Dear Ann Landers,
he letter ously considered suicide. Thank God about suicide stirred many emotions in I came to my senses in time, me. I identified strongly with the Every now and then someone we writer because many years ago I sen- know takes his (or her) life and all the I have contemplated suicide many times. I'm In my 50's now, and I hate nobody. Nor would I kill myself to make someone sorry they treated me badly. In fact, I can't think of anyone who has. My family and friends al-ways have been patient and consid-erate. I've had a great deal of counseling over a period of years, but it hasn't helped. I guess I'm just tired of swim-ming against the tide. I'm exhausted and depressed because I can't seem to make anything work. I seem to be fighting a losing battle on every front Life is joyless. I'm not being fair to my family because I'm a drag-a pessi-mist a kill-joy. I believe the world would be better off without me. I con-tribute nothing. So please, Ann, print this letter in case I do it one day. I'd hate to have those near and dear to me think I took my life to punish them. They don't de-serve to carry such guilt A LONG-TIME READER.

DEAR READER,
Get a little more counseling, please, and a physical ex-amination as well. There might be an organic reason for your depression. You sound like such a gentle soul. The world does need you-whether you think so or not Stick around. I care. relatives, friends and neighbors are shocked. That individual appeared to be so content, so fortunate. He seemed to have everything a person could want or hope for. Will you please print this poem by Edward Arlington Robinson? It has a lesson in it for all of us. Whenever Richard Cory went downtown, We people on the pavement looked at him. He was a gentleman from sole to crown, Clean favored, and imperially slim. And he always was quietly arrayed, And he was always human when he talked; But still he fluttered pulses when he said, "Good morning," and he glittered when he walked. And he was rich-yes, richer than a king. And admirably schooled in every grace; In fine, we thought that he was everything To make us wish that we were in his place. So on we worked, and waited for the light, And went without the meat, and cursed the bread; And Richard Cory, one calm, summer night, Went home and put a bullet through his head. A FRIEND OF YOURS DEAR FRIEND: I first came across that poem when I was a high school freshman. It stopped me dead in my tracks. It did so again 40 years later and I thank you for the enriching ex-perience. Suicide in Children and Adolescents American children and adolescents enjoy better health today than ever be-fore in our history because of improved living standards and advances in medical care. With the gradual elimination of many of the dread diseases of the past, the major threats to life in the 1970s are deaths from violence: acci- dents, homicide and suicide. Throughout the age span from one to twenty- four, accidents are by far the leading cause of death, accounting for approxi-mately one half of all deaths. Suicides are rare before age ten, still quite uncommon from ten to fourteen, but for the age range from fifteen to twenty-four, suicides are the third lead-ing cause of death for males (after accidents and homicides) and the fourth for females (after accidents, cancers and homicides). The over-all death rate between fifteen and twenty-four for males (192 out of 100,000) is much higher than that for females (69 out of 100,000), primarily because of much higher rates for violent deaths (four times higher for accidents and three times higher for homicide and suicides). Particularly alarming is the fact that suicide rates for both males and fe-males have been steadily increasing for the last twenty-five years as indicated in the following table based on the latest data from the National Center for Health Statistics. (Suicide rates for the age range five to nine are not tabulated separately in national mortality statistics; the relative rarity of sui-cide in this age group results in too high an unreliability in computed rates.) MALE SUICIDE RATES PER 100,000 Year: : Age Group: : : : 10-14: 15-19: 20-24: : 1950: 0.5: 3.5: 9.3: : 1960: 0.9: 5.6: 11.5: : 1970: 0.9: 8.8: 19.3: : 1975: 1.2: 12.2: 26.4: : FEMALE SUICIDE RATES PER 100,000 Year: : Age Group: : : : 10-14: 15-19: 20-24: : 1950: 0.1: 1.8: 3.3: : 1960: 0.2: 1.6: 2.9: : 1970: 0.3: 2.9: 5.7: : 1975: 0.4: 2.9: 6.8: : It should be emphasized that these tables present minimum incidence figures. For a death to be officially designated a suicide, proof that the suicide was intentional is required. Thus, a death from a poisoning, "falling" out of a window, gunshot or deliberate automobile accident will not be included in the statistics if a suicidal note or statement is not noted by-or reported to- authorities. Moreover, well-meaning physicians and coroners may label a known suicide as an accident in order to spare the family embarrassment. It has been estimated that actual suicide rates may be twice as high as reported rates. In all age groups, in all countries, and for all periods for which data are available, males consistently outnumber females by about three to one in completed suicides. On the other hand, reports of suicide attempts are consis-tently higher for females by three to one or more. The reports of attempts are based primarily on records from hospital emergency rooms. Consequently, they grossly understate the frequency of suicide attempts since those which can be managed out of the hospital (probably the majority) are not included. It has been estimated that the ratio of attempts to completions in young peo-ple is one hundred to one. Efforts to understand why young people kill themselves are mostly based on unsuccessful suicides since the individuals are still alive to be interviewed. When death has occurred, the attempt to reconstruct motives is limited to written notes, reported conversations with friends and relatives, and medical records, for those individuals under care prior to death. In such psychological autopsies, the investigator frequently discovers a his-tory of suicide in family members or close friends. In part, this indicates a family pattern of reacting to failure or disappointment. Most suicides have displayed a recent change in behavior (despondent mood, inability to con-centrate, truancy from school). Careful inquiry usually identifies a precipi-tating event such as school failure, rejection by a lover or a humiliating disci-plinary episode. Finally, completed suicide requires access to lethal means: poisons or weapons in the household and a long enough period without su-pervision to make their use possible. Children do not fully comprehend the permanency of death. Suicide at-tempts are sometimes intended to "change things"-to make parents or others regret the error of their ways in the fantasy that he will be treated bet-ter when he awakens. The thought process resembles Mark Twain's account of Tom Sawyer attending his own funeral. However unrealistic the premises on which it is based, the suicide attempt is a statement of personal agony. Moreover, it carries a serious risk of death because children (and adoles-cents) are poor judges of the permanency of the act. The relative rarity of su-icide under age ten reflects, among other facts, limited access to means of sui- tide, less ability to plan ahead and to manage lethal instruments, and fewer long periods of despondency. Among adolescents, a frequent motive for the suicide attempt is the effort to manipulate or punish significant others (parents, boyfriends or girlfriends, teachers). A common fantasy is: "You'll be sorry you were so mean to me after I'm dead." Anger as a prominent element in adolescent suicide has been emphasized by studies in England and in the United States. Many of the chil-dren whose histories were studied had exhibited behavior disorder, school difficulties and runaways prior to the attempt. Most had either talked about suicide or threatened suicide in the days and weeks before the event. Among the older adolescents, depression, similar in nature but different in its mani-festations to depression among adults, was a prominent underlying feature. Such