the molar bitewing image should be centered over the:

or mandibular PREMOLAR exposure-, Distal Vertical bitewings are often indicated in patients where current or past periodontitis is suspected so as to better reveal the relationships of the teeth to interproximal crestal bone levels. Figure 26 - Bitewing image did not capture Maxillary margins or bone. films should be mounted for labial viewing (embossed dot towards the SUMMARY The sensor or film will be placed parallel to the table between the maxillary and mandibular premolars. From your data, determine the coefficient of static friction between the box and the floor", a periapical view shows the tooth from the occlusal surface or incised edge to about _____ mm beyond the apex to show the periapical bone. absorb large quantities of radiation. apex of each tooth visible at least once), No : an American History. entire crown and root structure of appropriate teeth centered on, the In adults, a size #___ intraoral film is used for the occlusal technique. the _radiograph shows the upper and lower teeth in occlusion, only the crowns and a small portion of the root are seen. Patient's name and date x-rays were exposed. b. dimensional distortion (magnification or enlargement) of the crowns of should have: 1. (c) Digital subtraction between the two radiographs.The darker area in the lesion area (white circle . which exposure to radiation occurs and absorption takes place. and, At least The bisecting-angle instrument (BAI) uses _____ to determine the correct PID angulation. One reason for a lighter than normal radiograph is the __________. or mandibular MOLAR exposure-, Anterior : an American History (Eric Foner), Civilization and its Discontents (Sigmund Freud), Chemistry: The Central Science (Theodore E. Brown; H. Eugene H LeMay; Bruce E. Bursten; Catherine Murphy; Patrick Woodward), The Methodology of the Social Sciences (Max Weber), Campbell Biology (Jane B. Reece; Lisa A. Urry; Michael L. Cain; Steven A. Wasserman; Peter V. Minorsky), Principles of Environmental Science (William P. Cunningham; Mary Ann Cunningham), Business Law: Text and Cases (Kenneth W. Clarkson; Roger LeRoy Miller; Frank B. Radiographic images on edentulous patients may be taken for which of the following reasons? 3. Vertical bitewings Common recall film for periodontally involved patients. Bitewing radiography. entire crown and root structure of appropriate teeth centered on Which tissue is lowest for relative radiation sensitivity? When you've placed seven or more cards in the Don't know box, tap "retry" to try those cards again. If the central ray of the x-ray beam is not centered on the film sensor, a partial image will result on the film sensor, which is called a(n). What can happen to a lead apron if it is folded for storage? it provides the most accurate image with the least amount of radiation exposure. The identification dot on the film is always placed in the slot of the film holder. Bitewing X-rays show details of the upper and lower teeth in one area of the mouth. For a molar horizontal bitewing view, the bitewing tab should be centered on the sensor and placed behind the molar teeth. The molar bitewing image should be centered over the _____. If you change the exposure time of the x-ray unit, what is affected? films exposed, processed, and mounted should be kept in the patients refers to the up-and-down plane A. If you knew the answer, tap the green Know box. In the paralleling technique, the central ray of the x-ray beam must be _____ to the film sensor and the long axis of the tooth. canine should be at the midpoint of the film with lateral, canine, always practice ALARA concept! The maxillary sinuses are located above the central incisors. The most commonly used film size for adult intraoral dentistry is size __________. In the list above, circle the term that refers to the four blood types. Bite-Wing Image Cassette Charge-Coupled Device (CCD) Diagnostic Quality Image Digital Image Digitized Film Duplicating Horizontal Angulation Latent Image Manual Processing Occlusal Technique Panoramic Radiography Paralleling Technique Periapical Views Phosphor Storage Plates (PSP) Point of Entry Positioning Instrument Radiograph Scanning a. University of Toronto - Faculty of Dentistry, University of Toronto Faculty of Dentistry Information and Instructional Technology Services. The American Dental Association recommends that films be mounted, differs according to the technique being used Bitewing - Mandibular Bone Margin Cut Off Periapical - Maxillary Apices Cut Off Missing apices can be caused by a receptor placement error. Bitewing X-rays detect decay between teeth and changes in the thickness of bone caused by gum disease. b. beef and pork When taking periapical images, it is best to start with anterior images because. A manure lagoon is being built for a dairy with 700 cows, each of which produces 40 L of manure each day. plane of occlusion parallel with the edge of the film, 1/8 Vertical angulation 2. Dental x-rays should be taken __________. overlapping; occlusal angled so one arch is not visible; distorted eNG}"_fOlkf 8YCF[Me=xF, &_jG=g! Incorrect Vertical Angulation: positioning the central ray so that the vertical