Talk:Toothache/Archive 2

Archive 1

Archive 2

Queries

"The pulp of the tooth can cause pain when it is inflammed (pulpitis), when it is stimulated due to a pathologic process (such as a cracked tooth) and even when healthy (such as dentin hypersensitivity). "

• there are difficulties with this sentence... cracked tooth syndrome may be associated with pulpitis, furthermore there is no definate answer to the question of whether the pulp is inflamed in dentin hypersensitivity. Lesion (talk) 14:59, 27 January 2014 (UTC)

I've asked 2 endodontists this question and both agree it's not inflamed. Checked PoP and (to the best of my recollection) that quote about it being the only situation where a healthy pulp is painful came directly from it (paraphrased). Ian Furst (talk) 16:24, 27 January 2014 (UTC)

Dentin hypersensitivity that most sources were stating the pulp is healthy, but "PoP" stated something like "Others suggest that due to the presence of patent dentinal tubules in areas of hypersensitive dentin, there may be increased irritation to the pulp causing a degree of reversible inflammation."

One textbook I was reading today divided toothache into "dentinal pain" (including caries into dentin, hypersensitivity), "pulpal pain" and "periodontal pain". Artificial because dentin and pulp are one unit. My main concern about this sentence is it is quite broad, and would prefer a source to say something like this for us (He says, adding unsourced content in other places...) Lesion (talk) 18:02, 27 January 2014 (UTC)

Here's the direct quote from the opening paragrahhy (PoP, page 510), "Dentin hypersensitivity represents a special situation in which a significant, usually chronic, pulpal problem arises that does not seem to be associated with irreversible pulpal pathosis in the majority of cases." Agree that "dentin pain" is misleading, I'd avoid it. Re the original sentence, base on what I'm reading, dentin hypersensitivity can be present with or without pulpitis. Ian Furst (talk) 19:31, 27 January 2014 (UTC)

I never realized, above it says irrev pulpitis (I've highlight it now). Here's the rest of the paragraph, "The degree of inflammation in the pulp in cases of dentin hypersensitivity is not well characterized because the condition is usually not severe enough to warrant tooth extraction or endodontic therapy. However, patent dentinal tubules are present in areas of hypersensitivity261 (Fig. 13-10) and may result in increased irritation and localized reversible inflammation of the pulp at the sites involved"

I have removed the cn tag for this because it looks bad. I will be on the look out for a supporting source for this statement in the mean time. Lesion (talk) 20:30, 2 February 2014 (UTC)

"Pulpitis is initially difficult to localize to a specific tooth ... "

• Both reversible and irreversible pulpitis are poorly localized, unless there is combined periodontal involvement. This makes the word "initially" a bit misleading imo. Lesion (talk) 15:08, 27 January 2014 (UTC)

hmmm, tried to make the point that pulpitis does not involve the periodontal ligament but will eventually involve it. Better way to word the idea? It's not really the pulpitis that localizes, it's the involvement of the perio ligament. Ian Furst (talk) 16:24, 27 January 2014 (UTC)

I understood what you meant, but I am wondering if a reader will get this especially when we immediately go on to talk of reversible and irreversible pulpitis...Lesion (talk) 18:02, 27 January 2014 (UTC)

Probably not, not sure what best wording is though. Ian Furst (talk) 19:33, 27 January 2014 (UTC)

• I understand that "periapical periodontitis" and "apical periodontitis" are the same. Suggest we standardize throughout the article, with giving the alternative term in brackets after the first occurrence. My preference would be for apical periodontitis, purely because it is shorter. Thoughts? Lesion (talk) 16:16, 27 January 2014 (UTC)

agree, I think the other article is periapical periodontitis (also periapical abscess while we're at it), we should probably standardize to that? Ian Furst (talk) 16:24, 27 January 2014 (UTC)

I started periapical periodontitis a while back... if apical periodontitis is the more common term agree that page should be moved. Same rationale for periapical abscess agree. For this page, OK apical periodontitis and apical abscess it is. I am happy to update these in the article as I go thru. Lesion (talk) 17:52, 27 January 2014 (UTC)

PoP uses apical periodontitis throughout. Probably best to convert to that. Ian Furst (talk) 19:35, 27 January 2014 (UTC)

• I would like also to give another facet to the reversible/irreversible distinction, which in my mind is less to do with the character of the pain and more to do with whether or not the pulp can return to a state of health... Lesion (talk) 18:02, 27 January 2014 (UTC)

agree, I unintentionally glossed over this distinction. For the layperson I still think the difference in symptoms is important but it should be correlated to outcome for the tooth. I think the connection is made from irrev>>RCT/exo without the histologic state of the pulp. Ian Furst (talk) 19:37, 27 January 2014 (UTC)

• Started a table for the non dental causes section to list all the zebras. Feel free to add any you find. Lesion (talk) 18:02, 27 January 2014 (UTC)

K Ian Furst (talk) 19:38, 27 January 2014 (UTC)

I am now thinking to forgo this table and instead use prose. Lesion (talk) 19:51, 30 January 2014 (UTC)

