To get the best care, experts recommend speaking up. Here are tips for what to ask and how to evaluate the treatments you are offered.Think about the last time you went to a dentist: Did you walk out feeling like your questions were answered, or did you wonder whether your provider was being straight with you?Dental visits can be daunting — and not just because of the whirring drills. Dentists may seem to speak another language entirely, and everything they suggest can feel important. You must have a sealant painted on your tooth or risk bacteria creating holes in it. You must get an extraction because an oral infection has spread and is causing pain.To get the best results and a more positive experience, experts recommend speaking up. Here are tips for what to ask and how to evaluate the treatments you are offered at the dentist.Get a good look at the problems yourself.The first step to effectively advocating for yourself is understanding what your problems are. Ask your dentist to show you exactly where the pockets of your gums are getting deeper and letting bacteria accumulate, or which fillings are getting worn down by night grinding.“You don’t have to get technical about it,” said Ellie Phillips, a preventive dentist based in Austin. “But I would recommend noting if it’s something affecting your front teeth or the back of your mouth. Is it on the outside, which is the cheek side, or is it on the tongue side?”Visual aids like X-rays or images from an intraoral camera — or even just looking in a mirror — can also help demystify what’s going on in your mouth.Don’t feel pressured to agree to anything — even cleanings.Your dentist should be able to explain why particular problem areas need specific treatments, said Alyson Leffel, director of patient advocacy and social work at the NYU College of Dentistry. And it’s perfectly reasonable to ask them for time to research and reflect on your options.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Esto es lo que hay que saber para sortear el fin de la época de fiestas. Los expertos recomiendan vacunarse.Ahora que la temporada de fiestas llega a su fin y los casos de covid empiezan a aumentar, una variante llamada JN.1 se ha convertido en la más común del virus en todo Estados Unidos.Ya para mediados de diciembre, la JN.1, que surgió de la variante BA.2.86 y se detectó por primera vez en Estados Unidos en septiembre, representaba el 44 por ciento de los casos de COVID-19 a nivel nacional, lo cual fue un aumento comparado con el 7 por ciento de finales de noviembre, según los datos de los Centros para el Control y la Prevención de Enfermedades (CDC, por su sigla en inglés).En cierta medida, este salto era de esperarse. “Las variantes tardan en propagarse”, comentó William Schaffner, especialista en enfermedades infecciosas en el Centro Médico de la Universidad Vanderbilt. “Luego, se aceleran, se propagan con rapidez y, justo cuando están en eso, después de varios meses, aparece una nueva variante”.Según un informe de los CDC publicado el 22 de diciembre, el impulso de la variante JN.1 este mes da a entender que quizá esta se contagia con más facilidad o es más hábil para evadir nuestros sistemas inmunitarios que otras variantes en circulación. La agencia declaró que la COVID-19 sigue siendo “una amenaza grave para la salud pública”, sobre todo para quienes siempre han corrido mayor riesgo de enfermarse a un nivel grave, como los adultos mayores, los bebés, las personas con sistemas inmunitarios debilitados o padecimientos de salud crónicos, así como las embarazadas.Hasta donde saben los