Wikipedia:Peer review/Meth mouth/archive2

Meth mouth

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This article is currently a GA, and I'd like to try to get it featured. In this peer review, I'd like A. advice on whether it meets the medical criteria for featured articles (MEDRS, MEDMOS, etc.) and B. whether the prose, MOS, presentation, flow, etc. meet the FA criteria. Feel free to only weigh in on A or B depending on your familiarity with medical article/prose and punctiation etc. Thanks, Mark Arsten (talk) 17:43, 17 September 2012 (UTC)[reply]

From the lead section, paragraph 2, why is Novocaine singled out? I believe that Novocaine is a proprietary product containing procaine. In the UK, procaine is not used often; generally lidocaine is preferred. Exactly which reference is relevant? What does the reference say? Although the lead section is supposed to be a summary of the full article and therefore doesn't require references, I would recommend inclusion of references to help readers confirm verifiability. Axl ¤ [Talk] 18:34, 17 September 2012 (UTC)[reply]

There was no reason to single Novocaine out there, I've changed it to local anesthetic, the page source I cited says "If the patient has used methamphetamine within the last 24 h, the vasoconstrictor in the local anesthetic could result in further sympathetic drive to the cardiovascular system putting the patient at increased risk for cardiac dysrhythmias, hypertension, myocardial infarction, and cerebrovascular accidents". A previous page in the same study says "Local anesthetics with epinephrine or levonordefrin must not be used while the patient is high on methamphetamine as methamphetamine potentiates the response of sympathetically innervated organs to sympathomimeticamines". Mark Arsten (talk) 18:41, 17 September 2012 (UTC)[reply]

From the lead section, paragraph 2: "the cost of providing increased dental treatment for the incarcerated has taxed prison budgets in some regions." "Tax" has a specific meaning with respect to expenses. Perhaps change this to a more generic phrase. Axl ¤ [Talk] 18:37, 17 September 2012 (UTC)[reply]

Ok, instead of "has taxed prison budgets" I've changed it to "has strained the resources of prisons". Mark Arsten (talk) 18:43, 17 September 2012 (UTC)[reply]

~~From "Characteristics", paragraph 2: "Caries in the drug's users can be large." What is "large" caries? Axl ¤ [Talk] 18:45, 17 September 2012 (UTC)~~[reply]

Removed. Mark Arsten (talk) 19:48, 17 September 2012 (UTC)[reply]

~~From "Characteristics", paragraph 2: "These caries are usually on the buccal (cheek) side of the teeth." "Caries" is not a countable plural word. Axl ¤ [Talk] 18:53, 17 September 2012 (UTC)~~[reply]

Good point, I rephrased, hope this works. Mark Arsten (talk) 19:48, 17 September 2012 (UTC)[reply]

I have fixed a few similar problems. Axl ¤ [Talk] 20:37, 17 September 2012 (UTC)[reply]

Good catch, thanks for catching my mistakes. Mark Arsten (talk) 21:05, 17 September 2012 (UTC)[reply]

From "Causes", paragraph 1: "In a 2007 review of the effects of the drug on dental health, Jason Goodchild of New Jersey Dental School and Mark Donaldson of Oregon Health & Science University state: "The root of all dental evil for meth abusers is xerostomia"." Why are these guys and their universities singled out with a quote? Just delete the sentence. Axl ¤ [Talk] 19:00, 17 September 2012 (UTC)[reply]

Removed. Mark Arsten (talk) 19:45, 17 September 2012 (UTC)[reply]

In "Causes", last paragraph, the first and third sentences both seem to refer to localized acidity in the mouth. Surely these are connected? Axl ¤ [Talk] 08:40, 19 September 2012 (UTC)[reply]

From "Treatment", paragraph 1: "The application of fluoride is recommended by the American Dental Association." I do't see why the American Dental Association is named in the text. The reference should be enough to provide the source. Also, fluoride is mentioned in the preceding sentence. Just delete this sentence. Axl ¤ [Talk] 08:44, 19 September 2012 (UTC)[reply]

The remainder of the paragraph names Hamamoto and Rhodus, together with their university, in the text. Why are these guys named in the text? The referencing should be adequate to provide the source. Axl ¤ [Talk] 08:48, 19 September 2012 (UTC)[reply]

From "Treatment", paragraph 3: "This is often because of poverty or a poor medical system." What is a "poor medical system"? Axl ¤ [Talk] 22:52, 19 September 2012 (UTC)[reply]

From "Treatment", paragraph 3: "There is also an increased risk of serious side effects if antipsychotic or opioid medications are used in the patient's treatment." Why are antipsychotic medications relevant to meth mouth? Axl ¤ [Talk] 22:56, 19 September 2012 (UTC)[reply]

