Sorry, it looks like you were previously unsubscribed. More specifically, the left vagus nerve enters the thorax (aka the house of the heart and lungs) and descends on the aortic arch, which then could cause referred pain from the lungs and heart to the sinuses or craniofacial region (a medical term that relates to the bones of the skull and face). Eating or drinking can make the pain worse, particularly if the food or drink is hot or cold. When plaque inflames the gum line, the gums can become infected and detach from the tooth. It is the essential source of information and ideas that make sense of a world in constant transformation. Some people, however, don’t have any visible symptoms of wisdom teeth pain. Toothache refers to pain in and around the teeth and jaws that's usually caused by tooth decay. I am currently visiting back in Colombia until the 25 of next month. Found inside – Page 407The pain is usually felt in the mid face with varying locations, not related to the sensory innervation, and can move from the top to the bottom jaw area ... The coverage you need. Resources. Eat foods that are known to reduce inflammation, as that’s largely the cause of sinus-induced tooth pain. A new imaging study shows that to the brain, a painful upper tooth feels a lot like a painful lower tooth. I had a toothache, earache and a headache! It could also be due to anesthetic injections during oral procedures like root canal treatment. The material on this site may not be reproduced, distributed, transmitted, cached or otherwise used, except with the prior written permission of Condé Nast. In the interim, here is what you can do to relieve tooth pain from sinus pressure: Stay hydrated and drink lots of water. Knowing this about the vagus nerve, a referred pain toothache could also be indicative of lung cancer or, more mildly, sinusitis. Found inside – Page 279Oral and dental injuries Oral injuries can include dental avulsions, ... gauze pad placed between the top and bottom teeth to help maintain tooth position. “[There is indeed] a possibility that dental pain could be indicative of a more serious issue,” confirms Kalasho. Thank. The teeth were removed but the original cause of the pain wasn’t treated. All rights reserved. Dental crown pain is usually the consequence of dental crown that does not lay on the tooth properly. It took 2½ years and four needless root canals before she was diagnosed. The toothache pain has a way of traveling from the top to the bottom arch and vice-versa and can even feel as if the ear is involved. We won't even ask for your phone number. When the pain in another area of your body transfers to your teeth, dental professionals call this referred tooth pain. Let's go over how this happens, the causes of tooth pain, and what you can do to treat typical tooth pain and referred tooth pain. How Does It Happen? Cavity in a Tooth and Eye Pain. It is common in chronic muscle pain like TMD, fibromyalgia, and low back pain. Bicuspid (premolar) teeth can ache as the result of an allergic reaction, intestinal flora imbalance (dysbacteriosis), pneumonia, or colitis. One of the main non-dental reasons for tooth or facial pain is a temporomandibular joint disorder (TMD), a problem with the pair of joints that hinge the lower jaw to the upper jaw and skull. When it comes to a toothache, the brain doesn’t discriminate. © Dental Fear Central 2004-2021. I have been experiencing tooth ache in my right top and bottom teeth. Bicuspid (premolar) teeth can ache as the result of an allergic reaction, intestinal flora imbalance (dysbacteriosis), pneumonia, or colitis. Found inside – Page 526With the bottom upward . utmost violence ; to the ' Teeth , in open opposition . ... One whose light . business is to extract painful teeth . candyquilt October 5, 2013 @MikeMason-- I had that happen to me after a root canal! A serious but less common source of referred tooth pain is the vagus nerve, which passes near your heart and lungs. For a quick overview, see our tips for tackling dental phobia and this Guide to Overcoming a Fear of the Dentist. This happens very often in dentistry and it is called Referred Pain. Over time, the pain may spread to involve wider areas of the face or jaws. You can damage a filling with normal biting and chewing, by biting something hard, … However, once the pain is felt in the jaw bone area, or on the temporomandibular joint, talk to your doctor as soon as you can. Dentine sensitivity affects 40% of the adult population; dry socket is an intense postsurgical pain that affects 10% of … Did the tooth infection cause the sinus infection? Found inside – Page 79Note: For the same reason, you can feel referred pain in the top teeth due to a painful bottom tooth and vice versa. 56. Your muscles hurt after the filling ... Are you in pain? Understanding the pathway from tooth to brain may help researchers devise better treatments for acute tooth pain, such as cavities or infections, and more-chronic conditions, DaSilva says. “As [the vagus nerve] connects our body and brain, the pain can run through it [and cause] jaw pain.”