Secured Fit for a Renewed Life!

SOCIAL ANXIETY: Poorly fitted or loose dentures can cause many denture-wearers to be socially isolated. They rarely, if ever, go out to dinner. Eating their favorite foods is a thing of the past, and the blender becomes front and center in the kitchen, Samaha says. “These individuals worry their upper teeth will fall down and their lower teeth will float up,” she says. “It’s horribly embarrassing. Implant dentures are always securely fitted, allowing for renewed confidence, renewed health and a renewed social life.”

“There are other reasons why eating isn’t fun for many who wear dentures,” Samaha says. “The thick, hard plastic palate of upper dentures keeps the denture-wearer from experiencing the texture and temperature of different foods, as well. Sometimes, foods will even stick to the plastic palate.”

DISCOMFORT, INFECTIONS AND OTHER HEALTH PROBLEMS: When the teeth are worn down and dentures are loose, the constant movement of the denture can scratch gum tissue, creating ulcers, Samaha says. Sometimes the sores are extremely painful and the dentures end up in the nightstand drawer. Other times, the individual doesn’t even knows the sores are present because they don’t hurt. Either way, there is danger in ill-fitting dentures. “Constant irritation of the soft oral tissues can cause sores that can become cancerous,” she says. People with dentures are also very susceptible to fungal infections on the denture and on the tissue. The majority of denture-wearers who are infected are completely unaware they have a problem. And these infections are impossible to get rid of without professional attention,” Samaha says. So for all these reasons, it’s important for denture-wearing­patients to see a dentist at least once a year. However, when implants or natural teeth are present, maintenance appointments are required two to four times a year.

Ill-fitting dentures also lead to poor eating habits. “People who can’t chew properly are more likely to choose high carbohydrate, softer foods,” Samaha says. “Fresh, raw fruits and vegetables are typically lost from the diet. That can lead to cardiovascular disease, diabetes, gastrointestinal problems and other degenerative diseases. Many denture wearers already suffer from such illnesses, only making health issues all the more challenging to stabilize.”

SEVERAL OPTIONS FOR HELP: Today’s customized dentures can be paired with implants, to securely lock them in place. “Options without a palate are excellent for patients who have sensitive gag reflexes,” Samaha says.

Often, highly affordable mini implants can be gently placed in one short appointment, with the denture snapped into place before the patient even leaves the office.

  • “Either way, a patient can get dentures that snap onto as few as two to four implants,” Samaha says. This is the first and most conservative option.
  • “The next option to replacing missing teeth is a more permanent style denture, with no palate and minimal plastic, cemented onto several implants,” Samaha says. The dentist can periodically remove these dentures for cleaning—otherwise, they do not come in and out and they are cleaned much like natural teeth.”
  • A third option that mimics natural teeth in size and shape, includes more implants with porcelain crowns and/or bridges cemented onto them. “No denture or plastic of any kind is necessary in this case,” Samaha says.

Such options are only available in offices specially trained in implant dentistry. No matter which option is chosen, the result can be stunning and natural in the hands of a skilled dentist.

Posted in Uncategorized

So You’ve Tried Whitening Before…

“If You Haven’t Been Pleased – You Haven’t Tried KöR Deep Whitening!”

Deep within, we are always ready for the excitement holidays and special occasions bring. Let our team turn your anticipation of a brilliant holiday season or a memoable event into a dazzling smile just in time for those heartwarming moments.

So, if you’re too embarrassed to smile, have dark-stained teeth, or just simply want a whiter smile, the excellence of KöR Whitening is waiting for you.

At Port Warwick Dental Arts, we feature the highly regarded KöR custom teeth whitening for a fast, simple way to reverse years of yellowing with less sensitivity and better, deeper long-term results than traditional teeth whitening methods.

The KöR Whitening System produces the most profound whitening with the least sensitivity and is considered to be the most reliable and effective bleaching system ever developed. We have tried most every whitening system available over the years. Since we became certified in the KöR System several years ago, we haven’t looked back. We are always striving to stay at the forefront of technique and we are very proud to be one of a small number of practices in Virginia to offer this special system.

Perhaps you have only imagined a brighter, more youthful looking smile. Don’t wait for the camera to find you – Call or click today for more Cosmetic options. After all, don’t you de­serve a smile worth smiling about!?

