celebrities with burning mouth syndrome

"It's common in postmenopausal women, and affects up to 7 percent of the general population," said study co-author Dr. Maria Nagel, a neurovirologist and professor at the University of Colorado School of Medicine in Aurora. Background Burning mouth syndrome (BMS) is an idiopathic condition characterized by a continuous burning sensation of the mucosa of the mouth, typically involving the tongue, with or without. She also had a history of breast cancer. Burning mouth syndrome, also known as glossodynia, refers to pain or a hot, burning sensation in the mouth or oral cavity. Mary, another burning mouth success story Mary is a 58-year-old retired speech pathologist referred to me by her dentist who had seen my Burning Mouth presentation a few months prior at the American Dental Association annual conference. "The local factors include burning sensation due to allergy, dentures, reaction to a particular dental filling, teeth grinding, clenching, tongue thrusting, bacterial infection, and dry mouth,". Because stress depletes important nutrients, I started her on the strong antioxidant alpha-lipoic acid. Unfortunately, her marriage could not be saved, and divorce proceedings took place. Eventually, I will stop having these periods of remission. The condition becomes relentless. A healthy 65-year-old woman developed a relentless burning feeling in her mouth that stumped doctors and dentists for months before its strange cause was found, according to a recent report of. Controlled trials previously have shown orally ingested clonazepam to be effective in patients with burning mouth syndrome. After three weeks on low dose Naltrexone, her pain decreased further to 5/10 and some days down to 2/10. Totally agree with all you said. Following the bone graft, Polly started having what she described as weird sensations. The most pressing problem, however, was Burning Mouth Syndrome. Personality and mood changes (especially anxiety and depression) have been consistently demonstrated in patients with burning mouth syndrome and have been used to suggest that the disorder is a psychogenic problem.11 However, psychologic dysfunction is common in patients with chronic pain and may be the result of the pain rather than its cause. For example, oral infections and allergies to medications, foods, or dental products can be resolved with appropriate treatments such as antibiotics or adjustments in diet and/or medications.1. 2023 Sklar Center for Restorative Medicine. Medications that lower the amount of saliva in your mouth (dry mouth) carry . Medications that block nerve pain. Tooth decay. The results of the blood tests showed that Jill was definitely beginning menopause. All Rights Reserved. Perplexing and painful, burning mouth syndrome (BMS) is a complex pain disorder causing a burning or scalding sensation in the mouth. You can also try these self-care tips to help ease the pain of burning mouth syndrome: Talk with your dentist and doctor about other possible steps you can take to minimize the problems associated with burning mouth syndrome. Eventually, this will pass and the combo will taste normal again. Still, I fill the antifungal he prescribes, and take it. There are days when the pain is really bad or things taste especially weird or bad, and I just want to cry from the frustration. Salads were difficult to eat. Before you leave, check out the Todays RDH self-study CE courses. It stimulates the sprouting of new nerve fibers. trazodone [Desyrel].29. The pain had decreased from a 10/10 to 7/10. Difficult economy and loneliness forces some retirees to move in with family. I just choose to believe that in these magical moments, even, International Association for Suicide Prevention. Moderate to severe burning in the mouth is the main symptom of BMS and can persist for months or years. 2. Tests may include: Treatment should be tailored to your individual needs. Take the time to explain what you know about Burning Mouth Syndrome to your friends, your family, your Facebook, Instagram, or other social media circles, and raise awareness. Although candidiasis can cause burning pain, its prevalence has not been found to be increased in patients with the disorder compared with control populations.5,8. Topical clonazepam is administered as a dissolvable lozenge, and taken three times daily for two weeks. The burning may progressively increase throughout the day, reaching its greatest intensity by late afternoon and into early evening.8 Patients often report that the pain interferes with their ability to fall asleep. When I first met with her, she was 52 and her boys were seven years old. Keeping this in consideration, what can cause burning mouth syndrome? I begin to dread returning to the dentist after Im fully vaccinated against COVID-19 because I know that things in my mouth will not be good. Olanzapine (2.5 mg/day) brought about dramatic improvement in the patient's symptoms, and thereafter . "If she'd had cold sores, it would