Treatment of sinusitis after wisdom tooth removal

Why do teeth hurt when you have a runny nose and can they be cured?

Colds and runny nose are unpleasant conditions of the body. A person feels general malaise, chills, and a headache begins due to nasal congestion. If at this moment completely healthy teeth begin to hurt, then the pain of the person who has caught a cold intensifies even more. In this case, the sensations can be so strong that all other cold symptoms fade into the background.

Main reasons

Colds or ARVI, acute respiratory infections are a common occurrence in the cold season, especially when the air temperature drops sharply. Common symptoms of infection are cough, runny nose, and sore throat and muscles.

To all these unpleasant sensations, toothache can be added. Her character is varied: from constant whining to shrill. It can be so strong that the patient stops noticing other signs of a cold.

If perfectly healthy teeth begin to bother you, this may be due to several reasons.

Inflammation of the ternary nerve

A common phenomenon caused by the penetration of harmful viruses into the human body. After treatment of the underlying disease, pain may persist for some time. In case of acute attacks, painkillers should be taken. Usually the ailment goes away on its own without the need for additional treatment.

Complications of a cold with the development of sinusitis, acute rhinitis or sinusitis

There is an accumulation of pus in the upper sinuses of the jaw. Inflammatory processes develop that affect the roots of the teeth. Further development of the process leads to an increase in the growth of pathogenic bacteria, since stagnant pus is an excellent environment for their habitat. Further, inflammatory processes on the gums may occur. All these phenomena cause severe toothache.

Cold

This disease is often accompanied by the formation of inflammatory processes in the throat and upper respiratory tract. Constant nasal discharge and swelling of the mucous membrane do not allow normal breathing. The maxillary sinuses accumulate mucus, pressure occurs on the jaws, resulting in unpleasant sensations.

Mouth breathing

Due to nasal congestion, normal breathing is disrupted. The patient begins to breathe through his mouth, the mucous membrane dries out. Lack of moisture leads to the accumulation of sugar, which turns into acid when interacting with bacteria. The gums begin to become inflamed, and increased sensitivity and pain appear in the teeth.

Increased sensitivity

This happens due to the use of medications and drinks containing ascorbic acid and sugar. Tooth enamel becomes thinner and more susceptible. Begins to react painfully to hot or cold drinks.

Each cause of toothache requires an individual approach. In some cases, more thorough oral hygiene and rinsing with soda solution after taking medications and food will be enough. Other cases will require immediate medical attention.

Main symptoms

Depending on the cause, toothache has different severity. The human body is a very complex system in which everything is interconnected - colds, inflammation of the upper respiratory tract, swelling of the mucous membrane affect the area of the nerve endings of the teeth, which leads to an increase in their sensitivity and the development of pain of varying strength.

Painful dental sensations can occur unexpectedly. The most severe symptoms occur with inflammation of the ternary nerve. The pain is acute, as if radiating to the head, and as a result, a migraine develops. Severe pain forces a person to take large amounts of painkillers.

If a person has had a cold of the ternary nerve at least once, then with any cold or inflammatory process it will immediately make itself felt with severe piercing pain. At the same time, it seems that the unpleasant sensations have engulfed the entire mouth.

In other cases, the unpleasant sensations can be described as short-term, shooting, slightly aching or pulsating.

Increased sensitivity of the dentition manifests itself in discomfort upon contact with warm, cold water or food. The pain is not very severe and quickly disappears after the irritant is removed. It is enough to restore the dental covering and the discomfort will cease to bother you.

Inflammatory processes of the gums are accompanied by constant aching symptoms. With sinusitis or sinusitis, a dull pain is felt in the area of the alveolar process of the upper jaw.

If the process enters an acute phase, then unpleasant sensations may affect the infraorbital area. A throbbing, stabbing, pressing pain can affect the entire upper row of teeth.

In addition, as a result of the activity of pathogenic microorganisms, bad breath appears.

What to do

First of all, it is necessary to determine the cause of toothache. If the culprit is a cold, then you don’t have to plan a visit to the dentist. When the main provocateur disappears, the consequences will gradually disappear.

Experts do not recommend visiting the dentist’s office during the acute phases of an infectious disease. The body is weakened, it has to concentrate all its strength on fighting bacteria and microbes, so unnecessary stress is undesirable for it. Moreover, the patient can infect the doctor himself and his patients with the infection.