Visit our Before and After Gallery. Call today to schedule a Complimentary Consultation – (A $98 Savings) – and celebrate with the confidence you deserve.

Posted in Teeth Whitening

Affect Your Heart?

Since the mid-nineties, scientists have been increasingly observing a strong connection between poor oral health and heart conditions.

How might oral health affect the heart? In gingivitis, the milder form of gum disease, infection leads to chronic inflammation—gums are swollen, red, and sometimes bleeding. Bleeding gums indicate the bacteria is active throughout the mouth and the body. In periodontitis, the more severe form, the infection affects the bones that support the teeth, leading to tooth loss. In both cases, disease is caused by an accumulation of bacteria, or plaque, between the gums and the teeth. These organisms release toxins that can circulate through the body.

In particular, the body’s arterial system is affected. Numerous reports in the Journal of Clinical Periodontology and other esteemed journals, display a startling correlation: the more severe the gum disease, the thicker and harder the walls of the arteries. This is true even for young, healthy adults with no other symptoms of heart problems. Narrowing of the arteries (or atherosclerosis) is a key component of heart disease.

But gum disease threatens more than your heart. The toxins in dental plaque can cause harm wherever they go. In fact, scientists are finding more and more links between oral health and conditions such as diabetes, kidney disease, preganacy complications, osteoporosis, Alzheimer’s disease, and even many types of cancer.

With professional cleaning, excellent oral hygiene, nutrients and removal of bacterial buildup, gum disease can be reversed—if it’s caught in the early stages. In the later stages, it must be treated more definitively.

A 2007 report in the New England Journal of Medicine noted that patients in an intensive six-month program to treat gum disease emerged not only with healthier gums but with improved endothelial function—a reference to the lining of the blood vessels. This result has been confirmed in other studies.

Too many of us neglect our gums and teeth. Good oral health will obviously help you avoid tooth loss. And it is also the way to a healthier heart and much more.

Posted in Gum disease, Oral health, Periodontal Treatment

Angry, Frustrated or Worried About a Snorer in your House?

Do you find yourself sleeping on the couch because of a snorer in your house? While it can be pretty annoying to the bed partner, snoring can also be a sign of life-threatening sleep apnea.

Sleep apnea is defined by episodes when breathing stops during sleep. Untreated sleep apnea has been linked to heart attack and stroke while contributing to high blood pressure, diabetes, depression, low libido, weight gain, automobile accidents and more. The rumbling or gasping sounds of snoring are often the first symptoms of sleep apnea.

Working with a sleep physician, Dr. Samaha and her highly trained team at Port Warwick Dental Arts help apnea patients breathe easier during sleep, making dramatic improvements in their health and quality of life.

Ask about FDA-approved sleep studies, which can be done in the comfort of your own bed. If a sleep study, along with a sleep physician’s diagnosis, shows that you have apnea, a CPAP breathing machine is often the first approach to treat severe cases. Unfortunately, CPAP machines, with their face or nose masks, straps, hose and oxygen supply, can be uncomfortable, unwieldy and embarrassing. Research shows that more than 50% of those who should be using a CPAP machine, do not.

An oral appliance can be a highly effective treatment for those:

  • who cannot or will not wear a CPAP machine
  • with mild or moderate sleep apnea
  • who simply have a snoring problem

With a sleep physician’s referral, a custom-fitted oral appliance from Dr. Samaha gently shifts the lower jaw forward, moving the tongue out of the throat and allowing air to flow freely. An oral sleep appliance can be life-enhancing, even life-saving, for those individuals who cannot or will not wear a CPAP machine due to physical, emotional or practical reasons. It can also help to rescue a marriage troubled by a partner’s frustration – even anger -over having had his/ her sleep disrupted throughout the night.

Posted in Cosmetic Dentistry, Holistic dentistry, Sleep Apnea

Do you suffer from Tension or Migraine headaches? TMJ pain?

If you suffer from any of the above, you are probably all too familiar with over-the-counter and prescription reme­dies that can only offer you temporary relief (if any relief at all). Frustrating, to say the least. Wouldn’t it make more sense to treat the cause? Dr. Lisa Marie Samaha of Port Warwick Dental Arts believes so, and knows the answer to head and neck pain may be in your bite.

