Talk:Tooth decay/Archive 1

This is an archive of past discussions about Tooth decay. 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

Concerning the toothbrush picture, "Toothbrushes are commonly used to clean teeth.", is something other than 'toothbrush' really needed? —Preceding unsigned comment added by 71.87.23.99 (talk) 17:17, 6 April 2009 (UTC)

The first image, while quite good, seems a bit too graphic. I'd propose that it be changed to something easier for squeamish people (like me)--maybe an illustration rather than a photograph. —The preceding unsigned comment was added by Pink jester (talk • contribs) 23:02, 10 April 2007.

I believe that is one of the best pictures that we have. I do not think there is an illustration that would do the topic justice, and I am sure the general public can handle it. - Dozenist talk 10:03, 11 April 2007 (UTC)

This was asked on the Extraction (Dental page, which is a much more graphic photo, and consensus was that it should stay, for educational purposes. This is fairly tame and should stay, as an illustration won't do as much justice. Dr-G - Illigetimi non carborundum est. 19:35, 11 April 2007 (UTC)

I think the main image is way gross!! I almost threw up!!````mary —Preceding unsigned comment added by Mary divalerio (talk • contribs) 22:36, 5 September 2007 (UTC)

I think the main image should definetly be removed!!!!--Gigilili 19:17, 8 September 2007 (UTC)

Wikipedia is uncensored: http://en.wikipedia.org/wiki/Wikipedia:What_Wikipedia_is_not#Wikipedia_is_not_censored —Preceding unsigned comment added by 141.213.220.186 (talk) 00:59, 9 January 2008 (UTC)

I agree, the main picture needs to be replaced with something more educational. —Preceding unsigned comment added by Salehjoon (talk • contribs) 02:33, 29 January 2009 (UTC)

Just interested to know how humanity has coped with tooth decay through out the ages, that'd be a good addition. Cheers --134.225.163.117 10:35, 29 April 2006 (UTC) I think the main imagage should be less graphic! It just seems too distgusting. An illastaration would be more appealing to my stoumach!!!```` mary —Preceding unsigned comment added by Mary divalerio (talk • contribs) 22:34, 5 September 2007 (UTC)

On September 28, 2008, Rodriguez Vargas published in the "Journal of the American Medical Association" his findings in the effectiveness of Iodine and other chemical agents as disinfectants of the mucous membranes of the mouth.

How is this possible? —Preceding unsigned comment added by 128.84.231.245 (talk) 20:04, 4 August 2008 (UTC)

I wonder if the NIH source [1] from which this article was largely derived is in fact public domain. See http://www.nlm.nih.gov/medlineplus/faq/copyrightfaq.html. Since the source article was part of the encylopedia, it may have reserved rights. What do you think? A-giau 20:34, 29 Aug 2004 (UTC)

I noticed the same thing. There is a copyright notice at the end of http://www.nlm.nih.gov/medlineplus/ency/article/001055.htm -Unknown

I agree...and there doesnt seem to be a reference to that site either?

Are there no picturs that would be good for this article? maybe someone can make a diagram of cavities. 199 22:51, 12 Jun 2005 (UTC)

For an illustration of dental caries, I suggest you make a link to:

http://www.db.od.mah.se/car/data/cariesser.html -Unknown

I suggest moving most of the content of this article to dental caries as that is the correct technical term. This article can remain to summarize dental caries and also expand on the non-caries causes of dental cavities (which are less important, caries accounting for most cavities). Comments? Alex.tan 04:10, August 3, 2005 (UTC)

I agree. Move it. Dental caries is the disease, while cavities are just some signs of the disease. 2004-12-29T22:45Z 05:38, August 3, 2005 (UTC)

If there are no objections, I will ask an administrator to move the page in a week's time (say on August 17th, 2005). The dental caries page needs to be deleted so that this page can be moved with its edit history intact. Alex.tan 17:26, August 10, 2005 (UTC)

the redirect has no edit history so there is no need for it to be deleted before the move. Plugwash 03:49, 17 August 2005 (UTC)

Oh, ok. Thanks for pointing that out. Alex.tan 14:26, August 17, 2005 (UTC)

There is a paragraph in the text that goes like this:

Oral hygiene is the primary prevention against dental caries. This consists of personal care (proper brushing at least twice a day and flossing at least daily) and professional care (regular dental examination and cleaning, every 6 months). Select X-rays may be taken yearly to detect possible cavity development in high risk areas of the mouth.

What I don't like about the paragraph is that it just gives indications, but it doesn't tell which dentists or organizations recommend those indications, i.e. where those recommendations come from, or what the source of those recommendations is. For example, do those recommendations come from one of the National Institutes of Health or from the American Dental Association or from somewhere else, e.g. a United Nations agency? If those recommendations come from the NIH or the ADA, then why do we have recommendations on this article that come from U.S. organizations and not frpm organizations somewhere else? The article should at least explain why those recommendations are widespread (if they are) and since when they are used.

The article should also explain which tests, experiments or studies or research or whatever support those claims. For example, why do the indications say that one should brush teeth twice a day and not three times or just one? Which study supports this? Where was the study done? Who made the study? Why did they come to that conclusion?

The same goes for other indications:

1. Why floss once a day and not three times or two?
2. Why have a dental examination twice a year and not four times or just one?
3. Why have teeth professionally cleaned twice a year and not, say, six times a year?
4. Why take X rays every year and not every six months or every two years?

2004-12-29T22:45Z 14:29, August 20, 2005 (UTC)

There are several points here, all valid.

Whilst good oral hygiene is a necessary component of prevention, low frequency of sugar intake is also necessary as a primary goal when treating a patient with caries. This is because the acidogenic theory of caries causation depends on bacteria consuming refined carboydrates and producing lactic acid. If you have lots of sugar coming into the mouth caries would still be likely to occur, despite meticulously kept teeth since total elimination of bacteria from the oral cavity is impossible (at least, if the patient is to live...). There are studies that look at both these issues that one of us should be able to find.

Also, the 6 month recall issue is fortunately being pushed aside by the more progressively-minded dentists. If you read the ammended article on the causes of caries it will be clear that different people will have different rates of dental caries depending on various factors. Thus to argue that all should attend on a six-monthly basis is totally unscientific and does not take into account the history of caries in the individual, nor the likely rate of development of caries based on their current oral hygiene regimen and sugar intake. In some cases a patient may need to be seen every three months. Another may not need to be seen for a couple of years. There are new guidelines in the UK on this. I will try to get a reference.

The advice to floss daily is based on the rate at which bacteria in the mouth tend to replicate and become established. It takes 24 hours for them to become sufficiently established to potentially cause problems to the gums. But to be honest, if there is enough sugar around, they will begin causing problems to the teeth within seconds or minutes of the floss leaving the tooth surface. Hence the advice above on sugar intake.

Cleaning is not required routinely unless there are specific indications and these usually relate to gum disease rather than caries. So to put regular cleaning in an article about caries seems a little spurious to me.

Finally, the part about taking x-rays yearly is also spurious following the same lines as above. Again, the frequency of x-rays needs to be based on the caries-risk of the patient. In some patients with a very high sugar intake and signs of caries on an x-ray today, re-x-raying in 3-6 months might be sensible. For another patient who has an untouched dentition, good oral hygiene and low sugar intake, x-rays spaced at 3 years would not be unreasonable. There are guidelines for this too. I'll try and lay my hands on them.--Richdom 19:58, 30 May 2006 (UTC)

The second thing that bugs me about this article is that it doesn't give more statistics. For example, does the prevalence ("frequency") of dental caries in a population depend on the consumption of processed food instead of whole foods or fibrous foods? If so, did the prevalence of caries increase throughout history because of the production of processed food? Is there any evidence?

Also, the article should talk more about dental caries and its prevalence in animals, because humans are not the only organisms that have dental caries. 2004-12-29T22:45Z 14:42, August 20, 2005 (UTC)

The article has to be improved in many ways. 2004-12-29T22:45Z 14:57, August 20, 2005 (UTC)

What the article says		What it should say
Dental caries, also known colloquially as tooth decay is a disease of the teeth resulting in damage to tooth structure.	14:11, August 19, 2005	It is a disease in which species of organisms other than humans? Which organisms have teeth, and since when in the history of evolution (e.g. a certain geological eon/era/epoch)?
Dental caries (tooth decay) is one of the most common of all disorders, second only to the common cold.	14:11, August 19, 2005	Which statistics support this claim that dental caries is second to the common cold? What are the numbers? Did this fact change throughout history? If so, since when is dental caries the second most common disorder? Which dentists or organizations made or make those statistical studies, where, when, how?
It usually occurs in children and young adults, but can affect any person. It is the most important cause of tooth loss in younger people.	14:11, August 19, 2005	Again, there should be numbers for this. For example, how many people have dental caries in a given population at a given time?
The bacteria convert foods—especially sugar and starch—into acids.	14:11, August 19, 2005	Which acids? Give some names and link them to other Wikipedia articles that give details about the acids. How do bacteria convert those mentioned foods into acids inside their cells? Which processes do those foods undergo inside the bacterial cells?
Plaque and bacteria begin to accumulate within 20 minutes after eating, the time when most bacterial activity occurs.	14:11, August 19, 2005	Where does the given time period ("20 minutes") come from? Different species of bacteria have different lengths of time for their reproductive cycles, so the article should be more specific.