Before visiting a doctor, you can use the following treatment methods at home:

Relieving severe pain with special medications.
Rinse the mouth with a weak solution of baking soda. This will help slow down inflammatory processes in the gums, reduce the number of pathogenic bacteria and relieve discomfort.
Application of dental drops. They are applied to a cotton swab and applied to the area of discomfort. The drug consists of camphor and mint, which have a calming effect.
Using mint tablets . Slow resorption will relieve moderate pain within an hour.
Application of propolis. It will not only reduce discomfort, but also prevent possible suppuration.

If a person suffers from unbearable toothache or discomfort remains after treatment of ARVI, it is necessary to seek help from a dentist. Perhaps pathological processes have begun to develop in the oral cavity that require specialist intervention.

Not all symptoms of toothache with a runny nose can be dealt with independently; if there is inflammation of the ternary nerve, the development of sinusitis or acute sinusitis, then the patient will need the help of not only a dentist, but a neurologist and an ENT specialist.

Source: https://dentalblog.ru/zubnaya-bol/pri-nasmorke/

Causes of the inflammatory process

Pathogenic microorganisms from a problematic tooth can spread to the maxillary sinuses. They come out of the root canals due to dental surgery. Pathogenic bacteria begin to multiply, causing an inflammatory process.

The cause of odontogenic sinusitis is considered to be various dental diseases. Often the pathological process provokes:

periodontitis;
complicated caries;
periodontitis;
pulpitis;
impacted tooth;
cyst.

Another factor in the development of the inflammatory process in the maxillary sinus is erroneous manipulations by the dentist.

Sinusitis occurs after the removal of the upper teeth, when a fistula appears in its place. Through it, the infection easily penetrates into the maxillary sinus.

Factors in the development of pathology are improper cleansing of the oral cavity, untimely visits to the dentist and an enlarged maxillary sinus. A weakened immune system also contributes to the development of sinusitis.

Stuffy nose, headache, aching teeth

Quite often, with colds, such as a runny nose, people complain of a headache. At the same time, an underestimated symptom may indicate more severe and dangerous pathologies. When an infection enters the body, not only rhinitis, which most people do not consider a serious disease, can develop, but also diseases of the sinusitis level.

Most often, inflammation of the nasal mucosa or other respiratory diseases are accompanied by a severe headache, which is also considered common.

Causes of headaches due to colds

Headaches due to colds occur for several reasons. One of them is associated with an increase in the production of intracranial fluid. Most often, this occurs with a strong increase in temperature. A large amount of fluid begins to put pressure on the membranes of the brain, and pain appears.

In addition, headaches during colds occur due to intoxication. It occurs when the body is damaged by pathogenic microorganisms that release toxins.

Inflammatory processes affecting the sinuses or ears can also cause a headache when you have a runny nose.

In addition to headaches, colds often include chills, fever, aches, and pain in the joints and muscles. With influenza and other viral diseases, headaches are much more pronounced. The area of their localization is usually in the temples, forehead or above the eyes.

Severe headaches can lead to nausea and vomiting. And if this is accompanied by a very high temperature, then you should immediately call an ambulance. After all, these same symptoms accompany such a dangerous disease as meningitis.

If a headache with a runny nose becomes stronger when lifting heavy objects, bending over, or coughing, this condition also requires urgent attention to a specialist. These signs are characteristic of sinusitis and some neurological disorders.

Headaches that accompany a runny nose and do not go away for several days may indicate the development of otitis media, sinusitis or sinusitis. In case of such diseases, you should definitely see a doctor, because they can lead to very unpleasant consequences.

Why does a headache appear when you have a runny nose?

When you have a runny nose, your head can hurt only because pathogenic microorganisms or viruses have entered the body, and inflammatory processes begin, which becomes the cause of headaches. But at the same time, the same symptom accompanies the development of otitis and sinusitis.

You can distinguish a headache with a runny nose, which arose as a result of damage to the nasal sinuses, by some signs:

The runny nose usually becomes deep and affects the entire nasopharynx.
Headaches often appear after exposure to a draft or severe hypothermia.
The pain is more pronounced in the morning, immediately after waking up. This is due to the fact that at night the mucus does not flow into the throat, but stagnates.
The onset of headaches is rapid and severe. They have a clearly defined localization in some place of the head or face.
There is an increase in pain with a sudden change in body position, head movements, bending, moving to a cold room, sneezing, coughing, and also when drinking alcoholic beverages.