youngsters feel unwanted and unloved, come to regard themselves as bad or "inferior." They decide that death is the only way out There is no "treatment" for suicide. What is needed is a program for pre-vention; that is, (1) the creation of conditions which will minimize misery and despair and (2) the prompt response to threats and attempts at suicide by acting to change the feelings which provoked the behavior. Because the majority of attempters do give warning, there is almost always an opportunity to intervene. It may be difficult to predict risk accurately, but there are gen-eral principles which appear to be valid. Since the hazard is great if risk is underestimated, it is far better to err on the side of caution. Talk of suicide or threats of suicide should always be taken seriously. At the least, they represent an important message from the child about the inten-sity of experienced despair; at the most, they warn of an impending event As noted earlier, most suicides do give warning. We must not deceive ourselves into believing that most people who talk about suicide don't actually try it and be fooled by the fact that most who try it fail. The warning must be heeded because it is from among this group that fatalities occur. If a young-ster's attempt at suicide leads to a family response which manifests love and concern, peace of mind and a sense of well-being can be restored. This opens a new opportunity for growth toward health. Every suicide attempt is a medical emergency. Once medical measures have removed the immediate threat to life, the next pressing question that must be answered is whether hospitalization is necessary. The decision rests upon weighing the balance between two sets of factors: the degree of risk in the youngster and the family's ability to provide emotional support The de-gree of risk can be estimated from (1) the deadliness of the method the pa-tient had employed, compared to (2) the evidence for a wish to be rescued. Thus, the use of guns, rope or major poisons indicates a more serious wish to die than the taking of aspirin or superficial cuts at the wrist with a kitchen knife. However, one must be careful not to mistake an objective assessment of the lethality of the method for the logic of the youngster's deci-sion. That is, the child's ignorance of risk may dictate a choice that does not reflect his intent. He may use a drug which is fatal without realizing its tox-icity; or he may survive when death was intended because the amount used was insufficient. Most suicides are ambivalent; that is, along with the wish to die, there is a hope of being saved. The wish for rescue can be estimated from the ex-tent to which warning had been given and the choice of circumstances to per-mit discovery in time. For example, the patient who chooses a time when the family is out of the home and not likely to return for several hours has a more serious intent than the one who makes a dramatic gesture when parents are home and who calls attention to his actions. If the weight of the risk/rescue ratio is on the rescue side of the fraction and the parent or parents show understanding and concern, psychiatric treat-ment on an out-patient basis without hospitalization can be undertaken. But if the parents are indifferent, or worse yet, if they are angry and show no un-derstanding of the youngster's distress and fail to be supportive, then hospital treatment will be urgent even if the first suicide attempt appeared relatively minor. The failure of the gesture to arouse genuine concern may serve to confirm the patient's worst fears-that he is unloved. This often brings on a repetition of the attempt-with a fatal outcome. After the acute suicidal situation has been dealt with, the focus must be placed on treatment. For those patients in whom depressive disease is diag-nosed (a minority of the young) antidepressant medication will be necessary. But medication, even when it is indicated, is only one element in the treat-ment process. What is essential is the rebuilding of hope and self-confidence and the establishment of healthier ties among family members. Because the patient feels unloved and unworthy of love, the task of treatment is to convey a sense of caring and to restore faith in the possibility of a satisfying future. SUMMARY Threats of suicide and attempts at suicide are cries for help. If heard, they offer a major opportunity to reverse a potentially lethal situation. When fam-ily and friends rally to the side of the previously despondent individual and provide a network of emotional support, good mental health can be restored with psychiatric help. That suicide rates among adolescents are increasing can only reflect our failure as a society to meet the psychological needs of our young people. Fundamental remedies will require: (1) social supports to preserve the integrity of the family, (2) improvements in educational and vocational opportunities for the young and (3) re-creating a sense of na-tional purpose so that young people feel needed and wanted. CREDIT: Leon Eisenberg, M.D., Harvard Medical School, Children's Hospital Medical Center, Boston, Massachusetts. An Additional Thought by Ann Landers I cannot imagine a more tragic experience than to lose a child. We expect our parents to die before we do. The loss of a brother or a sister can be heartbreaking. To lose a beloved spouse can be extremely difficult But to lose a child must be the most wrenching experience of all. When that child dies by his own hand the agony and the feelings of guilt- the unanswered questions-the list of "if only's" must be a mile long. Suicides among young people are on the increase (over four thousand last year) and the reasons are many. The majority of teen suicides are in some way related to drug abuse and alcohol. Then there is the pressure of school- feeling that it is so important to get good grades in order to gain admittance to the so-called "better" colleges, medical and law schools. How sad. In many instances, a less prestigious school would have been the "better" choice. Whatever the reason, the parents of a suicide child need all the emotional support they can get. If I could speak to these parents I would tell them that no one knows for sure why some children can live through the most harrow-ing experiences, unscarred, and others cannot face the stresses of everyday life without cracking up. We have known for a long time that children have different thresholds of pain. And so it is with stress. I believe that some children have a death wish from an early age on-and nothing you could have done would have changed the situation. So stop punishing yourselves with afterthoughts of what yon did wrong. All parents make mistakes, and strangely enough, some parents who make the worst mistakes have the best-adjusted children. Their kids turn out just fine. In fact, they became stronger and tougher because they were knocked around and had no one to lean on. The parents I have known whose children were suicides were all fine peo-ple who loved their children and gave them a great deal of themselves- maybe too much. Almost all of these children had professional help. In the final analysis nothing could save them because they did not want to be saved. No one knows why. And they never will. More on Teenage Suicide According to the U. S. Public Health Service, the rate of suicide among fifteen- to twenty-four-year-olds has risen by almost 300 percent in just twenty years. It has almost doubled in the past ten years. Between 1974 and 1975-the latest statistics available-the suicide rate rose by a walloping 10 percent According to the Federal Bureau of Vital Statistics, more than four thou-sand teenagers kill themselves every year. Officials make it clear that at least twice as many go unreported-hidden by parents and disguised as accidents. Drug abuse, alcoholism, increase in violent crime, the ever-rising divorce rates, disintegration of the family, pressure to engage in sex at an earlier age, competition for places in the so-called "better schools"-all this has placed a great deal of added pressure on teenagers. Studies of youthful victims who died by their own hand show that only a small proportion are