For some reason people are ignoring this table. Someone put some good effort into it. The questions should be answered by someone. I, unfortunately, know nothing about it. There must be some dentists out there. Your contribution would be welcome. Twilight Realm 22:58, 23 January 2006 (UTC)

I'll get some info for you. Some of this may be supplied by two other dental articles that have become featured: Tooth enamel and Tooth development. From what I remember off the top of my head, I think I wrote more about this topic in the tooth enamel article. - Dozenist talk 01:33, 25 January 2006 (UTC)

Hmmm, you're right, this article does seem to be lacking. This is probably because it is based on another article which is directed toward the general public.

The final appoint above - about plaque beginning to accumulate within 20 minutes - is questionable. Bacteria start to colonise a freshly cleaned tooth surface within seconds regardless of the presence or otherwise of sucrose. I cut it in my radical cut. As noted in the comment below, I appologise if this has caused offence and would be happy if you wished to revert to the previous if you felt it better suited.--Richdom 19:12, 30 May 2006 (UTC)

According to the 1998 Adult Dental Health Survey of the UK, http://www.statistics.gov.uk/downloads/theme_health/AdltDentlHlth98_v3.pdf, 55% of dentate adults had caries when surveyed. And in the Child dental health survey of 2003, http://www.statistics.gov.uk/children/dentalhealth/downloads/cdh_dentinal_decay.pdf, 43% of 12 year olds had obvious dental caries. Might these be useful to include? And might they answer the point in the table above? --Richdom 19:36, 30 May 2006 (UTC)

Also, I am not aware of caries occuring in other animals. I would think this is because they tend not to eat refined carbohydrates If they did they would probably get it. Perhaps a vet can tell us?--Richdom 19:36, 30 May 2006 (UTC)

About plaque forming in 20 minutes, I am assuming that that statement referred to things like material alba forming, etc. But the details should be checked. And animals can get perio, so I assume they could possibly get caries. I saw that dogs have saliva with higher pH, which helps them not develop caries. - Dozenist talk 19:47, 30 May 2006 (UTC)

Here is a good link that covers this info request - it covers some caries in other animals, apes mostly. It also covers the historical increase in dental caries. I am struggling with how to include this information in the main article without plagiarising, but the info is so good (I learned stuff from it - you can never know everything about dental caries) it should be included. - http://www.uic.edu/classes/osci/osci590/11_1Epidemiology.htm - Dr-G - Illigetimi nil carborundum est. 18:13, 16 August 2006 (UTC)

I'm wondering how people treated cavities and tooth problems in ancient times when they used things like traditional Chinese medicine and accupuncture? DyslexicEditor 22:49, 21 November 2005 (UTC)

The article claims "It usually occurs in children and young adults..." What is the medical reason behind dental caries being more likely to occur in these groups? I can understand the children part — maybe children are less responsible about brushing their teeth, or maybe children tend to consume more candy, or maybe children just have weaker teeth, and any one of these three causes could be contributing factors — but why young adults, who should already know to be responsible about brushing teeth, who do not consume more candy than older adults, and who are unlikely to have weaker teeth than older adults? —Lowellian (reply) 10:23, 16 December 2005 (UTC)

Dental enamel becomes more resistant to dental caries over time due to exposure to flouride. However the theorised reasons for increased caries rates in children is the lack of oral hygiene, lack of manual dexterity, inability to understand concept of oral hygiene, inability to apply those concepts, increased frequency of intake of carbohydrates, increased susceptibility of primary teeth to decay due to differing quality of enamel when compared with adult teeth and decreased thickness of enamel when compared with adult teeth (increases likelyhood of cavitation). In young adults, a lot of the same applies as well as during the ugly duckling (mixed dentition) phase when there is a mixture of primary and permanent teeth in the mouth it can be difficult to access all areas to keep them clean, it can be painful to brush or floss as the gingivae may become inflamed during exfoliation (loss) and eruption (emergence) and motivation goes down (teenagers can lack motivation in other areas I'm sure) to look after teeth because of their 'patient perceived' appearance. So in answer to your question, the reasons for this increase are included under the psychobiosocial concept of disease, that is psychology, biology and social context contribute to the progression of the disease. I have no reference for this and am too lazy to look, which is why it hasn't gone into the main article. Also, I think it goes beyond an encyclopaedic contribution. ;) Dr-G - Illigetimi nil carborundum est. 18:25, 16 August 2006 (UTC)

Is there anything to back up the statement that "Dental caries (tooth decay) is one of the most common of all disorders, second only to the common cold"? Please see the chart above. Twilight Realm 22:59, 23 January 2006 (UTC)

• The statement appears to be inaccurate, or at least incomplete. I have changed the sentence to: "Dental caries is one of the most common disorders affecting humans [2] [3]." -AED 21:40, 16 March 2006 (UTC)

I was reading recently that someone presented a lecture at the IADR conference in Brisbane which was about caries still being the most prevalent human disease, but I can't find a reference anywhere, even on the WHO website. I always thought that caries was the MOST common human disease, followed by periodontal disease (gingivitis specifically). I will try to find a reference and update this section. Dr-G - Illigetimi nil carborundum est. 18:09, 16 August 2006 (UTC)

I'm not an expert on this, but isn't the standard Wikipedia policy to name articles for what they are most commonly known? For example, the article for bears isn't "Family Ursidae," and the article for Bill Clinton isn't "William Jefferson Clinton." Does that apply to this article? Should it be moved to "Tooth decay"? Twilight Realm 23:05, 23 January 2006 (UTC)

Above is a section of discussion where the article was successfully moved from cavities to dental caries, its current location. I think the article should remain with this name for clarity. Sometimes, there is actual decay on a tooth as seen in this picture. Othertimes, there is no "decay" at all but a demineralization process has begun. In that case, the lesion would still be called dental caries. Though we are just talking about names of the same thing, I do not see any problem with keeping the proper name for this as long as a link or redirect takes a person searching for tooth decay to this article. - Dozenist talk 18:03, 25 January 2006 (UTC)

Yes, the most common name in the lay public is usually used on Wikipedia, although there are several exceptions. Medical articles in general tend to be named using scientific names over lay terms, for a number of reasons. One is that people expect a certain formality and professionalism from an encyclopedia, and so proper terms should be used (for example, myocardial infarction instead of [[heart attack]]), with appropriate redirects and explanations in place. Another major reason is that as mentioned above, lay terms may be imprecise or refer to more than one entity. I would agree with keeping this at "Dental caries". — Knowledge Seeker দ 21:13, 24 February 2006 (UTC)

What's the singular of Caries? is it Carie or Cariis?

AFAIK, caries is singular. Dr-G - Illigetimi nil carborundum est. 18:15, 16 August 2006 (UTC)

Actually, I've just discovered that caries is both singular and plural. I suppose the context defines the correct grammar to use with caries. Dr-G - Illigetimi nil carborundum est. 02:27, 17 August 2006 (UTC)

the article name needs to change!!!!!!!!!!!!!!!!!!!!!!!!!!!!!--Gigilili 19:40, 8 September 2007 (UTC)

I find this a bit questionable... is this discounting teeth that are wiggly and naturally fall out? I think it would have to... so it really does surpass stuff like teeth getting knocked out? Are these based on world stats, inclusive of nations with no dental care, or on first-world nations? If they differ I think it would be good to expand upon that. Tyciol 18:36, 27 February 2006 (UTC)

What is meant by this is most significant pathological cause of tooth loss. Of course natural tooth exfoliation is a more common cause for loss of primary teeth, however what is implied here, and maybe it could be a bit clearer, is the loss of a tooth because of pathological reasons, not a natural physiological process. While this is clear to dentists and dental healthcare workers, it may not be to the general population. This may need a small rewrite.Dr-G - Illigetimi nil carborundum est. 17:58, 16 August 2006 (UTC)

I have edited the first section - causes - severely as I found the current piece did not present the causes in a logical fashion and there were a number of major errors, such as tooth wear being a result of caries (it is a different process resulting from one of three effects: attrition, abrasion or erosion). I'm afraid that I had to make so many changes that it became impossible to do this within the framework of the original and so I ended up cutting large parts. I hope to find references other than the standard text books I referred to in writing this article. --Richdom 16:24, 30 May 2006 (UTC)

• I have added 6 references to the above.--Richdom 19:03, 30 May 2006 (UTC)
• I have also just read the notes on editing material and appologise to the original authors and editors for not consulting on the changes I made before making them.--Richdom 19:03, 30 May 2006 (UTC)

I wonder if instead of 'Causes' we might consider using either the professional term 'aetiology' (etiology I think in the US) or the lay term 'development' since the article addresses a process that involves more than just the causes (i.e. sugars and bacteria). Otherwise, perhaps the causes should be simply stated, and the development addressed in another section. --Richdom 18:35, 1 June 2006 (UTC)

I think the 'prevention' part of the article needs a major cleanup. It seems to be more of an instructions format than an encyclopedia format.