“Headaches are not normal,” says Dr. Samaha. “Those who suffer from headaches, (including migraines) TMJ pain and generalized head, neck and jaw pain, often think this is ‘normal.’ And when they seek help, they are often told that their pain is the result of stress. Sometimes this is true. Often, individuals are evaluated by a skilled physi­cian, extensive testing is performed, only to result in the administration of prescription drugs that may control the pain, often have negative side effects and do little to treat the cause.”

“The overwhelming reality is that a person’s bite or bite habits are the origin of the majority of head, neck and jaw pain. In many cases pain can be resolved, sometimes overnight, with a gentle, straightforward process offered by a dentist who has the training necessary to evaluate and treat head and neck pain. Other times, more advanced techniques that include neuromuscular and structural analyses are necessary in order to unravel the cause(s).Once discovered, a more advanced and strategic plan can be developed.”

No matter what, when it comes to caring for her patients, Dr. Samaha is committed to diagnosing and treating the cause—rather than medicating the symptoms—of any disease process she encounters in her patients.

Although biting and chewing seem like relatively effortless processes, these functions are made possible by a complex series of muscles, ligaments and joints working together to keep your upper and lower jaws aligned. A misalignment between the upper and lower jaws can be caused by accidental trauma to the face or skull, or simply from trauma occurring as far back as the birthing process. When a distortion has occurred, the movable lower portion of the jaw (called the mandible) must find and fit into the upper stationary portion of the jaw (the maxilla) during th chewing process.

When any part of that alignment is off, the muscles and ligaments involved do their best to compensate and bring the jaws back into alignment. The associated twisting needed to make this happen can cause head, neck, jaw and even tooth pain.

So if you have more headaches than you’d care to count and you’re tired of masking the pain with pre­scription drugs rather than getting down to the true core of the problem, make an appointment today to see Dr. Samaha for a diagnostic evaluation. Treating the cause rather than just the symptoms is a hallmark of Dr. Samaha’s patient care. There is no need to live with unnecessary pain for another day.

Posted in Headaches, Holistic dentistry, TMJ treatment

Don’t hide your smile – SHOW IT OFF!

A beautiful smile can make all the difference in the world when it comes to your perceived attractiveness, your attitude, your con­fidence and even the overall youthfulness of your face. And while enamel (the translucent outer layer of your teeth) is the hardest sub­stance in the human body, teeth are still relatively fragile, especial­ly with all the stresses and strains we put them through. Once the enamel is decayed or cracked, it may be only a matter of time before extensive dental care is needed.

Dr. Lisa Marie Samaha from Port Warwick Dental Arts wants you to know that even if you don’t have a vibrant smile now, you can easi­ly have one more simply and in less time than you think, thanks to such technological marvels as porcelain veneers, crowns, and dental implants.

PORCELAIN VENEERS: A veneer is a very thin slip of porcelain requiring minimal to no preparation of tooth structure, due to new techniques provided at Port Warwick Dental Arts. In the past, veneers required aggressive tooth reduction. Not anymore, with the quality skill provided by the master lab technicians with whom Dr. Samaha works. Veneers enhance the color, shape and overall aesthetics of a tooth or teeth. Porcelain veneers can also fill in gaps between teeth, brighten discolored teeth and strengthen a tooth weakened by decay, cracks or inherent enamel defects.

PORCELAIN CROWNS: A crown is a tooth-colored shell of porcelain that is placed over the top of cracked or severely damaged teeth, restoring the strength and beauty of the tooth to near 100% of its original integrity. Crowns protect teeth from splitting, causing painful nerve exposure and/or even the need for extraction. In the past, crown procedures would always include two or three visits to the dentist, who would first take a mold of the prepared tooth and send it off to a dental lab, often taking weeks to be completed. While the new “tooth” is being manufactured, a temporary crown is worn over the tooth. Inconvenient and often uncomfortable, this procedure has been almost completely replaced at Port Warwick Dental Arts. Dr. Samaha offers strikingly beautiful, one-hour porcelain crowns that she designs and mills herself, on high-tech Cerec cad-cam technology. One visit, one hour. Sounds great!

DENTAL IMPLANTS: A dental implant is a small post that is gently placed in the jaw in a matter of minutes, in order to replace a missing tooth. The post is then cov­ered with a crown to make it look, act and feel like a nat­ural tooth.

