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It submitted my edit before I could explain...basically, someone deleted most of a paragraph of unreferenced medical advice. They left only a couple of sentences, which talk about the deleted information, so that you need the deleted information to understand what the remaining part is talking about. -- 12.116.162.162 18:57, 18 April 2007 (UTC)
Lesion - what did you mean by
The tooth pulp behaves like a visceral structure in terms of how associated pain is perceived. [1]
I'm not sure how to use the reference Ian Furst ( talk) 14:06, 20 December 2013 (UTC)
Lesion; I was still going to discuss odontogenic and non-odontogenic classification, but the individual headings add almost nothing except maybe to the dental audience. Should we just ditch the extra headings? Ian Furst ( talk) 15:08, 20 December 2013 (UTC)
I see you have merged the other "pulpal" causes of toothache into a section called "pulpitis". I question whether dentin hypersensitivity is a type of pulpitis. If these are merged (which I think is less clear for readers), then the title has to be something wider than pulpitis for accuracy. Lesion ( talk) 21:05, 20 December 2013 (UTC)
Ian Furst ( talk) 23:21, 20 December 2013 (UTC)
Replies:
I took Li2011 out of a reference in the pulpal area (switching over to non-primary) - but you'd used it in the perio section, sorry. Do you have the original reference or do you mind if I replace the refrence with one from pathways of the pulp (non-primary)? Ian Furst ( talk) 14:02, 22 December 2013 (UTC)
any preference for which section I hit next? Ian Furst ( talk) 17:18, 23 December 2013 (UTC)
I have tweaked the wording here. Also I feel we have a problem with this sentence:
Terms like psychogenic, somatoform and psychosomatic are commonly misused, but they have different definitions.
Similarly, there is difficultly linking psychogenic pain with drug seeking behavior...
There is a minefield of psych terms which we should probably avoid as much as possible... least of all because they keep changing the names of everything... Suggest if we are going to use any psych term, we keep it very general, not naming any specific condition like Munchausen, and make sure we give a correct definition. Lesion ( talk) 18:50, 23 December 2013 (UTC)
In terms of organic disease, I do not think we mention enough ... TMD? Although perhaps we will discuss that more in the section "occlusal trauma". I'm guessing that overloading of the periodontal ligament is the main mechanism by which TMD and bruxism cause dental pain. We also don't mention maxillary sinusitis... Suggest we start a list of things we want to cover here: Lesion ( talk) 14:25, 25 December 2013 (UTC)
the esthetics and balance of the thumb size pics are making me apeshit. I'm going to resize them, for now, and recalibrate the originals down the road. Hope that's ok Ian Furst ( talk) 14:07, 22 December 2013 (UTC)
what's that? Ian Furst ( talk) 16:55, 23 December 2013 (UTC)
Also posted on talk:dentin hypersensitivity
Hey Lesion, received a response back from an endo colleague regarding the etiology of the pain after asking if it was a mild pulpitis,
“ | No ! Dentinal sensitivity is the branstrom theory of fluid movement inside the Dentinal tubules and that causes firing if the nerves ending in the outer layer of the pulp. Theoricly[sic] pulp is healthy. Now repetitive and constant stimulus can be etiology for a future pulpitis. Check.[sic] Bramstron | ” |
— S.Abitbol, Endodontist, email communications |
With that info, I found a review at
pubmed pmid 22238734.
Bottom line, I think is that it's got to be it's own subcat, and by the same logic so does cracked tooth pain. Will modify both.
Ian Furst (
talk)
11:33, 21 December 2013 (UTC)
Here is a brief summary of the content on dentin hypersensitivty. I will put inline refs in later, they can be easily re-used from that article. Lesion ( talk) 16:55, 22 December 2013 (UTC)
Dentin hypersensitivity (also termed dentin sensitivity) is a very common cause of dental pain, occurring in about 15% of the general population to some degree. The pain is short lasting and sharp in character. It is triggered by thermal stimulae, especially cold drinks or cold air; or mechanical contact, e.g. toothbrushing. The main cause of dentin hypersensitivity is exposed dentin, which is normally covered by enamel or cementum and gingiva. A common scenario is gingival recession (receding gums) caused by either long term forceful/excessive toothbrushing or chronic periodontitis (gum disease). Being softer than enamel, the cementum and dentin are vulnerable to tooth wear (e.g. acid erosion caused by frequent consumption of acidic foods and drinks or conditions such as gastroesophageal reflux disease; or abrasion from toothbrushing). When dentin is exposed, dentinal tubules permit temperature and osmotic changes to be more readily detected by the nerves in the pulp. It is thought that dentin hypersensitivity usually represents a healthy, non-inflamed pulp responding to a lack of insulating layers of dental hard tissues to protect it from the external environment. There are many treatments and preventative strategies for dentin hypersensitivity, including desensitizing toothpastes and protective varnishes which are applied to the exposed dentin surface.
Sensitive teeth, or dentin hypersensitivity, is the short lasting pain to stimulants like cold drinks and spicy foods that occurs in 15% of the population. The pain is caused by a complex mechanism where the roots of teeth become exposed (often from GERD or abrasion) and the dentin of the root is laid bare to the mouth. Dentin, has small tubules which hold fluid and communicate with the pulp of the tooth. The pulp, in turn, has mechanotransducers, small nerve bodies that translate the movement of fluid into nerve impulses in the pulp, which create the painful sensation. When cold, heat, spicy food or a dental instrument touches the bare dentin on the root of the tooth, fluid moves in the dentin tubule and the mechanotransducer in the pulp creates a painful signal.
Ian Furst ( talk) 17:19, 22 December 2013 (UTC)
Good point re: sensitive teeth, my only concern being that 99% of the lay public will not draw the connection between "sensitive teeth" and "dentin hypersensitivity", imo and go along believe sensitivity to biting on an ice cube is abnormal. I think it would be better if you use a more formal version of point #3, maybe after reference #19? Something like, "This is sometimes referred to as sensitive teeth, however, truly sensitive teeth will.... whereas normal healthy teeth experience......". Right or wrong, the connection will exist in the minds of most, better to correct they myth than to avoid? Also, all but 1 of the references used are primary and I think could be replaced from most textbooks (e.g. nothing cutting edge being mentioned). Is there are particular reason you used them? Ian Furst ( talk) 22:57, 22 December 2013 (UTC)
Forgot: this sentence, "Most researchers concur that the pulp is notusually inflamed in this condition, and that nerves in the pulp have not become more sensitive to stimulae,[21][22] but rather that the stimulae have become more intense due to loss of insulating layers of tissues that used to separate dentin from the external environment. ". Doesn't read very well. It has a lot of qualifiers in it (most researchers..., not usually...,)and the point has already been made when you talk about the loss of cementum, enamel and gingiva. I was going to RW but I think the paragraph stands without it, unless there's a particular point you think has not been made? Ian Furst ( talk) 23:05, 22 December 2013 (UTC)
I have been wrapping up a publication in last few days. Sending to journal today so should be back on this task soon.