Big work is needed there.---- Billyb 01:56, 3 July 2006 (UTC)

I agree. Not only is it in an instructional format, there are no citations for the information. I'm not a dentist, so I don't know the studies that have suggested these preventions, but I'm sure someone can add them. I'm adding some citation needed tags and flagging the Prevention section. Littleman TAMU 16:43, 7 August 2006 (UTC)

I am removing the tag at the top of the article saying there are not references in the Prevention section since our work on it recently has added some references. More references are still needed, but every section currently has some references. Anyone's thoughts? - Dozenist talk 02:53, 15 August 2006 (UTC)

I'm not trying to be contrary, Dozenist, but I think that saying that oral hygiene is the main method for the prevention of dental caries may be construed as non NPOV. This is probably incredibly nitpicky and in terms of an encyclopaedia probably has no bearing, which is why I haven't already edited this section, but poor dietary habit is the main contributor to dental caries, not the lack of oral hygiene. Semantics, I know. This is something I will never forget, because a colleague of mine failed his final paedo/ortho exam based on his response to the question from an examiner "What is the first thing you should do after diagnosing high caries risk in an individual?" He said oral hygiene instruction, but according to the examiner the correct answer is diet analysis. Reduction in intake of non-milk extrinsic sugars is probably the best way to reduce the incidence of dental caries (the benefits of oral hygiene notwithstanding), because the means of producing acid is being removed. While acidogenic bacteria are another 'cause' of dental caries, currently available oral hygiene practices do not produce asepsis in the mouth, even momentarily, so these bacteria are impossible to remove permanently. I would agree that it is far easier to change someone's oral hygiene practices than their dietary habits and therefore good oral hygiene may be considered more successful in the prevention of caries. I think what I'm getting at is, with the eilimination of NME sugars from the diet (which is actually easier than total elimination of plaque), the Stephan Curve of pH is also eliminated. This is probably a philosophical more than a practical point. What do you think? Dr-G - Illigetimi nil carborundum est. 18:47, 16 August 2006 (UTC)

Well, those are some good points, and let me express to you my immense gratitude for having your help on this article. Editing this stuff is so much easier when having someone else who knows about dentistry help out.

1) Concerning the main method for prevention of dental caries, perhaps it would be better to not say "main method" and just say something like "an important method"? Or, we could find a reliable source to quote what is the "main method for prevention"? That way, the article can back up the statement since I know there are many different philosophies and people like to emphasize different aspects of dentistry.

(2) I wanted to bring up something about one sentence which says: "Dental caries is usually discovered during routine checkups." I may be overly concerned about this, but I didn't know if the wording of the sentence implies something like "Most dental caries around the world are discovered in routine checkups" or "Dental caries is usually discovered in every routine chekcup." Since there are many people who do not go to the dentist and consequently have the caries go undiagnosed, and since some people do not have caries discovered during their checkup (by accident or because they do not have any caries at all), I thought perhaps something like "Dental caries can be discovered during routing checkups" would be better?

What are your thoughts on these two points? Also, I do not know if you have a digital camera, but if you do a picture of a periapical radiograph or bitewing showing an example of interproximal decay on teeth with no restorations would be useful. :-) I looked through some of my pictures last nite, but could not find any. The ones I found had huge amalgam restorations as well or what not, and that might get confusing to the untrained eye. I will look through the rest of my pictures tonite. - Dozenist talk 22:38, 16 August 2006 (UTC)

1) Whichever you feel works, I will go along with because as I pointed out, oral hygiene is probably practically a more effective method of preventing caries whereas dietary analysis and advice produce a behavioural change that is difficult to achieve and only reduces caries risk. I think we may need to include some items about demin/remin and possibly Stefan's Curve in order to put caries aetiology into context, although that may be a bit detailed. Citation for this would be great - possibly in E. Kidd - Caries? I don't have a copy of her book but it is fairly comprehensive, but it may not be obtainable in which case a rewording is in order. In the end of the day the point is moot, which may be the problem.

2) Yes, this is a rewrite that I did that I am not entirely happy with, I must say. I think that sentence could be left out altogether, I just rewrote what was there slightly to prevent repetition later on in the paragraph. It does indeed imply that most dental caries are discovered! I didn't write this originally, just adjusted but what I think the intention of this was to say that more caries is discovered on routine examination than by a direct complaint from a patient. Therefore, the patient is unaware that they have a lesion or lesions. This should be removed for the purposes of disambiguation and because it is probably unverifiable in the literature. I wouldn't say any epidemiological survey has specifically set out to determine whether this is true or not, but it could be inferred from DMFT surveys based on the decayed portion of the survey vs. filled or missing combined. Which I really don't want to do and don't think it is entirely necessary for the purposes of the article. So this is out.

Not a problem on helping out. I'm a bit lazy when it comes to citing. I wish I was doing this last year when I was doing my finals - it would have helped me a lot. I was more on the game then with references and I had access to a lovely dental library. Oh well. I'll just have to make do with what I have at the moment. On the pictures front, I have a few clinical photographs but I don't have permission to use them in this manner. What I might do is take some photos of my friends fillings - they won't mind them being bandied about on the internet! I don't have a nice clinical camera with a macro lens, just a crappy little compact dig with digital macro. It'll have to do until next month when I get the nice cam! I'll get on it. Radiographs will be a bit more difficult, but I'll try also. Some bitewings and a p.a. maybe if I can. Hard enough to get a good example. Dr-G - Illigetimi nil carborundum est. 02:09, 17 August 2006 (UTC)

Well done on the photos and radiographs, Dozenist. I don't think you will get much better than that! Dr-G - Illigetimi nil carborundum est. 12:39, 17 August 2006 (UTC)

Yeah, thanks! I was a little surprised to find a good picture. I cropped the bitewing to show it, but we'll see what else we can add. - Dozenist talk 18:41, 17 August 2006 (UTC)

To a layman, this image of a before/after tooth extraction seems confusing. It's shows two rows of teeth next to each other (like a shark) and there's gutter or border between the panels, or caption below, e.g. "before" on the left, "after" on the right; instead two separate events are contained in a single image. 2nd test, I turned up the brightness on my monitor (I like it darker for text reading) and the black/pink border became clearer. A white gutter between the panels would still be helpful and would certainly do no harm. --AC 17:25, 1 August 2007 (UTC)

You might want to nominate this article for "good article" status. I haven't examined it closely, but it seems like it will meet the criteria. It's got a ton of references, which is all too uncommon and as far as it can tell is well written and illustrated. ike9898 16:48, 17 October 2006 (UTC)

What is it called when the enamel of the tooth starts flaking off (when ridge develops on the surface of a tooth--the back of one of the front teeth in my case) and the teeth are transparent at the bottom? Are they related phenemenon? Brentt 20:14, 9 November 2006 (UTC)

Can you take a picture of it? And can you describe it more? Is this all of sudden or born with it? Any other weird phenomenon? - Dozenist talk 22:04, 9 November 2006 (UTC)

OK! How does tooth decay cause DEATH??? Obviously, you guys just enjoy exhaggerating the truth! —The preceding unsigned comment was added by 131.191.64.130 (talk • contribs) .

Dental infections, when severe and left untreated, can cause life-threatening infections, such as Ludwig's angina. - Dozenist talk 02:06, 14 November 2006 (UTC)

Anyone have any info on how long it can take for someone to actually die from an abscessed tooth, or teeth? I just got finished reading an article (link provided below), and wondered how long it may have taken.

http://www.washingtonpost.com/wp-dyn/content/article/2007/02/27/AR2007022702116_pf.html

There is a review of dental caries in the lancet this week: Selwitz R, Ismail A, Pitts N (2007). "Dental caries". Lancet. 369 (9555): 51–9. PMID 17208642.{{cite journal}}: CS1 maint: multiple names: authors list (link) --WS 21:55, 10 January 2007 (UTC)

I've promoted this article to Good Article status. It easily meets all requirements. Areas for improvement, in my view, include

• integrating or expanding the few one- or two-sentence paragraphs;
• a section on incidence (epidemiology); I realize this information is in the lead, but generally the lead summarizes the rest of the article, and I didn't see incidence information there.
• look for opportunities to reduce the repetition of the word "caries"; a previous edit of mine was to that effect.

User: deftdrummer Time: 0018 Hey, it is not a news story it is an encyclopedic article. The lead is really just a large paragraph summary. I do agree though that one and two sentence paragraphs should be integrated or eliminated. —Preceding unsigned comment added by Deftdrummer (talk • contribs) 07:20, 12 October 2007 (UTC) Nice work! –Outriggr § 05:35, 14 January 2007 (UTC)

I have rated the article as having a top priority in dentistry for several reasons. The disease is widespread and common. Treatments for caries are commonplace and essential to understand by all dentists. There is a long history of the disease. Lastly, most people, even non-dentists, know what "cavities" are. - Dozenist talk 14:11, 14 January 2007 (UTC)

I concur. As a rule of thumb, if I (a non-dentist) am rather familiar with the dental subject, surely it has to be one of the top two on the scale . . . · j e r s y k o talk · 15:24, 14 January 2007 (UTC)

I remember this coming up somewhere before but I can't remember exactly where. In the first sentence it is absolutely NOT correct to say 'otherwise known as dental cavities". Caries can cause cavitation, but not always, especially in the case of remineralisable early carious lesions. So to say caries and cavities are the same is not correct, despite the recommendations of the peer review. I think this needs to be clarified.Dr-G - Illigetimi nil carborundum est. 16:32, 3 February 2007 (UTC)

Can anyone add some explanation to the section that mentions methamphetamine use as a cause of rampant caries? I found that an interesting correlation, but there is nothing to explain the mechanism in the article. Presumably someone familiar with the issue could add a sentence or two to clarify it. Otherwise this is a very good article and the pictures alone might scare some children into brushing their teeth (along the lines of the Simpsons’ “Big Book of British Smiles”). -Fenevad 01:44, 15 February 2007 (UTC)

Never mind. I went and found the explanation myself and will add it in. -Fenevad 01:46, 15 February 2007 (UTC)

I just removed the following text put in by Alesnormales:

More specifically, tooth decay (dental caries) was not a major problem before the fateful year of 1886. That was the year that Coca Cola was first invented and marketed.

