Tag Archives: toothache

Dental Emergency: Root Canal Therapy May Relieve Your Tooth Pain

Posted by Genny Skrobanek on December 5, 2023

Root canal therapy, also known as endodontic therapy or simply a root canal, is used to treat infected pulp. Pulp is a soft tissue residing inside teeth and is composed of nerves, blood vessels, and joining tissues.

Many people are afraid of receiving root canal therapy. Although the process is longer and more invasive than a regular dental visit and check-up, it is far better than suffering the pain and discomfort of the diseased pulp. Root Canal Therapy involves removing the infected parts of the tooth and protecting it from future contaminations. Continue reading to understand more about root canals, the conditions when it is required and why it’s important to contact Dr. Skrobanek at GPS Dental to have it treated quickly!

What Prompts the Need for Root Canal Therapy?  

Cracked, chipped, or fractured teeth are the most susceptible to infection. So, at the first sign of a damaged tooth, it is critical to repair it immediately. Unfortunately, if left untreated, food debris and bacteria can seep into the tooth, causing inner tissues or pulp to become decayed and infected.

As the tooth deteriorates, you will experience pain. You may also notice symptoms such as:

  • severe sensitivity to varying temperatures
  • pain when chewing
  • swelling of the gums
  • tenderness around the area
  • discoloration of the tooth

Should any of these signs arise, you are encouraged to seek immediate help. Letting the infection progress can lead to the loss of your tooth.

If you’re needing root canal therapy, there’s no reason to worry and every reason to move forward. Root canals are a dental procedure that eliminate bacteria from infected tooth roots and prevent reinfection because the infected pulp is removed and the surrounding area is carefully cleaned, filled, and sealed. Every year, millions of people undergo root canal therapy to treat diseased or damaged teeth. A root canal will relieve any oral pain you’ve been experiencing in that tooth and can make it healthy once again.

Related Articles:

Have You Been Experiencing These Symptoms?

In addition, these symptoms may indicate that a root canal procedure is needed:

  • Persistent dental pain
  • A chipped or cracked tooth
  • Pimples on gums
  • Darkening of gums
  • Decay
  • Tooth Mobility or feeling loose

To get your oral health back to normal, and to eliminate any pain you may be experiencing, a root canal is often the next, and best, step to take. If left untreated, there’s no doubt you’ll lose the infected tooth and experience more dental problems and more pain. You can even spread the infection to the rest of your body, if left untreated.

Related Article:

How a Root Canal Procedure Can Help You

Root canal therapy can provide relief to someone experiencing dental pain, especially when the pain is associated with infection or damage to the pulp of a tooth. Here’s how a root canal can help:

  1. Removal of Infected or Inflamed Pulp: Dental pain often occurs when the pulp (the innermost part of the tooth containing nerves and blood vessels) becomes infected or inflamed. A root canal involves removing the infected or damaged pulp, which eliminates the source of pain.
  2. Pain Relief: Once the infected pulp is removed, the pain caused by the inflammation and infection is alleviated. The procedure is performed under local anesthesia, ensuring that the patient is comfortable and does not feel pain during the treatment.
  3. Preservation of the Natural Tooth: A root canal is a treatment aimed at saving a natural tooth rather than extracting it. Preserving the natural tooth is beneficial for maintaining proper oral function, aesthetics, and avoiding the need for more extensive dental procedures like tooth replacement.
  4. Prevention of Spread of Infection: By removing the infected pulp, a root canal prevents the spread of infection to other areas of the mouth and the rest of the body. This helps in preventing more serious health issues and complications.
  5. Elimination of Swelling and Discomfort: Dental infections can cause swelling and discomfort in the affected area. By addressing the infection through a root canal, swelling is reduced, and the patient experiences relief from discomfort and tenderness.
  6. Resolving Sensitivity to Hot or Cold: Infected or inflamed pulp can make the tooth sensitive to hot or cold temperatures. After a root canal, the tooth is no longer responsive to temperature changes, leading to increased comfort during eating and drinking.
  7. Improvement in Overall Oral Health: By treating the infection and preserving the natural tooth, a root canal contributes to better overall oral health. It eliminates the need for tooth extraction, preventing potential complications that can arise from missing teeth.
  8. Durable and Long-Lasting Solution: After a root canal, the treated tooth is typically restored with a dental crown or filling, providing durability and long-term functionality. With proper oral hygiene and regular dental care, the treated tooth can last for many years.
  9. Elimination of Toothache and Discomfort: The primary goal of a root canal is to eliminate your toothache and discomfort associated with dental pain. By addressing the underlying issue, patients experience significant relief and can resume normal oral function.