If you are interested, I was thinking to eventually get this article to GA and then publish it via that method for wikipedia articles (I sent you the link after you wrote dental implant if you remember). I know this goal would help motivate me. Lesion ( talk) 13:20, 1 January 2014 (UTC)
I have moved this section to immediately follow the lead. This is not the MEDMOS, but I think it works better for this particular article. Suggest put into this section:
We are mentioning the spread of odontogenic infection several times. We should probably only mention it in one place. Not sure if it is better to do this in the "pathophysiology" section or the "prognosis" section... Lesion ( talk)
Dental causes of toothache tend to be considered as either pulpal or periodontal. The teeth and the periodontium (i.e. the tissues that support the teeth) are innervated by the maxillary and mandibular divisions of the trigeminal nerve. The maxillary (upper) teeth and their associated periodontal ligament are innervated by the superior alveolar nerves, branches of the maxillary division, termed the posterior superior alveolar nerve, anterior superior alveolar nerve, and the variably present middle superior alveolar nerve. These nerves run through the maxilla in close relationship with the maxillary sinus before together forming the superior dental plexus above the maxillary teeth. The mandibular (lower) teeth and their associated periodontal ligament are innervated by the inferior alveolar nerve, a branch of the mandibular division. The inferior alveolar nerve enters the medial surface of mandibular ramus at the mandibular foramen and runs inside the mandible, below the mandibular teeth in the inferior alveolar canal giving off branches to all the lower teeth ( inferior dental plexus). [2] [3]
The oral mucosa of the gingiva (gums) is also innervated by branches of the trigeminal nerve, however often the gum will be innervated by a different nerve to the adjacent tooth. The gingiva on the facial (labial) aspect of the maxillary incisors, canines and premolar teeth is innervated by the superior labial branches of the infraorbital nerve. The posterior superior alveolar nerve supplies the gingiva on the facial aspect of the maxillary molar teeth. The gingiva on the palatal aspect of the maxillary teeth is innervated by the greater palatine nerve apart from in the incisor region, where it is the nasopalatine nerve (long sphenopalatine nerve). The gingiva of the lingual aspect of the mandibular teeth is innervated by the sublingual nerve, a branch of the lingual nerve. The gingiva on the facial aspect of the mandibular incisors and canines is innervated by the mental nerve, the end branch of the inferior alveolar nerve after it emerges from the mental foramen of the mandible. The gingiva of the buccal (cheek) aspect of the mandibular molar teeth is innervated by the buccal nerve (long buccal nerve). [3]
I've been searching around for a comparable that has reached good article status, chest pain, back pain, headache and abdominal pain are all mostly lists. But check out Low back pain, reads well, good balance of diagrams and it's reached good article status. The biggest thing, is that the sections don't follow the classic MEDMOS guidelines and use everyday language.
My suggestion would be to promote the differential diagnosis section and rename to causes. Demote the pathophysiology section and shorten to a 1 paragraph section which includes the current first paragraph and a short synopsis of para 2 and 3 (e.g. the innervation). With subcategories of pathophys of anatomic structures (tooth, bone, muscles) and pain pathways (innervation).
Our categories could be opening, causes, pathophysiology, diagnosis, management (I liked this term more than treatment, it saves us from having to write a dissertation on rct, pulpectomy, etc..., instead we can give a quick blurb for each and point to the proper article), prognosis then leave the rest the same?
Are you re-doing pathophys? I thought I was going to deal with that one - or have you already launched into it? Tell me a subsection you're not working on so that I can. Also, great call on the diagram - been following the conversation over there and it looks like it will be a winner. Ian Furst ( talk) 02:10, 28 December 2013 (UTC)
I suggest the WP:MEDMOS recommended headers for signs/symptoms. Might not be able to find any content for some of the sections. Also, I merged History with society and culture.
Essentially, since this is a symptom, I suggest a glorified list format. The differential diagnosis section might constitute the majority of the article, with a short paragraph linking to each cause and giving a brief description. Diagnostic approach could do with major expansion. Not sure what could go into pathophysiology. Talking about innervation and pain fibers maybe? Lesion ( talk) 16:29, 14 December 2013 (UTC)
==Differential diagnosis==
===Pulpitis==
Pulpitis is inflammation blah blah...
===Cracked cusp syndrome===
(←Also we maybe need to make this stub, not sure how it is different to cracked tooth syndrome or if they are the same thing)
... etc
I think we should keep focussed on pain felt in the teeth, gums and/alveolus on this article. I consider toothache to be a specific type of orofacial pain, which may include other parts of the face...
Some of the definitions of toothache I am reading in popular online dictionaries I do not feel are suitable:
An aching pain in or near a tooth.
...but not all pain felt in teeth is aching in character.
An ache localized in or around a tooth.
...same as above. Also not all pain felt in teeth is localized.
A pain in or about a tooth.
...better, but what about radiation?
The definition we are using right now is made up by me, but I am still not happy with it. We use "pain" instead of "ache", and we say "one or more teeth" instead of referring to a single tooth. After all, someone with bruxism or TMD might complain of "toothache" in several teeth. Should we add the qualifier "which may be well localized or poorly localized"? Should we add "which may radiate to other parts of the face"? Lesion ( talk) 16:42, 14 December 2013 (UTC)
Chest pain → cardiac pain → MI : Orofacial pain → toothache → pulpitis. Yes excellent analogy. Agree with you about not limiting toothache to one presentation or etiology. It is a very general term. Perhaps we are overthinking things. Imo, it is entirely appropriate to list all the potential etiologies of toothache on this page, but we will have dedicated pages for nearly all of them (except for specific descriptive things like "food packing"). It would be good to have a definition of pain early in the article.
I am not happy with my current definition. I added "felt in" because this covers "nonodontogenic odontalgia" e.g. referred pain from the maxillary sinus which is perceived in the teeth.
I like parts of your wording.
"supporting structures" avoids jargon like alveolus.
But "actual or potential damage" does not cover referred pain or atypical odontalgia etc etc. I would like to get across in the definition that rarely there is no disease of the teeth or supporting structures.
How about this:
Toothache is pain perceived as originating in a tooth (or multiple teeth) and/or the supporting structures (i.e. the periodontium). Very commonly, toothache is caused by some disease process of the teeth or gums; but rarely other conditions can cause toothache without any evident dental cause, e.g. referred pain from maxillary sinusitis.