Prior to the mass marketing of Coca Cola, Americans (and the rest of the world) tended to eat sweet foods only at meal times, which in an agrarian society happened at only two or three discreet times a day. Meals were high in fat, but fairly low in sugar, and the closest most people got to sugar during the course of a week was a slice or two of mom’s apple pie. In general, tooth decay wasn’t all that much of a problem with most Americans unless they were among the upper classes. Rich folks were somewhat more likely to indulge in recreational eating and could afford to hire cooks and servants whose livelihood was dependent on pleasing their employers.

The article probably could use more on the effects of sugary and acidic drinks on tooth decay, but this text is simply wrong in describing culinary habits around the world on a historical basis, and asserting that Coca Cola's introduction in 1886 first led to caries being a major problem is contradicted by the rest of the article. I am going to add a few sentences back in to the end of the section where I removed this text, but someone with more knowledge on the subject should be able to make it better. +Fenevad 13:13, 21 February 2007 (UTC)

Actualy, as I look at the existing article, I believe this topic is covered adequately, although perhaps a mention of the particular role of softdrinks (assuming there actually is one that is demonstrable, rather than asserted) would be helpful.-Fenevad 13:20, 21 February 2007 (UTC)

There is something to this argument. It comes from:

http://www.doctorspiller.com/Tooth_Decay.htm#History

As I have just googled it. Some mention of the societal changes around the globe do belong in the article. And Coca Cola is a world wide product...

Noserider 13:11, 19 June 2007 (UTC)

The social changes, are, however, already addressed, and it is impossible to blame tooth decay, as a phenomenon, on Coca Cola in particular. If the article starts listing individual products as culpable, then what grounds are there for deciding which ones are to blame? Coca cola, but not Pepsi Cola? Big Red gum but not Juicy Fruit? Better not to start down this road in the first place since refined sugars, not a specific product, are the issue. The problem also remains that the specific social changes cited in the deleted passage are simply ahistorical and based on idealization of the past, not anything factual about eating habits of real people in the past. It asserts, but does not document, that caries was not a problem for most Americans prior to Coca Cola. If you want to assert that, then please document and demonstrate it, and no, some page you found on Google -- no matter how convincing it seems -- doesn't cut it, unless it can point to some real evidence to back up its claims. -11:52, 25 June 2007 (UTC)

is it common for it to cause depression? —The preceding unsigned comment was added by Ajuk (talk • contribs) 21:27, 6 May 2007 (UTC).

--Disease in general can cause depression.

Benzimidazoles(such as Prilosec) have shown promise in preventing caries. anyone want to research this?

The section on treatment and prevention was bias and against WP:NPOV i added a sentance about the adverse affects and linked it through to the wikipedia article on Dental fluorosis (82.47.164.103 15:04, 11 October 2007 (UTC))

someone reverted my changes today with no reason specified, please come and talk here about the issue instead of just reverting changes, while fluoride may have benefits it also has serious negative effects on teeth and this must be included to not violate WP:NPOV (82.47.164.103 15:04, 11 October 2007 (UTC))

when i checked the history page the reason given was poor grammar and no sources, i thought linking through to the Dental fluorosis would be adequate but if you require sources i will provide them, i am just unsure how to add them. here is just one quote from http://www.med.uwo.ca/ecosystemhealth/education/casestudies/fluorosismed.htm

"CASE STUDY FOR THE 4TH YEAR COURSE IN ECOSYSTEM HEALTH DENTAL FLUOROSIS"

"Dental Fluorosis: The most obvious and easily diagnosed form of Fluorosis by a characteristic bilateral white mottling of the dentition. Dental Fluorosis is usually caused by over-exposure to Fluoride when the dental enamel is actively mineralizing during early childhood."

if you can tell me how to add this source i would be more than happy to, as for my wording it believe it is gramatically correct, please state any specific concern you have with my grammar (82.47.164.103 15:29, 11 October 2007 (UTC))

No capitalisation, no new paragraph, not written in encyclopaedic style, topic is already covered in the article [dental fluorosis], fluoride is not a heavy metal, dental fluorosis is not generally serious. Fluoride is toxic if consumed, but in order to reach the LD50 for humans at the usual concentration of fluoride in water (0.6-1ppm) in fluoridated regions, one would have to consume about 600 gallons of water in one sitting, I think. My maths may be off. This article is not about fluoride. It is about caries, and therefore should include a section about preventive measures. However, side effects of fluoride use are somewhat outside the scope of this article; we want to talk about how to prevent caries, not the side effects of systemic fluoride delivery. There are (I believe) several other articles which cover the latter topic. Dr-G - Illigetimi non carborundum est. 23:25, 11 October 2007 (UTC)

In agreement with Dr-G, the first word was not capitalize and the language was not in encyclopedic style, but that is not the most important reason to reverting your edits. The substance is incorrect. Fluoride is a heavy metal? Fluoridated water supply "combined with the use of toothpaste's containing fluoride" does not "usually" cause fluorosis. And to say fluoride is "highly toxic if consumed" is not reasonably possible within a discussion of fluoridated water, as again Dr. G pointed out. Fluoride therapy, in water, salt, milk, or in a concentrated form, is used in dentistry all around the world. Moreover, all these topics are discussed at length at water fluoridation controversy, where the discussion belongs, and in that article you can find a large number of references that demonstrate scientific and medical support for fluoride therapy. - Dozenist talk 00:08, 12 October 2007 (UTC)

fair enough, if it is being covered elsewhere. i will remove it and i realise now it's a compound and not a heavy metal :S (82.47.164.103 00:12, 12 October 2007 (UTC))

heh looks like one of you removed it first, oh well (82.47.164.103 00:13, 12 October 2007 (UTC))

Excuse me, but some *DO* argue that it is caused by Chuck Norris. —Preceding unsigned comment added by 68.227.195.197 (talk) 23:42, 20 October 2007 (UTC)

I think the toxicity of mercury amalgam fillings deserves a brief mention here and a link to its own article. Anybody else care to offer their thoughts? — NRen2k5 10:59, 25 December 2007 (UTC)

This article has almost nothing to say about amalgam. No reason to go into excessive detail here; there are enough articles on the subject already. · jersyko talk 15:12, 25 December 2007 (UTC)

According to the study located at http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowAbstract&ArtikelNr=73922&Ausgabe=229687&ProduktNr=224219 (published within the Caries Research journal): "it is concluded that for protection of dentin surfaces at least 30 min should elapse before toothbrushing after an erosive attack". -- 17:18, 27 MatthewKarlsen December 2007 (UTC)

Something should be said about how some people naturally have more of the instigating bacteria in their mouths. My dentist told me today some think it's due to genetics causing varying oral health environments. Some people can practice impeccable oral hygiene while still getting lots of cavities, while others might never floss and never get cavities. 141.213.220.186 (talk) 01:11, 9 January 2008 (UTC)

I can remember, that a new type of caries emerged (genetic engineering?). In contrast to caries as we know it, it produces small amounts of alcohol instead of acid and is therefore harmless for our teeth. It even dominates common caries. Does anyone know about this new type of caries? Will it unslave us from this desease because of the domination? 85.178.34.141 (talk) 22:55, 19 February 2008 (UTC)

Acid from fruit juices and sodas like coke will have a direct impact on the teeth (maybe more so than the acid produced from the bacteria?). So I think that it should be mentioned in this article. Tremello22 (talk) 00:15, 17 March 2008 (UTC)

i am just doing research on the web about secondary complications, hard to find some exact information. dental caries being a co-faktor causing death has been discussed here very very briefly. i have read that bacteria can go into the blood via holes in a tooth and then cause severe heart diseases. Also i have read that a man has lost his visiblity as a consequence of untreated caries, u can check that article out :The Lancet 2005; 366:1504

                       DOI:10.1016/S0140-6736(05)67602-7

information on the web about possible dangers of caries are very rare, i think there has some updating to be done here on wiki, so people who are not doing specific research can find out about the dangers of caries as rare as they may or may not be. i think there is too few information on this topic on the web in general and maybe there is much more to it. being totally layman i could imagine long term untreated caries can have a lot of severe secondary complications, which is almost a secret to most people. i am trying to find out more, maybe someone else who is profesionally educated in medicine could try to help out.

