Sealants: An Overview

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Completing a single continuing education course does not provide enough information to give the participant the feeling that s/he is an expert in the field related to the course topic. It is a combination of many educational courses and clinical experience that allows the participant to develop skills and expertise.

CANCELLATION/REFUND POLICYAny participant who is not 100% satisfied with this course can request a full refund by contacting PennWell in writing.

IMAGE AUTHENTICITYThe images provided and included in this course have not been altered.© 2013 by the Academy of Dental Therapeutics and Stomatology, a division of PennWell

Educational Objectives1. Describe the basic placement of pit and fissure sealants. 2. Discuss the clinician’s role in optimizing best practices and safe use of pit and fissure sealants. 3. Educate patients on the role of dental sealants in an effective caries prevention program.

Course Evaluation1. Were the individual course objectives met? Objective #1: Yes No Objective #2: Yes No

Objective #3: Yes No

Please evaluate this course by responding to the following statements, using a scale of Excellent = 5 to Poor = 0.

2. To what extent were the course objectives accomplished overall? 5 4 3 2 1 0

3. Please rate your personal mastery of the course objectives. 5 4 3 2 1 0

4. How would you rate the objectives and educational methods? 5 4 3 2 1 0

5. How do you rate the author’s grasp of the topic? 5 4 3 2 1 0

6. Please rate the instructor’s effectiveness. 5 4 3 2 1 0

7. Was the overall administration of the course effective? 5 4 3 2 1 0

8. Please rate the usefulness and clinical applicability of this course. 5 4 3 2 1 0

9. Please rate the usefulness of the supplemental webliography. 5 4 3 2 1 0

10. Do you feel that the references were adequate? Yes No

11. Would you participate in a similar program on a different topic? Yes No

12. If any of the continuing education questions were unclear or ambiguous, please list them. ___________________________________________________________________

13. Was there any subject matter you found confusing? Please describe. ___________________________________________________________________ ___________________________________________________________________

14. How long did it take you to complete this course? ___________________________________________________________________ ___________________________________________________________________

15. What additional continuing dental education topics would you like to see? ___________________________________________________________________ ___________________________________________________________________