• The infobox image... not particularly ideal for the lead? Maybe we should put the diagram of the trigeminal nerves instead? Or another... Lesion (talk) 15:19, 30 January 2014 (UTC)

Personally, I love the one that's there just because it screams, "toothache". But I understand that it's a taste (figuratively) thing. Not a fan of the trigemminal nerve, only because I think the infobox image should graphically represent the topic of the article to a layperson (and I don't think that would). Maybe fractured tooth pic or something like that (comes off as too "gory")???? My vote is for what's there but not passionate about it either way. Ian Furst (talk) 16:34, 30 January 2014 (UTC)

OK. Lesion (talk) 19:51, 30 January 2014 (UTC)

• In each of the sections I've reviewed so far (pulpitis, dentin hypersensitivity, cracked tooth syndrome), there is mixed in diagnosis and treatment info. Should we move this content to the diagnosis and treatment sections? or alternatively maybe deal with the diagnosis and treatment of each condition as we go along? Lesion (talk) 20:30, 2 February 2014 (UTC)

I had noticed it as the article was building and tried to keep things completely separate but it turned into a Catch-22. In pulpitis for instance, under causes it talks about hot/cold sensitivity (not in great detail, but it mentions it). My rationale, was that it's difficult for a layperson to follow the logic of a degenerating pulp, without tying it to symptoms. But then when I thought about putting it all together, I really didn't want to take out the diagnosis section because it's fairly succinct and it flows well. Same with symptoms. The standard I was using (for what it's worth) was, "does it seem repetitive". When I read the article in it's entirety, if I felt I'd read the same thing 2 or 3 times, I took some of it out. If it just flowed, I left it in and didn't worry about a symptoms being described in a causation section (or whatever). Imo, we should do it on an individual basis. However, I think the article is too long and could do with some chopping, maybe this is a good opportunity. Ian Furst (talk) 01:04, 3 February 2014 (UTC)

Yes, difficult because everything is related. Here's one example where I feel there is repetition: talking about pulpitis being poorly localized in both the pathophysiology section, then immediately after in the pulpitis section. Thoughts? Lesion (talk) 18:27, 3 February 2014 (UTC)

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“ The dental pulp is now necrotic and emergency treatment may be required ”

• I changed is required to may be required. For many people with poor access to healthcare, pulp necrosis represents a (possibly only temporary) relief from the urgent need to see a dentist, because the acute pain is gone. Indeed, A necrotic pulp may only ever cause a grumbling chronic apical periodontitis (e.g. periapical granuloma) which may be symptomless. Therefore the wording that emergency treatment is required is misleading... Lesion (talk) 18:33, 3 February 2014 (UTC)

sounds good. agree Ian Furst (talk) 19:40, 3 February 2014 (UTC)

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“ Apical periodontitis does not occur because of pulp necrosis, but because of pulp infection, therefore a tooth that tests as if it's alive (vital) can still have symptoms of apical periodontitis and a tooth that is dead (non-vital) due to non-infectious reasons (such as in trauma) may not have it. ”

• I found this fact v interesting, and I would be strongly questioning its validity if not for the reputable source. Surely necrotic tissue releases enough toxins to cause local irritation in adjacent tissues? Also, I feel dental trauma is a poor example of what you are talking about... in my mind, if pulp necrosis has occurred because of trauma, the periodontal ligament is likely to have been affected by that same trauma? Lesion (talk) 18:27, 3 February 2014 (UTC)

It seems logical to me. When teeth go from IP to necrosis, they're pain free and non-tender to percussion. I've seen tons of teeth that test non-vital but are normal to percussion. I would suspect that there's some histologic apical periodontitis (I don't have any proof, just opinion) but I regularly seen necrosis with clinical evidence of apical periodontitis. I could email Hargreaves and ask? He's been helping me out with some of the stuff on regen endo. Ian Furst (talk) 19:40, 3 February 2014 (UTC)

amendment - decided to email him. Ian Furst (talk) 19:46, 3 February 2014 (UTC)

For me, histologic inflammation = true apical periodontitis, and pain is less trustworthy. Interested to hear what that expert has to say on this matter, please update when you have news. Lesion (talk) 20:41, 3 February 2014 (UTC)

He confirmed it, agreed with the quote other than some minor tweeks. As follows (I'll make the change in the text), ""Apical periodontitis does not occur because of pulp necrosis, but because of pulp infection, therefore a DENTAL PULP that tests as if it's alive (vital) can still have apical periodontitis and a DENTAL PULP that is dead (non-vital) due to non-infectious reasons (such as in trauma) may not have it""

Interesting. Could this also be due to the "necrobiosis" state where one root canal is alive and another dead, in a multirooted tooth? Or also the suggestion that pulp nerves may continue to work for a time after pulpal necrosis has occurred (read this somewhere). Lesion (talk) 22:20, 3 February 2014 (UTC)

By pure speculation I think there's a lag where the contents of the pulp degenerate to avascular necrosis but, due to the lack of blood supply, haven't leached out of the tubules and apex to cause trigger the inflammatory process. The nerves of the pulp only need a little pressure to become non-functional, so you could have sterile degeneration of the pulp that simply hasn't made it out the apex/tubules yet. The blood vessels and nerves will degenerate at different rates. Avascular necrosis of the hip is sterile and doesn't generate a massive inflammatory response. Ian Furst (talk) 23:43, 3 February 2014 (UTC)