have been obvious," Nagel told Live Science. The cause of burning mouth may not be known. Mary is a 58-year-old retired speech pathologist referred to me by her dentist who had seen my Burning Mouth presentation a few months prior at the American Dental Association annual conference. Kali. For many people, the burning sensation begins in late morning, builds to a peak by evening, and often subsides at night. I will become utterly exhausted and frustrated by this, and food will feel like too much damn work. In this five-part video series on Sjgrens syndrome, Dr. Alan Baer validates those who suffer from this disease, and informs those who dont, about the common misconceptions and challenges that Sjgrens syndrome patients face every day. Other investigations have found that the ability to detect bitter taste decreases at the time of menopause.21 This reduction in bitter taste at the chorda tympani branch of the facial nerve (cranial nerve VII) results in intensification of taste sensations from the area innervated by the glossopharyngeal nerve (cranial nerve IX) and the production of taste phantoms.22 It has been suggested that damage to taste might also be associated with loss of central inhibition of trigeminal-nerve afferent pain fibers, which can lead to oral burning symptoms.19, Case reports have linked burning mouth symptoms to the use of angiotensin-converting enzyme (ACE) inhibitors.2325 Once these medications were reduced or discontinued, oral burning was found to remit within several weeks. I have found that BMS Support lessens symptoms in about 25-30% of burning mouth sufferers. Take acetaminophen or ibuprofen for pain and inflammation. Estimates vary, but up to 70 percent of people worldwide may be infected with HSV-1, Nagel said. After an initial consultation, Polly was not ready to sign up for a program. You will feel uncomfortable and it can affect your tongue, gums, lips, inside of. Lamey and Lewis categorized burning mouth syndrome into three categories based on fluctuations in pain severity over a 24 hour period. A cemetery posted a personal ad for a goose whose mate died. It is usually seen in females, typically in the peri-menopausal and . Primary burning mouth syndrome Saliva replacement products. She had severe burning of the tongue and roof of the mouth along with taste alterations. Thousands of new, high-quality pictures added every day. Burning mouth . This situation not only adds to the health care burden of these complaints but also has a significant emotional impact on patients, who are sometimes suspected of imagining or exaggerating their symptoms. Depending on the cause of your BMS symptoms, possible treatments may include: When no underlying cause can be found, treatment is aimed at the symptoms to try to reduce the pain associated with burning mouth syndrome. Her dentist told her that a nerve might have been disturbed during the procedure. Maybe, I dare to hope, if that happens the BMS will just go away as quickly as it came on. There is still nothing obviously wrong with my tongue, but the pain gets so intense that I sometimes find it hard to sleep at night. When your brain . Lyme Disease News A month passes, and Im still miserable but Im also armed with a theory, so I return to my doctor. The medication isnt helping. When I first met Jill, she was a 51-year-old fitness professional with menopausal symptoms of hot flashes, mood swings, and loss of muscle tone. This patient explains that she has recently felt out of sorts and suspects she is nearing menopause. Although the underlying cause for burning mouth syndrome varies from person to person, the presentation typically involves many of the same neurological functions, which mimic hypertrophy of nerve pathways, resulting in tingling sensations and feelings of xerostomia, despite normal salivary function. She was able to eat a balsamic vinaigrette dressing on her salad for the first time in a year and half. If the cause of the burning symptoms can be justified by any local or systemic conditions, burning mouth syndromecannotbe diagnosed.3 Further, to diagnose burning mouth syndrome, the oral mucosa needs to be free of lesions or anomalies.3, Primary origin (meaning no original cause found, idiopathic): If no conclusion could be formed about the origin of burning mouth symptoms, the best course of treatment is determined on a case-by-case basis, with the primary goal being pain management which ranges from pain-relieving medications to salivary substitutes, pain relief oral rinses, or cognitive behavioral therapy.1, Secondary origin (caused by environmental, lifestyle, or internal factors): Treatment is much more specific when the secondary cause(s) is known. Do you have a compelling personal story youd like to see published on HuffPost? Tooth decay can happen when your teeth are exposed to acidic or dry conditions over a long period of time. Find Burning Mouth Syndrome stock images in HD and millions of other royalty-free stock photos, illustrations and vectors