Experts distinguish several types of sinusitis depending on which sinus was affected by the infection.

Symptoms such as severe nasal congestion and mucous or purulent discharge remain common to all species.

Headache due to sinusitis can be considered one of the diagnostic symptoms, since it differs in different types of disease:

sinusitis, inflammation of the maxillary sinuses, is characterized by severe pressing pain localized in the temples, cheekbones and forehead. Swelling of the cheeks may also occur. The pain intensifies when the head is tilted and affects the area of the upper jaw,
with ethmoiditis, inflammatory processes in the mucous membrane of the ethmoid bone, there is a very high temperature, severe headaches, affecting the area of the bridge of the nose and the inner corner of the eye. The sense of smell disappears completely,
with frontal sinusitis, damage to the frontal sinuses, a headache in the forehead area against the background of a runny nose. Fever and swelling of the upper eyelids may be observed. If you press on the inside of the eye, there is a sharp pain,
with sphenoiditis, inflammation of the sphenoid sinus, headache affects the back of the head. Patients often complain that their heads “split” and the pain radiates to the orbital area. Often there is a severe decrease in vision.

If a runny nose is not promptly and completely cured, it can cause otitis media. With this disease, severe headache “shooting” pains in the parotid region are noted.

Most of the symptoms of all of the above diseases are similar. Therefore, if you have a headache with a runny nose, fever and other signs of colds, then you should consult a specialist for an accurate diagnosis of the pathology.

How to cope with headaches due to runny nose and colds

Headaches will noticeably decrease if you stay in bed and eliminate physical activity as much as possible. Increased pain may be associated with reading books, watching TV or working at the computer.

Source: https://ormira.ru/zalozhen-nos-bolit-golova-lomit-zuby/

Surgery

It is not always possible to get rid of inflammation in the paranasal sinuses by washing, using antibiotics, or warming procedures. In case of purulent sinusitis, surgical intervention is used:

in the absence of a positive result for 5 days;
at high temperature;
severe headache;
with swelling of the connecting canal.

The procedure is carried out after anesthesia. The wall of the sinus is pierced with a thick needle. An antiseptic is injected with a syringe and the pus is removed.

After a sinus puncture, the person’s condition improves and the pain goes away. Treatment is continued with physiotherapeutic procedures and rinsing the nasal cavity with antiseptics.

Pain in teeth due to cold. Toothache during a cold: treatment and causes

During the development of acute respiratory viral infections and colds, many people not only develop painful sensations in the throat and muscles, but also begin to have toothache.

Such problems most often arise against the background of hypothermia due to wearing wet shoes, prolonged swimming in cool water, etc. When teeth hurt due to colds and acute respiratory viral infections, there is no need to specifically treat them.

The discomfort will go away on its own immediately after recovery. But if the pain intensifies and it becomes unbearable to endure, symptomatic treatment will come to the rescue.

Causes of toothache development

Can teeth hurt when you have a cold? Definitely yes, among the people this phenomenon has acquired the term “dental cold”, and although doctors do not make such a diagnosis, the phenomenon does occur.

There may be several reasons why teeth hurt during a cold; they are directly related to the disease itself or act as a consequence of infection.

So, the main factors suggesting the development of toothache during a viral or bacterial infection.

Inflammation of the trigeminal nerve

If a person is sick with a viral infection, inflammation of the jaw joint may begin when an enemy agent enters the body. It is accompanied by aching in the jaw and acute pain on the side where the inflammatory process predominates; swelling and swelling of the facial tissues are also pronounced.

When chewing food, trying to yawn, open your mouth wide, or laugh, severe discomfort occurs. Not only a viral infection can cause acute pain in the jaw; nerve damage can also occur if a person’s limbs and facial tissues freeze in the cold.

Sinusitis

If the first signs of a cold and runny nose are ignored by a person, sinusitis develops as a result of the layering of a secondary bacterial infection - inflammation of the paranasal sinuses. Against the background of this disease, the patient’s teeth ache along the entire length of the jawbone, and purulent bags may form on the gums. They weigh down the roots of the teeth, causing severe pain.