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“ Periodontal pain can be primary, as in A.N.U.G. or lateral periodontal abscess or secondary to another disease such as pulp necrosis. ”

• Not sure what is meant by primary/secondary here... do you mean a condition which starts in the gums (primary) and one which spreads to involve the periodontium (pulp necrosis becoming apical periodontitis)? Lesion (talk) 02:38, 7 February 2014 (UTC)

Primary periodontal pain, intended to mean it's a disorder of the periodontium that causes the periodontium to hurt. Secondary, meaning it's another structure (e.g. necrotic pulp) that's causing the periodontium to hurt. Ian Furst (talk) 02:45, 7 February 2014 (UTC)

Is primary/secondary sourced? Not sure if this is this introducing unnecessary complication? Lesion (talk) 10:20, 7 February 2014 (UTC)

I have provisionally removed this statement. Lesion (talk) 13:18, 7 February 2014 (UTC)

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• It would be good to mention the etymology of "angina" which is related to throat and strangling... this ties it more closely with possible referred pain to the jaw. Lesion (talk) 13:18, 7 February 2014 (UTC)

If it's easy to make the tie, it'd be nice but it would have to be linguistically slick to make it flow. Ian Furst (talk) 14:57, 7 February 2014 (UTC)

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• Cracked tooth syndrome-- I am not sure about this section... as you wrote "The term is falling out of favor" ... the reason that the "syndrome" has such variable symptoms is because it encompasses several different fracture types. Since a fracture can also involve the periodontal ligament and cause periodontal pain, this got me thinking that we should maybe be discussing "dental trauma" more generally (i.e. getting rid of the sections occlusal trauma and cracked tooth syndrome). Both dental trauma and cracked tooth syndrome do not conceptually fit neatly into one of the categories "pulpal" and "periodontal". It might cause pulpitis, or it might cause dentin hypersensitivity, it might cause pulp necrosis, periodontitis, etc etc. Perhaps a few sentences with wikilink to dental trauma in the intro paragraph of "Dental causes". Thoughts? Lesion (talk) 13:44, 7 February 2014 (UTC)

agree that re-titling it would be good (fractured tooth pain?). This is a common cause of toothache and deserves it's own section imo including the "old" term. I don't agree with it being under dental trauma any more than someone with deep caries, biting into something and fracturing a cusp which makes a pulpitis symptomatic would be dental trauma. Generally speaking, I consider dental trauma to be a mechanical injury from an extrinsic force. I doubt that's a formal definition but perceptually, it's how I classify it in my head. Maybe we should think of the classification as pulpitis, periodontitis, combination (of both) and all others. The classification is less important to me than making it readable to the layperson, there's a thousand classifications for toothache in textbooks - that's not really what we're about right? Somewhere, we need to make the symptoms associated with a fractured tooth obvious. Ian Furst (talk) 14:57, 7 February 2014 (UTC)

I think you may be on to something with the suggestion to classify as pulpal, periodonal, combined pulpal + periodontal, and non dental. It would not take much re-organizing to do this... and the new section (combined) would only really have dental trauma and maybe a few sentences on perio-endo lesions... Lesion (talk) 21:05, 8 February 2014 (UTC)

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• I turned on the reader feedback for this article, but no-one seems to be commenting. I suppose this is good. Interesting to read over the old comments from say 11 months ago (before you made your major revision) where many ask for more details about treatment and how long different causes will last. Lesion (talk) 21:05, 8 February 2014 (UTC)

I'm sure they'll come eventually. I'm going to make that .gif of the progression of toothache better though. Not sure how yet but.... 21:13, 8 February 2014 (UTC)

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• I have provisionally started a "Food impaction" section because a textbook I was using today discusses this as a cause of orofacial pain in its own right. I think this is correct since if there is no abscess formation, we have not previously discussed this mechanism. See what you think, if you feel unnecessary happy to remove, or possbily merge to another section. Lesion (talk) 21:05, 8 February 2014 (UTC)

sounds good, why differentiate from the lateral periodontal abscess though? Ian Furst (talk) 21:13, 8 February 2014 (UTC)

I think, because perio abscess has pus, by definition. Food packing may not progress to any pus. If you think better to merge this content to Periodontal abscess section happy to do this. Lesion (talk) 21:34, 8 February 2014 (UTC)

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Do we talk enough about apical abscesses? I could not find much content about it. Assume it would go into Apical periodontitis section? Lesion (talk) 21:34, 8 February 2014 (UTC)

I think so, I've run the article past a couple of friends and the first reaction has universally been that it's too long. We've got a picture of apical abscess on there - I think it's good. Ian Furst (talk) 21:38, 8 February 2014 (UTC)

Too long? Hmm... I wonder what can be reduced... perhaps the pulpitis section, and the periodontal abscess section? Lesion (talk) 20:11, 12 February 2014 (UTC)