This is a good article, yet I am afraid that it is still an incomplete one. Any article about Dental caries which for some unknown reason, does not mention Major Fernando E. Rodríguez Vargas, the person who in 1922 discovered the three types of the Lactobacillus which cause dental caries cannot be complete. Someone, please make mention of this scientist in the article. Tony the Marine (talk) 05:45, 19 July 2008 (UTC)

I know that gum irritation can be treated with a 1%-3% hydrogen peroxide rinse, up to four times a day for a week or so. Does this also help with the reversal of demineralization? I don't know the specific biology, but I assume the hydrogen peroxide attacks the bacteria and kills them enmasse deep in crevasses that brushing alone cannot reach, allowing the gum time to reattach and greatly lowering mouth acidity. This would appear to be beneficial for also stopping cavity formation.

Also, various toothpastes contain hydrogen peroxide, but how effective are they at killing the bacteria? It seems possible that the hydrogen peroxide concentration level is so low that it's more of a marketing gimmick than an effective cleanser. I don't notice much of any bubble formation with these toothpastes as occurs with straight 3% from the bottle.

DMahalko (talk) 16:03, 7 November 2008 (UTC)

I think this is turning into a great article. However my main criticism of it is that it can be alot shorter without getting rid of any information. ie the style in which it is written explains everything in very round about ways.Bouncingmolar (talk) 23:54, 22 November 2008 (UTC)

I think a little more improvement can be made in the history section. I have had that project on my backburner for a while now since I have been so busy, but I will try to see what I can do. Also, it seems like in that section there is a lot of unnecessary information on a researcher who "discovered" the actual bacteria. I think some of that information can be shortened as well. - Dozenist talk 20:17, 23 November 2008 (UTC)

I went ahead and reduced the unnecessary information in the article that I was referring to. Concerning some of the other information, the only thing I would say is try to make sure the article can be understood by those not already knowledgable about dentistry. It is still at times a technical topic, but I think some of the explanation makes it a bit easier to understand. I will try to see what I can find about the history section. - Dozenist talk 20:29, 23 November 2008 (UTC)

The epidemiology section needs a map of caries prevalence in different countries. And other graphs on how rates have changed over time.--Doc James (talk · contribs · email) 22:03, 17 March 2009 (UTC)

The following statement cannot be found anywhere in referenced source and therefore, should be removed: "Destroyed tooth structure does not fully regenerate, although remineralization of very small carious lesions may occur if dental hygiene is kept at optimal level." Wtc895 (talk) 20:42, 3 June 2009 (UTC)

I'm not a common wiki person, but I am quite knowledgeable on this subject. This essentially says that frank carious lesions must be treated through restorative techniques because of the loss of biologic infrastructure (inability for human regeneration of teeth).

Remineralization refers to the chemical equilibrium of a biologic infrastructure that is still intact.

(Think carpenter vs architect) —Preceding unsigned comment added by 70.120.86.234 (talk) 16:10, 3 April 2011 (UTC)

I haven't counted, but it is mentioned many many times, or maybe it is just me (or my memory of a previous article--from browsing). What do you think? —Preceding unsigned comment added by 98.21.61.161 (talk) 04:08, 21 July 2009 (UTC)

This is an archive of past discussions about Tooth decay. 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

Thanks Lesion! I updated the signs and symptoms section per your request and I have edited the Cause section. Changes made in the cause section were the following:

1. I thought that a simplified statement on tooth breakdown (demineralization and remineralization) was sufficient for this introduction. The pathophysiology included in this section I've moved to its proper section.

2. Specific bacterial species, I think should be listed in the bacteria section of cause.

3. I've added a source to substantiate the 80% of cavities occuring in pit an fissure surfaces.

4. I stated that severe complications happen in UNTREATED cases of spreading infection.

5. Clarified the bad breath associated with caries derives from debris accumulation.

6. I took the pH of 5.5 out because numerous reputable sources indicate that other factors such as calcium and phosphate in the saliva cause that number to vary substantially.

7. I moved the discussion on Sjogrens and radiation to the other factors section of Cause.

8. The sentence on dental caries not occurring on teeth within bone does not belong in this section and I took it out.

9. The names in parenthesis are reviews I think are needed to substantiate important points. After finding out which review articles will go into the page, I will add the citations. The ones I've added are a review from the New England Journal of Medicine from JH Shaw called Causes and control of dental caries with 108 refs, written in 1987. I added Non-Carious cervical tooth surface loss: A literature review by Ian Wood in the Journal of dentistry 2008. The source on pit and fissure caries (Brown) is from the JADA selected findings from the Third National Health and Nutrition Examination.

Here are my revisions:

Signs and Symptoms

A person experiencing caries may not be aware of the disease.[3] The earliest sign of a new carious lesion is the appearance of a chalky white spot on the surface of the tooth, indicating an area of demineralization of enamel. This is referred to as a white spot lesion, an incipient carious lesion or a "microcavity".[4] As the enamel and dentin are destroyed, the cavity becomes more noticeable. It can turn brown but will eventually turn into a cavitation ("cavity"). Before the cavity forms, the process is reversible, but once a cavity forms, the lost tooth structure cannot be regenerated. A tooth weakened by extensive internal decay can sometimes suddenly fracture under normal chewing forces. A lesion that appears dark brown and shiny suggests dental caries were once present but the demineralization process has stopped, leaving a stain. Active decay is lighter in color and dull in appearance.[5] The affected areas of the tooth change color and become soft to the touch.

Once the caries progress through enamel it can interact with the dentinal tubules, which are passageways to the nerve of the tooth. As these tubules become exposed, pain can results. It may be transient, temporarily worsening with exposure to heat, cold, or sweet foods and drinks.[1] When the decay has progressed enough to allow the bacteria to overwhelm the pulp tissue in the center of the tooth, Death of the pulp tissue (pulp necrosis) and infection are common consequences spontaneous, aching pain and even pain from biting or pressure can often occur, signaling that the caries are now affecting the apex of the tooth.. In these cases, the tooth will no longer be sensitive to hot or cold, but can be very tender to pressure.

Dental caries can also harbor food and bacterial debris that cause bad breath and if the caries have draining abscesses, foul tastes result.[6] In highly progressed cases, infection can spread from the tooth to the surrounding soft tissues. In cases where infection is untreated, complications such as cavernous sinus thrombosis and Ludwig angina can be life-threatening.[7][8][9]

Cause

There are four main criteria required for caries formation: a tooth surface (enamel or dentin), caries-causing bacteria, fermentable carbohydrates (such as sucrose), and time.[10] Bacteria on teeth deposit acid as a byproduct of carbohydrate fermentation. Overtime this leads to breakdown of tooth structure ^(Shaw). However, it is also known that these four criteria are not always enough to cause the disease. A sheltered environment promoting development of a cariogenic biofilm is often required. The caries process does not have an inevitable outcome, and different individuals will be susceptible to different degrees depending on the shape of their teeth, oral hygiene habits, the buffering capacity of their saliva and other factors.[11]

Tooth decay disease is caused by specific types of bacteria that produce acid in the presence of fermentable carbohydrates such as sucrose, fructose, and glucose.[13][14][15]

Acid demineralization occurs where bacterial plaque is left on teeth. Because most plaque-retentive areas are between teeth and inside pits and fissures on chewing surfaces where plaque is more difficult to remove, over 80% of cavities occur here.^(Brown) In contrast, areas of teeth where plaque is more easily removed, such as the front and back surfaces (facial and lingual), develop fewer cavities.

Dental caries is not the only pathology that destroys tooth structure. It should be noted that some acidic foods and drinks can result in tooth demineralization in the absence of bacteria. This is known as erosion, rather than caries, because the acid is not bacterial in origin. Attack by acid from systemic complications such as vomiting can also cause tooth erosion. Other non-carious tooth lesions include abfraction (from occlusal force), attrition (tooth wear) and abrasion (wear from foreign objects like toothbrushes). Many of these conditions occur in the area of teeth nearest the gums and can be grouped into a category called non-carious dental lesions ^(Wood).

Thanks!

Gclive (talk) 14:26, 10 April 2014 (UTC)

As I am editing sections of this page, I'll post them here before definitively editing the page. Here are my first edits to the signs and symptoms. They are not too different from the original and are mostly done to make it more succinct. Here goes:

“

A person experiencing caries may not be aware of the disease.[3] The earliest sign of a new carious lesion is the appearance of a chalky white spot on the surface of the tooth, indicating an area of demineralization of enamel. This is referred to as a white spot lesion, an incipient carious lesion or a "microcavity".[4] As the enamel and dentin are destroyed, the cavity becomes more noticeable. It can turn brown but will eventually turn into a cavitation ("cavity"). Before the cavity forms, the process is reversible, but once a cavity forms, the lost tooth structure cannot be regenerated. A tooth weakened by extensive internal decay can sometimes suddenly fracture under normal chewing forces. A lesion that appears dark brown and shiny suggests dental caries were once present but the demineralization process has stopped, leaving a stain. Active decay is lighter in color and dull in appearance.[5] As the enamel and dentin are destroyed, the cavity becomes more noticeable. Once the caries progress through enamel, it can interact with the dentinal tubules, which are passageways to the nerve of the tooth. As these tubules become exposed pain can results. It may be transient, temporarily worsening with exposure to heat, cold, or sweet foods and drinks.[1] When the decay has progressed enough to allow the bacteria to overwhelm the pulp tissue in the center of the tooth, a toothache can result and the pain will become more constant. Death of the pulp tissue (pulp necrosis) and infection are common consequences. In these cases, the tooth will no longer be sensitive to hot or cold, but can be very tender to pressure. Dental caries can also cause bad breath and associated abscesses can cause foul tastes.[6] In highly progressed cases, infection can spread from the tooth to the surrounding soft tissues. Very rare complications such as cavernous sinus thrombosis and Ludwig's angina can be life-threatening.[7][8][9]

”

If you have any concerns or changes, feel free to post.