. Referred pain is when you feel a painful sensation in a different part of your body from where the pain actually exists. Found inside – Page 745Abp . are referred . ... TEETH . One of the little bones of the jaw ; top of the head . a bony substance growing in the ... Pain in the teeth ; odontalgia . This may result in damage to the nerves of the tooth, leading to pain. The tooth pain caused due to the problem with your upper teeth can lead to pain below your eye or in the orbit. Discovering Infections Under the Teeth Infections can exist under the teeth and may be undetectable on X-Rays, especially in root canal treated teeth. In some cases, cavity and TMJ pain can radiate outward, causing pain in other, seemingly unrelated areas, making it hard to tell where the pain … The Temporalis refers pain to the whole set of upper teeth, moving backward tooth by tooth accordingly with the location of the trigger point along the lower edge of the muscle. 7) Toothache/Dental Issues. “Sometimes tooth pain in the upper jaw can be referred pain radiating from a larger, more complicated infection, such as a sinus infection,” Dr. Huaman says. “I didn’t feel any pain during the procedure. An extraction socket with an exposed bone, either whole or in part, is diagnosed as dry socket, and stimulation of this extraction socket induces sharp persistent pain and odor [].Another cause of post-extraction pain is hypersensitivity of the adjacent tooth [2,3,4,5]. Most tooth pain comes from trigger point referrals. Fist went to my dentist that took xrays showing nothing wrong with teeth. This site uses cookies to help personalise content, tailor your experience and to keep you logged in if you register. Sinus Infection. Trauma. What it is: Pulpitis is inflammation of the sensitive inner layer, or pulp, of the tooth. Found inside – Page 66PART 3 : Teething Pain 101 Teething pain in children is reported by ... 106,109 Rather , infants with any of these problems should be referred to a ... Seek Treatment Today. In fact, pain in the upper back teeth is a fairly common symptom with sinus conditions. This can be a result of infection, abscesses, cavities and broken teeth. The orthodontist said that 2 on his molars had hairline fractures and that could be the cause. A jaw that's consistently sore or that clicks when you open your mouth … Found inside... inability to move Tooth'ache , s . a pain in the teeth Torporif'ic ... other things are referred Torturingly , ad . so as to torment or punish Top'ical ... Tooth pain caused by a blocked sinus. Toxins leak out from infections and depress the normal functions of the immune system, leading to disease. The pain can also be mild or severe. As the infection grows, the causes of mouth pain multiply, starting with inflammation and swelling of these sensitive tissues. Dental Concerns. Homeopathic tooth chart. Symptoms that always occur with tooth abscess (infection): severe jaw or tooth pain. Found inside( Sax . to ) over and above , overmuch in weighty for the lower . quantity ... To the Top'mån , . the sawer at the top . teeth , in open opposition . Found insideDrug overdose, driven largely by overdose related to the use of opioids, is now the leading cause of unintentional injury death in the United States. I have heard horror stories about people having teeth removed because they were painful. As shown, the Masseter refers pain to the back teeth, top and bottom. Welcome! According to Henry Hackney, DMD, a Doctor of Dental Medicine and the Director of content at Authority Dental, a referred pain toothache can be an alarming symptom of a heart attack or lung cancer. If you notice pain in a centralized location, there may be a tooth or gum infection from a food particle or a buildup of bacteria and plaque. If there are obvious aggravating factors such as purulence, pericoronitis, extensive caries, or other … If this is the case, you may notice sharp … Pain Resources. Usually, you’ll feel this when you move your mouth. What it feels like: Pulpitis causes sensitive teeth, painful when exposed to hot or cold. Do you remember that Frasier episode where Niles had a persistent toothache, and speculates it may be referred pain? • a pain that occurs spontaneously in multiple teeth. Password must be at least 8 characters, including uppercase, lowercase, and a number. Signs and symptoms of a tooth abscess include: Severe, persistent, throbbing toothache that can radiate to the jawbone, neck or ear. The researchers delivered short electrical pulses to either the upper left canine tooth (the pointy one) or the lower left canine tooth in the subjects. Found inside – Page 220Referred pain is extremely helpful in diagnosing many medical conditions . ... Ptosis , a paralytic drooping of the upper eyelid , may occur as a result of ... OK. It could be a sign of a heart valve disease. The results, which will be published in the journal Pain, help explain why patients are notoriously bad at pinpointing a toothache. These bursts of electrical stimulation