“If you are missing a tooth, an implant may be the pre­ferred option for tooth replacement,” says Dr. Samaha. “An implant feels and functions like your own tooth and is cleaned just like a natural tooth. Implants are quickly becoming standard care for the replacement of a miss­ing tooth.”

If you’re embarrassed about your teeth, or if you’re ex­periencing gum, tooth or jaw pain because of cracked or missing teeth, let Dr. Samaha and her team put a daz­zling smile back on your face. You’ll be amazed at how quickly most procedures can be done and even more as­tonished by how a few small changes can improve your overall appearance.

Posted in Uncategorized

Just Six Months…To A Beautifully Straight Smile

Recently, we have seen an increase in the number of patients asking how they can get a straighter smile – discreetly, effectively, and quickly. It is at times like these that we are happy that we offer Six Month Smiles®.

When you visit us for your Six Month Smiles® consultation, we begin a careful process to deter­mine if this option will achieve your smile goals. We use only use tooth-colored braces and wires so they blend in with your natural teeth – inconspicuously. In one short appointment, we place your Six Month Smile® appliances and make monthly adjustments. That’s it! The quick, gentle and discreet way to a straighter smile!

Your new smile could be complete by your next dental check-up! Hands down, Six Month Smiles® can be the perfect “quick-turn-around” option for a straighter, healthier and more attractive smile!

If you are seeking a discreet, quick, and effec­tive orthodontic treatment, ask us for a Six Month Smiles® consultation. We will be excit­ed to help!

We are also certified in Invisalign® for those of you determined to “get straight” without actu­al braces. These thin, clear trays may take a bit longer to “do their thing,” but have certainly found a place in our repertoire of options.

Each and every orthodontic case is unique but each end-result is always a more confident smile.

Posted in Cosmetic Dentistry, Six Month Smiles

Gentle Dental Laser Treatment

Dental lasers are like many other lasers used in medicine. In fact, lasers are becoming “standard of care” in the medical world. The range of laser use in medicine is vast – including general surgery, neurosurgery, orthopedics, podiatry, cosmetic surgery, and probably the best known, LASIK eye surgery.

What is so special about the dental laser we have chosen to use at PWDA? Our laser is a pulsed CO2 laser. Because our laser has one of lowest levels of tissue penetration of all lasers available, it is incredibly safe and gentle. And because the use of the laser promotes quick healing, it is a wonderful way of doing almost all types of surgical and non-surgical treatment. Whether the laser is used for smaller procedures or larger surgical procedures, the result is the same: a more rapid and comfortable healing process. The danger of bleeding during or after any surgical procedure, as well as the need for pain medication is minimized, and most often nonexistent.

What can our laser do for you? For the greater part of each day, our dental laser is busy helping to improve the dental health of our patients in a variety of ways:

Periodontal disease treatment: We use the laser for the non-surgical treatment of periodontal disease. It plays an integral role in the nationally recognized protocol that Dr. Samaha has developed (and teaches) for the diagnosis and treatment of periodontal disease. The CO2 dental laser allows for the disinfection and elimination of diseased gum tissue and also removes the toxins that are embedded in the root surface of the teeth. It encourages gum tissue healing and can even stimulate new bone formation.

Treatment of Herpes and Canker Sores: When the tingling or irritation of a cold sore (fever blister or herpes sore) occurs, the sore can be minimized as the laser vaporizes the virus on-the-spot. If caught early on, treatment can eliminate the cold sore in a few days, instead of 2 weeks. And more importantly, future outbreaks of the cold sore can often be eliminated by several seconds of a quick and painless pass of the laser over the sore. Mouth ulcers can be treated similarly.

Gum lift procedures to remove excess gum tissue: Certain medications, smoking, heredity and periodontal infections can be responsible for excess overgrowth of gum tissue. Sometimes, teeth appear very undersized because of this. Laser treatment is ideal for these situations and can treat this condition in one, gentle visit.

Removal of excessive muscle attachments between teeth or under the tongue: Some people have a gap between their front teeth which is caused by a heavy muscle attachment called a frenum. Other times, the muscle under the tongue is heavy, causing a tongue-tie, or speech impediment. The laser is just perfect in both situations, even in babies.