"Perceived as originating" hopefully does not limit the location, and includes radiating pain. I think it would be good to say "single or multiple teeth" if not "which may be well localized or poorly localized". Suggest giving maxillary sinusitis as the nonodontogenic odontalgia example in the lead. I believe it is the most common non dental cause, but I have no source. It has been said that TMD pain is the second most common cause of orofacial pain, but per your analogy above, TMD pain may not always be toothache. Lesion ( talk) 21:52, 14 December 2013 (UTC)
Toothache is pain in a tooth or teeth caused by dental disease or localized non-dental disease that is referred to the teeth.
OK, I think we are getting there. I feel the wording "localized non-dental disease" might be confusing for readers? I also liked "supporting structures" that you suggested before. How about:
Toothache is pain in a tooth or teeth and/or supporting structures, caused by dental disease or non-dental disease which is perceived as toothache.
(Slightly off topic) When you ask about sinusitis causing mild periapical periodontitis, we are straying into the topic of maxillary sinusitis of odontogenic origin (aka odontogenic sinusitis), accounting for 10-40% of all maxillary sinusitis according to some reports. I think it is usually the other way around: the dental pathosis causes inflammation of the membrane of the sinus (see for example [4]). Perhaps sinusitis is a poor example (apart from being more common than the rest of the nonodontogenic toothaches), because the sinus is such an intimately related structure to the mouth, some sources do not consider this to be true referred pain. This is a quick excerpt from a paper I wrote recently:
Maxillary sinusitis is not uncommonly perceived as pain originating in the maxillary molar and premolar teeth, which may trigger patients to seek dental care. This is an example of so called "non-odontogenic toothache".[14] In one report, 11% of patients with sinusitis reported maxillary toothache.[15] In maxillary sinusitis, the posterior maxillary teeth may be tender to percussion,[16] and hypersensitive to cold stimuli. This is secondary hyperalgesia (i.e. concentric spread of pain beyond the area of tissue injury), rather than true referred pain.[17]
...Therefore "perceived as toothache" might be more general for the definition than specifically saying referred pain? Albeit incredibly rare, "percieved as toothache" also covers the truly psychogenic toothache. Lesion ( talk) 00:29, 15 December 2013 (UTC)
Toothache is pain in the teeth, their supporting structures, or both; caused by dental disease or non-dental disease which is perceived as toothache.
Ian Furst ( talk) 00:44, 15 December 2013 (UTC)
Just added a comma. I'm happy with this, not sure how others feel. Wonder if "in the teeth" should be "from the teeth" which better includes radiation of toothache into other parts of the face?
Lesion (
talk)
00:52, 15 December 2013 (UTC)
would it be good to include a short list of all the common mistakes people make when diagnosing toothache? See for example Pericoronitis#Diagnosis E.g. the "migratory abscess", where a pericoronal abscess tracts along the buccal sulcus and forms a parulis over the buccal aspect of the 6, and the 6 is extracted accidentally. Or diagnosing bilateral toothache in the lower posterior region as bilateral pericoronitis when in fact the myofascial element is more responsible for the pain. I'm also thinking about poorly localized toothache leading to treatment of a nearby obvious problem which is not contributing to the pain, when in fact there is some root caries in a periodontal pocket on the causative adjacent tooth. I have come across this sometimes. The grossly broken down tooth is dead and is not causing any of the pain, but the adjacent vital tooth with the tiny bit of decay is causing all the pain.
A few examples might highlight to readers how difficult it can be sometimes to diagnose the cause of toothache, even if that cause is dental and we are not looking at nonodontogenic toothache. Lesion ( talk) 22:28, 14 December 2013 (UTC)
Parameter | Dentin hypersensitivity | Reversible pulpitis | Irreversible pulpitis | Acute periapical periodontitis/ periapical abscess | Periodontal abscess | Pericoronal abscess | Myofascial pain | Maxillary sinusitis |
---|---|---|---|---|---|---|---|---|
Site | Poorly localized | Poorly localized | Poorly localized, unless combined with periapical periodontitis | Well localized. Classically patient able to point to involved tooth | Usually well localized | |||
Onset | - | - | - | |||||
Character | Sharp, shooting | Dull, continuous pain. Can also be sharp | Dull, continuous throbbing pain | Dull, continuous throbbing pain | ||||
Radiation | Does not cross midline | Does not cross midline | Does not cross midline | Does not cross midline | ||||
Associated symptoms | Patient may complain of receding gums and/or toothbrush abrasion cavities | - | - | Tooth may feel raised in socket | ||||
Time pattern | Hypersensitivity as long as stimulus applied. Often worse in cold weather | Pain as long as stimulus applied | Shooting pain when stimulus applied, but pain continues after stimulus removed. Also spontaneous pain with no stimulus. | |||||
Exacerbating/Relieving factors | Exacerbating: thermal, particularly cold | Exacerbating: thermal, sweet. | Simple analgesics have little effect | May still show symptoms of irreversible pulpitis, or no response to cold stimulus (pulp necrosis). Pain on application of heat may be more of a feature. Lying down worsens pain due to increased local blood pressure. Hurts to bite on tooth | ||||
Severity | Less severe than pulpitis | Severe, for short periods | Severe | Severe | ||||
Effect on sleep | None | None usually | Disrupts sleep | Disrupts sleep |
Most articles about medical signs and symptoms should follow the below recommended structure. Omit sections that your sources do not address and combine sections when this seems sensible. For example, the definition of some signs is amply covered by an explanation of the mechanism, so having a section dedicated to the definition would be redundant.
- Definition (current definitions)
- Differential diagnoses or Associated medical conditions
- Pathophysiology or Mechanism
- Diagnostic approach or Evaluation
- Treatment or Management (for the symptom itself, if any: e.g., analgesics for pain)
- Epidemiology (incidence, prevalence, risk factors)
- History (of the science, not of the patient: e.g., "The oldest surviving description is in a medical text written by Avicenna.")
- Society and culture (e.g., cachexia was a literary symbol for tuberculosis in the 19th century and for AIDS in the 1980s.)
- Research (Is anything important being done?)
- Other animals
Lesion - I was hoping to convert the existing lists into a narrative that is more user friendly. Here is a draft (without any links or references yet) I've been working on for pulpal conditions. What do you think about it? My thought, is that if you like the general tone, we can edit this paragraph together to get a better sense of each other's editorial style, then (assuming we find common ground) divide the remaining paragraphs.
The most common cause of toothache is pulpal inflammation. Each tooth is made of enamel over a softer core called dentin. Under the dentin, on the inside of the tooth, the root canal and pulp chamber contain the nerves and blood vessels of a tooth. The pulp structure is soft tissue (compared to the hard tissue of the outer structures) and susceptible to inflammation. When the pulp of the tooth becomes inflamed, a pulpitis occurs, nerves become sensitized and a toothache occurs. Many things can cause pulpitis such as cavities, a cracked tooth, a leaking filling and trauma.