It’s important to note that while a root canal is a common and effective procedure, not all dental pain requires this treatment. If you are experiencing dental pain, it’s crucial to consult with Dr. Skrobanek for a proper diagnosis and treatment recommendation. Early intervention can prevent the progression of dental issues and alleviate discomfort.

More about Root Canals from WebMD

Related Article: Restorative Dentistry: Porcelain Crowns Can Restore Teeth

If you’re suffering from tooth pain, we can help!

We hope we’ve given you information to answer some of your questions about getting root canal therapy; however, if you have additional questions, we’d love to answer them! Please contact our office at 210-633-3477. If you’re in pain, from a toothache, please let us know when you call us, so we can schedule your appointment as a dental emergency and get you scheduled for treatment immediately!

Dr. Gary P. Skrobanek’s experienced and friendly team at GPS Dental offers affordable dental care for all ages in San Antonio, TX area. Our Brooks City Base dentist office is conveniently located and offers early morning appointment times Monday through Friday to meet your needs. At GPS Dental, we promote dental health awareness to our patients and provide most dental services, from family and general dentistry to dental implants, sleep apnea, TMJ / TMD Treatment, cosmetic dentistry and much more. We accept most dental insurance plans and offer affordable financial solutions for any budget. Call us at 210-633-3477 to make an appointment.

Painful Dental Emergency: We Can Get You OUT OF PAIN!

Posted by Genny Skrobanek on April 25, 2023

Toothaches, or any kind of ache really, are never fun to experience. We thought we’d take a look at some common dental emergencies and the importance of seeing your dentist if you may be experiencing any toothaches, oral pain or are suffering from a painful dental emergency. Remember, if you’re overdue for a dental appointment, call us today to get that scheduled and stay on top of your oral health, which can help avoid some dental emergencies in the future.

Related Article: Emergency Dental Appointments Available at GPS Dental

How to Tell It’s a Dental Emergency

Not every situation is a painful dental emergency, but it’s important to know when you need to call your dentist right away. If you’re unsure, ask yourself these questions:

  • Are you in severe pain?
  • Are you bleeding from the mouth?
  • Do you have a loose tooth/teeth?
  • Do you have an infection?
  • Have you lost a tooth?
  • Are you experiencing major swelling in the face or mouth?

In general, if you need to stop any major bleeding, pain, or save a tooth – there’s no doubt you’re dealing with a dental emergency. Let’s take a look at some of the more common dental emergencies we see.

Related Article: Emergency Appointment: Do You Have a Toothache?

5 Most Common Dental Emergencies

  1. Broken Crown – If a dental crown falls off or completely breaks, it leaves your tooth very vulnerable. Schedule with us quickly to possibly avoid a root canal or extraction.
  2. Knocked-out Tooth/Teeth – If you’ve ever had a tooth knocked out, you know what a shock that can be. When you act quickly after a tooth has been knocked out, it’s possible that we may be able to reinsert your tooth. Pick up the tooth carefully, try not to touch the root, and gently rinse. Try to reinsert the tooth into the socket. If you can’t, place in a small container of milk until you see your dentist.
  3. Unexplainable Toothache – If you have a sudden, out-of-the-blue toothache, it’s important to reach out quickly to discover the source of the pain. While over-the-counter pain meds and a cold compress can help temporarily, it’s good to get to the source of the pain sooner rather than later; your odds of a minor fix will be much greater the faster you see your dentist.
  4. Bleeding or Swollen Gums – Some minor bleeding or irritation here and there is usually just fine and not concerning. However, if your gums won’t stop bleeding and is accompanied with swelling, it can often mean there’s an underlying health or dental issue that needs to be addressed.
  5. Food or Object Lodged in Teeth – If an object or stubborn piece of food gets lodged, brushing and flossing won’t help. Get professional help quickly to remove the food/object and prevent any decay or irritation.