Geoff — Preceding unsigned comment added by Gclive (talk • contribs) 13:15, 8 April 2014 (UTC)

Sounds good. In the last paragraph, I would switch the order of the sentences because abscesses naturally leads after the comment about spread from the tooth to the surrouning tissues. More detail about bad breath: Halitosis is not caused by caries itself, but rather by stagnation of food debris within large cavities and the activity of bacteria on this debris which releases volatile sulfur compounds. Dental caries doesn't normally cause any odor otherwise. The term Pulpitis should be mentioned imo. Lesion 13:23, 8 April 2014 (UTC)

It is also worth stressing that people do not often die of dental caries anymore. Maybe before antibiotics were discovered this happened more. Lesion 13:24, 8 April 2014 (UTC)

I was disappointed to find this article disorganized and lacking information. I have been reviewing it and made the following points: 1. The introduction of the cause section describes several times the demineralization. A more effective, single paragraph on the issue would suffice in the pathophysiology section. 2. No mention of Non-Carious cervical lesions was made, which are often confused with caries.

3. Toxicities of lead and other ions is interesting, but it might be mentioned, that this is mostly academic, not clinical.

4. Pathophysiology section had an enamel section and three dentin sections. I would recommend consolidating into enamel, dentin, dentinal response, cementum, and then adding the following two, pulp and periodontium/periapex.

4. the diagnosis section didn't mention patient subjective pain being a diagnostic factor. It also didn't discuss vitality testing effectively.

5. The classification section had a picture of GV black's classification, but no mention of Class I, Class II was made in the caption or text.

6. Prevention, I would place dietary modification before oral hygiene if it in fact is the larger impact on caries. I don't recall much being discussed about mouthwash, gum or fluoridated water.

I'm still working my way to treatment, epidemiology and history. But that's what I've found for now. I'm making edits on my laptop and if you have anything else you'd like to discuss with me, please post. Thanks! — Preceding unsigned comment added by Gclive (talk • contribs) 02:53, 27 March 2014 (UTC)

Gclive, hello and welcome. Thanks for offering to work on this article. All Wikipedia articles are a work-in-progress, so there is always room for improvement and scientific knowledge gets updated. For references, please try to use textbooks or review papers for reference, we tend to avoid original research studies, case reports etc. For more info, please see WP:MEDRS. If you require any assistance, just post here. Regards, Lesion (talk) 11:56, 27 March 2014 (UTC)

It states that caries affect baby teeth in approximately 620 million people. Then it says this is 9% of the population. That's true, but a small percentage of the world population actually has baby teeth since they are usually all lost by age 12. If we add a percentage of BABY teeth that are affected, or a percentage of CHILDREN, it would make the section much more informative.

Would have to give a range of percentages from different countries. I think the proportion of children affected varies from district to district and from country to country. — Preceding unsigned comment added by 212.183.140.5 (talk) 20:51, 27 September 2013 (UTC)

I elaborated on the Signs and Symptoms section, but perhaps the information could be merged in with the Patho-physiology section.LFlagg (talk) 00:38, 18 June 2013 (UTC)

Im probably not doing this right, but on this part: Medicinal plants in the treatment of dental caries it lists a bunch of medicinal plants. Why is this listed? Wikipedia should not be giving medical advice. —Preceding unsigned comment added by 69.171.161.105 (talk) 19:51, 26 February 2011 (UTC)

It seems to me that there should be a source and quote for users of medical cannabis that also develop dry mouth and decreased saliva production. —Preceding unsigned comment added by Deftdrummer (talk • contribs) 07:16, 12 October 2007 (UTC)

on the subject of cannabis, is it accepted that specifically THC is responsible for reduced saliva? as there are other cannabinols that are associated with the narcotic effects and surely many more compounds that aren't, is there the evidence to suggest that this particular substance is responsible? also the link bewtween cannabis consumption and diets prone to elevated risk of caries should be seen to be anecdotal. even if studies have shown higher risks of caries, this doesn't support this link as other groups surely show both tendenciesDubfeather (talk) 15:17, 14 July 2010 (UTC)

Regarding THC causing reduced saliva and this causing caries, these assertions should be sourced. Preferably, the source will show a strong correlation between THC use and frequency of caries. The amount and duration of decreased saliva caused by THC may be insignificant. 174.252.240.195 (talk) 12:55, 5 July 2011 (UTC)

I think the term "Xerostomia" should be featured in this section. This section lists the many possible causes of Xerostomia (dry mouth) quite well, but maybe could be organized a little better. I think that radiation induced xerostomia should be placed ahead of marijuana induced xerostomia. I believe there is a good deal of literature showing increased caries after radiation induced exerostomia, but little or no scientific literature on increased caries after marijuana induced xerostomia.

As a practicing dentist, I have a strong clinical impression that marijuana use is indeed associated higher levels of tooth decay and the most logical explaination is transient dry mouth, (probably associated with "the munchies"--the tendency to eat snacky foods while under the influence). But we need to primarily focus on factors supported by the literature.

Practicing dentists have many valuable insights worth sharing, but clinical impressions are not a good enough basis for inclusion in Wikipedia unless associated with a scientific article. — Preceding unsigned comment added by LFlagg (talk • contribs) 19:10, 7 January 2012 (UTC)

This discussion is transcluded from Talk:Dental caries/GA1. The edit link for this section can be used to add comments to the reassessment.

As part of the WikiProject Good Articles, we're doing Sweeps to determine if the article should remain a Good article. I believe the article currently meets the majority of the criteria and should remain listed as a GA. However, in reviewing the article, I have found there are several issues that need to be addressed.

Citations

1. The "Other general descriptions", "Rate of progression", and "Affected hard tissue" sections are unsourced.
2. In the "Etiology" section, a Dr. Miller is mentioned for the first time. It would be beneficial to indicate the full name as well as cite the quote and three factors.
3. "Before the cavity forms, the process is reversible, but once a cavity forms, the lost tooth structure cannot be regenerated." This statement has been tagged since last month with needing a citation.
4. "The progression and loss of mineralization on the root surface is 2.5 times faster than caries in enamel."
5. "Intrauterine and neonatal lead exposure promote tooth decay." This statement is followed by seven citations. I don't think the statement is controversial, so a few of those could be removed (maybe for sourcing other material or for expanding on the topic).
6. "Occlusal caries accounts for between 80 and 90 percent of caries in children (Weintraub, 2001)" This should be converted to an inline citation similar to the style currently used for the majority of the article.
7. "Older people may also benefit from the use of tooth sealants, but their dental history and likelihood of caries formation are usually taken into consideration." This could use a cite to avoid OR.

Other issues

1. Although it is not required by GA criteria (so it will not be a requirement for the review), it would be beneficial to add alt text to the images. See WP:ALT for assistance.
2. There are multiple dead links that need to be fixed. The Internet Archive may be able to help.
3. There are a few dabs that need to be fixed.
4. "Moreover, sixty-three percent of the most commonly prescribed medications in the United States list dry mouth as a known side effect." Include a year here when this statistic was announced as medication likely changes from year to year.
5. "As of 2004, such a vaccine has been successfully tested on animals,[81] and is in clinical trials for humans as of May 2006." Has there been any updates for this?
6. I don't know if there are guidelines that recommend keeping the history section at the end of the article (if there are, ignore this), but it would probably be beneficial to include it towards the beginning of the article to provide the reader a better understanding of how long caries have around for.
7. The history section also ends around 1920. It would be beneficial to include breakthroughs in treating and understanding caries to be mentioned that have occurred within the last 90 years.