Inflammation and swelling of the pulp cause sensitivity to cold and sometimes hot. If treated early or if the insult to the pulp is mild, the inflammation subsides, and the symptoms disappear. This is called reversible pulpitis and is usually characterized by short lasting pain to cold. If the pulp swells too much, however, the swelling constricts the vessels at the end of the tooth root and can obstruct the blood supply. The pulp in the root canal and chamber will then die. This type of inflammation is called irreversible pulpitis and is similar in principal to the swelling that occurs in a brain injury. The hallmark of irreversible pulpitis is spontaneous pain or lingering pain to cold. Once the pulp completely dies, there can be a period when the tooth doesn’t hurt unless it is causing periapical periodontitis. After that, the dying tissue, bacteria and gases build up in the pulp chamber and can force their way through the apex of the tooth. During this time, tooth pain is spontaneous and the tooth becomes tender to bite on as the periapical tissues inflame. Hot drinks can make the tooth feel worse (it's speculated that gases inside the pulp chamber expand), likewise, cold can make it feel better. The dental pulp is now necrotic and emergency treatment is required.
Ian Furst ( talk) 14:19, 16 December 2013 (UTC)
The think most logical way to organize discussion of causes is:
Hey Lesion, part II of today's missives. As we start to build this, what do you think about using the {{cite|pmid}} and {{cite|isbn}}? That way, as we build other articles we should have a mass of books already referenced in global templates? I've been using it in the dental implant and also find it helps with readability in edit mode. Ian Furst ( talk) 14:38, 16 December 2013 (UTC)
correct for {{cite isbn| xxx|pages=a-b OR page=zz}}, essentially it creates a unique template page for that book. Every time it's cited, it just grabs the info from the template page. The assumption is, you'll always be citing different page numbers anyways. However, if you want to cite the exact same reference twice (like you would with a PMID article or the exact same pages in a book) then you should include a refname. The only other different is PMID has a bot to autofill the template page, isbn does not. Ian Furst ( talk) 23:27, 20 December 2013 (UTC)
The referencing is turning into a mess. Apologies if this is my fault, I am not used to this format. Lesion ( talk) 15:06, 25 December 2013 (UTC)
I check pages listed in Category:Pages with incorrect ref formatting to try to fix reference errors. One of the things I do is look for content for orphaned references in wikilinked articles. I have found content for some of Toothache's orphans, the problem is that I found more than one version. I can't determine which (if any) is correct for this article, so I am asking for a sentient editor to look it over and copy the correct ref content into this article.
Reference named "Neville 2001":
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link)I apologize if any of the above are effectively identical; I am just a simple computer program, so I can't determine whether minor differences are significant or not. AnomieBOT ⚡ 02:17, 3 January 2014 (UTC)
looking for input on which labels to add, will do it as numbers (so legend will go underneath). Because this is a general article, I wasn't going to go crazy with the labels, just those needed to explain toothache. Here's what I thought (each will be a number):
Ian Furst ( talk) 19:34, 3 January 2014 (UTC)
I've taken high quality pics of tooth sleuth, ethyl chloride on cotton tipped applicator (cold), EPT, explorer/perio probe. Anything else I should get a shot of? Ian Furst ( talk) 17:55, 10 January 2014 (UTC)
vanity, body modification same as eyeball jewelry. It's just a diamond chip held on with composite, apparently an ex-employer did it for her. Pretty subtle Ian Furst ( talk) 02:09, 11 January 2014 (UTC)
initial table filled in, will work on referring and rewording tonight/tomorrow - feel free to edit as well. It's a lot. Ian Furst ( talk) 20:23, 14 January 2014 (UTC)
is an online resource that a great many dentists around the world rely on for evidence based treatment decisions in dental trauma. It's a critical support but I can't fit it into any of the reliable sources pigeon holes. Any ideas? Leave it out?
Hey Lesion, a rough draft of the completed article is now done imo. Some of the sections (perio abscess, occlusal trauma, part of necrosis) are still largely unreferenced. Next step is to read, start to finish for flow so you may see some copyediting. Will also watch to add pictures - don't like the endo pic so will get a new one. Ian Furst ( talk) 11:48, 17 January 2014 (UTC)
Should dry socket be classified under our periodontal pain? question from original author inline text. imo, including it in this article is arbitrary anyway (since there's no tooth, therefore no toothache) but should absolutely be included because it's so common. Periodontal seems a good a place as any, it's not non-dental, not pulpal. We could make another classification (for cysts, tumors, other diseases of the jaws that cause toothache) and include it in there? Ian Furst ( talk) 22:09, 19 January 2014 (UTC)
::PoP, page 55 divides it into somatic and neural structures but then provides a more practical list for nonodontogenic sources,
I went to the subsection with the intent of reorganizing, but I think it reads well and hits all the highlights mentioned about. Agree that DS should be part of periodontal. Ian Furst ( talk) 02:11, 20 January 2014 (UTC)
started reading thru the prognosis section to insert references and realized it deals mostly with a description of the naturally history of pulpitis. I was think the section should deal more with the prognosis of the common conditions, if treated. thoughts? Ian Furst ( talk) 20:54, 20 January 2014 (UTC)
Awkward sentence, IMO; rewrite?
"At first, only noxious stimuli stimulate the nerve minimizing the pain felt to that time when the stimulus is applied (for instance cold)." -- Hordaland ( talk) 19:04, 26 January 2014 (UTC)
I felt old diagram placed too much emphasis on long buccal, mental and infraorbital nerves, none of which consistently supply the teeth. Lesion ( talk) 19:33, 26 January 2014 (UTC)
"Irreversible pulpitis, characterized by severe spontaneous pain and lingering pain to cold..."