in the Shutterstock collection. Her pain was moderate and did not interfere with sleep, but prevented her from eating a variety of fruits, vegetables, and spices that she had previously enjoyed. celebrities with burning mouth syndrome. More women than men are affected by the condition. Emphasizing compliance with treatment recommendations, though, will provide the patient with greater confidence and control in maintaining a greater quality of life. Sometimes she even felt suicidal. Over the next few months her pain spread to mouth, tongue, and the right side of her jaw. BMS occurs most commonly after the age of 60 and women are five times more apt to suffer from it than men. The dental hygienists role is often only associated with cleaning teeth and discussing home care habits. Copyright 2023 CBS Interactive Inc. All rights reserved. Because doctors dont know what to do for them. I will look online for support, but even sites like. I tell him that I think it's burning mouth syndrome, or BMS, sometimes referred to as glossodynia. The tests showed that the woman's saliva was swarming with the infectious particles. It did not respond well to the gastric sleeve surgery I had in March 2018, and my thyroid levels have been fucked ever since. She had seen a dentist and ENT specialist without relief. Some of the triggers can be managed to achieve a complete resolution of symptoms. This consisted of estriol and testosterone creams, oral progesterone, DHEA, pregnenolone, bioidentical triiodothyronine, the active thyroid hormone (T3). I really like to talk). I dont mean to lower your spirits or hope. A few weeks later, though, I wake up to discover it is back with a vengeance. B vitamins are very important in the healthy function of nerves. "Burning mouth syndrome due to herpes simplex virus type 1." BMJ Case Rep. 2015 Apr 1;2015. Current treatment options are discussed, although data on the effectiveness of these treatments remain limited. Kampo medicine is a traditional Japanese medical system that has its roots partly in ancient Chinese medicine. This herpes simplex virus is spread through kissing, intimate contact, or sharing objects such as toothbrushes or towels, according to the Centers for Disease Control and Prevention. All information contained within the Johns Hopkins Jerome L. Green Sjogrens Center website is intended for educational purposes only. This was another Burning Mouth Syndrome success story. Ive seen a lot of thrush, having worked with infants for years. In burning mouth syndrome, a burning pain occurs in your tongue, lips, gums, palate or throat. The rheumatologist would say if the pain in my mouth is anything to do with fibro as he isn't a dentist! Role of Homocysteine in the Development of Cardiovascular Disease. Nagel and her colleagues still don't know why the herpes virus reactivated in the woman, but they speculated that it might have been due to hormonal fluctuations, because she was postmenopausal. Subscribe to Must Reads. Primary burning mouth syndrome, also referred to as idiopathic BMS (iBMS), is an idiopathic painful condition defined as "an intraoral burning sensation for which no medical or dental cause can be found." Its prevalence in the general population is relatively low (<1%) but increases with age, associated with a strong gender correlation, the . Here, see what you think. Sunday, 13 November 2022 / Published in levenshtein distance normalized. Vasculitis Center News Burning mouth syndrome is a very complex condition where a burning pain occurs on the tongue or lips, or over widespread areas involving the whole mouth without any obvious reason.The symptoms has for a long time been linked with a variety of other conditions, such as menopause, psychological problems, nutritional deficiencies, and disorders of the mouth like oral thrush or dry mouth. She started alow dose bioidentical estrogen cream, as well as bio-identical progesterone and testosterone. In fact, until about 15 years ago, I had never heard of the disease. Jon Feliciano Age: How Old Is Jon Feliciano? Affected patients often present with multiple oral complaints, including burning, dryness and taste alterations. Remarkably, for the first time in a year and a half, Mary was able to eat out in restaurants on a regular basis. Scleroderma Center News. How Dental Hygienists Can Help Patients with High Blood Pressure, Pediatric Care: How Breastfeeding Affects an Infants Oral Health, Reviewing the Relationship of Mental Health with Dental Hygiene Care, Caviar Tongue: Are Dental Hygiene Patients Displaying Signs of Aging?, Barodontalgia: How Pressure Changes can Cause Tooth Squeeze Pain, Childrens Oral Health: Strategies to Help Prevent Early Childhood Caries, Study: Periodontal Disease Increases Risk Esophageal and Gastric Cancer by 43%-52%, Research Looks at Work-related Musculoskeletal Disorders in Dental Professionals, VIDCAST: How Heartland Dental Helps Maximize Potential, QUIZ: Test Your Historical Women in Dentistry Knowledge, A Letter to