psychotic or medically insane. Most of them suffer from loneliness, feelings of hopelessness and despair. Suicidal people are tom be-tween wanting to live and feeling they have nothing to live for. How can you tell when an adolescent is becoming suicidal? The most obvi-ous clue is severe and continuing depression. They become gloomy, uncom-municative, down in the dumps, despondent, preferring to be by themselves for hours or days at a time-or even weeks. The best way to help such a person is to let him (or her) know you are aware of a change in behavior-and are concerned. Ask if he wants to talk about something that is troublesome. Try to break through the wall of isola-tion. Maybe he will reject you completely, but then again, he may open up. Try to get such a person to seek professional help. Temporary medication may be immensely useful. Or perhaps some minor physical problem, unat-tended, has caused at least part of the depression. The important thing is not to ignore such a person. Let him know he is not alone-that somebody cares. The most difficult aspect of teenage suicide is the guilt felt by parents and often brothers and sisters. They ask themselves, "Why didn't I see the signs? If only I knew he (or she) was so desperate I could have helped." Some of the most heartbreaking letters I receive are from parents whose children have taken their own lives. I tell these parents that they must accept in life that which they cannot change. Often the child harbored dark notions of suicide in the deepest recesses of his mind from an early age, and nurtured a sick preoccupation with death. In such instances, nothing could have changed the course of that child's life. A great many things occur that do not add up. They make no sense. We must accept them and not drive ourselves crazy looking for logical answers to questions relating to senseless behavior. Some of the finest people I know have lost children through suicide. They were devoted and loving parents-and their lives were tom apart by the trag-edy. I can only say, there are some mysteries in life that are and will remain forever unsolvable. You did your best-and all of us, being imperfect, make mistakes. Carry on-look forward, not back. CREDIT: Ann Landers. Sunburn Does soaking up the rays of a blazing sun make you feel healthy, young and full of vitality? Are you a sun worshiper who regards bronzed skin as a status symbol of the leisure life? There are countless reasons for exposing oneself to the sun. Some must do it as part of a job-lifeguards, farmers, fishermen, etc., but those who do it for cosmetic reasons rarely realize that in the long run, unless they are extremely careful, they will pay a heavy price for that "healthy" glow. Carefully weigh the facts about sunlight and your skin. You may become convinced (as are most medical experts) that the benefits of the sun's rays are mostly psychological and heavily outweighed by the damage. Too much sun during the teen years and early twenties can make a woman, at forty, look like sixty. It can also cause skin cancer, which resulted in the deaths of 5,300 people in 1977. Know the facts and decide just how much sun is best for you. Consider the time of day if you decide to sunbathe. The sun's rays are most potent between 10 a.m. and 2 p.m. when the sun is directly overhead. During these hours you are most likely to tan or bum. On the other hand, there is little chance of doing either if your sun exposure is before 8 a.m. or after 4 p.m. Atmospheric conditions also play a role in determining how the sun affects your skin. Many people feel they won't bum if the sun isn't shining brightly. Not true. The most vicious sunburns occur on overcast days, particularly in a fog, when people believe the sun isn't very hot because they can't see it Altitude is a factor, too. At high altitudes there is less atmosphere to filter the sun's ultraviolet rays. This is important for skiers to remember. Snow can act as a reflector and intensify the rays' penetration. Sand on the beach can do the same thing. It is a mistake to think a covering such as a beach umbrella will protect you from the sun. Because of sky radiation, ultraviolet waves radiate from all sides, and can easily get at you even if you are under an umbrella. To make matters worse, the heating rays of the sun, which ordinarily warn of too much overexposure, are reduced under an umbrella and you could get burned without realizing it. The environmental factors mentioned above are important in determining how the sun affects you, but they are only part of the story. The rest depends on what type of skin you have. The more pigment in your skin, the more protection you have against sun-burn. (But blacks can and do get sunburned if they expose themselves to too much sun.) If your first exposure of the season is too long, sunburn will occur before you get a tan. Furthermore, if the bum is hot enough to raise blisters and cause peeling, some surface skin is lost. For this reason gradual daily doses are far more sensible than long stretches on weekends. This is particularly important for fair-skinned people who get a two-week vacation and want to show up at the office on Monday morning looking like bronzed beauties and Adonises. Use common sense. Experiment cautiously to find out how long you can safely stay in the sun. Try to get out of the sun before you are lobster-red. Don't wait until you feel you're getting too much. By then it's too late. The best method is to follow the clock. If it's between 10 a.m. and 2 p.m. give yourself ten minutes the first day, fifteen the second, twenty the third, etc. Cancer. The threat of skin cancer is not a concern of the occasional sun- bather, but the evidence is clear that repeated and persistent exposure to sun-light can be one of the major factors in causing cancer of the skin in suscep-tible persons. Evidence shows that: Skin cancer has long been observed to be an occupational hazard to the farmer, the sailor and the rancher. Ardent outdoor sportsmen and sun worshipers share the same risk. Cancer of the skin occurs more often in the South and Southwest- areas noted for their sunny climates. Skin cancer occurs most frequently on the exposed parts of the body. One study showed that more than 90 percent of skin cancers originate on the face, ears, hands or neck. Skin cancer occurs more frequently in light-skinned than in dark- skinned persons. Skin cancer can be produced in mice 100 percent of the time by using ultraviolet light Aging skin. I repeat, the teenage girl who bakes in the sun to attain a glori-ous tan may find when she is forty that her skin looks fifteen to twenty years older. Years of overexposure are likely to result in wrinkles, skin folds and sagging. Once this type of destruction has occurred, no cream, lotion or series of fa-cials can undo the damage. Allergies. Some people have allergic reactions to the sun, which can result in skin rashes, blotching and a wide assortment of annoying problems. Often the problem begins after a severe sunburn. Or sometimes the skin becomes sensitive to sunlight after repeated contact with various plants, perfumes, cos-metics or some skin creams or suntan lotions. These problems can be persist-ent and may increase in severity with repeated exposure. Certain medications can help people who are "allergic" to the sun, but a permanent cure has not yet been discovered. Fortunately, some cases are lim-ited to childhood or appear only during certain times of the year. As with other allergies, the best treatment is to avoid whatever is causing the trouble -in this case the sun. What about the suntan lotions and other preparations sunbathers use to anoint their bodies? Are the benefits real or imagined? Actually, properly ap-plied suntan lotion can be somewhat helpful in preventing a bum and pro-moting a tan if you use one suited to your needs. Here's why: Certain commercial suntan preparations contain chemicals called sun-screens. They absorb some of the ultraviolet rays of the sun while letting others through. The better lotions allow you to stay in the sun longer with less risk of burning. However, do not expect even the best lotions to protect you from unlimited exposure. It is possible