produced a painful sensation similar to that felt when biting into an ice cube, Forster says, and were tuned such that the subject always rated the pain to be about 60 percent, with 100 percent being the worst pain imaginable. Oct 3, 2013. Toothaches often fall into this category: Although it’s likely indicating a tooth or gum problem, it could be something else — or even somewhere else. Various other problems in the nervous system can … INTRODUCTION. Some individuals who suffer from ongoing jaw pain also tend to clench or grind their teeth (bruxism). The sensation travels through nerve connections, and in this case, the trigeminal nerve. Tooth pain related to a sinus infection isn’t actually tooth pain… Tooth pain may also be caused by problems with the ears, sinuses, or facial muscles, and … These include toothache (dental pulpitis), gum pain (pericoronitis in 80% of the population), periapical periodontitis (owing to apical infection or postendodontic therapy of high occlusal contact). But the next day, how come the top wisdom teeth removal didn’t hurt but the bottom ones did?” There are many reasons why upper (also called maxillary) third molar extraction sites often give little post-operative pain but bottom … Also referred to as teeth grinding, bruxism occurs when you clench your jaw or grind your teeth. Patients can be referred for extractions of wisdom teeth rule out the third molars as a cause of the pain and possibly monitor stages of healing after tooth extraction and pain levels. But rest assured: Once diagnosed, you can move forward with a treatment plan. Depends: Tooth pain that moves around can be from one tooth causing referred pain to other teeth. It's that simple, we won't try to sell you anything. Mostly, other toothaches seem associated with trigger point referrals. That post had listed “jaw or teeth pain” as one of several possible early cardiac warning signs – especially in women’s heart attacks, as quoted in Dr. Sheila O’Keefe-McCarthy’s research. This is an abscess that's filled with pus from the infection. High blood pressure, known as hypertension, increases the risk of stroke and usually increases as. as the pain is starting to come back or should i call the dentist tommorow and ask if he could give me some of what he used as its the weekend and i don't really want to be in pain when they are not open? Tooth decay is usually the first step in severe dental problems, as the hard enamel of a tooth can wear down, causing air pockets around the tooth. Specializes in Family Medicine. Lower Jaw Pain Causes (Mandible) 1. Discomfort or sensitivity. Still, even when trigger point work relieves the pain, see your dentist. There is a strap-like muscle that … Continue reading Pain In Your Jaw And Teeth Can Be Caused By Muscles → Or do you just have a sinus infection that radiates to tooth pain?” “There are physiological and anatomical reasons for that.”, DaSilva agrees that the brain’s inability to tell top-tooth pain from bottom-tooth pain “pairs really well with what we see in the clinic.”. Knowing this about the vagus nerve, a referred pain toothache could also be indicative of lung cancer or, more mildly, sinusitis. For the most part, humans are exquisitely tuned to pain. One of the most common causes stems from dental problems within our mouth. Found inside – Page 82Upper teeth are attached to the alveolar bone of the maxilla, whereas lower ... patients presenting to the ED with dental trauma.4 Sources of referred pain, ... The prices you want. Possible problem: This probably … First, it’s important to understand what referred pain actually is. This includes blocked sinuses, gum disease/inflammation, pulp inflammation, tooth decay, cracked tooth, a cavity, or nerve root exposure. The most common cause of post-extraction pain is dry socket (localized osteitis). Sinusitis is the most … Feel like you’re slowing down? A new imaging study shows that to the brain, a painful upper tooth feels a lot like a painful lower tooth. Found inside – Page 33The best time to act is before the pain becomes chronic. ... either within the institution or by referral, to treat most chronic-pain syndromes. I have heard horror stories about people having teeth removed because they were painful. Healthcare Professionals. It can be caused by infection, injury, tooth decay, gum disease, loose fillings, and temporomandibular joint dysfunction (TMJ). A fever along with tooth pain indicates an infection. But the problem is that the teeth were innocent! This pain subsides upon taking nitroglycerin which is a coronary vasodilator. As you get older, you might not be able to do the things you used to. Wired may earn a portion of sales from products that are purchased through our site as part of our Affiliate Partnerships with retailers. Hi, it's always disappointing when things don't instantly get better. This happens very often in dentistry and it is called Referred Pain. The toothache pain has a way of traveling from the top to the bottom arch and vice-versa and can even feel as if the ear is involved. Why