Respiratory infection

When a person’s feet are very cold or he has spent a long time in frosty, windy conditions, a cold will not be long in coming, especially if the immune system is weakened.

At this time, the airways and paranasal sinuses become inflamed. The mucous epithelium becomes covered with sputum, which is difficult to remove.

It interferes with normal breathing and creates increased pressure in the sinuses, resulting in a person's jaw pain.

Dry mouth

During a cold, a severe runny nose begins, which is not so easy to stop.

The nose is clogged, the patient has to breathe through his mouth, the situation is aggravated by coughing - the mucous tissue of the oral cavity dries out.

For this reason, sugar and acids intensively settle on the surface of the teeth, damaging the enamel layer; the process is accompanied by severe discomfort and aching pain in the jaw area.

Jaw pain after dental treatment

Signs of poisoning

Another reason why teeth can hurt is a severe case of influenza. A viral infection often causes nausea and vomiting, upset stomach, and diarrhea. The stomach intensively produces acid, which is thrown out during vomiting, and its remains actively corrode the enamel layer of the teeth.

What to do if your teeth hurt due to a cold? The most important thing is to establish the root cause of the phenomenon and deal directly with it

To reduce unpleasant symptoms, you should rinse your mouth more often with saline or soda solution, potassium permanganate or Furacilin. This way, you can at least remove acid residues from the surface of the teeth and wash away bacterial plaque from the mucous membrane.

Additional negative factors

Pain in the teeth during a cold does not always occur for physiological reasons - due to increased acidity in the stomach or a viral infection. In some situations, the person himself provokes the problem, which further aggravates the course of the disease; discomfort in the jaw develops here for the following reasons:

How to take Analgin for toothache?

Inadequate oral care. When a person is sick, he does not have the desire and strength to carry out hygiene procedures with the same zeal; this can be explained by fatigue, fever, and drowsiness. Most of the time the patient lies in bed, ignoring brushing his teeth, believing that it recedes into the background. But after a week of lack of dental care, food debris accumulates in the gaps, and bacteria multiply, destroying the enamel. All this is aggravated by the remnants of vomit and other factors discussed above; if the teeth were previously affected by the initial stage of caries, it begins to progress rapidly.
Eating acidic foods. Everyone knows that when you have a runny nose or a cold, it is useful to drink tea with lemon and raspberries; the drink removes toxins, copes with infections and reduces fever. However, a large amount of acid entering the body and settling on the teeth corrodes the enamel layer, causing discomfort and pain. Sensitivity increases, there is an acute reaction to sweets, hot and cold.
Periodontitis. This is an inflammation of the gums and tooth root, which does not occur just like that; it develops as a consequence of untreated caries. During a cold, due to inadequate oral care, the carious process worsens, which is fraught not only with acute pain, but also with the development of dangerous complications (autoimmune reactions, pathologies of the heart, kidneys, joints).
Granuloma. So, it is called a capsule filled with purulent contents, located deep in the gums, at the root of the tooth. The formation of a granuloma is accompanied by aching and bursting pain in the gums, swelling of the surrounding mucous tissues and an increase in temperature. Pathology can occur either independently or against the background of a viral infection, but is aggravated by caries and bleeding gums (and these problems come to the fore with a severe cold).

Possible complications

It happens that the pain during pulpitis subsides on its own (after 3-7 painful days). This doesn't mean everything is fine. The source of infection has not gone away, and the disease can take a chronic form.

In this case, toxins will constantly penetrate into the blood, causing poisoning of the body and inflammation of internal organs.

In the absence of dental care, pulpitis can quickly turn into periodontitis and spread beyond the tooth root.

In this situation, breathing may be difficult, so tracheostomy (surgery to install a temporary opening between the trachea and the environment) cannot be ruled out. Often a cold nerve causes periostitis, which also has to be treated surgically.

How can this be unpleasant and dangerous?