Dental Hygienists from Your Temp Hygienist, The Possible Connection Between Bipolar Disorder and Periodontitis, 9 Simple Temping Tips for Dental Hygienists, The RDH Detective: Discovering Sleep Disordered Breathing in Adults, Newborns: How Hygienists Plant the Seeds of Oral Care before Birth, Deep and bilateral burning on a daily basis, Burning pain that lasts at least four to six months, Severity remains constant or increases throughout the day, Sensory changes in the mouth, such as changes in taste or tingling. Celebrities Buzz July 7, 2022 2 Min Read In burning mouth syndrome, a burning pain occurs in your tongue, lips, gums, palate or throat. celebrities with burning mouth syndrome. Mouth pain: This may constantly feel like a burning, tingling pain of the roof of the mouth (palate), gums, inside of the cheeks, and lips. Worry the tea and then use the excerpts. But it's easily treatable with antiviral medication," she said. The program consists of thyroid medication, estrogen and testosterone creams, DHEA, pregnenolone, Vitamin D with Vitamin K 2, progesterone and melatonin. In addition, she also was able to eat fresh pineapple and pepper which she had not been able to do previously. The hormonal changes around the menopause can be related to burning mouth syndrome. Most people don't even know they have this. Burning Mouth Syndrome. Unfortunately, the reality is that BMS is an entirely different experience. All rights reserved. Dry mouth (caused by such conditions as Sjogrens syndrome, certain medications, or radiation therapy) Lack of iron, vitamin B12, or folic acid. With the recently increased understanding of the role that taste damage plays in the pathogenesis of burning mouth syndrome, many of these etiologies can now be viewed as part of a larger model of disease. Taste and olfactory disorders in . Burning mouth syndrome is a health problem that causes discomfort and pain in the mouth. The scientificjournals say that most clinicians dread seeing patients with pain in their mouths. Recent studies have pointed to dysfunction of several cranial nerves associated with taste sensation as a possible cause of burning mouth syndrome. , or BMS, sometimes referred to as glossodynia. Burning mouth syndrome is a name given to discomfort or pain in the mouth. Two case reports of patients suffering from burning mouth syndrome (BMS), a type of somatoform disorder, who were treated with olanzapine are discussed. 2007;7 (7). This time I noticed some very tiny bumps or papules on the sides of her tongue which I thought might be herpes type 1. Burning mouth syndrome symptoms Main symptoms. Response to Treatment with Melatonin and Clonazepam versus Placebo in Patients with Burning Mouth Syndrome. After 18 months of misery, my dentist will formally diagnose the condition. I am sorry you are dealing with TNS, but I have been told by several neurologists that it is unlikely that it is the cause of your BMS symptoms. According to the Genetic and Rare Disease Information Center (GARD), solutions to ease burning tongue symptoms may include: Avoid irritants for two weeks to see if there is any improvement, including mouthwash with alcohol, chewing gum, smoking and tobacco, acidic liquids, spicy foods, soft drinks, and coffee. These include thrush infections and blood or vitamin deficiencies. Wet a clean cloth with clean water and hold it on top of the burn. You may have oral allergies to different foods than I, but the rinse should help a great deal once you identify the offending foods. Treating burning mouth syndrome, which may require medication or behavioral treatments, should be done under the care of your healthcare provider. I began with a detailed history and physical exam. The pain is endless. I will find myself explaining it to them, hoping they can understand given how ridiculous it all sounds, even to me the one living with it. Some women have an innately greater chance of suffering from burning mouth syndrome because of physical, behavioral, and psychological reasons, such as age, oral habits, and excessive stress.These predisposing factors can affect a woman's hormone levels and increase the chances of her suffering from burning tongue. Burning mouth syndrome (BMS) is a chronic condition characterized by pain in the oral cavity. Typically, patients awaken without pain but note increasing symptoms through the day and into the evening. I feel great.. Burning mouth syndrome can be painful and irritating. Although she focuses her efforts primarily on clinical supervision and part-time You may feel this burning on your tongue, gums, lips, inside of your cheeks, roof of your mouth or large areas of your whole mouth. (LogOut/ We should have both, but unlike other neuropathic pain syndromes that have celebrity spokespeople, foundations, or nonprofits to raise money for research, or even a decent percentage of name recognition in the medical community, Burning Mouth Syndrome has none of these. After 3 weeks of the BMS Advanced Support, Polly felt better, more