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• What should we do about other rarer types of painful gingivitis? Mainly I refer to the desquamative gingivitis and gingivostomatitis conditions here, but also where we talk about gingival tumors etc in nondental causes. Logically, should these be mentioned in the periodontal causes section? Perhaps under "Other painful periodontal conditions"...Lesion (talk) 21:34, 8 February 2014 (UTC)

For that matter you could add all kinds of mucocutaneous disorders. Again, I think the point that the gingiva itself can be a source of pain is covered with the most common causes. I would add a quick sentence about less common disorders such as .... and add the links without going into any detail. Ian Furst (talk) 21:38, 8 February 2014 (UTC)

Ok I have done this in the non-dental causes section. Lesion (talk) 20:11, 12 February 2014 (UTC)

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• Regarding "Reversible" and "Irreversible" treatments... I feel this terminology is unsupported by any source that I can see... and also introduces unnecessary confusion with pulpitis. Conceptually it is also inaccurate to say even a shallow filling is reversible treatment, since it is impossible to go back afterwards and put the original tooth substance back. Lesion (talk) 20:11, 12 February 2014 (UTC)

It's not reversible/irreversible treatments, but treatment of reversible/irreversible pulpitis. The heading structure is Treatment>>Pulpitis causes>>Reversible causes. Maybe the heading nomenclature makes it confusing? Ian Furst (talk) 03:26, 13 February 2014 (UTC)

My misreading, apologies. Lesion (talk) 11:14, 13 February 2014 (UTC)

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• Something we have not yet mentioned: "galvanic pain" Not even sure how to classify it... it is not a type of hypersensitivity or pulpitis... maybe it would need its own section in Pulpal... Lesion (talk) 23:10, 12 February 2014 (UTC)

I haven't heard the term galvanic pain since dental school. It's a pretty rare bird imo but if you can find an adequate secondary source, I'd put it in the same class as dentin hypersensitivity (causes with a normal pulp???). Is it even listed in PoP? Ian Furst (talk) 03:26, 13 February 2014 (UTC)

I've never seen it in real life. Yes I think the pulp is supposed to be healthy... it is an electric current that flows between contacting dissimilar metals. I feel we should aim for completeness, even if it is just a mention. E.g. we link to barodontalgia in the pulpitis section: "...or rarely barometric changes and ionizing radiation." which takes up barely any room at all.

UPDATE: I just made the stub galvanic pain so we could better understand this phenomenon. Lesion (talk) 12:05, 13 February 2014 (UTC)

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Trephination-- how often is this carried out in oral surgery? Doesn't the term imply that a hole has been drilled in bone? I assume the only time it would therefore be needed is if an apical abscess did not drain via the access cavity or socket. Lesion (talk) 20:21, 16 February 2014 (UTC)

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There are mixed messages with regard antibiotics. My understanding was never to give antibiotics unless there is systemic involvement (elevated temperature, malaise, lymphadenopathy), or if the eye or the airway is threatened... perhaps also infection in diabetics etc. When antibiotics are given, they are an adjunct to the local measures like I&D.Lesion (talk) 20:31, 16 February 2014 (UTC)

Generic treatment for toothache

Was thinking about why people find this page. Good chance it's because they have a toothache are looking for a short term solution until they see a dentist (and to try and figure out why they've got the ache). How about we add a quick section to treatment, basically saying that most toothache is inflammatory and should be treated as such. Ian Furst (talk) 01:06, 16 February 2014 (UTC)

It might be better to make the whole treatment section as generic as possible, and move all the mentions of the specific treatments to their respective sections in causes? That being said, with all the causes mentioned on the page, it is difficult to give any generic advice that goes far beyond "see someone who will be able find out what is wrong"... Lesion (talk) 01:12, 16 February 2014 (UTC)

In the old feedback comments, requests for info on treatment certainly featured prominently. Lesion (talk) 01:14, 16 February 2014 (UTC)

Yeah, one of things I was thinking about. You've got a better sense of the best way to structure (I have a total n=4 articles that I've reworked). MEDMOS suggests the section on treatment and it works for me. Maybe just an opening paragraph to the treatment section. Something like, "The treatment for toothache depends on the cause. In general, dental pain tends to be inflammatory in nature and is treated with non-steroidal anti-inflammatory medication, cleaning of any infection in the tooth or it's supporting structures." Now that I've read it, maybe it just doesn't matter. Doesn't add much. Ian Furst (talk) 01:24, 16 February 2014 (UTC)

More generic treatment section is good imo. Lesion (talk) 03:02, 16 February 2014 (UTC)

Generic treatment section:

• What to do before you manage to see a dentist-- talking about OTC meds, warning about maximum doses, not putting tablet against gum etc
• 2nd Paragraph: Very general treatment goals of dentist- "Relieve pain and wherever possible restore and preserve function".
• 3rd paragraph: summarizing the range of treatments involved. Mention importance between reversible pulpitis and irreversible pulpitis/necrosis
• 4th paragraph: could talk very generally about common themes in management of abscesses: pericoronal, apical, periodontal.
• When to use antibiotics, when not to use antibioticsLesion (talk) 20:49, 16 February 2014 (UTC)

Generic prognosis section

• Odontogenic infection- possible airway threat, possible cavernous sinus thrombosis
• Talk about immunocompromized pts
• Prognosis when nondental causes... MILesion (talk) 20:49, 16 February 2014 (UTC)

Prevention section

I was reading over the AAFP source [1] and saw they have a nice little prevention section. Maybe we should do this too... after treatment I suppose. Lesion (talk) 16:10, 16 February 2014 (UTC)

•  Done -- anyone feel free to add to it. Lesion (talk) 12:29, 19 February 2014 (UTC)

Pre-GA review edits

• I have requested the guild of copyeditors to have a look, and also specifically on WP:History to see if hte history section can be sorted out a bit better.