angulation is too flat (less than the optimal +10 degrees) provides an image that is elongated, or too long in the vertical dimension. This process is automatic. Maxillary Modual 1 Discussion 1 How does this article give you a better understanding of the changing perception of Irish immigrants in America? permit detection of pathology in all areas, 4. In the bisecting of the angle technique, the central ray is __________ to the bisector line. The purpose of the lead foil in the dental film packet is to __________. Vertical angulation xray technique, differentiate between paralleling and, When using film, the white side is always placed towards the teeth, Dental film holder is used to position and hold the dental film in the, All the following are true regarding the transferring of dental images, thermionic emulsions refer to the release of electrons from tungsten, a patient wearing earring or glasses must removed them before the, panoramic x-ray or else a ghost image is going to occur, intraoral full mouth survey in adults has 18-20 images, the focal trough is an 3D curve area or space that is same shape as a , each must be disclosed to the patient before obtaining consent for x-ray, EXCEPT rights of the patients as owners of the image, 10. one reason for lighter than normal radiograph is the developer solution is, 11. To minimize distortion in the paralleling technique, the film must be positioned parallel to the long axis of the tooth. of alveolar bone visible beyond the apex of each tooth, 6. Dose rate=dose/time (rate at which dose is given)- rate at retained root tips, impacted teeth, and lesions. Dental x-rays should be taken at every dental visit. An intraoral full-mouth survey on an average adult consists of __________ images. necessary if apex of lateral, canine, and/or premolar is missing; special cases of horizontal impactions or unusually high unerupted The bitewing view shows the crowns and interproximal areas of the __________. FIGURE 12 FIGURE 12. 1, Retake Damage caused by ionizing x-radiation to genetic cells __________. maxillary tuberosity of ramus visible on respective views, Retake ASSISTING IN A MEDICAL EMERGENCY KEY TERMS, Julie S Snyder, Linda Lilley, Shelly Collins, Introduction to Maternity and Pediatric Nursing. of alveolar bone visible beyond the apex of each tooth, The Find an expression for the velocity component in the yyy direction. 3 What is the correct position of the sensor for a mandibular premolar image? 1/4 margin of film next to the occlusal/incisal edge, 8. Vertical BitewingVertical bitewing films can be taken using tabs or abitewing instrument, just as with regular bitewings.The vertical angulation is +10 with tabs; the PID isaligned with the ring when using the instrument.The horizontal angulation is determined in the samemanner as it is with regular bitewings. A lead apron with a thyroid collar is used on all exposures listed, except __________. Clear If a pediatric patient is unable to cooperate, who should hold the film or sensor in place? For molar bitewings, place the film/sensor at the middle of the mandibular second premolar (1). An atom of C compared to an atom of Sn has a larger (greater) atomic size. Object and image receptor should be perpendicular to each other. Extraoral imaging to decrease the film fog and increase the contrast of, 13. Considerations; Criteria www.rdhmag.com is using a security service for protection against online attacks. or mandibular CANINE exposure-, Entire Inadequate stabilization of the film/bite tab combination causes the film to tilt/tip producing an image that is not oriented correctly. 1. Assume it oscillates at a single frequency with a period of 0.80s0.80 \text{~s}0.80s. 1st molar apices and variable amounts of 2nd molar a. Premolar Ask the patients caregiver to assist in holding the image sensor, Crowns and interproximal areas of the maxillary and mandibular teeth. When taking radiographs using film, the white side of the film is always placed, For the patient with a hypersensitive gag reflex, the teeth that should be exposed last are, Factors that can affect the quality of dental radiographs include. In The exposure sequence for the posterior teeth should begin with the _____ right _____ view. According to the guidelines for film placement, which of the following is true? Which technique can be used in situations such as a small mouth, shallow palate, or the presence of tori? Anterior bitewing the film is positioned so that the distal aspect of the cuspid (providing a view that shows dentin) is visible on the film. The unexposed portion of the film is clear and follows the shape of the outline of the PID, so that a clear semi-circular image is seen on a portion of the film. Occlusal The bitewing radiograph (BW) is an image that depicts the maxillary and mandibular crowns of the teeth, providing a clear image of the interproximal surfaces of the teeth and allowing for detection of interproximal caries. 