to bum through a tan. Most suntan preparations also contain a lubricant This helps to keep your skin from drying out too quickly. Suntan lotions must be reapplied at least every two hours during exposure and whenever the protecting film may have worn off or washed off. Some people claim that mineral oil or baby oil mixed with iodine makes a good suntan lotion. The fact is that these preparations do not contain sunscreens and therefore will not help you tan, nor will they prevent burning. Their only benefit is that they provide lubrication to cut down on the drying effects of the sun. Recently artificial tanning preparations known as "bronzers" have become available. These contain a water-soluble stain. They simply color the skin, but the color comes off when you shower or bathe. Although artificial tanning lotions appear to be safe, remember that they do not protect you from the sun (unless they also contain a sunscreen agent), and their prolonged use may cause your skin to become dry and scaly. If you have stayed in the sun too long, don't expect a quick "cure" for the problem. You can, however, get relief from the discomforts of painful sun-burn. Ointments, wet compresses and soothing lotions can be helpful. A bland cold cream or lightweight mineral oil may also give relief. A word of caution about commercial sunburn medications: These products contain ingredients which are intended to relieve pain, but they can cause allergic skin reactions. If the pain becomes unbearable or if extensive blister-ing occurs, see your physician. The most widely advertised benefit of the sun is that it gives you more vita-min D. The average American, however, gets enough vitamin D in his diet and does not need a supplement from the sun. Certain skin disorders, such as acne, eczema and psoriasis, can be helped by the sun, but check with your doctor before trying the sun as a treatment for any skin problems. I repeat, for normally healthy people, anything beyond moderate and careful exposure to the sun can do you more harm than good. If you will forgive a personal reference, I have studiously avoided the sun since I was thirty years of age and people tell me I look many years younger than I am. The secret of course is the skin. credit: Ann Landers with information from the American Medical Association: Department of Health Education, Committee on Cutaneous Health and Cosmetics. This year at least twelve thousand people who used sunlamps were burned so badly they required hospital emergency-room treatment. Almost half of the victims said they "fell asleep." Why do people use sunlamps? Many insist the heat makes them feel better. Others like to look "sun-kissed" all year round. These psychological benefits are understandable, but according to a spokesman from the American Medi-cal Association, sunlamps have very little, if any, therapeutic value. Barbara Shea, of Newsday (Long Island), did some investigating to learn why so many people are binned year after year by sunlamps. She reported as follows: Most were sold without control devices or timers. Only 10 percent came with protective goggles. Instructions for proper use usually were in the form of printed ma-terial that could be lost or mislaid. Information on exposure time and safe distance from lamp to user was not included in some instructional material. In only a few cases was any safety warning affixed permanently to the lamp. The government is exploring the feasibility of requiring the sunlamp bulbs to be made so that they cannot be screwed into an ordinary lamp that is not equipped with a timer. If you must use a sunlamp, buy only the type that has a timer with an auto-matic turn-off. And be aware that your body is being cooked even if you don't feel a thing. If you overdo it, you'll feel plenty within an hour and then it will be too late. Don't ever get under a sunlamp without protective goggles. Heat dries the eyes and causes cataracts and other eye problems. credit: Ann Landers with information from the American Medical Association: Department of Health Education, Committee on Cutaneous Health and Cosmetics. Surgery Few subjects are as fascinating to the teller and as boring to the listener as details of an operation. But when the doctor says, "You need surgery," the words can be very frightening. People worry about everything from size of the scar to the possi-bility of dying on the table. Some patients are very proud of their scars. (Remember that famous photograph of Lyndon B. Johnson lifting his pa-jama top after his gallbladder surgery?) At the other extreme, a San Francisco stripper was very distressed by hers. She claimed the scar from her hysterectomy had ruined her career. The woman applied for permanent disa-bility. Surgery should never be taken lightly. Any operation, with the accompa-nying anesthetics and drugs, involves hazards that a patient must be willing to face in return for the benefits of the surgery. An operation affects each patient differently-according to his ability to stand pain, his general physical condition and his understanding of the opera-tion that is to be performed. Every patient should be told in advance exactly what to expect Fear of the unknown is probably the most upsetting part of surgery. First, your doctor must evaluate the problem. He will carefully question you about symptoms and collect data from X-ray studies and laboratory tests. From this he will make a diagnosis of what appears to be wrong and what treatment is called for. If your doctor tells you you need an operation and you do not trust his judgment, by all means seek a second opinion. If the second doctor's evalua-tion is not in accord with the first doctor's, get a third opinion and then make up your mind. PREPARATION Except in emergencies, surgical patients go through a tedious preparation period before an operation. The prompt action required in an emergency pre-vents lengthy observation and preparation, but the greater hazard is justified by the urgency of the treatment required. Normal preparatory procedures may be inconvenient and uncomfortable, but they help put the patient in the best possible physical condition for both anesthesia and surgery. Preparation usually calls for an overnight stay in the hospital during which time you will be asked many questions, usually by a medical student or an in-tern. It is very important that you answer all questions honestly and not for reasons of false pride and vanity withhold information. (Example: Some people do not wish to admit that they wear dentures. A patient who under-goes surgery with dentures or partial plates may choke to death while under an anesthetic.) The skin surfaces around the site of the operation are shaved and cleansed to reduce the chance of infection. The lower bowel is cleansed with an enema to reduce postoperative discomfort. If food is allowed, it is limited to a light supper. A relaxed sleep is assured with sedatives. You will be told not to take any liquids or eat any food after midnight. This advice should be taken seriously. A patient who has surgery with particles of food in his stomach could choke while vomiting. The anesthesiologist usually visits his patient the evening before the opera-tion to explain what he or she will do and what the patient should expect. He will ask about recent colds and other respiratory infections, possible allergies, dentures that might interfere with breathing and other factors that could cause problems. The anesthesiologist, who is a physician just like your doc-tor, often orders the sedatives that set the stage for smooth anesthesia by keeping the patient relaxed and quiet before surgery. A surgical patient may never remember seeing the operating room, because the medication given to him while still in his bed will make him so drowsy he will not be able to recall anything that happened. When a local anesthetic is used, such as an injection in the spinal canal or into the tissues involved in the operation, the patient may be awake in the operating room and be aware of what is going on, but he will probably be under heavy sedation and feel no pain. Even in cases where general anesthesia is used for complicated surgery the patient may be semi-conscious