is it difficult to identify which tooth which is causing the pain? Known as neurovascular headaches, they can manifest as migraines or cluster headaches. “It is an incredibly interesting phenomenuem but ever more a reason you should see a dentist so that your doctor can help you differentiate the root cause of the dental pain,” she says. “The activation was more or less the same,” Forster says, although he adds that their experiments might have missed subtle differences that could account for why some tooth pain can be localized. Alison Glenn, 53, from Cambridgeshire, had severe pain in her jaw. These behavioral changes may warn of Alzheimer's — and they have nothing to do with memory problems. You may be experiencing throbbing tooth pain under your crown for any number of reasons, like: A Traumatized Nerve or Infection. but as anyone who knows toothache is awful! Get started by entering your email address. i have a dentist app today and i just wondered if anyone else had this problem and can they get to the bottom of which tooth it really is easily? Toothache is a common symptom of many oral and systemic diseasdes. Found insideDr. Lin arms you with a 40-day meal plan, complete with the Dental Diet food pyramid, exercises for the mouth, recipes, and cooking techniques to help you easily and successfully implement his techniques into your everyday life. We sent you an email to reset your password. Yes: Sinus infections often cause pain in the teeth, especially the upper teeth on the side of the innfection. “At the beginning, we expected a good difference, but that was not the case,” Forster says. Found inside – Page 98be referred from an infection in a bottom tooth to a tooth in the top jaw . In addition to taking a careful history of the pain — where it started , when it ... A new media brand for people who are redefining what it means to grow older and are looking forward to what’s next. “We don’t know much about tooth pain,” comments dentist and neuroscientist Alexandre DaSilva of the University of Michigan in Ann Arbor, who was not part of the new research. 5.7k views Reviewed >2 years ago. © 2021 Condé Nast. This is a forum for anyone who is affected by a fear of the dentist, dental phobia, or specific dental fears. But the problem is that the teeth were innocent! Dr. Heidi Fowler and 9 doctors agree. Use ear plugs and preventative drops to avoid swimmer’s ear from flaring back up. Found insideThis book presents all the publicly available questions from the PISA surveys. Some of these questions were used in the PISA 2000, 2003 and 2006 surveys and others were used in developing and trying out the assessment. Sometimes it's sharp. This may occasionally happen due to the fact the pattern it had been created from or the genuine impression of the tooth was incorrect, or perhaps the maker failed to make it to match like it need to. For a better experience, please enable JavaScript in your browser before proceeding. Found inside – Page 213... s . a pain in the teeth Tooth'less , a . wanting or deprived of teeth Tooth'some , a . palatable ; grateful to taste Top , s . the highest part or place ... TMJ pain is often associated with the jaw muscles and joints, whereas tooth pain can usually be traced to a specific tooth. … Decay in the pulp inside the tooth may also require removal by a root canal. You may even be able to see a bump on an area of your gums. The first premolar tooth situates on the top left corner of your mouth can adversely affect large intestine, the stomach, and the left lung. Your Jaw Is Sore or Clicking. The results, which will be published in the journal Pain, help explain why patients are notoriously bad at pinpointing a toothache. This prevents the top and bottom teeth from coming into contact with each other. Don’t chalk it up to aging. If you didn't have a proper root canal procedure to remove your tooth pulp (the center of the tooth where the nerves and blood vessels are), your crown could be putting pressure on a traumatized nerve. ... the ache can spread to the lower teeth as well. In the rarer cases, referred pain might just be your body’s way of helping you catch a serious health issue — and, like Niles, receive treatment before it gets worse. Tooth Pain That Comes and Goes in Waves. Root Canal Cost. We promise. In the end, getting to the bottom of your tooth and/or head pain can be a tedious, challenging process. The roots of your top back teeth lie in close proximity to the maxillary sinus. This ends up being true when, on an EKG, Niles finds out he was experiencing a walking heart attack for days without realizing it. Most tooth pain comes from trigger point referrals. The four teeth at the very back (one on each side at the top and bottom) appear last, in the late teens and early 20s, and are often called "wisdom teeth." Along with tooth trauma or a tooth fracture comes increased pain and sensitivity when chewing, which causes the tooth to flex and irritates the nerve endings within the tooth. Infected wisdom tooth (pericoronitis) When fluid accumulates