expertos, la JN.1 no parece causar enfermedad grave en la mayoría de las personas, aunque hasta un caso leve puede hacerte sentir “bastante mal durante tres o cuatro días”, señaló Schaffner. Los síntomas de una infección por JN.1 son similares a los que causaban las variantes anteriores de covid, pues incluyen tos, fiebre, dolor de cuerpo y fatiga.Para protegerte contra la infección y enfermedad grave, los expertos siguen recomendando el uso de mascarillas, mejorar la ventilación en interiores siempre que sea posible, quedarse en casa si se está enfermo y pomerse la vacuna más reciente contra la covid.Las investigaciones preliminares muestran que las vacunas actualizadas contra la COVID-19 lanzadas en septiembre producen anticuerpos efectivos contra la JN.1, que tiene una relación, aunque lejana, con la variante XBB.1.5, para la cual fueron diseñadas las vacunas. La gente tal vez no acumule tantos anticuerpos contra la JN.1 como para la XBB.1.5, pero, de todos modos, los niveles deberían reducir el riesgo.“Entre quienes se contagiaron o se pusieron una dosis de refuerzo recientemente, la protección cruzada contra la JN.1 debería ser bastante decente, según muestran nuestros estudios de laboratorio”, indicó David Ho, virólogo de la Universidad de Columbia que dirigió la investigación sobre la JN.1 y las vacunas contra la covid, la cual se publicó como un artículo en versión preliminar a principios de diciembre. Las pruebas rápidas también siguen siendo una herramienta valiosa, y los CDC afirman que las pruebas que ya están en el mercado funcionan bien para detectar la variante JN.1.Hay indicios de que los casos de COVID-19 van en aumento una vez más. La semana del 10 de diciembre, hubo poco menos de 26.000 hospitalizaciones relacionadas con el coronavirus, un incremento del 10 por ciento de las casi 23.000 de la semana previa. Pero las cifras de hospitalizaciones por covid siguen siendo mucho menores que durante el auge de la primera ola de ómicron en enero de 2022 y, hasta ahora, solo son la mitad de lo que fueron durante el pico de la ‘tripledemia’ del invierno pasado, cuando surgieron casos de COVID-19, influenza y VRS al mismo tiempo.Es demasiado pronto para saber si la JN.1 es responsable del aumento de las hospitalizaciones o si los casos están repuntando en parte debido al aumento de los viajes y las grandes reuniones por Acción de Gracias y las vacaciones de invierno.“Cuando las personas se reúnen en lugares cerrados, celebran fiestas, viajan y cosas por el estilo, en esas circunstancias todos los virus respiratorios, incluida la JN.1, tienen posibilidades de propagarse”, explicó Schaffner. Añadió que, por lo general, la covid también presenta cierta estacionalidad; en los países del hemisferio norte suele producirse una pausa en los casos en otoño, antes de que las infecciones y las hospitalizaciones vuelvan a aumentar en invierno.Según Schaffner, lo más probable es que la JN.1 siga siendo la versión dominante del coronavirus hasta la primavera. Schaffner y otros expertos señalaron que, aunque las vacunas ofrecen protección contra esta y otras variantes, su aceptación sigue siendo baja: solo el 18 por ciento de los adultos han recibido las últimas vacunas. Los expertos señalaron que todo el mundo debería considerar la posibilidad de vacunarse, especialmente los mayores de 65 años, las personas inmunodeprimidas, las que padecen afecciones que las exponen a un mayor riesgo de enfermedad grave o las que viajan para visitar a seres queridos que pueden ser vulnerables.“Vacúnate como regalo de Año Nuevo si aún no lo has hecho”, dijo Schaffner.