but he will feel no pain. A surgical operation involves three teams. First, the anesthesiologist and his assistants. They administer the anes-thetic, drugs and other substances, measure pulse, respiration and blood pres-sure and keep the surgeon informed about the patient's condition. Second, the surgeon and his assistants. They perform the operation while a surgical nurse or technician keeps the operating team supplied with the in-struments needed. The third team is made up of nurses, orderlies and aides who remove and account for used instruments, gauze packs and sponges. The type of operation being performed determines the nature of the oper-ating theater. A room for operations on the ear, nose or throat under local anesthesia will be equipped quite differently from one used for setting a bro-ken bone. Heart and lung surgery that requires a heart-lung machine to maintain cir-culation will be equipped much differently than the room for an abdominal operation. Equipment also will differ according to the position of the patient on the operating table. Some operations require one to lie flat, others use a tilted table. In a few instances, the patient is required to be in a sitting position. When surgery is completed and the wound is closed and protected with dressings and supporting binders, the anesthetic is discontinued, and post-operative care begins. RECOVERY Depending on the patient's need, he will be taken to an intensive treatment center, a recovery room or his own hospital room. When he recovers from the anesthetic, he may be surprised at the array of bottles, tubes and equip-ment attached to various parts of his body. If the patient is receiving a blood transfusion, a bottle of blood will be con-nected to a vein in his arm or leg by a tube through which the blood flows. Liquid food and medication are administered the same way from a different bottle. After abdominal operations, gas may accumulate in the bowel and cause discomfort. To prevent this, a small suction tube may be passed through the nose and throat and into die stomach and upper bowel. This picks up gas bubbles, and aids the patient's comfort Other tubes, electronic equipment and a host of devices may be used in special situations. All of these, though unfamiliar to the patient, have impor-tant functions. The patient who comes to the hospital expecting to spend all his time in bed may be in for a surprise. In many cases he will be encouraged to sit up and walk soon after the operation. Even while wearing an array of tubes, the patient may be asked to sit up and dangle his legs over the side of the bed to stimulate circulation. The day after the operation, or sometimes the same day, the tubes may be disconnected long enough for a short walk or a trip to the toilet. Exercise promotes rapid recovery and is started as soon as possible. It im-proves circulation and helps to prevent the clots and vein inflammations that used to plague surgery patients. Exercise also makes the patient feel stronger and shortens the hospital stay. The length of the recovery period varies with the operation and the physi-cal condition of each patient. Abdominal operations such as uncomplicated appendectomies may heal quickly enough for the patient to go home after three or four days, sometimes even before the stitches are removed. Once a patient returns home, he may have to visit his surgeon or personal physician for subsequent care, but often he may go about his business in two or three weeks and be unrestricted after two months. REHABILITATION Following bone or joint surgery, neurological surgery, extensive skin graft-ing or other complex operations, the patient may require rehabilitation through physical therapy and other procedures. When surgery involves an amputation, an artificial limb must be fitted and the patient must be taught how to use it. Patients with less dramatic problems may also need help in readjusting to a normal life after illness and surgery. This is all part of rehabilitation-and the patient's co-operation is very important. A positive mental attitude can be his most valuable asset. The doctor can do only so much. Each patient must be an active participant in his own recovery. The person who is determined to recover rapidly and get back into the swing of things will probably do so. The chronic complainer who enjoys poor health will use his operation to get sympathy and avoid responsibility. He will also recover slowly and feel "lousy" for a long, long time. credit: American Medical Association; Dr. David Skinner, Professor and Chair-man of the Department of Surgery, University of Chicago. Tattoos If I am to believe my readers, nine out of ten people who have had them-selves decorated with tattoos were drunk at the time and wish they hadn't done it. Every week I receive letters asking for advice on how to remove a tattoo. Usually it's a male who wants the name of a girlfriend taken off his arm or hand because he is now going with (or is married to) someone else. Sometimes the man writes and says he wants to get rid of the battleship on his abdomen because he has joined a health dub and gets too many ques-tions. Recently, an architect wrote to say he was interested in a young lady but the tattooed snake around his arm was "hurting his sex life." He had to get rid of it because his girl hated it and it "turned her off." Women sometimes write about tattoo marks. Usually it's a man's initials they want taken off a thigh or a shoulder. Occasionally, women who went in for peacocks and butterflies write to say they are embarrassed when they go swimming and wish they hadn't been so foolish. "How can I get rid of it?" they ask. There are several techniques. The most satisfactory is dermabrasion. This is the removal of the outer layers of skin with a sandpaper wheel which is run by electricity. In the hands of a skilled technician, preferably a dermatologist (skin sperialist), this procedure is excellent. Sometimes salt is used instead of sandpaper. In both instances, the area is anesthetized, but when the anes-thetic wears off there is some pain until the healing takes place. While the pain is not excruciating, it may last for days. If an individual has an obscene word or picture he wishes to obliterate, he can have a tattoo artist tattoo a skin-colored pigment over the word or scene. Even with a near-perfect color match (it is never perfect) the skin-colored tattoo generally looks different than the surrounding skin. Of course, it doesn't tan, which can be a problem. Surgical grafting is another technique. The physician can remove the tattoo with a scalpel, and graft a piece of skin (taken from another part of the body) over the area. Often this technique leaves an unsightly scar, but it is preferable to the tattoo if a patient wants to be rid of it. If I were to give some advice in regard to tattooing, I would say, "Don't do it. The chances are very good-like nine out of ten-you'll regret it" credit: Harry J. Hurley, M.D., Upper Darby, Pennsylvania, President of the Dermatology Foundation, 1976-77. Teenage Drinking Approximately 1.3 million American teenagers have a serious drinking prob-lem, according to the National Institute on Alcohol Abuse and Alcoholism. A survey of high schoolers revealed that 80 percent of the males and 75 percent of the females drink alcoholic beverages and about 15 percent of them drink enough to be considered abusers. Drinking is started at an earlier age than ever-twelve is not unusual. Ex-perts predict that 20 percent of early drinkers will become alcoholics. It is likely that the number of adult alcoholics twenty years from now will be in-creased considerably. Many teenagers who drink only beer fail to realize that beer can be just as harmful as hard liquor. There is more alcohol in a twelve-ounce bottle of 5 percent beer than in a cocktail containing one ounce of 90-proof liquor. Put another way, drinking a six-pack of 5 percent beer is equivalent to drinking almost a third of a fifth of whiskey or gin. Three fourths of the students surveyed admitted that they drank. Con-sumption ranged from very little to astonishing quantities of alcohol. About 50 percent said they started with booze and then turned to drugs. Multiple