If the respiratory process is accompanied by painful aching sensations in the gums and teeth, this may indicate the emergence of health-hazardous conditions. They may be:

Inflammatory process in the area of the trigeminal nerve process , as it can easily become affected by a cold infection. Bacteria are capable of enveloping nerve endings through the plexus of blood vessels and affecting the trigeminal nerve. In addition to cold symptoms, toothache begins to be felt, starting from the temples and ending with the jaw.
Inflammation of the maxillary sinuses . The development of sinusitis increases pressure on the anterior bone of the upper jaw. Due to this, aching pain appears. It is because of sinusitis that teeth hurt most often when there is a runny nose. The pain goes away after completion of the therapy process.
Common cold process . It happens that the very appearance of aching toothache indicates an acute respiratory viral infection. This is explained by non-standard physiological characteristics. Teeth begin to ache even before the appearance of fever, runny nose, chills, cough and other cold symptoms.
Hidden dental pathologies . A person without the help of a dentist may not feel their presence for a long period. They can manifest themselves when the body is weakened by a cold infection. Diseases such as pulpitis, periodontitis or gingivitis are just waiting for the body’s immunity to weaken in order to manifest itself in all its glory.

To identify the exact cause, you need to seek help from specialists. In such cases, you cannot self-medicate at home. This can lead to serious consequences. Sinusitis, for example, can progress to a stage where surgical intervention is indispensable.

Disease prevention

Very often, the cause of hypothermia of the dental nerve is untreated caries. This is due to the fact that any impact on the nerve, including cold, can only cause harm if the tooth is already damaged.

articles

Many people are familiar with the symptoms of a dental cold - aching or throbbing pain in one tooth, or more often in several adjacent teeth. Sometimes a person who has a cold in his teeth has pain in his entire upper or lower jaw.

But how to distinguish the symptoms of a dental nerve cold from dental problems - caries, periodontitis, etc.? What to do if you have a cold in your teeth? What treatment is required for a cold dental nerve? In this article we will give answers to all your questions.

What to do to relieve pain

The cause of the disease will help determine the treatment method. Oral pain can be relieved in the following ways:

In case of inflammation of the trigeminal nerve, treatment is prescribed only by a specialist. In some situations, surgery is necessary.

To get rid of pain, it is possible to use an antiseptic liquid in the absence of proper care.
Rinsing your mouth or drinking a glass of clean water will help relieve pain when eating foods that are high in acid.
Rinsing your mouth with a saline solution will help with indigestion.

Toothpastes and gels

For increased enamel sensitivity, toothpastes are used. When your teeth hurt, your dentist selects toothpaste based on the symptoms of the disease. If it is not possible to contact a specialist, it is recommended to use toothpastes for sensitive teeth.

Anesthetic gels will help you get rid of severe pain. By acting externally, they are able to alleviate the inflammatory process for a long time. The most common and effective gels are Dentol and Metrogyl Denta.

Preventive measures

To prevent toothaches from bothering a person during colds, he needs to constantly take preventive measures, which include:

a ban on the use of toothpastes and other oral care products containing sodium lauryl sulfate;
eating large quantities of fresh vegetables and fruits, especially in winter;
hardening of the body;
regular visits to the dentist.

Also, do not alternate hot food with cold food and eat a lot of fruits with a high acid content. Such measures will help maintain dental health for many years.

Treatment methods

To get rid of a toothache, the patient must find out the cause of its formation. When determining the factors causing the disease, you should follow some recommendations.

Painful sensations in the teeth during a cold indicate an insufficient amount of vitamin C. Therefore, if the question arises, what to do if your teeth hurt from a runny nose, first of all, take care of your oral hygiene and take vitamin complexes.

Vitamin C is found in large quantities in ascorbic acid.

During treatment, avoid taking aggressive liquids, including sour and sweet drinks. In addition, the patient should not eat foods that are too cold or too hot.

Source: https://PlastikaPlus.ru/rot/lomit-zuby-pri-prostude.html

When and how do teeth hurt with sinusitis?

With sinusitis, the cheek, temple, and forehead may hurt. One of the symptoms may be toothache. It can manifest itself in different ways: it occurs during chewing, the doctor can identify it by palpation.

Sometimes there is discomfort, a feeling as if the teeth of the upper jaw have lengthened.

In some cases, the pain is neuralgic in nature (the so-called shooting pain, which radiates to the upper jaw, ear, temple).

Why are toothache and sinusitis related?