Here’s what to know about the coronavirus variant, which was first detected in the United States in September. As the holiday season winds down and Covid-19 cases start to pick up, a variant called JN.1 has now become the most common strain of the virus spreading across the United States.JN.1, which emerged from the variant BA.2.86 and was first detected in the United States in September, accounted for 44 percent of Covid cases nationwide by mid-December, up from about 7 percent in late November, according to data from the Centers for Disease Control and Prevention. To some extent, this jump is to be expected. “Variants take some time to get going,” said Dr. William Schaffner, an infectious disease specialist at Vanderbilt University Medical Center. “Then they speed up, they spread widely, and just when they’re doing that, after several months, a new variant crops up.”JN.1’s momentum this month suggests that it may be more transmissible or better at evading our immune systems than other variants currently circulating, according to a C.D.C. report published Dec. 22. The agency said that Covid remains “a serious public health threat,” especially for those who have always been at high risk of severe disease, such as older adults, infants, people with compromised immune systems or chronic medical conditions and those who are pregnant. As far as experts can tell, JN.1 does not seem to be causing severe illness in most other people, though even a mild case can still make you feel “quite miserable for three or four days,” Dr. Schaffner said. The symptoms of a JN.1 infection are similar to those caused by previous Covid variants, including a cough, fever, body aches and fatigue. To protect yourself against infection and severe disease, experts continue to recommend wearing masks, improving ventilation indoors when possible, staying home when sick and getting the latest Covid vaccine.Preliminary research shows that the updated Covid vaccines released in September produce antibodies effective against JN.1, which is distantly related to the XBB.1.5 variant that the vaccines were designed to target. People may not build up as many antibodies to JN.1 as they would to XBB.1.5, but the levels should still decrease the risk. “For those who were recently infected or boosted, the cross-protection against JN.1 should be decent, based on our laboratory studies,” said Dr. David Ho, a virologist at Columbia University who led the research on JN.1 and Covid vaccines, which was released as a preprint paper in early December. Rapid tests also continue to be a valuable tool, and the C.D.C. has said tests already on the market work well at detecting JN.1. There are signs that Covid cases are once again creeping up. There were just under 26,000 hospitalizations due to Covid the week of Dec. 10, a 10 percent increase from about 23,000 hospitalizations the week prior. But Covid hospitalizations are still far lower than they were during the peak of the first Omicron wave in January 2022, and so far only about half as high as they were during the peak of the tripledemic last winter, when Covid-19, flu and R.S.V. cases all surged at the same time. It is too early to know whether JN.1 is responsible for the rise in hospitalizations or whether cases are picking up partly because of an increase in travel and large get-togethers for Thanksgiving and the winter holidays.“When people are gathered inside close to each other, having parties and traveling and the like, those are the kind of circumstances where all respiratory viruses, including JN.1, have opportunities to spread,” Dr. Schaffner said. Covid generally also has some seasonality, he added; countries in the Northern Hemisphere tend to see a lull in cases in the fall before infections and hospitalizations rise again in the winter. JN.1 will most likely remain the dominant version of the coronavirus through spring, Dr. Schaffner said. He and other experts noted that while vaccines offer protection against it and other variants, uptake remains low, with only 18 percent of adults having received the latest shots. Experts said everyone should consider getting vaccinated, especially those who are over age 65, are immunocompromised, have health conditions that put them at higher risk of severe illness or are traveling to visit loved ones who may be vulnerable.“Give yourself a New Year’s present by getting this vaccine if you haven’t done it yet,” Dr. Schaffner said.

A new study found that more than a third of those who recovered from an infection had symptoms recur days or weeks later.When the antiviral treatment Paxlovid came into wider use for Covid-19 infections earlier this year, doctors who prescribed it and patients who took it noticed that symptoms sometimes flared up again a few days after having gone away. Some people even tested negative before they experienced the rebound. But this puzzling phenomenon can occur whether you take Paxlovid or not, according to a new study.Researchers found that when patients received a placebo instead of treatment, a portion of them still experienced a rebound of their symptoms after they had initially improved.