drug use was common among the students. About 55 percent admitted using two drugs, and 44 percent said they used three or more drugs, including alco-hol. Health professionals warn against the hazards of mixing alcohol and drugs. "Everyone should be aware of the potentially lethal interaction of alcohol and barbiturates, which can cause serious physical distress and even death," says pharmacologist Joe Graedon. "The simultaneous consumption of a cou- pie of drinks and a few tranquilizers can produce an effect greater than either one alone. The result can be unintentional suicide by causing a big fall in blood pressure and breathing failure." Even aspirin should not be mixed with alcohol. When alcohol is introduced, the stomach becomes supersensidve to the irritating effects of the salicylates in aspirin and serious bleeding can re-sult Authorities believe that today's teenagers are turning to alcohol more fre-quently because of several factors: Peer pressure. Young people who want to feel like "part of the crowd" are apt to go along with others who are drinking even though they may not like the taste of alcohol or the effect it has on them. Easy availability. Almost anyone under age can buy alcoholic beverages by faking an identification card or by having someone older buy it for them. Al-cohol is also cheaper than most other drugs, and in many ways the high it offers is more predictable. A person knows that if he drinks a six-pack of beer he will really "feel it" On the other hand, drugs such as marijuana sold on the street are often so adulterated and weak that the high isn't as strong. Role Models. Many youngsters see their fathers and/or mothers come home from their jobs and have a few drinks. Drinking has become an ac-cepted part of the home scene in many families. Advertising. Drinking is depicted as glamorous and sophisticated. It is equated with having a good time. In recent years many of the commercials and print ads, particularly those touting wines that taste like fruit drinks and milk shake-fiavored liquor, have been aimed at the youth market Feeling of alienation. Teenagers who feel alienated from the world in gen-eral and their families in particular frequently seek an escape from their fears and frustrations through drugs. They believe that the high they get from drugs (including alcohol) will help them cope with life's pressures. A Gallup youth survey backed up the findings of the authorities on youth and behavioral problems. Teenagers listed the major reasons for using alco-hol as: peer pressure, escape from their problems, to have a good time and feel good, showing off to look grown-up, boredom, rebellion and parental indifference. The survey also revealed that only 57 percent of the nation's teens have received any kind of instruction about the dangers of alcohol abuse. Many youth experts maintain there is a need for more prevention programs designed to stop the growth of alcohol abuse among teenagers. They believe that early education combined with parental understanding is the key to the prevention of alcohol abuse among the young. "Because studies show that drinking is starting at an earlier age, it is cru- rial to begin the educational process in elementary schools," says Mary Bren-nan, director of the Central States Institute of Addiction's alcohol and drug abuse programs for the schools in the Chicago area. The Institute's program begins at the fifth-grade level with lectures, films and discussions of alcohol abuse. In high schools the program is offered as an alternative to expulsion. Students identified as having a drinking problem are required to attend six sessions at the Institute accompanied by parents. Miss Brennan contends that not enough parents understand the seriousness of the teen drinking problem. "We feel it is vital to increase family com-munication, lack of which is at the core of most drug abuse," she says. "When told about their child's problem, many parents say, Thank God, it isn't drugs.' They don't understand that alcohol is a drug." She says teens have to learn that it is okay not to drink. They have to learn that not giving in to peer pressure shows strength. They have to be taught that chemical solutions to problems are not effective and it is better to keep busy with productive, creative activities such as athletics and the arts. Education should focus on giving students the facts about alcohol, which puts the responsibility on them for abusing it or not Among the facts to be pointed out: Alcohol can be dangerous to a person's health. It can be detrimental to the development of healthy cells, particularly in young bodies that are still in the state of development. Driving while under the influence of alcohol is a leading cause of accidents, many of which are fatal. Do they want the responsibility of injuring or killing someone? Studies indicate that young people have become physically addicted to al-cohol more quickly (six months to two years) than adults (five to fifteen years). Do they really want to become alcoholic? The teenager who abuses alcohol often does not get the help needed be-cause of a protective family that will not admit the problem. Because it is ig-nored, the teenager continues to drink and the problem becomes intensified. "If someone protects the teenaged alcoholic, he is protecting that person to death," says Dr. John Steffek, a professor of psychiatry at the University of Illinois College of Medicine. "Professional help is essential because the prob-lem is apparently too big to be handled inside the home." It is vital for the teen who abuses alcohol to admit that he has a problem so he can seek help. These are some of the questions to ask yourself to deter-mine whether you have a drinking problem: Do you lose time from school because of drinking? Are your grades slipping because of your drinking? Do you drink to build up self-confidence, such as before you go out on a date? Do you drink because you have difficulty facing up to stressful situations like problems at home or in school? Do your friends drink less than you do? Do you drink until the bottle is empty? Have you begun to drink in the morning before going to school or work? Do you often prefer to drink alone than with others? Have you lost friends since you started drinking? Does it bother you if someone says you drink too much, and do you lie about the fact that you drink? Have you ever had a loss of memory from drinking? Do you get into trouble when you are drinking? Have you had an automobile accident while under the influence of alcohol? Do you think you have a problem with liquor? If you answer yes to three or four of the questions, that is an indication that you have a problem with drinking. Affirmative answers to half of the questions or more indicate your problem is acute. Males and females of any age are welcome to become members of Alco-holics Anonymous, according to a spokesman for the group. Because teens may be inhibited about attending meetings with older members, several AA. chapters throughout the country have special youth groups where teens may feel more comfortable meeting with those of their own age. (For information about groups in your area, write to: AA., P. O. Box 459, Grand Central Sta-tion, New York, New York 10017.) Alateen (an auxiliary of Al-Anon, an organization which helps families of alcoholics) is not associated with Alcoholics Anonymous. Members are chil-dren of alcoholic parents who share their experiences and learn how to deal with problems. Al-Anon believes that alcoholism is a family illness and that changed attitudes within the family group can aid in the alcoholic member's recovery. For information write to: Al-Anon and Alateen, P. O. Box 182, Madison Square Station, New York, New York 10010. credit: Barbara Varro, Chicago Sun-Times. Teeth Capping Teeth Have you ever marveled at the beautiful, gleaming, perfectly shaped teeth that smile at you from the stage, TV, movie screen, political podium, or across the room at a cocktail party? "How lucky she (or he) is to have such wonderful teeth," you may say to yourself enviously. Well, it may be more than luck. The person with the gorgeous smile may have had a little help from his friendly