Really? That's not my experience. I've had several root canals, and the pain preceding them was relieved, not intensified, by cold (ice in my mouth). -- Hordaland ( talk) 18:43, 26 January 2014 (UTC)
Hey Lesion, I think we've got it looking pretty good. Lots of pictures, all secondary sources (although the one trauma guide reference is still in, but also in the EL's). What are your thoughts about submission to GA? Ian Furst ( talk) 20:13, 26 January 2014 (UTC)
OK, I'm going to leave it alone for a bit and let you work your magic. Once you think it's ready for a GA submission, either let me know so I can help you make the changes as they're recommended or I can submit. Happy to help out either way. Like the additional cultural shots. Ian Furst ( talk) 20:55, 26 January 2014 (UTC)
Could this be a better lead image? Lesion ( talk) 13:25, 4 February 2014 (UTC) →
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This is an archive of past discussions. Do not edit the contents of this page. If you wish to start a new discussion or revive an old one, please do so on the current talk page. |
Archive 1 | Archive 2 |
It submitted my edit before I could explain...basically, someone deleted most of a paragraph of unreferenced medical advice. They left only a couple of sentences, which talk about the deleted information, so that you need the deleted information to understand what the remaining part is talking about. -- 12.116.162.162 18:57, 18 April 2007 (UTC)
Lesion - what did you mean by
The tooth pulp behaves like a visceral structure in terms of how associated pain is perceived. [1]
I'm not sure how to use the reference Ian Furst ( talk) 14:06, 20 December 2013 (UTC)
Lesion; I was still going to discuss odontogenic and non-odontogenic classification, but the individual headings add almost nothing except maybe to the dental audience. Should we just ditch the extra headings? Ian Furst ( talk) 15:08, 20 December 2013 (UTC)
I see you have merged the other "pulpal" causes of toothache into a section called "pulpitis". I question whether dentin hypersensitivity is a type of pulpitis. If these are merged (which I think is less clear for readers), then the title has to be something wider than pulpitis for accuracy. Lesion ( talk) 21:05, 20 December 2013 (UTC)
Ian Furst ( talk) 23:21, 20 December 2013 (UTC)
Replies:
I took Li2011 out of a reference in the pulpal area (switching over to non-primary) - but you'd used it in the perio section, sorry. Do you have the original reference or do you mind if I replace the refrence with one from pathways of the pulp (non-primary)? Ian Furst ( talk) 14:02, 22 December 2013 (UTC)
any preference for which section I hit next? Ian Furst ( talk) 17:18, 23 December 2013 (UTC)
I have tweaked the wording here. Also I feel we have a problem with this sentence:
Terms like psychogenic, somatoform and psychosomatic are commonly misused, but they have different definitions.
Similarly, there is difficultly linking psychogenic pain with drug seeking behavior...
There is a minefield of psych terms which we should probably avoid as much as possible... least of all because they keep changing the names of everything... Suggest if we are going to use any psych term, we keep it very general, not naming any specific condition like Munchausen, and make sure we give a correct definition. Lesion ( talk) 18:50, 23 December 2013 (UTC)
In terms of organic disease, I do not think we mention enough ... TMD? Although perhaps we will discuss that more in the section "occlusal trauma". I'm guessing that overloading of the periodontal ligament is the main mechanism by which TMD and bruxism cause dental pain. We also don't mention maxillary sinusitis... Suggest we start a list of things we want to cover here: Lesion ( talk) 14:25, 25 December 2013 (UTC)
the esthetics and balance of the thumb size pics are making me apeshit. I'm going to resize them, for now, and recalibrate the originals down the road. Hope that's ok Ian Furst ( talk) 14:07, 22 December 2013 (UTC)
what's that? Ian Furst ( talk) 16:55, 23 December 2013 (UTC)
Also posted on talk:dentin hypersensitivity
Hey Lesion, received a response back from an endo colleague regarding the etiology of the pain after asking if it was a mild pulpitis,
“ | No ! Dentinal sensitivity is the branstrom theory of fluid movement inside the Dentinal tubules and that causes firing if the nerves ending in the outer layer of the pulp. Theoricly[sic] pulp is healthy. Now repetitive and constant stimulus can be etiology for a future pulpitis. Check.[sic] Bramstron | ” |
— S.Abitbol, Endodontist, email communications |
With that info, I found a review at
pubmed pmid 22238734.
Bottom line, I think is that it's got to be it's own subcat, and by the same logic so does cracked tooth pain. Will modify both.
Ian Furst (
talk)
11:33, 21 December 2013 (UTC)
Here is a brief summary of the content on dentin hypersensitivty. I will put inline refs in later, they can be easily re-used from that article. Lesion ( talk) 16:55, 22 December 2013 (UTC)
Dentin hypersensitivity (also termed dentin sensitivity) is a very common cause of dental pain, occurring in about 15% of the general population to some degree. The pain is short lasting and sharp in character. It is triggered by thermal stimulae, especially cold drinks or cold air; or mechanical contact, e.g. toothbrushing. The main cause of dentin hypersensitivity is exposed dentin, which is normally covered by enamel or cementum and gingiva. A common scenario is gingival recession (receding gums) caused by either long term forceful/excessive toothbrushing or chronic periodontitis (gum disease). Being softer than enamel, the cementum and dentin are vulnerable to tooth wear (e.g. acid erosion caused by frequent consumption of acidic foods and drinks or conditions such as gastroesophageal reflux disease; or abrasion from toothbrushing). When dentin is exposed, dentinal tubules permit temperature and osmotic changes to be more readily detected by the nerves in the pulp. It is thought that dentin hypersensitivity usually represents a healthy, non-inflamed pulp responding to a lack of insulating layers of dental hard tissues to protect it from the external environment. There are many treatments and preventative strategies for dentin hypersensitivity, including desensitizing toothpastes and protective varnishes which are applied to the exposed dentin surface.
Sensitive teeth, or dentin hypersensitivity, is the short lasting pain to stimulants like cold drinks and spicy foods that occurs in 15% of the population. The pain is caused by a complex mechanism where the roots of teeth become exposed (often from GERD or abrasion) and the dentin of the root is laid bare to the mouth. Dentin, has small tubules which hold fluid and communicate with the pulp of the tooth. The pulp, in turn, has mechanotransducers, small nerve bodies that translate the movement of fluid into nerve impulses in the pulp, which create the painful sensation. When cold, heat, spicy food or a dental instrument touches the bare dentin on the root of the tooth, fluid moves in the dentin tubule and the mechanotransducer in the pulp creates a painful signal.
Ian Furst ( talk) 17:19, 22 December 2013 (UTC)
Good point re: sensitive teeth, my only concern being that 99% of the lay public will not draw the connection between "sensitive teeth" and "dentin hypersensitivity", imo and go along believe sensitivity to biting on an ice cube is abnormal. I think it would be better if you use a more formal version of point #3, maybe after reference #19? Something like, "This is sometimes referred to as sensitive teeth, however, truly sensitive teeth will.... whereas normal healthy teeth experience......". Right or wrong, the connection will exist in the minds of most, better to correct they myth than to avoid? Also, all but 1 of the references used are primary and I think could be replaced from most textbooks (e.g. nothing cutting edge being mentioned). Is there are particular reason you used them? Ian Furst ( talk) 22:57, 22 December 2013 (UTC)
Forgot: this sentence, "Most researchers concur that the pulp is notusually inflamed in this condition, and that nerves in the pulp have not become more sensitive to stimulae,[21][22] but rather that the stimulae have become more intense due to loss of insulating layers of tissues that used to separate dentin from the external environment. ". Doesn't read very well. It has a lot of qualifiers in it (most researchers..., not usually...,)and the point has already been made when you talk about the loss of cementum, enamel and gingiva. I was going to RW but I think the paragraph stands without it, unless there's a particular point you think has not been made? Ian Furst ( talk) 23:05, 22 December 2013 (UTC)
I have been wrapping up a publication in last few days. Sending to journal today so should be back on this task soon.