Related Article: Handling Dental Emergencies

Let’s Talk Toothaches

Toothaches are tricky — they can feel like a minor tinge or they can cause crippling pain. That’s why we want to share some common toothache causes, their symptoms and when you should seek help from your dentist if you are suffering from a painful dental emergency because of a toothache.

Q. What is the definition of a toothache?

A. Pain or inflammation in or around the tooth, often caused by tooth infection or decay.

Q. What are common toothache causes?

A. A toothache can have causes that are not due to underlying disease. Toothache causes may include getting something stuck in between the teeth, flossing, biting into something hard, or braces. Remember, in children, tooth pain is a regular part of the developmental process.

Common Toothache Causes:

  • Tooth decay
  • Abscessed tooth
  • Tooth fracture or broken tooth
  • Sensitive Teeth
  • Damaged filling
  • Infected gums or gum disease
  • Inflammation of tooth pulp
  • Impacted tooth
  • Repetitive motions, such as grinding teeth or chewing gum
  • Sinus congestion or infection (non-dental related issues)

Common Symptoms of a Toothache:

  • Tooth pain that may be constant, throbbing, or sharp
  • Bleeding or discharge from around a tooth or gums
  • Headache or fever
  • Trauma or injury to the area
  • Cold or hot sensitivity when eating or drinking
  • Swelling in your jaw or around the tooth
  • Tooth pain while chewing
  • Pain results only when pressure is applied to the tooth, for some people
  • Foul-tasting drainage from the tooth infection

We Provide Same-Day Emergency Services

Your Dental Pain is Our TOP Priority … call us today at 210-633-3477

If you are suffering from a painful dental emergency, we offer Emergency Dental Appointments, because we know they are more than just an everyday dental issue. If you’re dealing with pain or injury, it’s important to be seen right away. Our philosophy on dental emergencies is very simple “If you need toothache relief or another type of dental emergency, you are first in line… PERIOD.” Our office in San Antonio, TX is open Monday through Friday, 7 AM-5:30 PM, and our talented Dr. Skrobanek will be there to provide urgent dental care. We are willing to come in early, stay late, and even work through lunch to get you in, treated and comfortable again. Give us a call at 210-633-3477 … we can get you out of pain.

Dr. Gary P. Skrobanek’s experienced and friendly team at GPS Dental offers affordable dental care for all ages in San Antonio, TX area. Our Brooks City Base dentist office is conveniently located and offers early morning appointment times Monday through Friday to meet your needs. At GPS Dental, we promote dental health awareness to our patients and provide most dental services, from family and general dentistry to dental implants, sleep apnea, TMJ / TMD Treatment, cosmetic dentistry and much more. We accept most dental insurance plans and offer affordable financial solutions for any budget. Call us at 210-633-3477 to make an appointment

Emergency Dental Appointments Available at GPS Dental

Posted by Genny Skrobanek on August 23, 2022

So many things in our lives can be confusing and complicated – ordering for multiple people at
Starbucks, figuring out dinners every week, finding a new doctor, filing your taxes, etc. We’re here to
make the dental care aspect of your life simple and straightforward!

At GPS Dental, we are accepting new patients and offer emergency dental appointments.
Look no further and give us a call today to set up a routine appointment, get help for a dental
emergency, or discover more about our services.

We Make it Simple for New Patients

If you’re a new patient, our website offers a convenient link to our new patient forms, along with helpful resources, including information on our dental emergency services, dental anxiety tips and tricks, and dental services we offer.

Emergency Dental Appointments

Our philosophy on dental emergencies is very simple “If you need toothache relief or are having another type of dental emergency, you are first in line … PERIOD.”

Our goal is to provide:

  • Immediate relief
  • Gentle care
  • Proven results

Here are some Dental Emergency Tips from the American Dental Association.

We Offer Same Day Emergency Dental Appointments

We set aside time in our schedule every day to help with dental emergencies. We want to help you the same-day or ASAP to eliminate your pain and find a solution that works for you.

Common dental emergencies include:

  • Missing tooth/knocked-out tooth
  • Swollen and/or bleeding gums
  • Broken tooth
  • Chipped or cracked tooth
  • Unexplainable toothache/severe toothache
  • Abscessed tooth
  • Exposed nerves
  • Swollen mouth or jaw
  • Broken crown
  • Missing filling

Related Article: Common Dental Emergencies

If you’re unsure if you’re dealing with an emergency problem, ask yourself:

  • Am I in severe pain?
  • Am I bleeding?
  • Am I missing a tooth?
  • Is my mouth or gum swollen?
  • Do I have an infection?