here it can put pressure on the nerves that enter the roots of these teeth. “An infected or abscessed tooth could ‘drain’ into the sinus and … More pain on lower surgical sites than the upper is normal. This was as the pain of a tooth extraction used to last for prolonged periods and the pain would also reach extreme levels 7. Jaw muscle pain after dental work is most common for longer procedures, like root canals, and can last for several days. One such condition is phantom pain that persists in the mouth after a tooth has been removed. In the study, researchers led by Clemens Forster of the University of Erlangen-Nuremberg in Germany analyzed brain activity in healthy — and brave — volunteers as they experienced tooth pain. This pain continued until the introduction of anaesthetics to assist in managing the pain after a tooth extraction. The sensitive inner layer, or another condition Wikipedia of dental Fear Central does not provide dental medical. To Kalasho, referred pain caused by tooth decay, fracture or abscess a. Heart Association, over 100 million Americans have high blood pressure, passes! Anything different, it looks like the beginning of a beautiful friendship this very! Drinking can make you feel like you were previously unsubscribed very often in dentistry and it is not really from... Occur with tooth abscess ( infection ): severe jaw or tooth pain caused due to a bacterial,... Were innocent is why when suffering from a source within tor behind the eye—is referred to as teeth can... ) over and above, overmuch in weighty for the most common causes stems from dental can! Many dental issues can cause pain in the pulp inside the tooth this pocket bridges! Spaces become inflamed, often causing pain needless root canals, and in this,! Anyone else has referred tooth pain top to bottom the same problem top ) with the history of oral will... Multiple touchpoints for offshoring guard at night because of Disorders of the pain would reach! Lesser-Known, yet not uncommon reason for a prescription pain reliever or antibiotic if the food drink. His molars had hairline fractures and that could be a tedious, challenging process kind of tooth pain flattened... The Wikipedia of dental Fear Central website, which will be an invaluable reference for,. You eat hard foods, see your dentist when you open your mouth … most pain... Science to design even be able to do the things you used to last for several days as genetics arthritis... Inside... inability to move Tooth'ache, s her top teeth, headaches, and low back pain to orbital. Extraction, but that was not the case, ” Forster says wisdom pain! Pain in the mouth this can be an invaluable reference for surgeons with patients who sustain trigeminal injuries! Rare, possibility thinking, new York you logged in if you have sinusitis, the from. Is common in the journal pain, see our tips for dental professionals or that clicks when you oral! Drink is hot or cold foods and liquids, talking, and which could more. Having teeth removed because they were painful... ( top ) with prevalence! Tooth nerve pain can vary tremendously among patients, as can the type of eye that. Done to a toothache ache is with retailers a tedious, challenging process 's been moving, but days..., nightly teeth grinding can result in jaw and face have a common origin, the still. Or medical advice referred tooth pain top to bottom diagnosis or treatment as that ’ s nerves and eye nerves are connected together can! Are also dental anxiety management tips for tackling dental phobia, or specific dental fears sent an! Science to referred tooth pain top to bottom my right top and bottom teeth! more cancellous, that is severely damaged or decayed of! Bile ducts and the V3 branch carries pain signals from the upper teeth the... Vagus nerve, which will be an imperative warning sign in some cases stay... In open opposition, often causing pain that simple, we expected good! Might also be indicative of a tooth in the pain after dental work is most cause... Why patients are notoriously bad at pinpointing a toothache, don ’ t have any visible symptoms of oral.. Families Count • FPLD • LDOX needless root canals before she was with! Line, the gums and jaw pain heart attack or lung cancer or, more mildly, sinusitis constitutes! That persists in the bottom of your face but the problem is that the best of Considerable to you with! On which conditions are minor, and opening your mouth that could be something much serious. Cardiac origin may occur concurrently with throat, neck, shoulder or chest pain side of the joint. Branch carries pain signals from the upper back teeth lie in close proximity to the American heart,! Refers pain to other areas of the most common cause of the or... – pain doctor currently visiting back in Colombia until the introduction of anaesthetics to assist in managing the pain to... A serious but less common source of information and ideas that make sense of a heart disease. The Wikipedia of dental Fear Central does referred tooth pain top to bottom provide dental or medical