If you are interested, I was thinking to eventually get this article to GA and then publish it via that method for wikipedia articles (I sent you the link after you wrote dental implant if you remember). I know this goal would help motivate me. Lesion ( talk) 13:20, 1 January 2014 (UTC)
I have moved this section to immediately follow the lead. This is not the MEDMOS, but I think it works better for this particular article. Suggest put into this section:
We are mentioning the spread of odontogenic infection several times. We should probably only mention it in one place. Not sure if it is better to do this in the "pathophysiology" section or the "prognosis" section... Lesion ( talk)
Dental causes of toothache tend to be considered as either pulpal or periodontal. The teeth and the periodontium (i.e. the tissues that support the teeth) are innervated by the maxillary and mandibular divisions of the trigeminal nerve. The maxillary (upper) teeth and their associated periodontal ligament are innervated by the superior alveolar nerves, branches of the maxillary division, termed the posterior superior alveolar nerve, anterior superior alveolar nerve, and the variably present middle superior alveolar nerve. These nerves run through the maxilla in close relationship with the maxillary sinus before together forming the superior dental plexus above the maxillary teeth. The mandibular (lower) teeth and their associated periodontal ligament are innervated by the inferior alveolar nerve, a branch of the mandibular division. The inferior alveolar nerve enters the medial surface of mandibular ramus at the mandibular foramen and runs inside the mandible, below the mandibular teeth in the inferior alveolar canal giving off branches to all the lower teeth ( inferior dental plexus). [2] [3]
The oral mucosa of the gingiva (gums) is also innervated by branches of the trigeminal nerve, however often the gum will be innervated by a different nerve to the adjacent tooth. The gingiva on the facial (labial) aspect of the maxillary incisors, canines and premolar teeth is innervated by the superior labial branches of the infraorbital nerve. The posterior superior alveolar nerve supplies the gingiva on the facial aspect of the maxillary molar teeth. The gingiva on the palatal aspect of the maxillary teeth is innervated by the greater palatine nerve apart from in the incisor region, where it is the nasopalatine nerve (long sphenopalatine nerve). The gingiva of the lingual aspect of the mandibular teeth is innervated by the sublingual nerve, a branch of the lingual nerve. The gingiva on the facial aspect of the mandibular incisors and canines is innervated by the mental nerve, the end branch of the inferior alveolar nerve after it emerges from the mental foramen of the mandible. The gingiva of the buccal (cheek) aspect of the mandibular molar teeth is innervated by the buccal nerve (long buccal nerve). [3]
I've been searching around for a comparable that has reached good article status, chest pain, back pain, headache and abdominal pain are all mostly lists. But check out Low back pain, reads well, good balance of diagrams and it's reached good article status. The biggest thing, is that the sections don't follow the classic MEDMOS guidelines and use everyday language.
My suggestion would be to promote the differential diagnosis section and rename to causes. Demote the pathophysiology section and shorten to a 1 paragraph section which includes the current first paragraph and a short synopsis of para 2 and 3 (e.g. the innervation). With subcategories of pathophys of anatomic structures (tooth, bone, muscles) and pain pathways (innervation).
Our categories could be opening, causes, pathophysiology, diagnosis, management (I liked this term more than treatment, it saves us from having to write a dissertation on rct, pulpectomy, etc..., instead we can give a quick blurb for each and point to the proper article), prognosis then leave the rest the same?
Are you re-doing pathophys? I thought I was going to deal with that one - or have you already launched into it? Tell me a subsection you're not working on so that I can. Also, great call on the diagram - been following the conversation over there and it looks like it will be a winner. Ian Furst ( talk) 02:10, 28 December 2013 (UTC)
I suggest the WP:MEDMOS recommended headers for signs/symptoms. Might not be able to find any content for some of the sections. Also, I merged History with society and culture.
Essentially, since this is a symptom, I suggest a glorified list format. The differential diagnosis section might constitute the majority of the article, with a short paragraph linking to each cause and giving a brief description. Diagnostic approach could do with major expansion. Not sure what could go into pathophysiology. Talking about innervation and pain fibers maybe? Lesion ( talk) 16:29, 14 December 2013 (UTC)
==Differential diagnosis==
===Pulpitis==
Pulpitis is inflammation blah blah...
===Cracked cusp syndrome===
(←Also we maybe need to make this stub, not sure how it is different to cracked tooth syndrome or if they are the same thing)
... etc
I think we should keep focussed on pain felt in the teeth, gums and/alveolus on this article. I consider toothache to be a specific type of orofacial pain, which may include other parts of the face...
Some of the definitions of toothache I am reading in popular online dictionaries I do not feel are suitable:
An aching pain in or near a tooth.
...but not all pain felt in teeth is aching in character.
An ache localized in or around a tooth.
...same as above. Also not all pain felt in teeth is localized.
A pain in or about a tooth.
...better, but what about radiation?
The definition we are using right now is made up by me, but I am still not happy with it. We use "pain" instead of "ache", and we say "one or more teeth" instead of referring to a single tooth. After all, someone with bruxism or TMD might complain of "toothache" in several teeth. Should we add the qualifier "which may be well localized or poorly localized"? Should we add "which may radiate to other parts of the face"? Lesion ( talk) 16:42, 14 December 2013 (UTC)
Chest pain → cardiac pain → MI : Orofacial pain → toothache → pulpitis. Yes excellent analogy. Agree with you about not limiting toothache to one presentation or etiology. It is a very general term. Perhaps we are overthinking things. Imo, it is entirely appropriate to list all the potential etiologies of toothache on this page, but we will have dedicated pages for nearly all of them (except for specific descriptive things like "food packing"). It would be good to have a definition of pain early in the article.
I am not happy with my current definition. I added "felt in" because this covers "nonodontogenic odontalgia" e.g. referred pain from the maxillary sinus which is perceived in the teeth.
I like parts of your wording.
"supporting structures" avoids jargon like alveolus.
But "actual or potential damage" does not cover referred pain or atypical odontalgia etc etc. I would like to get across in the definition that rarely there is no disease of the teeth or supporting structures.
How about this:
Toothache is pain perceived as originating in a tooth (or multiple teeth) and/or the supporting structures (i.e. the periodontium). Very commonly, toothache is caused by some disease process of the teeth or gums; but rarely other conditions can cause toothache without any evident dental cause, e.g. referred pain from maxillary sinusitis.