Inflammation of the maxillary sinus is accompanied by various ailments. There may be a headache, a rise in body temperature, and a stuffy nose. But these signs are characteristic of all sinusitis. But with sinusitis, the teeth of the upper jaw often hurt . There are many reasons for this phenomenon:

The accumulated exudate presses on the walls of the sinus. Since it is located above the upper jaw, discomfort and pain occur in the area of the upper teeth. The pain intensifies when chewing, tapping on the molars (the doctor thus identifies why the patient has a headache and a stuffy nose).
The inflammatory process affected the trigeminal nerve. Therefore, neurological type pain (shooting) occurs, which can radiate to the teeth and ear.
Due to a long-term, chronic illness, not only the mucous membrane became inflamed, but pathological processes began in the bone tissue (osteomyelitis). Since the maxillary sinus in adults is located directly above the upper jaw, it is also affected.
Sinusitis is caused by diseases of the upper molars.

Teeth pain with sinusitis can occur in different ways. If the pain is dull and intensifies with chewing, then most likely it is associated with toxic damage to the trigeminal nerve . Sharp and strong - indicates that the patient has an acute form of odontogenic disease.

What is odontogenic sinusitis and how does it occur?

Inflammation of the maxillary sinus, resulting from disease of the upper molars, is very common in adults. It is usually detected by dentists, since sinusitis causes teeth pain.

What will help with odontogenic sinusitis?

First of all, for treatment it is necessary to identify the diseased, “causative tooth”. Therefore, in case of inflammation of the maxillary sinus, consultation with a dentist is necessary. Sinusitis of dental origin is treated in 2 ways:

Sinus drainage. This method will only help if the canal connecting the oral cavity with the sinus closes on its own, or if lubrication with iodine tincture helps.
Surgery after removal of a diseased tooth. Often, to close the fistula, it is necessary to perform plastic closure of the perforation hole.

After the diseased tooth is removed, cured, and the fistula is healed, conservative treatment begins. Prescribed:

antibiotic therapy;
sinus rinsing;
anti-inflammatory drugs;
physiotherapy.

If choleastomy occurs due to tooth inflammation, surgery is recommended.

The number of odontogenic forms of sinusitis is about 9% of all inflammations of the maxillary sinus. They are identified and treated mainly in dental clinics.

But sinusitis and tooth pain can bother the patient not only with odontogenic inflammation. It also occurs when the sinus is infected due to the pressure of accumulated exudate, trigeminal neuritis.

In this case, getting rid of it is symptomatic treatment necessary to alleviate the patient’s condition.

How to relieve toothache with sinusitis

If there is a dull pain, a feeling of pressure on the upper jaw, most likely the toothache is caused by the accumulation of exudate in the sinus. It will help you get rid of it:

sinus rinsing;
taking mucolytics, which thin and facilitate the removal of mucus;
introduction of vasoconstrictor drugs into the nasal cavity.

As soon as the sinus is cleared of pathological secretion, the pain will subside.

If the cause is toxic damage to the trigeminal nerve, then consultation with a neurologist is necessary . The doctor will examine the patient, determine if any other complications have arisen after sinusitis and additionally prescribe:

analgesics;
physiotherapy.

Electrophoresis with novocaine or lidocaine added to a solution is especially effective for relieving neurological pain. Darsonvalization is often recommended.

Warming helps relieve toothache. But only a specialist can prescribe them, since in some forms of sinusitis heat treatment is contraindicated.

In any case, before you start treating a toothache, you should consult a doctor. Only a specialist, after conducting the necessary research, will identify the cause of pain and prescribe appropriate treatment. Self-medication for sinusitis is fraught with intracranial and orbital complications.

Source: https://gaimorit-sl.ru/mestnye-simptomy/bol-v-zubah-pri-gaimorite.html

Viktor belan

With sinusitis, severe headache and heaviness in the frontal region. I constantly want to blow my nose, but nothing comes out. You can apply a heating pad to the bridge of your nose and warm it up a little, then try to blow your nose; if pus starts to come out, you’re very lucky. Then rinse your nasopharynx with a weak solution of potassium permanganate.

Hello. With sinusitis, runny nose. In most cases, the patient experiences mucous (transparent) or purulent (yellow, green) discharge from the nose.

But you will have to. Toothache is considered the most painful.

hold it near the nose with good pressure with your finger. If you have sinusitis, you will feel it. And above the eyebrows. The sinuses are there.

this is a stupid question. when I had sinusitis, it was accompanied by the following symptoms: 1 point headache 2 pressure on the teeth (that scabby feeling you want to gnaw on everything) 3 clogged nostrils (they mostly clogged one at a time) 4 fatigue

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