like herself and able to cope. Burning Mouth Syndrome Clonazepam. Low dose Naltrexone reduces symptoms in many pain conditions. Follow Tanya Lewis on Twitter. The sensation of burning in the mouth can occasionally be the result of medical or dental problems. Anxiety and depression are common in people withBMS and may result from their chronic pain. In more than one half of patients with burning mouth syndrome, the onset of pain is spontaneous, with no identifiable precipitating factor. She saw a neurologist who recommended gabapentin again. Many patients are seen on a rotational basis, and a dental hygienist can easily fall into the habit of running through the same routine, patient after patient. This dental device was sold to fix patients' jaws. Its aetiopathogenesis remains unclear and is probably of multifactorial origin, with increasing evidence that BMS may be a neuropathic disorder. You can also text HOME to 741-741 for free, 24-hour support from the Crisis Text Line. Look under the hood, and take a behind the scenes look at how longform journalism is made. celebrities with burning mouth syndrome . Her symptoms consisted of her tongue, palate, and throat feeling as if they were constantly on fire. When her burning mouth pain was under control, her anxiety was manageable. I tell him that I think its. However, these conditions have not been consistently linked with the syndrome, and their treatment has had little impact on burning mouth symptoms. But their connection is unclear, and the exact cause of BMS cannot always be identified with certainty. The first time this happens after the start of the pandemic, Im just grateful to have experienced it before, since loss of taste is a COVID-19 symptom. Awful sensation! In June 2020, she had some decrease in her pain. This condition is characterized by a burning pain or hot sensation which can be localized to the lips or tongue or more widespread in the mouth. If burning persists after management of systemic or local oral conditions, a diagnosis of burning mouth syndrome can be considered, and empiric treatment for sensory neuropathy may be offered. Water tastes like soap. When I started feeling better in general a couple months later, the sensation was gone. [16 Oddest Medical Case Reports]. Not to mention, of course, there just arent that many of them. The condition, called burning mouth syndrome, affects nearly 5 percent of people in the United States and a new, small study shows that it could be partly linked with menopause. I begin to feel incredibly isolated and alone in dealing with it. After her evaluation and testing I started her on a hormone restoration and balancing program. When she is awake, she feels a tingling and burning sensation in her mouth, but she cant recall consuming anything hot let alone anything that would cause these symptoms to last this long. One of the greatest reports for symptom management is shown with the supplementation of vitamins B, C, B12, folic acid, and minerals. In fact, consuming black tea is also additional out of the How to Get Rid of Burning Mouth Syndrome at Home that people who suffer from burning mouth should not look down, but try to make usage for good. Become ambassador and add your answer Celebrities with Burning Mouth Syndrome I know that any food or drink, at any given moment, might taste completely fucked up. Burning Mouth Syndrome (BMS) is a painful, frustrating condition often described as a scalding sensation on the tongue, lips, palate, or throughout the mouth. I know there are beautiful, brilliant, breathtaking days yet to come that I absolutely do not want to miss, and I also know that on those days my ham and cheese sandwich might taste like fish. So why not Burning Mouth Syndrome?. She was referred to a world famous oral-facial specialist. On some days I have to force myself to. But I know that they wont all be that way. Ohio Appointments 216.444.8500 Appointments & Locations Request an Appointment Symptoms and Causes It is a life saver for heroin and oxycontin overdoses. The gabapentin helped but she felt like a zombie while taking it. Rinse mouth with 1 teaspoon of a 1:2 dilution (or higher) of hot pepper and water; increase strength of capsaicin as tolerated to a maximum of 1:1 dilution. The first time I notice this, I think my dishwasher hasnt rinsed the dishes properly. Change). A more unusual but not uncommon symptom of menopause. I have had endometriosis, which caused so much pain that even narcotics couldnt touch it. A year and a half after finishing her treatment, the patient remains pain-free, researchers said. People with burning mouth syndrome may also have a subjective xerostomia (dry mouth sensation where no cause can be found such as reduced salivary flow), paraesthesia (altered sensation such as tingling in the mouth), or an altered sense of taste or smell. It was easier for her to eat raw vegetables and apples. She found the Sklar Center while surfing the world wide web looking for help. Clinical manifestations