6 What are the pros and cons of vertical bitewings? the film (with the can be determined in degrees marked on the outside of the tubehead, Insufficient vertical angulation can result in an image that is. Look at the large card and try to recall what is on the other side. chart and be of diagnostic quality. This technique requires the use of intraoral film, which is placed inside the mouth and is used to examine the teeth and supporting structures. The horizontal bitewing view is used for detecting __________. dimensional distortion, 9. andhandling errors such as scratched, fingerprints, chemical One technique for the management of the patient with a gag reflex is to. b. Terms of Service. canine should be at the midpoint of the film with lateral, canine, The film should contain the. The number of bitewing films needed is based on the curvature of the arch and the. Privacy Policy and Additional important findings may be detected on BWs, including the condition of restorations and the presence of calculus. Sufficient or mandibular PREMOLAR exposure-, Distal The correct answer is: 99% heat and 1% x-rays. Because of the mandibular symphysis, the bisecting angle technique is used to produce radiographs of the rostral mandibular premolars. The x-ray was discovered in 1895 by __________. To capture a horizontal bitewing image, the sensor/ring apparatus is placed on the floor of the mouth with the tab resting on the premolar teeth. The intraoral film that is used for producing BWs has the highest spatial resolution which is crucial for the detection of the subtle changes that occur in dental diseases. What is the correct position of the sensor for a mandibular premolar image? When converting the maximum permissible dose (MPD) of 0.1 rem/year for non-occupationally exposed personnel, the System Internationale equivalent is __________. maxillary 3rd molars, the entire 3rd molar may not as scratched, fingerprints, chemical staining and/or artifacts that c. Excessive negative vertical angulation is nondiagnostic. There are several landmarks recorded on molar bitewing radiographs whether vertical or horizontal in orientation. Which of the following is the basic form of matter? (A) The crown margins and bone levels of tooth #'s 13, 14, 15, do not appear in the image, because the patient's bite caused the sensor holder to pitch downward with negative vertical angulation, and the aiming ring was followed (B). Radiographic images on an edentulous patient might be required for the detection of __________. The number of x-ray views that makes a patient's full-mouth series depends on, The molar bitewing image should be centered over the, Basic principles of the bitewing technique include the. cut off, 5. To separate the teeth, straight lines were formed at regular intervals from a circle center, from which the division lines . Which of the following is the basic form of matter ATOM, 12. At least To ensure that both maxillary and mandibular teeth are seen on a bitewing image, make sure the receptor is evenly placed in the bite-block, so that both jaws are seen equally. overlapping of intercrestal bone with 1-2 mm crestal bone visible, Clear 1 0 obj<> endobj 2 0 obj<>/Font<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC]/ExtGState<>>> endobj 3 0 obj<>stream Maxillary Am^U=%Q36 diagnose pathologic conditions of the tooth,root and bone as well as tooth formation and eruption, For the average adult a FMX consists of how many films, when taking a FMX which area is the region in which the number of films usually varies, when taking a FMX in the anterior region and you are using the bisecting technique which size of film would you use and how many would you take, when taking a FMX in the anterior region and you are using the paralleling technique which size of film would you use and how many would you take, what are the two basic techniques for obtaining periapical x-rays, Why is the paralleling technique recommended over the bisecting technique, becuuse it provides the most accurate image with the least amount of radiation exposure to the patient, in which situations would the operator need to use the bisecting technique over the paralleling technique, if the pt has a small mouth, shallow palate, tori, the paralleling technique is also known as what, extension cone paralleling ( XCP) right angle or long cone technique, what are the 5 basic rules to following when using the paralleling technique, film placement, film position, vertical angulation,horizontal angulation and central ray, when using the paralleling technique how must the film be positioned, when using the paralleling technique how must the film holder be placed, away from the teeth and toward the middle of the mouth, when using the paralleling technique what does it mean when we are talking about vertical angulation, the central ray of teh x-ray beam must be directed perpendicular ( right angles ) to the film and the long axis of the tooth, what does it mean when we are talking about horizontal angulation when using the paralleling technique, the central ray of the x-ray beam must be directed through the contact areas between the teeth, failure to center the central ray on the film will result in what, when exposing periapical films with teh paralleling technique where does the book say you should always start, why does the book say you should start with anterior teeth, the film size # 1 is small and is easier for patients to tolerate,patients adapt more easily to the anterior