"Perceived as originating" hopefully does not limit the location, and includes radiating pain. I think it would be good to say "single or multiple teeth" if not "which may be well localized or poorly localized". Suggest giving maxillary sinusitis as the nonodontogenic odontalgia example in the lead. I believe it is the most common non dental cause, but I have no source. It has been said that TMD pain is the second most common cause of orofacial pain, but per your analogy above, TMD pain may not always be toothache. Lesion ( talk) 21:52, 14 December 2013 (UTC)
Toothache is pain in a tooth or teeth caused by dental disease or localized non-dental disease that is referred to the teeth.
OK, I think we are getting there. I feel the wording "localized non-dental disease" might be confusing for readers? I also liked "supporting structures" that you suggested before. How about:
Toothache is pain in a tooth or teeth and/or supporting structures, caused by dental disease or non-dental disease which is perceived as toothache.
(Slightly off topic) When you ask about sinusitis causing mild periapical periodontitis, we are straying into the topic of maxillary sinusitis of odontogenic origin (aka odontogenic sinusitis), accounting for 10-40% of all maxillary sinusitis according to some reports. I think it is usually the other way around: the dental pathosis causes inflammation of the membrane of the sinus (see for example [4]). Perhaps sinusitis is a poor example (apart from being more common than the rest of the nonodontogenic toothaches), because the sinus is such an intimately related structure to the mouth, some sources do not consider this to be true referred pain. This is a quick excerpt from a paper I wrote recently:
Maxillary sinusitis is not uncommonly perceived as pain originating in the maxillary molar and premolar teeth, which may trigger patients to seek dental care. This is an example of so called "non-odontogenic toothache".[14] In one report, 11% of patients with sinusitis reported maxillary toothache.[15] In maxillary sinusitis, the posterior maxillary teeth may be tender to percussion,[16] and hypersensitive to cold stimuli. This is secondary hyperalgesia (i.e. concentric spread of pain beyond the area of tissue injury), rather than true referred pain.[17]
...Therefore "perceived as toothache" might be more general for the definition than specifically saying referred pain? Albeit incredibly rare, "percieved as toothache" also covers the truly psychogenic toothache. Lesion ( talk) 00:29, 15 December 2013 (UTC)
Toothache is pain in the teeth, their supporting structures, or both; caused by dental disease or non-dental disease which is perceived as toothache.
Ian Furst ( talk) 00:44, 15 December 2013 (UTC)
Just added a comma. I'm happy with this, not sure how others feel. Wonder if "in the teeth" should be "from the teeth" which better includes radiation of toothache into other parts of the face?
Lesion (
talk)
00:52, 15 December 2013 (UTC)
would it be good to include a short list of all the common mistakes people make when diagnosing toothache? See for example Pericoronitis#Diagnosis E.g. the "migratory abscess", where a pericoronal abscess tracts along the buccal sulcus and forms a parulis over the buccal aspect of the 6, and the 6 is extracted accidentally. Or diagnosing bilateral toothache in the lower posterior region as bilateral pericoronitis when in fact the myofascial element is more responsible for the pain. I'm also thinking about poorly localized toothache leading to treatment of a nearby obvious problem which is not contributing to the pain, when in fact there is some root caries in a periodontal pocket on the causative adjacent tooth. I have come across this sometimes. The grossly broken down tooth is dead and is not causing any of the pain, but the adjacent vital tooth with the tiny bit of decay is causing all the pain.
A few examples might highlight to readers how difficult it can be sometimes to diagnose the cause of toothache, even if that cause is dental and we are not looking at nonodontogenic toothache. Lesion ( talk) 22:28, 14 December 2013 (UTC)
Parameter | Dentin hypersensitivity | Reversible pulpitis | Irreversible pulpitis | Acute periapical periodontitis/ periapical abscess | Periodontal abscess | Pericoronal abscess | Myofascial pain | Maxillary sinusitis |
---|---|---|---|---|---|---|---|---|
Site | Poorly localized | Poorly localized | Poorly localized, unless combined with periapical periodontitis | Well localized. Classically patient able to point to involved tooth | Usually well localized | |||
Onset | - | - | - | |||||
Character | Sharp, shooting | Dull, continuous pain. Can also be sharp | Dull, continuous throbbing pain | Dull, continuous throbbing pain | ||||
Radiation | Does not cross midline | Does not cross midline | Does not cross midline | Does not cross midline | ||||
Associated symptoms | Patient may complain of receding gums and/or toothbrush abrasion cavities | - | - | Tooth may feel raised in socket | ||||
Time pattern | Hypersensitivity as long as stimulus applied. Often worse in cold weather | Pain as long as stimulus applied | Shooting pain when stimulus applied, but pain continues after stimulus removed. Also spontaneous pain with no stimulus. | |||||
Exacerbating/Relieving factors | Exacerbating: thermal, particularly cold | Exacerbating: thermal, sweet. | Simple analgesics have little effect | May still show symptoms of irreversible pulpitis, or no response to cold stimulus (pulp necrosis). Pain on application of heat may be more of a feature. Lying down worsens pain due to increased local blood pressure. Hurts to bite on tooth | ||||
Severity | Less severe than pulpitis | Severe, for short periods | Severe | Severe | ||||
Effect on sleep | None | None usually | Disrupts sleep | Disrupts sleep |
Most articles about medical signs and symptoms should follow the below recommended structure. Omit sections that your sources do not address and combine sections when this seems sensible. For example, the definition of some signs is amply covered by an explanation of the mechanism, so having a section dedicated to the definition would be redundant.
- Definition (current definitions)
- Differential diagnoses or Associated medical conditions
- Pathophysiology or Mechanism
- Diagnostic approach or Evaluation
- Treatment or Management (for the symptom itself, if any: e.g., analgesics for pain)
- Epidemiology (incidence, prevalence, risk factors)
- History (of the science, not of the patient: e.g., "The oldest surviving description is in a medical text written by Avicenna.")
- Society and culture (e.g., cachexia was a literary symbol for tuberculosis in the 19th century and for AIDS in the 1980s.)
- Research (Is anything important being done?)
- Other animals
Lesion - I was hoping to convert the existing lists into a narrative that is more user friendly. Here is a draft (without any links or references yet) I've been working on for pulpal conditions. What do you think about it? My thought, is that if you like the general tone, we can edit this paragraph together to get a better sense of each other's editorial style, then (assuming we find common ground) divide the remaining paragraphs.
The most common cause of toothache is pulpal inflammation. Each tooth is made of enamel over a softer core called dentin. Under the dentin, on the inside of the tooth, the root canal and pulp chamber contain the nerves and blood vessels of a tooth. The pulp structure is soft tissue (compared to the hard tissue of the outer structures) and susceptible to inflammation. When the pulp of the tooth becomes inflamed, a pulpitis occurs, nerves become sensitized and a toothache occurs. Many things can cause pulpitis such as cavities, a cracked tooth, a leaking filling and trauma.