AwesomeIan Furst (talk) 11:41, 19 February 2014 (UTC)

• I have moved much of the specific content from prognosis and treatment to their respective sections in causes. This has also highlighted some of the repetition that was going on. Each causes section can be reduced in length if this repetition is gone.

AwesomeIan Furst (talk) 11:41, 19 February 2014 (UTC)

• I also feel that the diagnostic approach section could be tighter... that bullet list for one thing is likely to cause a problem during the GAN.

Agreed, if the information is in the table below it, doesn't need to be in the text. It may just need to be broken into manageable paragraphs. Ian Furst (talk) 11:41, 19 February 2014 (UTC)

• ditto with treatment and prognosis sections... Lesion (talk) 16:58, 18 February 2014 (UTC)

Disagree, I think they look pretty good Ian Furst (talk) 11:41, 19 February 2014 (UTC)

I mean these sections just need a good read over, perhaps some rewording if possible to bring the overall length of the article down... Lesion (talk) 12:28, 19 February 2014 (UTC)

• Another cause of pain we have missed- "buccoverted" upper third molars, traumatizing the buccal mucosa. These teeth may be sharp from lack of attrition as they have never been in occlusion with another tooth. I personally would not call this pericoronitis since it is the buccal mucosa that is giving the pain, not the tissues around the crown of the tooth. Indeed, this problem tends to happen with upper third molars that are not partially erupted. Lesion (talk) 11:23, 19 February 2014 (UTC)

As much as I'd like to include this, the more generalized term would be cheek biting. Not sure where to list it (if at all??) Periodontal? Ian Furst (talk) 11:41, 19 February 2014 (UTC)

Good point... it's not really toothache since it is the buccal mucosa that hurts... I had this myself not too long ago... every time I smiled or laughed I was in pain from this traumatic ulcer that had formed. Got one of my colleagues to smooth off the cusps of the tooth and everything was fine in a day or two. Lesion (talk) 12:28, 19 February 2014 (UTC)

• Going to merge Treatment and prognosis since the latter has repetition and is a short section. Lesion (talk) 22:56, 19 February 2014 (UTC)

Nice change, that improves the flow considerably imo. Ian Furst (talk) 01:53, 20 February 2014 (UTC)

Toothache, antibiotics and suicide

Re recent edits to content about use of antibiotics for toothache and risk of suicide,

• Reliably sourced content is being changed from:

“ The reality is however that antibiotics are rarely needed, ”

to:

“ The reality is however that antibiotics are rarely needed for the long term treatment of toothache, ”

When the source in question states:

"For most infections causing swollen faces, effective drainage of pus and removal of the cause are the only treatment required"

"Antibiotics provide little benefit over drainage and removing the cause, but they are often used but rarely required"

• PubMed search with keywords "toothache" + "suicide" gave no relevant hits: [2], nor did a google book search: [3]. Need a proper medical source to support such a statement please. Lesion (talk) 14:31, 21 February 2014 (UTC)

Paragraph length

Hey Lesion - started to re-read again and noticed that we've left each section as a single paragraph. It's formidable to look at (e.g. Pulpitis is a 400 word paragraph). Do you mind if I break it up a bit into more manageable chunks or does that fly in the face of GA protocol? Ian Furst (talk) 12:07, 20 February 2014 (UTC)

My rationale for merging each section into one para where possible was that it might make the overall article look shorter =) if you are going through, please have a look and see if you can spot any repetition or stuff that can be reduced... many thanks, Lesion (talk) 12:10, 20 February 2014 (UTC)

Started to break up that section into paragraphs. We should try to cut the length down in any way possible now imo... should we get rid of these things:

Main article: blah

See also: blah

Thoughts? Lesion (talk) 14:08, 20 February 2014 (UTC)

Sorry - just saw this. I think its' the "wordyness" of the entire article. Take a look at how Axl broke up Lung cancer (even has some bullet points). The sections are very short. For the moment, what do you think about 1) breaking up the paragraphs so that each is a single thought. Even if it means longer length. 2) Then we can go through and chop thoughts that are repetitious or pointless. 3) we can ensure each small paragraph is referenced. Ian Furst (talk) 01:31, 21 February 2014 (UTC)

OK Lesion (talk) 12:08, 21 February 2014 (UTC)

Overall, I think that several paragraphs are rather long and therefore somewhat awkward to read. If it would be helpful, I could list all of the lengthy paragraphs with a view to splitting them. Axl ¤ [Talk] 02:16, 22 February 2014 (UTC)