dentist. Capping is now a widely used technique for people whose teeth were chipped, cracked, discolored, misshapen, unattractively spaced or knocked out in an accident The term "cap" means to cover or replace the outer surface of the tooth. In dentistry, the term can be interchanged with the word "crown." A cap should look natural and not interfere with the normal positioning of the lip. The decision to cap one or more teeth is based on the following: Appearance: The teeth may be badly stained or have large, unsightly fillings. They may be broken, jagged or poorly spaced. Strength: A tooth may have too many fillings or too much decay, leaving its biting edge unsupported and fragile. Mobile teeth: When bone structure has weakened, caps may be neces-sary to splint or join one tooth to another for additional stability. Missing teeth: A fixed bridge (non-removable) can be made to re-place a missing tooth by adjoining an artificial tooth to the adjacent capped teeth on either side of the space. Twisted teeth can be capped and splinted to prevent further move-ment. Once the decision to cap the teeth has been made, the dentist must concern himself with two primary issues: root canal therapy and gum disease. In the center of a tooth is a pulp chamber which houses blood vessels and nerves. These vessels connect at the base of the tooth to the blood supply of the body. The shape and size of this chamber is an important consideration in making the cap. If the chamber is encroached upon, either by decay or by the depth of the preparation necessary to create a well-contoured crown, the chamber must be sterilized and sealed. This process is called root canal treat-ment It prevents infection from going into the bloodstream. The strength of the tooth in the jawbone must also be considered. If dis-ease of the gum and bone is present, special treatment is required before caps can be put on. To prepare for a cap, enough structure is removed from the outer surface of the tooth to allow for the required bulk of the selected capping material. All decay is removed and, if necessary, the remaining tooth structure is medicated and strengthened. A temporary plastic cap is made so the person will look presentable and have a "working" tooth. An impression is taken, from which a model is made to duplicate the prepared tooth outside of the mouth. The dentist or technician then makes the cap in the laboratory. There are several types of caps being used today. The two most common caps for front teeth are the porcelain jacket crown and the porcelain veneer crown. The porcelain jacket is formed from powdered porcelain which is baked in an oven. The porcelain is very strong and, when used properly, there should be no breakage. The porcelain jacket is not gold-reinforced and thus has superior color characteristics. It is not, however, generally consid-ered strong enough for replacing missing teeth. The porcelain veneer crown is a cast gold crown with porcelain fused directly to the gold in an oven under high heat and vacuum. The porcelain to gold combination is very durable and quite good-looking. The gold backing provides extra strength, which is ideal for supporting loose teeth and replac-ing missing teeth with a bridge. The caps generally used in the back of the mouth are made of gold, gold and acrylic, and porcelain. Processed plastics have a tendency to lose their luster and are susceptible to physical or chemical wear. The gold caps are probably the best choice when no consideration is made for cosmetics. Gold is the easiest material for the dentist to work with and the most durable. The porcelain fused to gold is also excellent for capping back teeth when appear-ance is important Depending on the work load and proximity of the technician, the labora-tory procedures may take one to two weeks. A single cap may be completed in two visits, and a splint or large bridge usually takes longer. How long will a cap last? A well-made cap will generally last for many years with proper home care (good oral hygiene) and the avoidance of any unusual accident. Gums tend to recede with time. When this occurs, a dark line may appear around the upper rim of the cap. This may bother some people for cosmetic reasons, in which case they can have the cap replaced. Capped teeth should be cared for as if they are natural teeth. They should be cleansed with dental floss or dental tape and a toothbrush, after each meal if possible, but surely every morning and every night People who want their teeth capped for appearance's sake only should be aware of the extent to which healthy teeth must be changed in order to make the transition. Those with dental reasons for caps or crowns should under-stand the long-term benefits of this procedure. credit: Jordan C. Block, DD.S., Chicago, Illinois. Straightening Children's Teeth STRAIGHTENING TEETH-WHAT DOES THAT MEAN? Straightening teeth means the repositioning of teeth within the dental arches. This is done to enhance the appearance of the face and the teeth, to improve the ability to chew or both. Repositioning of teeth is known as orthodontics. HOW IS IT POSSIBLE TO STRAIGHTEN TEETH? Changing the positions of teeth is possible because (1) teeth can be moved (within limits) and (2) the bone which holds the teeth can be changed in shape by applying pressure to the teeth. In other words, a tooth does not remain tightly fixed in its original position throughout life. Changes in position of teeth occur with growth of the arches, the eruption of new teeth and biting and chewing and sucking habits. Changes are also made by pressure applied in orthodontic treatment HOW DOES ONE KNOW THAT TEETH NEED TO BE STRAIGHTENED? If teeth are unattractive because of their position it is time to ask questions of a qualified person. A children's dentist will inform parents at the time of regular visits. If your child has not had "regular visits" to a dentist and it is obvious to him or her or to you that the second teeth are coming in crooked, by all means take the child to a dentist for evaluation. If you don't know of a dentist, call the County Dental Society (look in the phone book) and one or two will be recommended. If you are not satisfied with the dentist's appraisal, go to another dentist In evaluating the mouth of a child one must look ahead to the distant fu-ture, not merely the next few years. This has to do, primarily, with the areas of the mouth which support the teeth. Problems with gum tissue and supporting bone are the dental problems of the adult. There are times when the entire mouth of a child may look quite satisfactory, but in spite of the acceptable appearance there may be a bite problem which will not be disturbing until the patient is in middle age. One example is a closed bite in which the upper front teeth close over the lowers beyond the desirable limit. After many years the heavy stress on the lower front teeth may cause severe wear to the teeth or damage to the bone which supports the teeth. Another example is the positioning of the teeth near the outer surface of the bone of the arch with only a thin layer of bone covering the roots of the teeth. This may look and feel all right at twelve or fourteen years, but at thirty-five or forty the too-thin bone may gradually disappear, and the patient will have real trouble. Dentists and patients need not always insist on the toothpaste-ad perfect line-up look. Often they are willing to settle for satisfactory appearance and efficient function. When function is acceptable, bony support is good and no future harm is predicted, the dentist should thus inform the patient. The pa-tient and parents then can make the decision regarding treatment, based on their standards of acceptable appearance. People's values differ. Economic resources and financial obligations vary. Patients must feel free to ask, "Is it essential that my child have treatment now or may we postpone it or avoid it?" WHAT HAPPENS IN SUCCESSFUL ORTHODONTIC TREATMENT Briefly, the teeth become properly aligned and fit correctly, top to bottom. The aim in orthodontic treatment is to properly align the teeth so they pro-duce a good, solid bite. A variety of straightening problems may occur. A few teeth or many