Inflammation and swelling of the pulp cause sensitivity to cold and sometimes hot. If treated early or if the insult to the pulp is mild, the inflammation subsides, and the symptoms disappear. This is called reversible pulpitis and is usually characterized by short lasting pain to cold. If the pulp swells too much, however, the swelling constricts the vessels at the end of the tooth root and can obstruct the blood supply. The pulp in the root canal and chamber will then die. This type of inflammation is called irreversible pulpitis and is similar in principal to the swelling that occurs in a brain injury. The hallmark of irreversible pulpitis is spontaneous pain or lingering pain to cold. Once the pulp completely dies, there can be a period when the tooth doesn’t hurt unless it is causing periapical periodontitis. After that, the dying tissue, bacteria and gases build up in the pulp chamber and can force their way through the apex of the tooth. During this time, tooth pain is spontaneous and the tooth becomes tender to bite on as the periapical tissues inflame. Hot drinks can make the tooth feel worse (it's speculated that gases inside the pulp chamber expand), likewise, cold can make it feel better. The dental pulp is now necrotic and emergency treatment is required.
Ian Furst ( talk) 14:19, 16 December 2013 (UTC)
The think most logical way to organize discussion of causes is:
Hey Lesion, part II of today's missives. As we start to build this, what do you think about using the {{cite|pmid}} and {{cite|isbn}}? That way, as we build other articles we should have a mass of books already referenced in global templates? I've been using it in the dental implant and also find it helps with readability in edit mode. Ian Furst ( talk) 14:38, 16 December 2013 (UTC)
correct for {{cite isbn| xxx|pages=a-b OR page=zz}}, essentially it creates a unique template page for that book. Every time it's cited, it just grabs the info from the template page. The assumption is, you'll always be citing different page numbers anyways. However, if you want to cite the exact same reference twice (like you would with a PMID article or the exact same pages in a book) then you should include a refname. The only other different is PMID has a bot to autofill the template page, isbn does not. Ian Furst ( talk) 23:27, 20 December 2013 (UTC)
The referencing is turning into a mess. Apologies if this is my fault, I am not used to this format. Lesion ( talk) 15:06, 25 December 2013 (UTC)
I check pages listed in Category:Pages with incorrect ref formatting to try to fix reference errors. One of the things I do is look for content for orphaned references in wikilinked articles. I have found content for some of Toothache's orphans, the problem is that I found more than one version. I can't determine which (if any) is correct for this article, so I am asking for a sentient editor to look it over and copy the correct ref content into this article.
Reference named "Neville 2001":
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link)I apologize if any of the above are effectively identical; I am just a simple computer program, so I can't determine whether minor differences are significant or not. AnomieBOT ⚡ 02:17, 3 January 2014 (UTC)
looking for input on which labels to add, will do it as numbers (so legend will go underneath). Because this is a general article, I wasn't going to go crazy with the labels, just those needed to explain toothache. Here's what I thought (each will be a number):
Ian Furst ( talk) 19:34, 3 January 2014 (UTC)
I've taken high quality pics of tooth sleuth, ethyl chloride on cotton tipped applicator (cold), EPT, explorer/perio probe. Anything else I should get a shot of? Ian Furst ( talk) 17:55, 10 January 2014 (UTC)
vanity, body modification same as eyeball jewelry. It's just a diamond chip held on with composite, apparently an ex-employer did it for her. Pretty subtle Ian Furst ( talk) 02:09, 11 January 2014 (UTC)
initial table filled in, will work on referring and rewording tonight/tomorrow - feel free to edit as well. It's a lot. Ian Furst ( talk) 20:23, 14 January 2014 (UTC)
is an online resource that a great many dentists around the world rely on for evidence based treatment decisions in dental trauma. It's a critical support but I can't fit it into any of the reliable sources pigeon holes. Any ideas? Leave it out?
Hey Lesion, a rough draft of the completed article is now done imo. Some of the sections (perio abscess, occlusal trauma, part of necrosis) are still largely unreferenced. Next step is to read, start to finish for flow so you may see some copyediting. Will also watch to add pictures - don't like the endo pic so will get a new one. Ian Furst ( talk) 11:48, 17 January 2014 (UTC)
Should dry socket be classified under our periodontal pain? question from original author inline text. imo, including it in this article is arbitrary anyway (since there's no tooth, therefore no toothache) but should absolutely be included because it's so common. Periodontal seems a good a place as any, it's not non-dental, not pulpal. We could make another classification (for cysts, tumors, other diseases of the jaws that cause toothache) and include it in there? Ian Furst ( talk) 22:09, 19 January 2014 (UTC)
::PoP, page 55 divides it into somatic and neural structures but then provides a more practical list for nonodontogenic sources,
I went to the subsection with the intent of reorganizing, but I think it reads well and hits all the highlights mentioned about. Agree that DS should be part of periodontal. Ian Furst ( talk) 02:11, 20 January 2014 (UTC)
started reading thru the prognosis section to insert references and realized it deals mostly with a description of the naturally history of pulpitis. I was think the section should deal more with the prognosis of the common conditions, if treated. thoughts? Ian Furst ( talk) 20:54, 20 January 2014 (UTC)
Awkward sentence, IMO; rewrite?
"At first, only noxious stimuli stimulate the nerve minimizing the pain felt to that time when the stimulus is applied (for instance cold)." -- Hordaland ( talk) 19:04, 26 January 2014 (UTC)
I felt old diagram placed too much emphasis on long buccal, mental and infraorbital nerves, none of which consistently supply the teeth. Lesion ( talk) 19:33, 26 January 2014 (UTC)
"Irreversible pulpitis, characterized by severe spontaneous pain and lingering pain to cold..."
Really? That's not my experience. I've had several root canals, and the pain preceding them was relieved, not intensified, by cold (ice in my mouth). -- Hordaland ( talk) 18:43, 26 January 2014 (UTC)
Hey Lesion, I think we've got it looking pretty good. Lots of pictures, all secondary sources (although the one trauma guide reference is still in, but also in the EL's). What are your thoughts about submission to GA? Ian Furst ( talk) 20:13, 26 January 2014 (UTC)
OK, I'm going to leave it alone for a bit and let you work your magic. Once you think it's ready for a GA submission, either let me know so I can help you make the changes as they're recommended or I can submit. Happy to help out either way. Like the additional cultural shots. Ian Furst ( talk) 20:55, 26 January 2014 (UTC)
Could this be a better lead image? Lesion ( talk) 13:25, 4 February 2014 (UTC) →
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