Talk:Tooth decay/Archive 2

Unnecessary mass of references in the lead
We current have this one sentence "Caries are also associated with poverty, poor cleaning of the mouth, and receding gums resulting in exposure of the roots of the teeth." supported by 7 refs when all that was needed was two.


 * This is a literature review from 2014
 * This is a meta analysis from 2015

We do not need these 5
 * Review but we have a newer one
 * A systematic review but we have a newer one
 * Primary source
 * This is a primary source
 * This is a primary source

Doc James (talk · contribs · email) 12:05, 16 August 2015 (UTC)

Remineralization - reversal of dental caries.
In the intro, we currently say: "There is no known method to grow back large amounts of tooth." http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4226000/ however, says "They have developed a patented technology for the regeneration of enamel. The monomers of peptide p11-4 (curodont) forms a matrix [that] enables de novo enamel crystal formation from saliva in constant equilibrium with demineralization [19]. In vivo studies revealed that the peptides were shown to decrease demineralization and show a strong trend toward increasing remineralization [20]." (and mentions other progress on tooth regeneration) So while I doubt we have the MEDRS sources to put "There is a known method to grow back very significant amounts of tooth." in the intro, I do think the intro needs some editing in light of this development.

We should have a bit more data in Dec 2016 and Dec 2017. A very promising clinical safety trial is too preliminary.--Elvey(t•c) 21:29, 4 December 2015 (UTC)

selective excavation
http://www.ncbi.nlm.nih.gov/pubmed/25511906 suggests selective excavation is best practice, so I think the first sentence of the following needs revision; it conflicts with the second one: "Before a restoration can be placed, all of the decay must be removed otherwise it will continue to progress underneath the filling. Sometimes a small amount of decay can be left if it is entombed and the there is a seal which isolates the bacteria from their substrate."--Elvey(t•c) 21:29, 4 December 2015 (UTC)


 * Elvey agree should be mentioned if not already. the technique you refer to is called stepwise caries removal or indirect pulp cap. Pulp_capping. Matthew Ferguson (talk) 04:01, 5 December 2015 (UTC)

Other prevention
thank you for adding the content about other types of prevention. thank you for adding the page number. I tweaked the reference to include both page 6-7 since the content is covered on both pages. Sydney Poore/FloNight&#9829;&#9829;&#9829;&#9829; 15:29, 10 March 2016 (UTC)
 * Ah yes see it. Have adjusted the text to better match. Doc James  (talk · contribs · email) 17:43, 10 March 2016 (UTC)

We need to know more about Resin Infiltration for Proximal Caries!
http://www.ncbi.nlm.nih.gov/pubmed/?term=proximal+caries+infiltration

http://www.ncbi.nlm.nih.gov/pubmed/26545080

88.192.242.201 (talk) 12:31, 3 April 2016 (UTC)


 * I don't disagree... Sofixit!  Simply posting links to what you think are potentially useful and reliable sources isn't quite as good as adding them to the article and adjusting the text accordingly!  Wikipedia is something anyone can edit, including you.  Seize the day!  KDS4444 (talk) 10:04, 26 October 2016 (UTC)

RfC about article's lead image
Should we use a photograph or a diagram for the article's lead image? KDS4444 (talk) 14:45, 3 November 2016 (UTC)