and diagnosis of oral allergy syndrome (pollen-food allergy syndrome) food becoming lodged in the throat and may mimic PFS and other forms of food allergy. When the virus is activated -- typically due to stress or a suppressed immune system -- it usually causes cold sores that eventually go away on their own. Follow us @livescience, Facebook & Google+. I have lost count of the doctors, specialists, friends, and colleagues I have educated about this chronic pain and I know there will be many more. Burning mouth syndrome (BMS) is mainly found in middle aged or elderly women and is characterized by intense burning or itching sensation of the tongue or other regions of the oral mucosa. I went on a mission. I wanted to find outwhat Burning Mouth Syndrome is. Some days are absolute shit, yes. Thank you for learning how you can become another burning mouth success story. She looked forward to visiting with her grandchildren, gardening, and generally enjoying life. I was in a dark place and now I am on the other side.. It worked. new eczema treatment 2022 australia . The symptoms are often worse in the afternoon and evening, and mild or . HSV-1 may be the culprit for a number of unexplained medical symptoms besides burning mouth syndrome. 20,000 people may have been exposed to measles at Asbury University revival, Infant's death tied to contaminated breast pump, CDC says. Some sensations may be temporarily relieved during eating or drinking. Topical lidocaine is not recommended for symptom relief due to its short-term effectiveness. After two months, her burning symptoms had decreased. They see more BMS patients than most doctors do. It can also be accompanied by other symptoms like dryness, an unpleasant taste, or feelings of numbness. Some water sources taste more metallic than others, but always, in the end, there is at least a faint taste of soap. I try all sorts of mouthwashes, but the most they offer is a numbing effect similar to Orajel, and ironically many of them burn too much to be worth it. In addition, the pain did not improve at all throughout the day. Im hoping my most recent medication adjustment will be the one, and that it will finally stabilize for more than five minutes. (2019, February 14). 1099 or W-2: Which Tax forms Should Temp Dental Hygienists Receive? So I fight through my darkest moments. Burning mouth syndrome is the medical term for ongoing or recurring burning in the mouth without an obvious cause. Nicole Howell, MSHS, BSDH, began her career as a dental assistant in 2003 Try it, and let me know how it goes. Interestingly, loss of taste sensation has also been reported with the use of ACE inhibitors.23, Candidal infections are also purported to cause burning mouth syndrome. Another Burning mouth success story is Anne. Alex Murdaugh sentenced to life in prison for murders of wife and son, Biden had cancerous skin lesion removed last month, doctor says, White supremacist and Holocaust denier Nick Fuentes kicked out of CPAC, Tom Sizemore, actor known for "Saving Private Ryan" and "Heat," dies at 61, Biden team readies new advisory panel ahead of expected reelection bid, At least 10 dead after winter storm slams South, Midwest, House Democrats unhappy with White House handling of D.C.'s new criminal code. I hope you are finding coping strategies to help you and thanks for the support! Matt Phelps YouTuber & Founder of STEEL help@steeljawlinegum.com P.S is a strong, chiseled jawline essential for being a famously attractive celebrity? 10 Celebrities with W eak Jawlines Part of HuffPost Personal. Burning mouth syndrome1 is described as a "burning, scalding, or tingling feeling in the mouth that may occur every day for months or longer.". Kathy, Like so many burning mouth patients, she had seen a dentist, oral surgeon, and allergy specialist, all without help. It is found more in women during or after menopause. patient care, her true calling lies with public outreach, teaching, and motivating It is miserable I agree. I will find myself explaining it to them, hoping they can understand given how ridiculous it all sounds, even to me the one living with it. I never know what something will taste like from day to day. I will look online for support, but even sites like The Mighty dont have resources or communities of fellow sufferers. After discussing with the dentist, you both concluded that the patient could suffer from burning mouth syndrome. Burning mouth syndrome (BMS) is characterized by burning pain in a normal-appearing oral mucosa lasting at least four to six months. ACE inhibitors and angiotensin receptor blockers are perhaps the most commonly noted in case reports. My burning tongue is not nearly as bad. By entering your email and clicking Sign Up, you're agreeing to let us send you customized marketing messages about us and our advertising partners. MIRIAM GRUSHKA, M.SC., D.D.S., PH.D., JOEL B. EPSTEIN, D.M.D., M.S.D., AND MEIR GORSKY, D.M.D.

Mekanism Induction Matrix, Dr Harrison Lee Ffs Before And After, Articles C