Regarding how much amphetamine "use" is necessary for "meth mouth", the NIDA said in 2010: "Long-term methamphetamine abuse has many negative health consequences, including extreme weight loss, severe dental problems ("meth mouth") ..."[1] Is this what is meant by "user"? MathewTownsend (talk) 19:37, 17 September 2012 (UTC)[reply]
- On the GA review, J Milburn said "I worry that "abuser" carries a particularly judgemental overtone- a more neutral term would probably be "user". Everyone can agree that people are using meth, but whether they're "abusing" meth is a potentially questionable claim." So I removed "abuser". I'll add "long-term" as a qualifier, I guess. Mark Arsten (talk) 19:45, 17 September 2012 (UTC)[reply]
Maybe a good read of WP:MEDMOS may help. Personally, I think there needs to be some incidence figures. Who has "meth mouth, worldwide incidence, percentage in prisons perhaps? Concrete figures, since NIDA seems mostly concerned with use by adolescents, who don't apparently have a problem with "meth mouth". How many months, years does it take to occur? Also, is there a formal medical term for the condition? MathewTownsend (talk) 01:04, 19 September 2012 (UTC)[reply]
- I'll look again, but how would you suggest I proceed if reliable sources don't have anything on incidence or years to occur? Mark Arsten (talk) 02:12, 19 September 2012 (UTC)[reply]
  - Well, either that there are statistics somewhere that justify media attention to "Meth mouth" and the grant by NIH of $1.86 million to UCLA School of Dentistry for 'meth mouth' research (actually a pretty puny amount for a serious problem), or this dental condition is something that gets press mention because of some startling pictures a dentist took (copyrighted) that made great billboards, real problems in prison medical budgeting, and the public's concern about amphetamine use in general and it's possible health effects, including on dental health.
  - Does it have a medical (dental) diagnosis in some dental diagnostic manual? Is there a formal medical term for the condition? Perhaps more searches in journals relevant to dentists? European sources, since its use is said to be rampant there, so that meth mouth doesn't seem just an American/Australian concern? MathewTownsend (talk) 16:10, 19 September 2012 (UTC)[reply]
    - Basically, I think the answer to your first question is the latter. As to the second sentence, I haven't been able to find sources discussing meth mouth as a problem in Europe. As far as dental diagnostic manuals and more specific sources than pubmed, I'm not sure, I just pinged someone from the dental wikiproject for help. Mark Arsten (talk) 16:58, 19 September 2012 (UTC)[reply]
      - good idea. MathewTownsend (talk) 17:04, 19 September 2012 (UTC)[reply]
        Head of WikiProject Dentistry here -- I say that not to lend any greater weight to my comments but only to indicate that I'm responding to Mark's request to visit and comment. There seems to be no formal term for "meth mouth" other than "advanced tooth decay attributed to heavy methamphetamine use" -- this might be because those who suffer meth mouth exhibit no signs or symptoms that are restricted to the effects of methamphetamine. Rather, it appears that the group of signs/symptoms associated with methamphetamine use occur at a faster rate and to a greater extent due to the drug use/abuse, such as but not limited to: dry mouth, tooth decay, tooth fracture and gum disease. (See this link) And because dentistry (at least in the US) bills by treatment codes and not by diagnosis codes, there is not necessarily a collaborative effort to give groups of signs/symptoms a particularly well-agreed upon name. A glance through PubMed shows that the term "meth mouth" brings up the topic, but no other term would do the same, except for perhaps "methamphetamine and dentistry." A similar phenomenon occurs in respect to bisphosphonate-associated osteonecrosis of the jaw, which has at least 5 different names and is abbreviated BON, BON of the jaw and BRONJ, and probably others as well. DRosenbach ^{(Talk | Contribs)} 18:29, 19 September 2012 (UTC)[reply]

I don't think we need a section header "Controversy" unless we're highlighting that lots of researchers get on sides to debate whether or not there is undertainty on the condition. Perhaps "Uncertainty" as a section title instead? Also, who are these advocates, and are they a significant minority viewpoint of medical researchers? Or are they fringe? Or are they fringe lobby groups and just a social phenomenon (and unreliable for biomedical information?) We could use some clarification/attribution in the article, I think. You can probably treat at least one my questions as rhetorical. Biosthmors (talk) 19:59, 19 September 2012 (UTC)[reply]

Comments: As usual, this is a really good article on a really interesting, unusual, and important topic. I know the volume of comments is large, but they are mostly minor fixes, and some of them don't even necessarily have to be addressed. Nice work.