Background: the article currently has a photograph of a severely decayed tooth. There is no question as to this photo's accuracy-- nevertheless, it is a somewhat shocking visual. We also have an SVG diagram of a tooth suffering from decay which we might use as the lead image. The diagram conveys the same basic concept (tooth decay), has less shock value, and is also labeled with parts of the tooth and types of cavities. Either image is suitable, of course, but I feel the diagram has greater encyclopedic value; others disagree. Please share your comments. Thank you. KDS4444 (talk) 14:54, 3 November 2016 (UTC)
 * Diagram. A diagram is much more clear and concise and a simple photo does not represent what is actually going on within the tooth. — Preceding unsigned comment added by Funkyman99 (talk • contribs) 18:49, 3 November 2016 (UTC)
 * Diagram per both above. Without getting into any kind of WP:CENSORED/WP:GRATUITOUS kerfuffle, the diagram is far more informative about different kinds of decay, relevant anatomy, etc—all absent from the photo, or only visible to specialists. Furthermore, MOS:LEADIMAGE recommends pictures with lower shock value even if both were equally informative. FourViolas (talk) 21:57, 6 November 2016 (UTC)
 * The diagram is far superior when it comes to actually illustrating the subject. I'm not even sure a non-professional would recognize the photograph as a tooth if given only a quick glance—it has a sort of odd angle to it. Carl Fredrik   💌 📧 22:08, 6 November 2016 (UTC)
 * Picture You can barely tell what the diagram is at normal size and therefore the diagram is not informative at all. The tooth we are looking at is moderately decayed. It quickly orientates the reader to what the article is about while the diagram requires study to figure out what it is about. Doc James  (talk · contribs · email) 06:20, 7 November 2016 (UTC)
 * The diagram is a vector image, and so could be presented at any size for the reader, including much larger size with no loss of detail. KDS4444 (talk) 15:51, 7 November 2016 (UTC)
 * I think it is a great diagram. IMO however it goes best in the body of the article. Doc James  (talk · contribs · email) 16:06, 7 November 2016 (UTC)
 * Picture, with the diagram included elsewhere in the article - The picture clearly depicts a dental caries; the diagram depicts multiple caries, but not clearly so; it is not immediately apparent to the reader which part of the diagram is the article subject. The diagram also suffers from not including the article title in any of the captioning text. NOTE: Changes to the diagram text would not be sufficient to change this !vote. - Ryk72 'c.s.n.s.' 09:28, 7 November 2016 (UTC)
 * Would any change to the diagram text be sufficient to change your !vote? Or do you object to the diagram qua diagram?  Is there any form the diagram could take which would address these concerns?  KDS4444 (talk) 15:51, 7 November 2016 (UTC)
 * I do not know; there are potential changes which are as yet beyond my understanding or imagination. No, I do not object to the diagram simply because it is a diagram. I do not know; there are potential forms which are as yet beyond my understanding or imagination. - Ryk72 'c.s.n.s.' 17:00, 7 November 2016 (UTC)
 * Which isn't very helpful. It seems you know what you don't like but you can't explain what you would like, which leaves others at a loss here.  KDS4444 (talk) 08:03, 9 November 2016 (UTC)
 * I think I've expressed a clear, and sufficiently explained, preference, above. - Ryk72 'c.s.n.s.' 23:35, 9 November 2016 (UTC)


 * picture per the reason of Ryk72, the diagram could go elsewhere (the picture is far superior...IMO)--Ozzie10aaaa (talk) 10:34, 7 November 2016 (UTC)
 * The picture is far superior how? Can you please be more specific?  Thanks!  KDS4444 (talk) 15:51, 7 November 2016 (UTC)

My concerns with the first photo is that it may be slightly confusing to the lay person. What about this one I found on commons (picture 2)? Carl Fredrik  💌 📧 10:41, 7 November 2016 (UTC)
 * Having a tooth isolated is more clear IMO. Not completely opposed but not convinced that one is better. Doc James  (talk · contribs · email) 10:44, 7 November 2016 (UTC)
 * I partially agree, but for someone like me it could just as well be necrosis of the scaphoid bone. Without the enamel's surface visible I'd have a hard time telling just off the picture at this angle… I might just be bad at teeth though… Carl Fredrik   💌 📧 11:07, 7 November 2016 (UTC)


 * Comment Please consider that for other articles depicting graphic damage to the human body (decapitation, dismemberment, spina bifida, circumcision, etc.) we almost never use actual photographs of the damage done as the lead image— not that such photographs do not exist or are not highly informative to the reader, but that they are unnecessarily upsetting to view. I feel very similarly about this subject, which is in large part why I am proposing the diagram.  KDS4444 (talk) 16:06, 7 November 2016 (UTC)
 * This is not a very upsetting photo. It depicts the disease well IMO. We are not censored. Doc James  (talk · contribs · email) 16:26, 7 November 2016 (UTC)
 * There's a great line from a Simpson's episode: the setting is a party at the Simpson's house. Barney Gumbal, the town drunk, is there, as is little Lisa.  At one point Lisa tells Barney, "Mister Gumbal, You're scaring me."  Barney responds by saying, "No, I am not!"  The sense of shock/ fright is not for the person presenting it to determine in the mind of the person experiencing it.  Like saying the image is not upsetting to view.  That you may perhaps not be upset by it does not make it upsetting!  Which was kind of my point.  But that seems to be getting lost now.  KDS4444 (talk) 07:52, 9 November 2016 (UTC)
 * Yes disease sucks and it is often upsetting. We are a knowledge source first and formost though. While one wants to use editorial judgement hidding an educational image because it can upset some people is not something I support. One can turn off pictures on the internet and just read text if they want. THe Simpson's is amazing :-) Doc James  (talk · contribs · email) 11:51, 9 November 2016 (UTC)