teeth may overlap, or be out of line. The teeth may have been moved out of position by a prolonged pressure habit. There may be extra teeth present. There may be teeth missing, never formed, or lost when they should have been retained. The arches and teeth may close over farther than is desirable-closed bite. The lower teeth may fail to reach the upper teeth when closure is complete-open bite. AT WHAT AGE SHOULD A PATIENT HAVE ORTHODONTIC TREATMENT? There is no set age for orthodontic treatment. Early treatment, when not actually preventing problems, may make later treatment easier and shorter in duration. Adults, even after growth has been completed, can have ortho-dontic treatment, though the scope may be limited. The decision about timing for treatment is important. If there is a choice, treatment should be done in a stage of growth when the most can be accomplished in the shortest period of time. WHO IS QUALIFIED TO STRAIGHTEN TEETH? Any licensed dentist can make and place appliances for the purpose of straightening teeth. All dentists have had some training in this area, some more than others. There are many degrees of difficulty in the correcting of dental problems- from the simplest band and loop for the maintenance of space, to the im-provement of a severe facial deformity. There is much variation in training and experience in the professional persons permitted to straighten teeth. The dentist who has accepted the responsibility for the dental care of the patient, whether he is a general dentist or a pedodontist (pediatric dentist), will sug-gest that he do the orthodontic treatment himself or he will refer the patient to an orthodontist. Orthodontics is one of the recognized specialties in dentistry. Every qualified orthodontist has had specialized training in the use of appliances for correction. His practice is limited to the exclusive practice of this specialty. The choice of the professional person to treat the problem, should hinge on: (1) The established reputation of the dentist; (2) the ability and willing-ness of the dentist to teach and explain; (3) faith on the part of all partici-pants. WHY ARE SOME KIDS SO LUCKY? NO CROOKED TEETH. What determines whether or not teeth are straight (properly aligned) or crooked? Let's look at personal characteristics which are set before birth: Jaw size. Large or small; wide or narrow. This determines the space available for the lining up of the teeth in each dental arch. Tooth size. Wide or narrow. Add one or two millimeters to the size of each of fourteen or sixteen teeth in one arch and we add perhaps more than an inch to the over-all measurement Envision that for yourself. It's a loti Or, subtract the same amount. Tooth number. There may be extra teeth, more than the usual num-ber. An extra tooth is called a supernumerary. Some teeth which are expected to appear may never have formed. These are called congenitally missing teeth. Jaw or arch relation. An upper or lower arch may appear to be set back or set forward or shifted to one side in relation to its partner. Muscle strength and tone. Lips, cheeks, tongue pressures exert force on teeth. There are many possible variations. The above factors are inherited from one parent or the other in varying combinations. Of six children of the same parents, there may be none with problems, all with problems, or some with problems. HOW SIGNIFICANT IS THUMB-SUCKING? The answer is: It depends. First, thumbs are not the only things that are sucked. There are various one-finger, two-finger positions, also lips, tongue, pacifier, pencil, blanket comer, etc. Thumbs do win out, though, in a poll. The age of the sucker is important. The bone of the infant, the three-year- old, even the four-year-old is quite pliable. Remove the sucked object and the bone that holds the teeth resumes its original contour because of the pressure from the lips, the cheeks, the tongue. If the habit continues to six, seven, ten, the return to the desired shape is less likely. The amount of force exerted in the sucking is important. A resting thumb or finger does not move teeth or bone. A thumb that pushes does damage. If, in addition to the push, there is a strong sucking pull, putting in motion cheeks and swallowing muscles, as is sometimes seen in enthusiastic ten-year- old habits, the problem obviously becomes complicated. Brief advice about managing thumb-suckers-advice more easily given than followed: Don't hassle your young thumb-sucker. Leave him alone until you can both talk about the problem in a reasonable manner. Identify your reason for wanting the habit stopped. Refer to it as a dental problem, not a behavioral problem. Get a kind, reasonable, professional person to help you if you aren't sure when to ignore, to go easy or to insist. Another person may be helpful, but remember that you know your own child best BRACES Pressure on teeth is created by what professional persons call orthodontic appliances. We call them orthodontic appliances instead of "braces," not to make a more important sounding term but because the idea is not to hold the teeth but to move them, not to support them but to apply pressure to them. There are many types of orthodontic appliances. Some are fastened to the teeth with cemented bands or brackets bonded directly to the tooth surfaces. Some are removable, not fastened to the teeth, and can be removed by the patient. Both metals and plastics are used. WHAT INFORMATION IS NECESSARY BEFORE TREATMENT MAY BEGIN? All the patient's questions about treatment are usually not answered at the first visit. For diagnosis and the planning of the treatment considerable infor-mation must be collected and a period of time for study must follow. Dental X rays. Films which show all the teeth, including the roots. These films answer many questions: Are there missing teeth? Are there extra, unerupted teeth? Is the bony support healthy? Is infection present? Are there cavities to be filled? Cephalometric films. Films of the head made at intervals which show growth direction as well as the relationships of the bony parts of the face and head. Study Models. Hard plaster models poured from dental impressions. These models show positions of the crowns of the teeth, duplicating the patient's dentition. They enable the dentist to study the dentition from every angle. Photographs. Over-all views of the face and teeth, used to show change and progress. Case History. A detailed questionnaire, a medical and dental history, es-sential for correct, carefully thought-out treatment. After the essential diagnostic aids are put together and carefully studied, the orthodontist is ready to present information to the patient and to answer the patient's questions. Some patients and parents want to know a great deal more than others and the presentation of the treatment plan can be a pleas-ure to the orthodontist. Others ask very few questions. WHAT IS THE MINIMUM INFORMATION NEEDED BY THE PATIENT, PARENT? Is treatment necessary? Is now the proper time to begin? What appliances will be used? How long is treatment anticipated? How much will it cost? A WORD ABOUT HOME CARE-ORAL HYGIENE Orthodontic appliances do not cause tooth decay. They do increase the hazard, however. Dental cavities are caused by acid excreted by bacteria which live in plaque-gook-which sits on the tooth surfaces. Anything for-eign in the mouth which is not kept meticulously clean can contribute to plaque formation. If there is no plaque, there can be no cavity. Many patients with complicated appliances in their mouths maintain plaque-free teeth. It is not easy, but it is certainly possible. Optimum fluoride, conscientious hy-giene, the minimum of sugar will prevent decay or keep it at a minimum. Pa-tients with appliances must continue regular dental checks. A WORD ABOUT PATIENT CO-OPERATION The dentist must diagnose as accurately as is possible; he must com-municate to the patient his plan of treatment. He will construct and place the appliances and make the adjustments for the correct amount of pressure in the specific areas at the proper time. Tooth movement and progress in treat-ment, however, is impossible without the patient's co-operation. The presence of mechanical dev