Discolorations or hereditary hyper-pigmentation of the gum tissue: People of African American, Native American and Indian ethnicity may have a dark, mottled appearance to their gum tissue. Some wish to have it removed. Much like a tattoo, it can be vaporized with a laser. It heals rapidly, often with no pain medication at all. In one visit, the discoloration is permanently removed.

Biopsies of diseased oral tissue: When lumps or bumps occur in the mouth, it is important to have them checked out as soon as possible. They can be a sign of a serious dental infection, such as an abscessed tooth, or they can be a sign of oral cancer. Other times, they can be a hereditary lesion or one that has occurred as a result of trauma. Our dental laser is perfect for removing such lesions and even for biopsying them, (in the case of suspicious lesions). No surgical blades and sutures required!

Hemangiomas of the lips: These are purplish-red isolated lumps of blood vessels which often occur on the lips. Removing them with traditional surgical means can be risky, but with our dental laser, they can be quickly dissolved, once and for all, with no scarring.

What does it feel like to have dental laser treatments – or even laser surgery? Most often, it doesn’t feel like much of anything. In fact, most of our patients say they don’t feel a thing. Some feel a slight rubbing on the tissue. Occasionally, one of our patients might say the laser treatment feels a little warm and/or tingly. In some advanced situations, we might need to gently place a little local anesthesia to assist us in your comfortable care.

Who performs our laser treatments? As the dentist at Port Warwick Dental Arts, I perform all laser treatments on our patients, without question. During the past few decades, dentistry has soared gracefully into the world of high tech. In so doing, procedures have become safer, quicker and gentler. The dental laser is one of the reasons why.

Posted in Cosmetic Dentistry, Gum lift, Laser Dentistry, Periodontal Treatment

Is Your Snoring Killing You?

Snoring is something we often make fun of in our society. Loud, gurgling noises occur all night long. But it isn’t funny to the person trying to sleep next to you. And what it’s doing to your body is not funny either. This is because it may be killing you, just slowly. The whole nighttime ordeal can be quite unsettling, even scary, for a bedmate, especially when you stop breathing!

Snoring occurs because there is a disruption of airflow going into your lungs. The usual cause for the disruption is your tongue falling back into your throat and partially blocking air. This causes the gurgling noises. Over time, the condition gets worse. Your throat can become completely closed off so no air goes through to your lungs. This is called Obstructive Sleep Apnea. Sleep apnea is defined as when you fail to breathe for 10 seconds or more during sleep. These ten seconds of not breathing can last far longer and can occur up to hundreds of times during the night. Your brain will detect the lack of oxygen and try to correct it. It will continually wake you up, sometimes with a jerk and gasping for air. Most often, though, you will have no recollection of this happening, as you will be in a deep state of sleep. Your heart will be racing, trying to increase the blood carrying the oxygen to your brain. When you are sleeping your heart should be resting, not racing.

Over time, this physical stress will cause significant damage to your heart. Other health problems will begin to occur as the quality of your sleep continually gets worse. During sleep, our bodies regulate many hormones, some of which control hunger. This is one major reason why you might be gaining weight so easily and can’t get rid of it. And diabetes is just around the corner.

If you’re a diabetic, have heart disease or high blood pressure, it is very important that you find out if you also have obstructive sleep apnea. Heart disease, high cholesterol, diabetes, stroke, weight gain, memory decline, menstrual irregularities, low libido, erectile dysfunction, teeth grinding, periodontal disease and depression are all symptoms and effects of obstructive sleep apnea. These are all diseases affected because your sleep cycles are interrupted and your body’s hormones are not being regulated.

Most of the patients we treat for sleep apnea are between 35 and 60. Many have great bodies, active life styles, and growing careers. Many of them are on some form of antidepressants and struggle to focus, have trouble remembering names and dates, and fall asleep during the day –often while driving. Their obstructive sleep apnea is preventing them from going through all phases of sleep. Sleep is classified into 4 phases that we go through repeatedly each night: N1, N2, N3/4, and REM. N3/4 is when our brain processes facts and data. If you have trouble remembering what you learned in class or what was said in a board meeting you may not be getting to this stage enough during sleep. REM stage is where we process emotions and events. If you have trouble controlling your emotions it may simply be that you don’t get enough REM sleep each night because you have obstructive sleep apnea.