 * Use photo I oppose the diagram just because I think the abstraction in this case is less easy to understand than the photo image. There are two photos suggested here; either is fine for me. I do not think this photo is shocking. Sometimes in wiki I advocate for shocking images to not be in the lead, but in this case, I think either tooth photo is fine. This is among the most common communicable diseases in the world and I think it is fine to show a picture. I do think that conversations like this one are useful because there could be more clarity on when to use what sort of image. Right now these things are subjective.  Blue Rasberry   (talk)  21:03, 7 November 2016 (UTC)
 * Comment while I think a simplified version of the diagram would be fine, I prefer the second photo. With no dental/medical background, I also didn't immediately recognize the first photo as a tooth (At first glance, thought it was the decaying larval form of something...). Then again, since it's on a page about dental carries, the average reader will probably figure it out in a hurry. Ajpolino (talk) 22:24, 7 November 2016 (UTC)
 * Use the second photo. It addresses any concerns about ugliness, it puts the subject in context (in the mouth not in isolation) and it's technically an excellent, clear photo. --Anthonyhcole (talk · contribs · email) 02:21, 8 November 2016 (UTC)
 * Use the second photo or the diagram. I'm not worried about the "ugliness", and I have no trouble recognizing it as a tooth, but I think that the other options are more educational. As for the concerns about size, if they're "too small" (on your screen/without your reading glasses/whatever), then the first image is not required to be placed inside an infobox, so the size can be anything that we want.  WhatamIdoing (talk) 07:50, 8 November 2016 (UTC)


 * Keep the photo . I am not convinced that "the diagram has greater encyclopedic value". Nor am I convinced that the photo has "shock value". I think that most viewers would recognise the photo as a tooth, and the black area as damage to the tooth. However the diagram requires more careful scrutiny to realise that it is a cross-section of a tooth set in the jaw. Axl ¤ [Talk] 12:39, 8 November 2016 (UTC)
 * Use the second photo. In view of CuriousMind01's statement that he did not recognise the original photo as a tooth, it is preferable to use the second photo. Axl ¤ [Talk] 12:20, 19 November 2016 (UTC)


 * Use the second image good, clean photo. Not like the current image (poor quality) nor the proposed alternative (cluttered and I do not think it focuses well on what caries are). --Tom (LT) (talk) 07:05, 10 November 2016 (UTC)
 * Hi Tom, "caries" is not plural btw. Correction: "focuses well on what caries is". Matthew Ferguson (talk) 00:42, 17 November 2016 (UTC)


 * Second photo -- both photos and diagrams should be used into he article. For the lead a photo would be better. However, the photo of the extracted tooth is not ideal since it is not "in situ", would prefer an image of a decayed tooth as it appears in the mouth of a person. Picture 2 is also of decay in a child so perhaps not that ideal either, but is a better lead image than the extracted tooth imo. If there are no more suitable images on commons available I can take some better clinical pics if that is helpful. Matthew Ferguson (talk) 00:42, 17 November 2016 (UTC)
 * Second photo. I did not recognize the current photo as a tooth at first. I think the diagram is good in the body, but does not depict a cavity well, because of its complexity. I think the Mayo clinic type picture http://www.mayoclinic.org/diseases-conditions/cavities/multimedia/types-of-cavities/img-20005822 is a better type diagram to use to depict cavities.CuriousMind01 (talk) 12:46, 18 November 2016 (UTC)
 * Comment The need to separate concerns here is serious.
 * Shock effect. The fact of the matter is that unwelcome pathological medical (including dental) conditions are unwelcome just because they are variously nasty, messy, ugly, disgusting, embarrassing, downright scary and painful. To represent them in all their revolting glory is not always necessary, but to represent them blandly for fear of shocking anyone, is a dangerous disservice. For purposes of the lede, that diagram is about as misleading as an idealised map of the London Underground, however useful it might be to would-be passengers, would be when trying to discuss the city's sewerage system, the social regions it passes through or connects, with all their smells, sounds, and topography. Analogously that diagram is as wrong for such functions as it is right for mapping where which kinds of caries might be found and discussed, and for introducing terminology. WP is not here to recommend or even sanitise pathology. Even the photo of that child's tooth errs in that respect, and conveys far less than the photo of the extracted tooth does. Remember that AIDS, rabies, smallpox, and dozens of other deadly and debilitating conditions are quite pleasant and attractive &mdash; once one has stripped them of their undesirable attributes. But to do so is misleading, and to mislead is unencyclopaedic.
 * Role of instant comprehension in lede illustrations precludes the diagram; it is good and should be included, but it is unrealistic and didactic rather than representative. You have to stop and read it and even after that it gives little idea of what the real thing is or is like. No good for a lede. Although I understand correspondents who had wondered about larvae etc, I for one (neither dentist nor doctor, and lately reduced to wearing spectacles) never even blinked in identifying it, first as a tooth, and secondly as a carious tooth, so it cannot be impossibly difficult, especially as the article title is Dental caries, and not Arthropod metamorphosis. Even if one's first impression is "What the bleep? Oh yech!" one glance at the title should be sufficient, especially if we modify the caption appropriately. Even as it stands however, it clearly and conspicuously says "Dental caries" at the top, and "Destruction of a tooth by dental caries" just beneath, so anyone still at a loss for comprehension after a second or so, has worse problems than dental caries. Clarity and transparency are nice, but any informative illustration of a complex concept is likely to be the better for annotation.
 * Aesthetics and misleading representations covered in the preceding diatribe.
 * Comprehensibility of the photos and diagrams. Ditto
 * Informativity of the photos and diagrams. See next item.
 * Value of less obvious, implicit information content of items. Both of the photos, especially that extracted tooth, are full of informative signs and could benefit from professional annotation. One of my neighbours is a professor of dentistry. If I can run him to earth, (not always easy) I'll ask him for helpful material to highlight in a copy of the photo in Wikimedia.
 * Encyclopaedic standards All three of the options have encyclopaedic merit and deserve a place unless onyone can find better examples of each. The only real issues IMO concern their respective merits as lede pictures, which are different in several ways from what is desirable elsewhere in the article.