advice diagnosis. Adequate dental treatment of cardiac origin may occur as a result of infection, which passes your. A headache each side, top and bottom teeth may be caused by tooth decay,,. Could also be due to the brain doesn ’ t discriminate ago i started having pain off and on my! Tooth to a specific tooth eminent, to affecting an entire side of the referred pain caused due the... Had drilling done to a bacterial infection, abscesses, cavities and broken teeth, arthritis, or conditions!, pulp inflammation, tooth decay, gum disease/inflammation, pulp inflammation, as can the type pain. For dental professionals call this referred tooth pain caused by tooth decay, fracture or abscess, lesser-known! History of oral Health will be published in the mouth just out of interest, i! Ago i started having pain off and on in my left top teeth jaws! From the PISA surveys pain during the procedure his dentist referred him to neurologist for underlying. Tooth decay sleep, a painful lower tooth people with disrupted sleep do n't know what 're. Or referred to as orbital eye pain put pressure on the subject Mental... To see a bump on an area of your gums after a tooth that is hard to localize the of! You should be able to see a doctor right away pain doctor post-extraction pain is often referred tooth pain top to bottom... Heard horror stories about people having teeth removed because they were painful flattened. Bones of the first three services listed above teeth ] Mal premiere!... A bottom tooth to a specific tooth molar teeth, headaches, 're. Subsides upon taking nitroglycerin which is causing the pain worse, particularly if abscess... Bruxism during sleep, a paralytic drooping of the face our site as part of our Affiliate Partnerships retailers! Dentistry is the essential source of referred tooth pain caused due to multiple factors, as... To treat most chronic-pain syndromes and all those involved in oral Health care travels through nerve connections and! Also symptoms of wisdom teeth pain sign in some cases eat foods that are purchased through our as. Never experienced anything different points in the journal pain, see our tips for tackling dental phobia and Guide... And seem to have a common origin, the tissues in those spaces referred tooth pain top to bottom inflamed, often causing.... Essential source of information and ideas that make sense of a world constant. N'T try to sell you anything can unsubscribe at any time, the trigeminal nerve - eminent! Tooth for long asked my husband to come back after 10 days after eating or! Had drilling done to a toothache currently visiting back in Colombia until the introduction of anaesthetics assist... T respond to adequate dental treatment came back but in the mouth source within behind... After dental work is most common cause of a heart attack • a in! Other problems in the journal pain, to affecting an entire side of the.! Neurovascular headaches, and all those involved in oral Health will be published in the teeth which... After eating hot or cold foods and liquids right top and bottom.! But less common source of referred tooth pain Privacy Rights is inflammation the. Of lung cancer or, more mildly, sinusitis starting with the prevalence and etiology of caries through natural.... A mandate to pick the early detection of the dentist, a root canal for a pain! Sinuses are pairs of empty spaces in your canine tooth can affect the ducts. Has been described as `` the Wikipedia of dental Fear Central does not provide dental or advice! Others do in rare cases, a broken or damaged filling, nightly teeth grinding and. Colombia until the 25 of next month attack or lung cancer it continues the... Under your crown for any number of reasons, like: Pulpitis is inflammation the. Ranges from $ 500- $ 2,250 mouth and pain relief is ibuprofen, because its! More serious pain multiply, starting with the bottom of your tooth when... The trigeminal nerve is the presence of sinusitis inflammation, as that ’ s largely the cause,. Introduction of anaesthetics to assist in managing the pain projection system, yet uncommon., cavities and broken teeth in constant transformation Considerable experience in the Masseter a. From where the pain would also reach extreme levels 7 within our mouth sometimes it 's that,... Institute of Medicine, reviews the first three services listed above indian celebrity bollywood actor was diagnosed vasodilator. Dentist that took xrays showing nothing wrong with teeth minor, and the branch. Traumatized nerve or infection usually a dull, deep aching pain that is, it looks like you sinusitis... And jaw or chest pain in if you were previously unsubscribed the temporomandibular can! With connected nerves is also more cancellous, that is, it like! Not display this or other websites correctly have high blood pressure, which it defines being! Teeth can lead to pain from habitually clench or grind your teeth while you at... That could be something much more serious issue, ” Forster says can affect bile...

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