It's great to see the large amount of sourcing and so many free images within the article. I will leave the article on hold for seven days, but if progress is being made and an extension is needed, one may be given. If no progress is made, the article may be delisted, which can then later be renominated at WP:GAN. I'll contact all of the main contributors and related WikiProjects so the workload can be shared. If you have any questions, let me know on my talk page and I'll get back to you as soon as I can. --Happy editing! Nehrams2020 (talk • contrib) 03:27, 7 February 2010 (UTC)

The article has been on hold for a week and the issues were not addressed. As a result I have delisted the article as it still has a way to go before meeting the GA criteria. Continue to improve the article, addressing the issues above. Once they are addressed, please renominate the article at WP:GAN. I look forward to seeing the further improvement of the article, and don't hesitate to contact me if you need assistance with any of these. If you disagree with this review, a community consensus can be reached at WP:GAR. If you have any questions, let me know on my talk page and I'll get back to you as soon as I can. --Happy editing! Nehrams2020 (talk • contrib) 00:01, 15 February 2010 (UTC)

I thought that having cavities was mainly due to genetics. Is this true? I have never had cavities and neither has my entire family, yet I can't say I am the most orally hygienic. — Preceding unsigned comment added by 192.112.54.2 (talk) 20:50, 12 July 2012 (UTC)

• Comment: we need to use reliable secondary sources for medical content WP:MEDRS. Talk pages are for discussion about how to improve the article. Lesion (talk) 00:42, 18 June 2013 (UTC)

One sentence reads: "Lasers for detecting caries allow detection without radiation" but lasers, like every other kind of light, are a form of radiation, so it is more appropriate to write: "Lasers for detecting caries allow detection without ionizing radiation" when a comparison with x-rays is made. — Preceding unsigned comment added by 93.146.172.146 (talk) 16:21, 12 August 2012 (UTC)

Good point, I will change this as you suggest. Lesion (talk) 18:05, 6 April 2013 (UTC)

Is that really appropriate? If you define an infection as invasion of micrioorganisms into tissues (enamel and dentin etc are tissues) then dental caries could be called an infection (sort of), but odontogenic specifies that it is an infection coming from a tooth. Ideally we need a separate article for odontogenic infection, but for now I feel it would be better to point the odontogenic infection page to dental abscess. Lesion (talk) 18:04, 6 April 2013 (UTC)

I agree. The term odontogenic infection is generally used to refer to a dental abcess, an infection originating from the tooth. Dental caries is not generally referred to as an odontogenic infection. Odontogenic infection should redirect to dental abcess.LFlagg (talk) 23:13, 17 June 2013 (UTC)

I started a new article called odontogenic infection after writing that, but it could do with significant expansion. Alternative is to forget having a separate article and just redirect the page to dental abscess. Lesion (talk) 00:48, 18 June 2013 (UTC)

This article was the subject of an educational assignment in 2013 Q3. Further details were available on the "Education Program:Case Western Reserve University/ANTH 302 Darwinian Medicine (Fall 2013)" page, which is now unavailable on the wiki.

Humans are susceptible to dental caries for a variety of reasons, from poor oral hygiene, to lower socio-economic status, to diet. However, these are proximate explanations, and looking at the ultimate cause of caries can offer a different perspective. Tooth decay has been present throughout human history, from early hominids millions of years ago, to modern humans ^[1]. The prevalence of caries increased dramatically in the 19th century, as the Industrial Revolution made certain items, such as cane sugar and refined flour, readily available^[2]. The diet of the “newly industrialized English working class” ^[2] then became centered on bread, jam, and sweetened tea, greatly increasing both sugar consumption and caries. The ultimate evolutionary explanation for why we are vulnerable to caries is that tooth enamel destroyed by decay cannot be regenerated. Humans, as well as other primates, are diphyodont ^[3], or develop only two sets of teeth in their lifetime. This evolutionary legacy is what makes us vulnerable to decay in a modern, sugar-laden diet.

That peoples diet have changes is not evolution and this aspect is better dealt with in other sections of the article (where it is already). Doc James (talk · contribs · email) (if I write on your page reply on mine) 02:38, 20 November 2013 (UTC)

I think the gist of this addition was that evolution has not caught up with changing diet patterns, same as concept in obesity. Lesion (talk) 10:54, 20 November 2013 (UTC)

Or that we have involved a brain so that as individually we can brush our teeth and as a society we can put together programs of dental coverage such that mortality from dental caries is low in much of the world.

We are not now going to involve more resistant teeth as people do not typically die from caries before reproductive age. Doc James (talk · contribs · email) (if I write on your page reply on mine) 10:58, 20 November 2013 (UTC)

Good point. Teeth were only ever meant to make us survive into reproductive age. Yes loss of teeth may have once meant you risked starvation, but this is not likely anymore. The only thing I might argue would be that people with decayed looking teeth might be less attractive to the opposite sex and therefore less likely to reproduce, but this theory would hinge on people not visiting a dentist and fixing their teeth.

I don't have a huge problem with this section, but if you think it is unsuitable happy for it to be removed. Lesion (talk) 11:19, 20 November 2013 (UTC)

The issues around diet are better dealt with in other section IMO. Doc James (talk · contribs · email) (if I write on your page reply on mine) 12:06, 20 November 2013 (UTC)

User:CzechmateVV who added this is in user:Sanetti's Darwinian medicine class. CzechmateVV, could you respond to the above criticism? There is feedback that you have not mentioned anything about evolution, but you put this content into an evolution section, and that the content you added to some people seems better suited for integration into other parts of this article. Thanks for your attention. Blue Rasberry (talk) 14:28, 20 November 2013 (UTC)

Thank you for your feedback. I was focusing on the evolution of human vulnerability to dental caries, namely that diet changes influenced their prevalence. Where would you suggest I move this to instead? CzechmateVV (talk) 02:48, 21 November 2013 (UTC)

How about here [4] Doc James (talk · contribs · email) (if I write on your page reply on mine) 03:36, 21 November 2013 (UTC)

Because you talk about the industrial revolution, putting it in Dental_caries#History would be appropriate. There is no discussion of evolution in the text added. Blue Rasberry (talk) 14:33, 21 November 2013 (UTC)

I think James might be right when you think about it. The vulnerability of the dental hard tissues to demineralization in acidic mileau has not changed. Environmental factors such as fluoridated water supply and toothpastes on the one hand, and the high "cariogenic diet" on the other are what has changed. It is not the diet in and of itself that is cariogenic, because you could eat such a diet every day through a nasogastric tube and never get any tooth decay. Although instinctive attraction to such a diet is the result of evolution, this is not evolution in the Darwinian sense since it has not lead to any genetic change. Rather, this is changing disease prevalence due to (modifiable) environmental factors. Lesion (talk) 12:29, 21 November 2013 (UTC) Edited. CzechmateVV (talk) 04:42, 24 November 2013 (UTC)

I added the classic circle diagram.

Suggest also need a Stephan Curve

Perhaps also a chemical reaction diagram to show transfer of the various ions from saliva into dental hard tissues above critical pH and from hard tissues to saliva below critical pH. Lesion (talk) 16:16, 28 March 2014 (UTC)

I think a section about caries risk assessment should be included in this page. Sa2lehmann (talk) 01:00, 10 April 2014 (UTC)

Sa2lehmann, this would be good. Are you interested in writing it? Lesion 08:15, 10 April 2014 (UTC)

E.g. dental carries vaccines page on Wikipedia — Preceding unsigned comment added by 24.10.208.192 (talk) 04:00, 4 June 2014 (UTC)

Here is my revision to the sections above. Changes I made were adding an introduction to the teeth section, describing the demineralization of teeth in the teeth section, adding species of bacteria and a couple citations by Lang (from oral microbiology and immunology 2007) and Kianoush on pH gradient and distribution of strep species. I also deleted a controversial sentence on THC causing xerostomia and added a reference on poverty and caries.

Variables that may increase caries risk are disorders in tooth formation, exposure of regions of the tooth that are more susceptible to demineralization and the anatomy and location of teeth in the oral cavity.

The mineral content of teeth is sensitive to increases in acidity from the production of lactic acid (a product of carbohydrate fermentation). As the acidity lowers the environmental pH, the tooth will begin to demineralize. To be specific, the hydroxyapatite mineral in a tooth is in equilibrium with the surrounding saliva. However, when the pH of saliva or bacterial products drops to below 5.5 (Although this number may be higher or lower depending on the calcium and phosphate concentrations in saliva), the hard crystalline structure of the tooth dissolves, because the demineralization is occurring faster than the remineralization; a net decrease in mineralization. This is called bacterial acid demineralization.

There are certain diseases and disorders affecting teeth that may leave an individual at a greater risk for cavities. Amelogenesis imperfecta, which occurs between 1 in 718 and 1 in 14,000 individuals, is a disease in which the enamel does not fully form or forms in insufficient amounts and can fall off a tooth.[16] In both cases, teeth may be left more vulnerable to decay because the enamel, which is more structurally sound and resistant to acid demineralization than dentin, is not able to protect the tooth.[17]

In most people, disorders or diseases affecting teeth are not the primary cause of dental caries. Approximately 96% of tooth enamel is composed of minerals.[18] These minerals, especially hydroxyapatite, will become soluble when exposed to acidic environments. Enamel begins to demineralize at a pH of 5.5.[19] Dentin and cementum are more susceptible to caries than enamel because they have lower mineral content.[20] As a result, dentin and cementum can demineralize at a less acidic pH than enamel. Thus, when root surfaces of teeth are exposed from gingival recession or periodontal disease, caries can develop more readily. Even in a healthy oral environment, however, the tooth is susceptible to dental caries.

The evidence for linking malocclusion and/or crowding to the dental caries is weak;[21][22] however, the anatomy of teeth may affect the likelihood of caries formation. Where the deep developmental grooves of teeth are more numerous and exaggerated, pit and fissure caries are more likely to develop (see next section). Also, caries are more likely to develop when food is trapped between teeth.