Hi Axl, yes fresh eyes would be most welcome here, thank you kindly. Lesion (talk) 13:09, 22 February 2014 (UTC)

• Do we need this: "The pulp and the periodontal ligament have different embryoloic origins, and they each have a different profile of sensory receptors." ? The next sentence makes it a bit redundant... Lesion (talk) 19:57, 21 February 2014 (UTC)

Nope, take it out. I'm going to do some chopping tomorrow am (finished with Anesthesia for a bit. Axl it would be great if you split some stuff up. Lesion and I have been knee-deep in this article for ?2 months already. Sometimes it's hard to see the forest. Thx. Ian Furst (talk) 03:02, 22 February 2014 (UTC)

Yes and the worst part is it is still incomplete... indications and contra-indications for antibiotics clearly needs more detail, possible complications: airway, cavernous sinus thrombosis, cellulitis... Lesion (talk) 12:07, 22 February 2014 (UTC)

Wait, you want me to edit the article? Er, okay. Axl ¤ [Talk] 13:33, 22 February 2014 (UTC)

Lesion, I'm doing some chopping this morning. Let me know if it's too radical. Ian Furst (talk) 13:53, 22 February 2014 (UTC)

Np, thanks. I can see a few small typos but I will highlight them later to avoid edit conflicts now. Lesion (talk) 14:02, 22 February 2014 (UTC)

Got distracted on anesth again - going to the gym now. Food for thought, should we (in general) change pulp to dentin-pulp complex throughout?Ian Furst (talk) 17:24, 22 February 2014 (UTC)

Yes that would be more accurate. Lesion (talk) 17:40, 22 February 2014 (UTC)

A note re WP:INTEGRITY

We have to be careful when re-wording content that the new wording is still supported by the sources. E.g. I noticed this:

Old:

“ ...while periodontal pain tends to be well localized, although not always. ”

New:

“ Because toothache often involves both the dentin-pulp complex and the periodontal ligament, localization of the pain is not always so specific. ”

What source actually states is: "Pain originating in the periodontium is more readily loacalized than is pulpal pain. The improved ability to localize the source of pain may be attributed to the proprioceptive and mechanoreceptive sensibility of the periodontium that is lacking in the pulp. However, although localization of the affected tooth is often precise, in up to half of cases the pain is diffuse and radiates into the jaw on the affected teeth. It is not usually aggravated by hot or cold".

At no point does the source use the explanation that simultaneous involvement of the pulp is the reason that not all periodontal pain is poorly localized. The content is no longer supported by the source. This concept is dealt with in WP:INTEGRITY. Lesion (talk) 17:40, 22 February 2014 (UTC)

p.55 from PoP, "Unlike pulpal pain, pain of periradicular origin is easier to localize. Mechanoreceptors are numerous in the periodontal ligament (PDL) and are most densely concentrated in the apical one third.74 Once inflammation from pulpal disease extends into the periodontal ligament patients are able to locate the source of the pain much more readily.........The tooth is unique in the human body in that it has a visceral-like component, the pulp, and a musculoskeletal component, the periodontal ligament. Therefore, odontogenic pain can have a wide variety of presentations." and then goes on to describe the varying presentations. Maybe we should swap out the Scully reference for PoP? Ian Furst (talk) 21:25, 22 February 2014 (UTC)

Based on what you have pasted above, that would be more appropriate for that statement. I also like the visceral/musculoskeletal terminology in pathways... would be good to use this if possible imo. Lesion (talk) 00:21, 23 February 2014 (UTC)

A note re WP:OVERLINK

“ Generally, a link should appear only once in an article, but if helpful for readers, links may be repeated in infoboxes, tables, image captions, footnotes, and at the first occurrence after the lead. ”

Let's aim for a link in the lead, then one more link in the body of the article... possibly also another link in a caption if needed. Otherwise shouldn't keep repeating wikilinks in the body of the text... This is discussed in WP:OVERLINK. Lesion (talk) 18:17, 22 February 2014 (UTC)

K Ian Furst (talk) 21:25, 22 February 2014 (UTC)

What differentiates physiologic sensation from dentin hypersensitvity?

“ what separates hypersensitivity from regular tooth sensation is the intensity of the pain. ”

Been looking through a few sources and none seem to support this statement. Lesion (talk) 15:47, 23 February 2014 (UTC)

I put it in for you. When we started this project you had said that it was a concern of your's that people realize cold sensation is normal. Dentin hypersensitivity is something else. How else would you define it? Ian Furst (talk) 20:57, 23 February 2014 (UTC)

We have references stating that short, sharp pain lasting as long as stimulus, or in response to extreme temp changes is physiologic pain, and descriptions of DH, but I don't think the above is sourced. I think what distinguishes DH and physiologic sensation is the presence of open dentin tubules, except that not all teeth with exposed tubules are hypersensitive. Asked on ResearchGate to see if anyone has a source for this. I'm going to be busy the next few days as I need to wrap up a manuscript before a deadline. Lesion (talk) 23:25, 23 February 2014 (UTC)