“Symptom return is common,” said Dr. Davey Smith, the chief of infectious diseases and global public health at the University of California, San Diego School of Medicine, who led the study. “It doesn’t mean that things are going south. It’s just the natural way the disease goes.” What is surprising, however, is how many people may experience a rebound, he said.To understand the natural variability in coronavirus symptoms, Dr. Smith and his team tracked 158 clinical trial participants who had tested positive for Covid from August to November 2020. Each person kept a daily diary and marked 13 different Covid symptoms as being absent, mild, moderate or severe. Among the 108 people whose symptoms had improved without antiviral treatment, and had completely disappeared for at least two consecutive days, 48 people (44 percent of those who recovered) noted that symptoms flared up again at various times during four weeks of follow-up.“The good news is that nobody who had their symptoms return needed to go to the hospital or died or even got severe symptoms,” Dr. Smith said. Eighty-five percent of those who had a rebound reported that their symptoms were mild; 15 percent had at least one moderate symptom.Read More on the Coronavirus PandemicWarnings of a ‘Tripledemic’: An expected winter rise in Covid cases appears poised to collide with a resurgent flu season and a third pathogen straining pediatric hospitals in some states.Updated Boosters for Kids: The Food and Drug Administration broadened access to updated Covid booster shots to include children as young as 5.A Decline Among Seniors: Americans over 65 remain the demographic most likely to have received the original series of Covid vaccinations. But fewer are getting booster shots, surveys indicate.Personality Changes: New research suggests that Covid’s disruption of social rituals and rites of passage have made people less extroverted, creative, agreeable and conscientious.The most common complaints during a symptom rebound were coughing, feeling fatigued and having a headache. These were all similar to symptoms people reported at the start of the study, in the active phase of their infection, Dr. Smith said.One of the limitations of the study, however, is that it looked at older strains of coronavirus in people, before vaccines became available. That makes it hard to extrapolate how frequently rebound symptoms may be an issue with the current Omicron strains, especially since most people also have some immune experience with the virus at this point in the pandemic, either because of a past infection or their vaccination. Symptoms can also change with each variant, and their severity can be very subjective, said Dr. Bruce Farber, the chief of public health and epidemiology at Northwell Health in New York. Patients noted rebound symptoms that “were remarkably mild and, quite frankly, fairly unimpressive,” he said.Why do symptoms sometimes make a comeback?The pattern of waxing and waning symptoms occurs in several respiratory diseases, including the common cold, flu and respiratory syncytial virus. “People have never really paid a lot of attention to it in the past, to be honest, as long as the patient is clinically doing better,” Dr. Farber said.Symptoms sometimes disappear and then show up again because of the body’s own immune response to infection, Dr. Farber said. While initial symptoms like a fever, cough or runny nose may be triggered by the virus itself, the body produces its own alarm signals when it senses a foreign invader. These signals come in the form of proteins that help inactivate viral RNA and tell white blood cells where to find more of the pathogen, speeding its removal from the body. At the same time, these reactions create inflammation in the body, which can give you a headache, make you feel exhausted or prolong the duration of a cough.“I call this friendly fire,” Dr. Farber said. “The immune system is very well intentioned and 100 percent needed, but it is clearly overreactive at times, and that often causes problems.”What do you need to know about rebound symptoms from Paxlovid?Concerns about rebound symptoms when taking Paxlovid — and another antiviral drug called molnupiravir — appear to have reduced people’s interest in using treatments for Covid. But the new study shows that you can have a rebound with untreated Covid as well. “I hope this can help people to be less afraid of a potential rebound,” Dr. Smith said.Paxlovid and other drugs can be lifesaving treatments for many patients with Covid, Dr. Smith said. Research has shown that they successfully reduce the risk of hospitalization and death by 88 percent in unvaccinated people. In a fact sheet for doctors prescribing Paxlovid, Pfizer noted that rebounds occurred in some patients receiving the treatment — and at similar rates among people who got a placebo.There may be several potential reasons for a Paxlovid rebound. Some doctors have speculated that in addition to the likelihood of a rebound caused by the body’s own immune system, Paxlovid taken too early may prevent the immune system from adequately preparing to fight off any remaining virus once the drug tapers off. “If you’re young and healthy, and you’ve been vaccinated and boosted, then I don’t push Paxlovid on people, for the most part,” Dr. Farber said.But experts agree that people who are sick and at high risk of developing severe Covid — including adults 65 and older, as well as those of any age with underlying health conditions like heart disease, cancer, diabetes or obesity — should seek treatment.If you do experience a rebound after treatment, there is no evidence that you need to start another course of Paxlovid. Isolate a while longer in case you are contagious to others. And try to manage symptoms with pain and fever-reducing medicines, home remedies and time, Dr. Smith said. “I recommend staying hydrated, watching ‘The Golden Girls’ and eating chicken soup.”