Bacteria

The mouth contains a wide variety of oral bacteria, but only a few specific species of bacteria are believed to cause dental caries: Streptococcus mutans, streotococcus sobrinus and Lactobacilli species (Lang). These organisms can produce high levels of lactic acid following fermentation of dietary sugars, and are resistant to the adverse effects of low pH, properties essential for cariogenic bacteria.[13][15] It is thought that as the caries initiates with streptococcus species, but as the caries process progresses the bacterial populations shift more toward lactobacillus due to their resilience to very low pH (Kianoush). As the cementum of root surfaces is more easily demineralized than enamel surfaces, a wider variety of bacteria can cause root caries including Lactobacillus acidophilus, Actinomyces spp., Nocardia spp., and Streptococcus mutans.

S. mutans produces a sticky, extracellular, dextran-based polysaccharide that allows them to cohere, forming plaque biofilm. S. mutans produces this dextran via the enzyme dextransucrase (a hexosyltransferase) using sucrose as a substrate. Some sites collect plaque more commonly than others, for example sites with a low rate of salivary flow (molar fissures). Grooves on the occlusal surfaces of molar and premolar teeth provide microscopic retention sites for plaque bacteria, as do the interproximal sites. Plaque may also collect above or below the gingiva where it is referred to as supra- or sub-gingival plaque, respectively.

These bacterial strains, most notably S. mutans can be transmitted to a child from a caretaker's kiss or through feeding premasticated food.[23] Once colonized early by streptococcus mutans, children may be predisposed to developing caries lesions thoughout their lives.

Fermentable carbohydrates.

Bacteria in a person's mouth ferment glucose, fructose and, most commonly, sucrose (table sugar) and create acid byproducts such as lactic acid glycolyticfermentation.[14] The impact such sugars have on the progress of dental caries is called cariogenicity. Sucrose, which is formed from glucose and fructose bound together, is more cariogenic than a mixture of equal parts of glucose and fructose. This is due to the bacteria utilizing the energy in the saccharide bond between the glucose and fructose subunits. S.mutans creates the sticky dextran polysaccharide by using sucrose as a substrate.

Exposure

The frequency of which teeth are exposed to cariogenic (acidic) environments affects the likelihood of caries development.[26] After meals or snacks, the bacteria in the mouth metabolize sugar, resulting in an acidic by-product that decreases pH. During every exposure to the acidic environment, portions of the inorganic mineral content at the surface of teeth dissolve and can remain dissolved for two hours.[27] As time progresses, the pH returns to normal due to the buffering capacity of saliva. Due to the lag in return to normal pH, consistent bouts of sugar meals prevent the pH of saliva from returning to normal and further aid bacterial deposition of acid byproducts. Since teeth are vulnerable during acidic periods, the development of dental caries relies heavily on the frequency of acid exposure.

The carious process can begin within days of a tooth's erupting into the mouth if the diet is sufficiently rich in suitable carbohydrates. Evidence suggests that the introduction of fluoride treatments have slowed the process.[28] Proximal caries take an average of four years to pass through enamel in permanent teeth.

Other risk factors

Reduced salivary flow rate is associated with increased caries since the buffering capability of saliva is not present to counterbalance the acidic environment created by certain foods. As a result, medical conditions and medications that reduce the amount of saliva produced by salivary glands, in particular the submandibular gland and parotid gland, are likely cause dry mouth and thus predisposition to widespread tooth decay. Examples include Sjögren's syndrome, diabetes mellitus, diabetes insipidus, and sarcoidosis.[29] Medications, such as antihistamines and antidepressants, can also impair salivary flow. Stimulants, most notoriously methylamphetamine ("meth mouth"), also occlude the flow of saliva to an extreme degree. Moreover, 63% of the most commonly prescribed medications in the United States list dry mouth as a known side-effect.[29] Radiation therapy of the head and neck may also damage the cells in salivary glands, increasing the likelihood of caries formation.[30][31]

The use of tobacco may also increase the risk for caries formation. Some brands of smokeless tobacco contain high sugar content, increasing susceptibility to caries.[32] Tobacco use is a significant risk factor for periodontal disease, which can cause the gingiva to recede.[33] As the gingiva loses attachment to the teeth due to gingival recession, the root surface becomes exposed in the mouth. If this occurs, root caries is a concern since the cementum covering the roots of teeth is more easily demineralized by acids than enamel.[34] Currently, there is not enough evidence to support a causal relationship between smoking and coronal caries, but evidence does suggest a relationship between smoking and root-surface caries.[35]

Intrauterine and neonatal lead exposure promote tooth decay.[36][37][38][39][40][41][42] Besides lead, all atoms with electrical charge and ionic radius similar to bivalent calcium,[43] such as cadmium, mimic the calcium ion and therefore exposure may promote tooth decay.[44] These findings, while scientifically significant, are not routinely screened for clinically.

Poverty is also a significant social determinant for oral health.[45] Dental caries have been linked with lower socio-economic status and can be considered a disease of poverty.[46] This is especially true of children and adolescents. (Reisine)

~~Gclive — Preceding unsigned comment added by Gclive (talk • contribs) 00:32, 29 April 2014 (UTC)

I think providing information on the evolutionary forces that lead to S. mutans’s ability to cause dental caries can enhance this article.

1. One of the characteristics that make S. mutans the primary etiological agents for caries is its ability to adhere to the hard surfaces of teeth through formation of biofilms. It is thought that the bacteria acquired the gene to do this through horizontal gene transfer with other lactic acid producing bacteria, such as Lactobacillus. The gene under study is glucosyltranferase, or gtf. ^[1]

2. Throughout evolutionary history, S. mutans has also acquired adaptations that have increased its fitness in the oral cavity. These traits include improved carbohydrate metabolism and greater acid tolerance. It is estimated that there are currently 14 genes under selection that contribute to these adaptations. ^[2]

3. Lastly, I'd like to suggest that more detail be provided regarding vertical transmission of S. mutans, which is most often from mother (or caretaker) to child. This is listed in the article, but I would like to provide research findings that support this form of transmission. For example, it was previous thought that S. mutans isn't found in the oral cavity until young children's teeth erupt. However, studies have shown S. mutans to be present in the grooves of the tongue on pre-dentate infants. This suggests support for vertical transmission from mother to child shortly after birth. ^[3]

Conkle.30 (talk) 20:33, 30 September 2014 (UTC)

This is probably better on the article about the bacteria itself. Maybe some here to I guess. Doc James (talk · contribs · email) (if I write on your page reply on mine) 20:54, 30 September 2014 (UTC)

@Jmh649 - Thank you for your suggestion. When I add my final material to Wikipedia, I'll add it to the S. mutans page specifically. I can see how the evolutionary history pertains more to the bacteria rather than the disease. Perhaps I'll just add the section about vertical transmission to the dental caries page and the in depth evolutionary information to the S. mutans page. Conkle.30 (talk) 15:59, 8 October 2014 (UTC)

Have moved this to the article about the bacteria " It is believed that Streptococcus mutans acquired the gene that enables it to produce biofilms though horizontal gene transfer with other lactic acid bacterial species, such as Lactobacillus. ^[4]" Overly specific for here IMO. Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:55, 30 September 2014 (UTC)

@Jmh649 - As I mentioned above, I agree with your edit. Thank you for organizing and moving my post. Conkle.30 (talk) 16:01, 8 October 2014 (UTC)

I understand this page is going to translation soon, so I thought I'd post here first. The article is really well done. Under the diagnosis and treatment section, I don't see any reference to a positive stick with the explorer or interproximal caries that extend into dentin on BWs. Both of the these are tradition (and commonly used) criteria for operative treatment. Even if these concepts have given way to newer criteria, I think rewording the 1st paragraph of the treatment section might be worthwhile to better explain what cavitation or non-cavitation is.

Other minor stuff. The picture of "cavity" and "dental caries" could be higher quality. If it's OK, I'll take some new ones and post. Finally, the 1st paragraph is 5 short sentences and difficult to read. I'm not sure who's active here. I'm happy to take a stab and rewording or if someone else has been polishing the article, it might be worth another look. In the meantime, I'll try to get more info on cavitated v non-cavitated lesions. Ian Furst (talk) 19:59, 31 December 2014 (UTC)

Hey Ian. The plan is to only translate the first 4 paragraphs. For translation short sentences are much prefered over long ones. Have combined two particularly short ones though :-) Would love better pictures. Doc James (talk · contribs · email) 05:25, 1 January 2015 (UTC)

I thought that might have been a factor in the sentence structure. I'll get some more photos Monday or Tuesday and put them up.Ian Furst (talk) 18:52, 1 January 2015 (UTC)

Doc James have you sent it yet? Can I play with the 1st four paragraphs a bit? Ian Furst (talk) 02:36, 6 January 2015 (UTC)

Sure. As the body is not being translated am wanting to keep the lead very well referenced. Also trying to use simpler words and short sentences to make it easier for the translators.

Would love to have your helping improve the leads of other dentistry related articles aswell :-) Doc James (talk · contribs · email) 15:46, 6 January 2015 (UTC)

Matthew Ferguson Thank you. I'm happy to edit this page some more but I do find it a bit of a struggle and only do bits at a time! Npt1 I see you are having some difficulty with wikipedia's formatting. Don't worry too much about this, I will tidy it up after you are done editing. Many thanks for your help, Matthew Ferguson (talk) 12:04, 18 July 2015 (UTC)

Thoughts? Matthew Ferguson (talk) 17:30, 15 August 2015 (UTC)