If you answer YES to anything, give us a call immediately for care. Our team of experts are caring and informed, and can help you with a dental emergency. Please call our office at 210-633-3477 and we will schedule your emergency dental appointment as quickly as possible.

Related Articles:

Importance of Calling Your Dentist for Emergencies 

Although oral pain and trauma may not seem like a huge deal, it cannot be ignored. Small problems can escalate and cause more pain in the future, so seeing your dentist for any emergency treatment is imperative. If you’re unsure if you’re dealing with a dental emergency, please give us a call. However, a good rule of thumb is – if it hurts, then it’s an emergency. 

Related: Dental Emergency Q&A  

GPS Dental Can Get You OUT of Pain!!

At GPS Dental we are prepared to assist our patients when a dental emergency occurs. When patients call in this type of scenario, we always do our best to accommodate same-day emergency appointments. You may not be able to anticipate when a dental emergency will happen; however, you can rest assured that you will receive swift expert emergency care when you call our office. If you’re experiencing a dental emergency, remember … Emergency Dental Appointments are Available at GPS Dental.

Please give us a call at 210-633-3477 and let us know you are experiencing tooth pain.

Dr. Gary P. Skrobanek’s experienced and friendly team at GPS Dental offers affordable dental care for all ages in San Antonio, TX area. Our Brooks City Base dentist office is conveniently located and offers early morning appointment times Monday through Friday to meet your needs. At GPS Dental, we promote dental health awareness to our patients and provide most dental services, from family and general dentistry to dental implants, sleep apnea, TMJ / TMD Treatment, cosmetic dentistry and much more. We accept most dental insurance plans and offer affordable financial solutions for any budget. Call us at 210-633-3477 to make an appointment

National Toothache Day: GPS Dental Can Get You OUT of PAIN!

Posted by Genny Skrobanek on January 25, 2022
national-toothache-day

Toothaches, or any kind of ache really, are never fun to experience. With National Toothache Day approaching on February 9, 2022, we thought we’d take a look at some common dental emergencies and the importance of seeing your dentist if you may be experiencing any toothaches, oral pain or problems. Remember, if you’re overdue for a dental appointment, call us today to get that scheduled and stay on top of your oral health, which can help avoid some dental emergencies in the future.

Related Article: Toothache Causes: My Tooth is Throbbing! What do I do?

How to Tell It’s a Dental Emergency

Not every situation is a dental emergency, but it’s important to know when you need to call your dentist right away. If you’re unsure, ask yourself these questions:

  • Are you in severe pain?
  • Are you bleeding from the mouth?
  • Do you have a loose tooth/teeth?
  • Do you have an infection?
  • Have you lost a tooth?
  • Are you experiencing major swelling in the face or mouth?

In general, if you need to stop any major bleeding, pain, or save a tooth – there’s no doubt you’re dealing with a dental emergency. Let’s take a look at some of the more common dental emergencies we see.

Related Article: Experiencing Tooth Pain? When it’s Time to Visit the Dentist

5 Most Common Dental Emergencies

  1. Broken Crown – If a dental crown falls off or completely breaks, it leaves your tooth very vulnerable. Schedule with us quickly to possibly avoid a root canal or extraction.
  2. Knocked-out Tooth/Teeth – If you’ve ever had a tooth knocked out, you know what a shock that can be. When you act quickly after a tooth has been knocked out, it’s possible that we may be able to reinsert your tooth. Pick up the tooth carefully, try not to touch the root, and gently rinse. Try to reinsert the tooth into the socket, but if you can’t, place in a small container of milk until you see your dentist.
  3. Unexplainable Toothache – If you have a sudden, out-of-the-blue toothache, it’s important to reach out quickly to discover the source of the pain. While over-the-counter pain meds and a cold compress can help temporarily, it’s good to get to the source of the pain sooner rather than later; your odds of a minor fix will be much greater the faster you see your dentist.
  4. Bleeding or Swollen Gums – Some minor bleeding or irritation here and there is usually just fine and not concerning. However, if your gums won’t stop bleeding and is accompanied with swelling, it can often mean there’s an underlying health or dental issue that needs to be addressed.
  5. Food or Object Lodged in Teeth – If an object piece or stubborn piece of food gets lodged, brushing and flossing won’t help. Get professional help quickly to remove the food/object and prevent any decay or irritation.