My ha'porth... JonRichfield (talk) 09:44, 20 November 2016 (UTC)
 * Diagram Looking at it, I feel that the diagram offers more information to the reader than the picture does, as it offers information about the internal structure of the tooth that isn't apparent in the photo. Gluons12  ☢&#124;☕ 21:33, 24 November 2016 (UTC).
 * Picture The diagram needs to be included elsewhere in the article but the lead image should be an actual image of what the condition is. It is shocking as many have stated, which is sort of the point. The lead should be an actual representation of what the condition is, the medical diagrams should be elsewhere in the article.  Nik ol ai Ho ☎️ 04:45, 28 November 2016 (UTC)

Timing of eating sugars
Quite early on, this article says that a diet high in sugar increases risk of dental caries. Should it not also clarify that if one eats sugars at lots of different times in a day, that will do teeth more damage than if one only eats, say, once, as when one eats sugar, thirty minutes damage to one's teeth begins (although, of course, this can be prevented if one brushes one's teeth after eating sugar)Vorbee (talk) 15:30, 20 July 2017 (UTC)


 * The frequency of sugar episodes per day is very important factor in tooth decay. However, teeth should not be brushed immediately after eating to reduce tooth wear. Matthew Ferguson (talk) 20:01, 20 July 2017 (UTC)

Should this be renamed tooth decay since that is what most people know it as?
Should this be reamed tooth decay since that is what most people know it as? Tremello (talk) 18:26, 18 November 2016 (UTC)
 * I would be supportive. Doc James  (talk · contribs · email) 21:29, 18 November 2016 (UTC)
 * Me too. --Anthonyhcole (talk · contribs · email) 11:16, 19 November 2016 (UTC)
 * Yes. If you mean rename the article. Per my understanding tooth decay is the process that results in a tooth cavity/dental cavity, also known as a dental caries. I think Tooth decay is a better and more comprehensive name to describe the process, cause and effect(the cavity) for this article.CuriousMind01 (talk) 04:06, 20 November 2016 (UTC)
 * I'll rename it, but I'm open to having a fuller discussion if others would want. NW ( Talk ) 01:53, 1 January 2017 (UTC)
 * Thank you, NW, and may all your wishes be fulfilled in 2017. --Anthonyhcole (talk · contribs · email) 13:07, 2 January 2017 (UTC)

Dietary sugars section
The definition of cariogenicity in this article is at odds with the one in the ref below, which states that cariogenicity is the strength of the caries-producing effect of a food, not the effect of sugars on caries. the latter is not a medrs, but the section generally seems a bit muddled; it's also based on a non-medical ref from 2006 and a ref from 1983.

HLHJ (talk) 22:48, 25 March 2018 (UTC)