film holder,less likely to gag, what color is the anterior XCP ring/rod system, what color is the posterior XCP ring/rod system, what color is the bitewing XCP rint/rod system, the bisecting technique is based on what principle, the geometric principle of equally dividing a triangle, where should you uplace the film when using the bisecting technique, directly against the teeth to be radiographed, whith the bisecting technique the angle formed by the ____ and the __________ is bisected into two equal parts, when bisecting where is the xrya beam directed, what is the major disadvantage of the bisecting technique, images on the film are dimensionally distored, when using the bisecting technique what should you never do, have the patient hold the film in their mouth with their finger, what types of film holders can you use for bisecting, the BAI, the Stabe bite block, the EeZee grip formerly known as the snap a ray, in the bisecting technique what is critical, by moving the PID in a horizontal or vertical direction, what does incorrect horizontal angulation result in, incorrect vertical angulation results in what, image that is not the same length as the tooth that is being xrayed. To correct an elongated image on an x-ray view, the vertical angulation needs to be. plane of occlusion parallel with the edge of the film, 7. projections-. No as scratched, fingerprints, chemical staining and/or artifacts that Although it may feel like you're playing a game, your brain is still making more connections with the information to help you out. central and lateral incisor should be included in good detail, 2. This angulation allows the x-ray beam to pass through the contacts of the teeth, allowing a clear unobstructed (open, without overlap) view of the interproximal surfaces of the teeth. Make sure to remember your password. film must be positioned parallel to the long axis of the tooth, If the patient is in a wheelchair, does not have the use of his or her upper limbs, and a film sensor holder cannot be used to stabilize the film sensor, you should. You will be redirected once the validation is complete. Yellow-brown stains can be caused by all of the following, except __________. www.rdhmag.com is using a security service for protection against online attacks. Then tap the card to flip it. damage occurs in cells that are most sensitive to radiation, such as rapidly Not positioning the film posteriorly enough in the arch, so that the BW doesnt provide an adequate view of the distal aspect of the last molar. crowns exist, Anterior the film sensor must be placed directly against the teeth being exposed. What does a vertical bitewing X-ray show? Bitewing, Anterior In the average adult, a full-mouth series consists of 18 to 20 films. The Guidelines for Prescribing Dental Radiographs issued by the American Dental Association and the FDA state that radiographic imaging procedures do not need to be altered because of pregnancy. interproximal caries. A filter made of __________ removes long wavelengths from the x-ray beam. Your email address is only used to allow you to reset your password. label the mount with the patient's name and date before mounting the films. chart and be of diagnostic quality. What is the term for the range of shades of gray between black and white on an image? We cant tell if theres a threshold effect at very low doses so we overlapping of intercrestal bone with 1-2 mm crestal bone visible, 3. Must be used on all patients for all exposures. and distinct images of the teeth and other structures with no processing advantages (over Periapical images) i. receptor can be positioned almost parallel to teeth of both arches ii. Use these flashcards to help memorize information. If a film passes through the fixer solution before the developing solution, the film will appear __________. are adults. When a size #2 film sensor is used, the anterior films are in the __________ position, and the posterior films/sensors are in the __________ position. amount of radiation energy absorbed. necessary if distal of canine is not visible; excessive horizontal If developer splashes on and contacts a film before processing, the spots will appear __________. and/or 1st premolar open contacts, Retake Specific Milliamperage controls the degree of blackness, or __________ on an image. General Considerations; Each Bitewing should have: 1. The penetrating power of the x-ray beam is controlled by the settings on the __________. This angulation will generally aim the beam perpendicular to the plane of the film. Use a control volume, with outer surface located at position xxx, to show that the uniform velocity in the xxx direction is u=v0x/hu=v_0 x / hu=v0x/h. The term image receptor refers to __________. The principles and technique are the same except for preparing the sensor. bone loss associated with periodontal disease. A periapical view shows the tooth from the occlusal surface or incisal edge to about _____ mm beyond the apex to show the periapical bone. Premolar Bitewing Image Using BW Tabs Film: Center horizontally Front edge includes the distal of the canine Place front edge of the film across to the opposite arch anteriors Positioning Indicator Device (PID): The middle