Related Article: Handling Dental Emergencies

GPS Dental Can Get You OUT of Pain!!

National Toothache Day is not cause for celebration; however, If you’re experiencing a dental emergency, remember Emergency Dental Appointments are Available at GPS Dental. Please give us a call at 210-633-3477 and let us know you are experiencing tooth pain.

Dr. Gary P. Skrobanek’s experienced and friendly team at GPS Dental offers affordable dental care for all ages in San Antonio, TX area. Our Brooks City Base dentist office is conveniently located and offers early morning appointment times Monday through Friday to meet your needs. At GPS Dental, we promote dental health awareness to our patients and provide most dental services, from family and general dentistry to dental implants, sleep apnea, TMJ / TMD Treatment, cosmetic dentistry and much more. We accept most dental insurance plans and offer affordable financial solutions for any budget. Call us at 210-633-3477 to make an appointment

Experiencing Tooth Pain? When it’s time to visit the dentist

Posted by Genny Skrobanek on January 5, 2021

Experiencing tooth pain is no small thing. In fact, tooth pain can ruin your day or put you in a bad mood. Sharp pain can make it difficult to concentrate at school or work, and extreme sensitivity can ruin mealtimes. What causes these frustrating tooth pains? Let’s take a closer look at the top five reasons for tooth pain and see when it’s time to visit your dentist!

Related Articles:

Top 5 Reasons for a Toothache

  • Sensitivity: Has a certain tooth developed sensitivity to cold and/or hot temperatures? Tooth sensitivity can happen for a myriad of reasons and is often the indicator of an underlying symptom, so it’s important to let your dentist know if you’re experiencing extreme sensitivity. There are many treatments that can help, such as using a sensitive toothpaste. 
  • Gum Disease: Gum disease is as worrisome as it sounds and affects many adults every year. Gum disease, or periodontitis, is when bacteria eat away at your gums. This is most often caused from bad dental hygiene and excess bacteria in the mouth. Gum disease can make your gums feel tender, or sometimes bleed, and cause tooth pain. The earlier you catch gum disease and begin treatment and better dental hygiene, the better. If you notice a toothache and swollen or red gums, come in and see your dentist quickly for an examination.
  • Decay: Plaque and bacteria in the mouth do more than just bother your gums, they also begin to dissolve your enamel on your teeth. When your enamel gets broken down, your teeth aren’t as strong anymore and are more susceptible to weak spots and pain. When bacteria concentrate in an area, you can experience a cavity/holes in the teeth. When this happens, your teeth may feel sore and sensitive.
  • Dental Abscess: Also caused from an excess of bacteria, an abscess forms when bacteria builds up inside your tooth’s pulp. This causes an infection and leads to swelling and soreness, or a toothache. Pus can also develop around the tooth, so it’s important to visit your dentist right away if you see these symptoms. An x-ray can confirm the diagnosis and often antibiotics are used to fight the infection.
  • Chipped Tooth: Although enamel is extremely tough and durable, sometimes we experience a chipped or broken tooth whether it be from an injury or whatnot. Try to not chew on ice, pens, open packages with your teeth, and so on to prevent any breakage. A crack in the tooth can cause extreme sensitivity and pain. Sometimes, a crack may not be clearly visible to you and may be in the back area of the tooth. If you think you may have a crack, visit your dentist right away. Treatment options often include crowns and root canals, depending on severity.

More reasons for a toothache: https://www.health.com/condition/pain/tooth-pain-causes

GPS Dental Can Get You OUT of Pain!!

If you’re experiencing a dental emergency, remember … Emergency Dental Appointments are Available at GPS Dental. Please give us a call at 210-633-3477 and let us know you are experiencing tooth pain.

Related Article: Toothache Causes: My Tooth is THROBBING!! What do I DO?