Diagnosing sleep apnea is not complicated. First we have to figure out if you suffer from it. If you snore, grind your teeth, have reflux, (GERD), have migraines, trouble sleeping, sleepiness during the day, a large neck size, are overweight, have diabetes or heart disease, ask your dentist or family doctor with special training in sleep disorders if they will screen you for sleep apnea. If they feel you may have problems, you will be referred to a Board Certified Sleep Physician who will require that you have a sleep study – either in a sleep center, or at home. Your Sleep physician will determine if you have sleep apnea, to what degree, and will also diagnose other sleep problems. Treating sleep apnea is simply getting air into your lungs while you sleep. Many patients use a machine called a CPAP. It consists of a hose connected to a pump and facemask that forces air into your throat to open the blockage and get air into your lungs. If you have tried a CPAP and can’t wear one, or your lifestyle does not allow you to wear a CPAP each night, you may be able to be fitted with a dental mouth piece. An oral sleep appliance is small, custom-fitted and gently repositions the jaw forward, keeping your tongue out of your throat and allowing you to breath.

The wonderful aspect of the human body is its ability to correct itself. If you can get a good night’s sleep, many of the symptoms of sleep apnea will begin to get better and your health may even return to normal over time.

Posted in Cosmetic Dentistry, Sleep Apnea, Snoring

Mind the Gap! Dental Implants Are Becoming Standard Care

A gap-toothed smile is charming on a seven-year old.

Not so much for an adult. But if you’re missing a tooth or teeth, you have several options to restore your smile, says dentist Dr. Lisa Marie Samaha of Port Warwick Dental Arts in Newport News.

Those options are:

  • A removable appliance, also known as a partial or complete denture. That’s the least expensive but also in most cases the least desirable, Samaha says.
  • A bridge. Teeth on either side of the gap are reduced. A porcelain tooth fills in the gap and attaches to the teeth on either side. A bridge is usually more expensive than an implant.
  • An implant. A titanium metal post which is later covered by a crown. “If you are missing a tooth, an implant is the preferred option to a bridge in most cases,” Samaha says. “It feels and functions like your own tooth and is cleaned like a natural tooth. Implants are quickly becoming the preferred choice for replacing a missing tooth.

The success rate for implants is high: 98 percent for lower implants and 91 percent for upper implants, according to the University of Iowa College of Dentistry.

Unlike a removable denture that rests on the gums or a bridge that uses adjacent teeth as anchors, a dental implant is typically a titanium post that is gently placed into the jawbone. The crown is then placed on top, looks and acts just like your natural tooth. Dental implants never slip and don’t make embarrassing noises that alert the world to your false tooth or teeth. Because the implant is fused with the jawbone, bone loss is generally not a problem, according to the American Association of Oral and Maxillofacial Surgeons.

It is vital that any candidate for an implant be totally committed to a meticulous regimen of oral hygiene as well as preventative maintenance as prescribed by the dentist, Samaha notes, as periodontal infection can occur around an implant, just like a natural tooth. The good news is, implants don’t decay.

Advances in dental technology can reduce healing time after getting the implant post placed. In fact, if you’re getting implants, it’s possible but not typically recommended to get the crown placed the same day as the titanium post, Samaha says. “In general, most situations are not ideal for immediate crown placement,” she cautions, and a few months of healing helps to create greater stability of the implant

A crown is a long-lasting artificial cover for a tooth. It can be made of gold or other metals, porcelain or ceramic or a combination of metal and ceramic. A ceramic or porcelain crown can be made to mimic a beautifully natural tooth, Samaha says.

If you’re getting a crown on an existing tooth, you can even skip the inconvenience of a temporary crown and proceed straight to a permanent crown, thanks to computer-aided design technology. So instead of a couple visits to the dentist over three to four weeks and the hassle of dealing with a temporary crown that can pop out or crack, you can get your new crown in as little as a one-hour visit, Samaha says.

The technology that makes it possible is called CEREC 3-D. Samaha takes a pin-sharp optical image of the tooth. She then prepares the tooth and digitally designs the crown in as little as 5 minutes. No need for gooey impressions, second visits or extra numbing shots.

Tooth-colored CEREC crowns can restore up to 100 percent of the tooth’s natural strength, Samaha says. They are quite stunning, too.

 

 

Posted in Uncategorized
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Port Warwick Dental Arts - Dr. Lisa Marie Samaha
251 Nat Turner Blvd S
Newport News, VA 23606
757-223-9270

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