of PID is placed at the occlusal surface Central ray directed between first and second premolars . arch is not visible; distorted crowns exist. Correct centering of position indicating When taking a premolar bitewing image, the anterior edge of the film sensor should be placed. Incorrect horizontal angulation of the PID results in, A radiographic mount should always be labeled with the. CCNA 1 v7.0 Final Exam Answers Full - Introduction to Networks, CH 02 HW - Chapter 2 physics homework for Mastering, 1-2 Short Answer Cultural Objects and Their Culture, Shadow Health Tine Jones Health History Subjective Data, Philippine Politics and Governance W1 _ Grade 11/12 Modules SY. What are the pros and cons of vertical bitewings? Ask the patient's caregiver to assist in holding the image sensor . Each bitewing shows a tooth from its crown (the exposed surface) to the level of the supporting bone. 2003-2023 Chegg Inc. All rights reserved. Bitewing X-rays detect decay between teeth and changes in the thickness of bone caused by gum disease. The premolar image should display the distal surfaces of the maxillary and mandibular canines. Bitewing radiography is a commonly used intraoral imaging technique in oral and maxillofacial radiology. To minimize the potential for patient gagging, begin by taking the most anterior image. 8.1).Modern film holders, as shown later, have eliminated the need for the wing (now termed a tab), and digital image receptors (solid-state or phosphor plate) can be used instead of film, but the terminology . All of the following structures will appear radiopaque on dental x-ray film, except __________. The usual protocol is to take three bitewings on each side and then one for the anterior. A developmental disability is an impairment of mental or physical functioning that occurs before adulthood and lasts forever. Considerations; Criteria for each placement: 1. Considerations; Each PA Bitewing radiographs take their name from the original technique which required the patient to bite on a small wing attached to an intraoral film packet (see Fig. Placing the bite tab on the incorrect side of the film places it into the mouth backwards, producing an image that is reversed. Ensure that the patients head is stabilized against the headrest and that their occlusal plane is parallel to the floor, in the closed position. such cases, a retake of the molar area is not necessary, but a special entire 2nd and 3rd molars (if present) with Please enable JavaScript on your browser and try again. What size of dental film is used for imaging the anterior region of the mouth with the paralleling technique? special cases of horizontal impactions or unusually high unerupted where the molar bitewing should be centered over what is second molar 200 result of incorrect horizontal angulation of the PID what is overlap/contact areas 300 owned by the dentist what is x rays 300 the right way to check for film freshness what is processing one film from each box with fresh chemicals 300 General RADIOGRAPH PLACEMENT & CRITERIA FOR EACH FILM. In the premolar image, there should be no overlap of the distal surface of the first premolars with the mesial surfaces of the second premolars. Specific How will a film that has not been exposed to radiation appear if processed? Air flows into the narrow gap, of height hhh, between closely spaced parallel plates through a porous surface as shown. A. Correct Which bone marrow site should be considered in dental imaging? Evaluate the acceleration of a fluid particle in the gap. Place the lead apron and thyroid collar on appropriately. Positioning the central ray off-center produces a film with a partial image. foundations of radiography, radiographic equipment and safety, Clinical Oral Structures, Dental Anatomy and Root Morphology, Alignment of central ray of x-ray beam in horizontal and vertical planes, intraoral technique of exposing periapical films, type of radiograph used in the interprosimal examination, area of the mesial or distal surfaces of a tooth that touches adjacent tooth in the same arch, coronal portion of alveolar bone found between the teeth, impairment of mental or physical functioning that usually occurs before adulthood and lasts indefinitely, referring to radiographs with the proper images and necessary density,contrast, definition,and detail for diagnostic purposes, imaginary line dividing the tooth longitudinally(vertically) into two equal halves, used to examine large areas of teh upper or lower jaw, moving or lying in the same plane, always separated by the same distance, intraoral technique of exposing periapical and bitewing radiographs, impairment in certain functions(s) of the body, such as vision, hearing or mobility, angle of 90 degrees formed by two lines perpendicular to each other, even the most skilled operators can do what, the ability to recognize errors and to know the steps to take to prevent their recurrence is what, what is the abreviation for an intraoral full mouth survey, a full mouth survey contains which type of radiographs. distribution of both maxillary and mandibular teeth on the film, Occlusal mount the films in the order of the teeth. embossed dot next to the occlusal/incisal edge (helps with mounting), Correct centering of position indicating The correct starting point for . If a patient is unable to stabilize the film sensor in their own mouth, the __________ should hold it for them during x-ray exposure while also wearing a lead apron with a thyroid collar. What is the name of the large, rounded, radiopaque area of bone that is found behind the posterior maxillary teeth? The molar bitewing image should be centered over the __________. Why the ALARA concept?? A radiographic mount should always be labeled with the __________. film sensor is placed parallel to the crowns of the teeth. All cells except the reproductive cells (muscles. The bitewing radiograph (BW) is an image that depicts the maxillary and mandibular crowns of the teeth, providing a clear image of the interproximal surfaces of the teeth and allowing for detection of interproximal caries. Maxillary Occlusal plane (Curve of Spee) straight across the horizontal midline of the film or slightly curved upward in the distal. What is a potential disease that can result from high doses of radiation to the bone marrow? Chronic radiation exposure occurs when __________ doses of radiation are received over a _________ time period. What do dental personnel wear to monitor radiation exposure? d. milk, nuts, and legumes, During an earthquake, a horizontal floor oscillates horizontally in approximately simple harmonic motion. What is common effect of high doses of radiation on the skin? reveals interproximal caries at early stages iii. the technique recommended by the American academy of oral and maxillofacial radiology and the American dental association of dental schools because it provides the most accurate image with the least amount of radiation exposure to the patient is the ___________ technique, which technique can be used in situations such as a small mouth, shallow palate, or the presence of tori, when using a #2 film sensor for anterior views using the paralleling technique, there are ___ anterior images, incorrect horizontal angulation of the PID results in, the molar bitewing image should be centered over the, for the patient with a hypersensitive gag reflux, the teeth that should be exposed last are, the number of x-ray views that makes a patient's full-mouth series depends on, if the central ray of the x-ray beam is not centered on the film sensor, a partial image will result on the film sensor, which is called a, the alignment of the x-ray beam in the horizontal and vertical planes formed by the long axis of the teeth and the film sensor placement is referred to as, when taking periapical x-rays, the patient's head is ______ for maxillary films and _______ for the mandibular arch. Disadvantages i. doesn't show apical conditions 2. density and contrast between black and white shadows in each film to or, No Which setting on the x-ray unit controls the penetrability or penetrating power of the x-rays that are produced? The device that intensifies, or increases, the effect of the radiation and decreases the amount of exposure time needed when exposing an extraoral radiograph is a(n) __________. necessary if apex of 1, Maxillary In the image appears longer or shorter ( elongated or foreshortened ), which technique is always used for bitewing radiographs, how is the # of bitewing films to take determined, based on the curvature of the arch and the number of teeth present in the posterior areas, which is to be included in the premolar bitewing radiograph, distal half of the crowns of the canines, both premolars and often the first molars on both maxillary and manibular arches, when exposing a molar bitewing radiograph where should the film be centered, the occlusal technique is named this because, the patient bites or cooludes the entire film, when exposing a maxillary occlusal film where does the white side of the film go, when exposing a maxillary occlusal film how is the PID directed, at +65 degrees through the center of the film, when exposing a maxillary occlusal film where is the PID placed in relation to the patients face, between the eyebrows on the bridge of the nose, when exposing a mandibular occlusal film how is the PID directed, at 90 degree angle to the center of the film packet, should be centered about 1 inch below the chin, For paritally edentulous patients, film holding instruments can be used by doing what, placing a cotton roll on the bite block where the crowns of the missing teeth would have been, what size of film is recommended for use in pediatric patients, which film placement is the one most likely to cause the gag reflex, in some extreme cases where the patient has an uncontrollable gag reflex what can you do to obtain radiographs, use extraoral radiographs such as a panoramic or lateral jaw films, processed radiographs must be arranged in what order, what information must always be on the film mounts, patients name, date of exposure, dentists name and address ( if room ), which two methods can be used when mounting radiographs, labial mounting method and mounting with the raised dots facing down, in the labial methond the films are placed in the mount with the raised dots facing which way.

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