Dr. Gary P. Skrobanek’s experienced and friendly team at GPS Dental offers affordable dental care for all ages in San Antonio, TX area. Our Brooks City Base dentist office is conveniently located and offers early morning appointment times Monday through Friday to meet your needs. At GPS Dental, we promote dental health awareness to our patients and provide most dental services, from family and general dentistry to dental implants, sleep apnea, TMJ / TMD Treatment, cosmetic dentistry and much more. We accept most dental insurance plans and offer affordable financial solutions for any budget. Call us at 210-633-3477 to make an appointment

Emergency Dental Appointments Available at GPS Dental

Posted by Genny Skrobanek on March 24, 2020

We’re only three months into 2020 and finding ourselves facing a serious situation as the pandemic known as COVID – 19 sweeps across the globe. It is extremely important to take the necessary preventative measures (such as washing your hands, limiting physical contact with each other and social distancing) and to stay on top of recent developments regarding this health crisis.

However, for those in need of dental care during this time, please be assured that GPS Dental will remain open and accepting emergency dental appointments.

As we are following the recommendations of the American Dental Association (ADA) during the COVID-19 outbreak, it is recommended that dentists across the country postpone all non-essential dental services until further notice.

Emergency Dental Appointments: Essential vs. Non-Essential Treatments

If you have visited our website or read any previous blog entries, you will know that there are three different types of dental services that we provide including, preventative, restorative, and cosmetic based procedures. While there is a certain degree of overlap between some of the procedures, to reduce any unnecessary health risks for both our patients and staff, we will only be offering essential treatments until further updates from the ADA.

Who will you call when you need an emergency dental appointment?

At GPS Dental we are prepared to assist our patients when a dental emergency occurs. When patients call in this type of scenario, we always do our best to accommodate same day emergency appointments.

Treatment and Prevention for a Dental Emergency

While we can’t prevent every tooth-related issue, knowing some prevention methods for dental emergencies can be very helpful. To help prevent injury:

  • Never use your teeth to open packages or cut items – use scissors instead
  • Avoid chewing extremely hard food items, such as candy, popcorn kernels, and ice
  • When playing sports, wear a mouth guard

In-depth information on the types of dental emergencies and injuries according to the American Academy of Family Physicians.

Signs of a Dental Emergency

Our goal is to fix any dental emergency as soon as possible and get you back on your feet and out of pain. Accidents can happen, and quick action and knowledge of dental emergencies can easily save a tooth! Make sure to give us a call at GPS Dental as soon as you experience the signs of a dental emergency.

Learn more from this Dental Emergency FAQ.

Other Reasons for needing emergency dental care:

  • Knocked Out Tooth
  • Chipped or Broken Tooth
  • Partially Dislodged Tooth
  • Abscess
  • Toothache
  • Lost Filling
  • Lost Crown

Related Article from WebMD: Handling Dental Emergencies

You may not be able to anticipate when a dental emergency will happen; however, you can rest assured that you will receive swift expert emergency care when you call our office.

While these signs are often correlated to a dental emergency, there are other signs and symptoms to also be aware of that aren’t as sudden or apparent. Symptoms such as prolonged pain, or a swollen jaw are major indicators that something isn’t right, even if they do seem more subtle.

  • Prolonged toothache
  • Jaw pain or swelling
  • Sore gums
  • Metal taste in the mouth
  • Canker sore that will not heal
  • Numb tooth
  • Constant headaches
  • Extreme tiredness

Related Articles:

Tooth Extractions: Reasons for Pulling Teeth

Colds, Flus, and Cavities: Is Your Medicine Hurting Your Teeth?

We’re All in This Together!

Although we will be temporarily suspending certain services, please remember that if you require any emergency dental procedures, you will be able to receive the care you need at our office. It is important that you receive the necessary care as oral health problems will worsen if left untreated.

You may not be able to anticipate when a dental emergency will happen; however, you can rest assured that you will receive swift expert emergency care when you call our office.

From all of us at GPS Dental, we would like to thank you all for your patience and understanding during this unprecedented situation. We will be keeping a close eye on the situation as it progresses.

If you have any questions or concerns, please contact our office.

Dr. Gary P. Skrobanek and his experienced, friendly team at GPS Dental offer affordable family dentistry and gentle dental care in the San Antonio, TX area. Our office is conveniently located and offers early morning appointment times Monday through Friday to meet your needs. At GPS Dental, we provide most dental services, from family and general dentistry to dental implants, sleep apnea, TMJ / TMD Treatment, cosmetic dentistry and much more. We accept most dental insurance plans and offer affordable financial solutions for any budget. Call us at (210) 633-3477 to make an appointment.