Found this on page 510 of PoP, "Dentin hypersensitivity is characterized by short, sharp pain arising from exposed dentin in response to stimuli—typically thermal, evaporative, tactile, osmotic, or chemical—that cannot be ascribed to any other form of dental defect or pathology." The source (aside from PoP) is Holland GR, Narhi MN, Addy M, Gangarosa L, Orchardson R: Guidelines for the design and conduct of clinical trials on dentine hypersensitivity. J Clin Periodontol 24:808, 1997. The distinction, I assume, is that it's painful whereas normal sensations is...well.... normal. Good luck with the publication. Ian Furst (talk) 00:05, 24 February 2014 (UTC)

Thanks, it's the updated version following a peer review, so not a huge amount of work. The quote from pathways above does not explicitly state that pain intensity distinguishes DH... I imagine putting an electric pulp tester up to max and holding it too long on a healthy tooth... there would be sharp, short pain for as long as stimulus. What I am trying to say, is that "physiologic pain" is proportional to the stimulus applied, and therefore it is perfectly possible to have worse physiologic pain compared to the level of pain from DH in another person. According to the descriptions of DH, I think what distinguishes this condition from normality is the presence of exposed dentin tubules rather than pain intensity... but I don't have a source that explicitly states that either. Lesion (talk) 00:13, 24 February 2014 (UTC)

Not so sure I agree with that. Lots of people have recession (e.g. exposed tubules) but not all have DH. Let me email Ken and see what he says. Ian Furst (talk) 00:59, 24 February 2014 (UTC)

Yes, not all teeth with exposed tubules have DH, but all presumably it is impossible to have DH without exposed tubules. Lesion (talk) 12:37, 24 February 2014 (UTC)

GA Review

This review is transcluded from Talk:Toothache/GA1. The edit link for this section can be used to add comments to the review.

Reviewer: Vinethemonkey (talk · contribs) 05:14, 11 March 2014 (UTC)

All right, here I am. I'm ready to roll!

Sources

Most are good and reliable, although I would question the use of making a Wikisource as a source. Please replace this with a more reliable source; otherwise, the section that mentions it will get removed.

 Done

Wonderer

If you wonder where it is, I'll notify you right now, it is number 53.

I don't understand sorry... Lesion (talk) 22:31, 11 March 2014 (UTC)

Pictures

Good use of pictures. There are quite a few pictures here, and they are all adequate.

Length

I say this is a good length for an article.

Notice sources

See notices for improvement. It may affect the length, but certainly not my opinion. Even if you remove it, I will still like the length.

Other comments

Good grammar/spelling. This article is neutral and well-written. List used. Good! I think that as long as you change the single source, I will put this into a good article. Thank you!

Thank you, I've got limited access to internet for a couple of days then will update. @Lesion: Ian Furst (talk) 18:40, 11 March 2014 (UTC)

Thank you also. I asked about Wikisource on the help desk and people were agreeing with you that we should not link to wiktionary, wikisource etc... which I found surprizing but the MOS does indeed state not to link to wikis. Some helpful person, presumably reading the helpdesk msg or your comment in the GA RV has already replaced the wikisource with a book, so no issues with that now. Lesion (talk) 22:13, 11 March 2014 (UTC)

Great! I will update it in a bit. Good job again on this article.VINETHEMONKEY 04:43, 12 March 2014 (UTC)Vinethemonkey

Thank you, Lesion 18:16, 11 April 2014 (UTC)

DYK

Lesion Nice work on the DYK nomination. I was in the OR all day without internet access and missed it up on the front page. Did you get a screenshot of it? Ian Furst (talk) 02:23, 11 April 2014 (UTC)

I didn't, but assume that it is possible to look at the history of the main page to get the old version of the main page. We should finish this topic and get it published at some point. Most of the work is already done I feel, it's mostly rewording now I suspect. Lesion 18:16, 11 April 2014 (UTC)

Sure, where do you think we should publish? I'll review the info to authors and start tailoring to their specs. Ian Furst (talk) 18:18, 11 April 2014 (UTC)

Not sure traditional journals would accept the fact that the "paper" is already published on wiki. Idea was the JMIR_Wiki_Medical_Reviews, if this topic is within scope (Jmh649 thoughts?). Helpfully, the style guidelines are MEDMOS so not much effort there as theoretically this article should already be following the MEDMOS. Just read that the article needs to be an FA, so maybe we should nominate the article for FA? Lesion 18:38, 11 April 2014 (UTC)

Yes bring first to FA and than we can consider it for publication. Doc James (talk · contribs · email) (if I write on your page reply on mine) 09:54, 12 April 2014 (UTC)

Hopefully this won't be too painful. Lesion 10:23, 12 April 2014 (UTC)

Seeking consensus for standardized ref formatting

Suggest using cite journal for journals. Journals which are cited more than once could have a named reference. I note that authors are all listed in same field, instead of first=, last= and coauthor= ... should make things more simple. Where should aim for pmid, doi and pmc where applicable for every journal citation imo.

{{cite journal |author=Bannen RM, Suresh V, Phillips GN Jr, Wright SJ, Mitchell JC |title=Optimal design of thermally stable proteins |journal=Bioinformatics |volume=24 |issue=20 |pages=2339–43 |year=2008 |pmid=18723523 |pmc=2562006 |doi=10.1093/bioinformatics/btn450 |url=//bioinformatics.oxfordjournals.org/cgi/content/full/24/20/2339 }}

producing:

• Bannen RM, Suresh V, Phillips GN Jr, Wright SJ, Mitchell JC (2008). "Optimal design of thermally stable proteins". Bioinformatics. 24 (20): 2339–43. doi:10.1093/bioinformatics/btn450. PMC 2562006. PMID 18723523.{{cite journal}}: CS1 maint: multiple names: authors list (link)

For Books, suggest using cite book template, but using a matching author name format as above. Currently we have a variation in styles. Suggest leave page ranges out of the cite book template, instead using {{rp|XX}} for every single inline citation to a book reference. As above, when a book is cited more than once could have a named reference. URL to google books preview of textbooks? I've been putting these in for some books, but just realized the links are google.co.uk ... maybe this is an issue and they should be google.com?

<ref name=Tencate2008>{{cite book|author=Nanci A|title=Oral histology: development, structure, and function.|year=2008|publisher=Mosby|location=St. Louis, Mo.|isbn=978-0-323-04557-5|url=http://books.google.co.uk/books?id=nLW3Ts_TDpEC&pg=PA191&dq=dentin+pulp+complex&hl=en&sa=X&ei=gtoIU-a7F4K3hQeMhoHQCQ&redir_esc=y#v=onepage&q=dentin%20pulp%20complex&f=false|edition=7th}}</ref>{{rp|118}}

• Nanci A (2008). Oral histology: development, structure, and function (7th ed.). St. Louis, Mo.: Mosby. ISBN 978-0-323-04557-5.</ref>

Ian (and anyone else), if you are happy with this I will start work on it. As I see it there are these jobs left for us to do:

• Find refs for unref'd content (or just remove it...)
• Copy edit, reduce word count, put in paragraphs
• Make sure reference style is consistent. Lesion 20:35, 12 April 2014 (UTC)

I'm fine with that. I standardized the reference format on Dental implant for GA and it is mind-numbing. I've got limited availability for the next 2 weeks or so due to work, but still check in daily. If you'd like me to help find a reference or review a section leave me a note and I'll do it. Ian Furst (talk) 01:44, 14 April 2014 (UTC)

OK no worries. Lesion 08:40, 14 April 2014 (UTC)

Parallelism

Calliopejen1 To the request to improve parallelism in this sentence; "Dentin hypersensitivity is a sharp, short-lasting dental pain occurring in about 15% of the population, which is triggered by cold (such as liquids or air), sweet or spicy foods, and beverages" how about, "Dentin hypersensitivity is a sharp, short-lasting dental pain that can be triggered by cold air, cold beverages, sweet and spicy foods. It occurs in about 15% of the population." Ian Furst (talk) 23:00, 14 April 2014 (UTC)

There is still a parallelism error in the revised sentence (these are the worst to have to edit out!). I'd recommend: "Dentin hypersensitivity is a sharp, short-lasting dental pain that can be triggered by cold air, cold beverages, or sweet or spicy foods. It occurs in about 15% of the population." Calliopejen1 (talk) 23:09, 14 April 2014 (UTC)

That is consistant the the scientific content. Ian Furst (talk) 02:05, 15 April 2014 (UTC)

Could also be sweet beverages I suppose? Lesion 09:17, 15 April 2014 (UTC)

A beta nerves in the pulp

Have we missed these out? Lesion 15:57, 17 April 2014 (UTC)

• Reversible pulpitis mostly carried by A delta, irreversible pulpitis mostly by C fibers. Lesion 16:00, 17 April 2014 (UTC)

Temporary notes for Ian on references

change this reference to non-primary {{cite journal|last=Li|first=Wei|coauthors=Huang, Jian Tao; Chen, Xiao Qing; Shi, Rong Hua; Jiang, Lei; Zhao, Yun Fu|title=Non-odontogenic toothache revisited|journal=Open Journal of Stomatology|year=2011|volume=01|issue=3|pages=92–102|doi=10.4236/ojst.2011.13015}} primary source to be removed and replaced by

Ian Furst, Not sure what has happened with this ref. The authors Li Wei etc are not the authors of this paper: [www.scirp.org/journal/PaperDownload.aspx?paperID=7668]

I am really confused... Lesion 21:04, 17 April 2014 (UTC)

not a clue - I don't remember putting that in (to be honest, I rarely include all the authors). Seems like a good review, just change the authors? Ian Furst (talk) 09:56, 18 April 2014 (UTC)

The plot thickens. These authors correspond to this totally different paper [4], on radial forearm free flaps. Perhaps a digit in the doi got mixed up. Can't find "Non-odontogenic toothache revisited" on pubmed. Substituted for correct authors anyway. Lesion 12:02, 18 April 2014 (UTC)

Nice work Sherlock. I did the pubmed search and couldn't find them. I wonder if this is why everyone hates the {{cite pmid, cite doi}} stuff. Ian Furst (talk) 13:40, 18 April 2014 (UTC)