Lead:

"symptomatic of extended methamphetamine (meth) use" Methamphetamine may or may not be commonly recognized as a drug by the average reader. What about "symptomatic of extended use of the drug methamphetamine (meth)" or something similar?
"because of the interaction of local anesthetic with methamphetamine" What are the results of this interaction? We conclude from the context that they are dangerous, but how dangerous?
"To treat patients with the condition, dentists prescribe measures to fight tooth decay (dental caries) and dry mouth. Fluoride and drugs that increase saliva are recommended to treat dental decay and dry mouth." Combine into one sentence as: "To treat patients with the condition, dentists prescribe fluoride and drugs that increase saliva in order to fight tooth decay (dental caries) and dry mouth."
"The patient is educated to practice better nutrition and dental hygiene" Can we change this to active voice somehow?
"few long-term users make the behavioral changes needed" According to whom?

Characteristics:

"Caries often occurs in the cervical regions of teeth, where the tooth surface narrows at the junction of the crown and the root. Caries is usually found on the buccal (cheek) side of the teeth, and on tooth surfaces that are adjacent to incisors and canine teeth" Seemed weird to start two straight sentences with "caries"; maybe combine these sentences or at least use the pronoun "it" to start the second one.
"The decay seen in the condition can..." I think you can drop "seen in the condition".
"Parallels have been drawn" By whom?
"Methamphetamine users sometimes experience soreness in the joint of the jaw and dental attrition (tooth wear), owing to bruxism (grinding of the teeth) caused by the drug." The way this is written, it is unclear if both the soreness and the dental attrition are caused by bruxism, or only dental attrition. A well-placed "both" might solve this. Also, it isn't clear to me exactly how the drug "causes" bruxism.
"This bruxism can occur continuously, rather than being limited to the night." Is it widely understood that most bruxism occurs at night?
"Chronic use of the drug might also cause trismus, the inability to open the jaw." I thought "trismus" might by synonymous with "lock jaw", but after reading the article, I see that in the case of amphetamine use, bruxism is often erroneously referred to as trismus (or so says our wiki-article). Might want to clear this up.

Causes:

"Long-term methamphetamine use can cause parafunctional habits, routine actions of a body part that are different than their common use, which can result in tooth wear and exacerbate periodontal diseases. One such habit that may affect the development of meth mouth is bruxism, particularly as the drug's effects wane and stereotypy occurs, often referred to as "tweaking"" Ah, here we have the answer to how the drug causes bruxism. Maybe move these sentences to the earlier section.
"There has also been speculation that oral consumption" Speculation by whom?
"likely does not reach a level that causes caries" Who opines that this is likely?

Treatment:

"They recommend 5 000 ppm sodium fluoride" Unclear antecedent; who are "they"?
"Hamamoto and Rhodus" Who?
"Hamamoto and Rhodus argue that pilocarpine and cevimeline, sialogogues that are Food and Drug Administration (FDA) approved to treat hyposalivation caused by Sjogren's syndrome, have the potential to effectively treat methamphetamine-caused xerostomia." Are there any significant arguments on the other side?
"the use of sugar-free gum has been suggested" By whom?
"Tooth extraction is required in severe cases." You kind of already said this in the characteristics section. ("In some cases, the teeth are permanently damaged and must be removed.") Does it need to be both places?
"few are willing to participate in such a course of action. This is often because of poverty or a poor medical system." I'd connect these two thoughts in the same sentence.
Consider moving the last paragraph in this section to the first instead. I think it sets up the rest of the section well.

Controversy:

"whether the drug has a unique affect on dental health" Change "affect" to "effect".

Society and culture:

"members of the U.S. Congress sought increased funding for dental care in prisons, in response to the prevalence of the condition" The political junkie in me wants to know who these members of Congress were. Was it a bipartisan effort to increase funding? Were the legislators mostly from a specific geographic region or other readily identifiable constituency (i.e. conservatives vs. liberals, rural areas vs. urban areas, etc.)? What was the name of the legislation? Did it pass? If so, has it had any discernable effects?
Overall, I find this section satisfying in it's attempt to address the international nature of the issue and somewhat unfulfilling because it feels a little like a collection of international facts given without much context or follow-up. For example, "In 2007, an official at the Australian Dental Association stated that the increased use of drugs, including methamphetamine, posed a "serious problem" to the dental health of young Australians." What prompted them to issue this statement? Was there an increase in meth use in that country? Why does the statement specifically reference "young Australians"? I realize that such context and follow-up may not be available, so treat this as much as a perception as an actionable request, but anything you can do to provide context would really make this section better.

I'm leaving on vacation tomorrow and will have limited access to the Internet for about a week, so I may be slow about striking these once they are resolved. If there's something you really want me to have a look at, hit me with a {{tb}} on my talk page. Acdixon ^{(talk · contribs)} 16:59, 20 September 2012 (UTC)[reply]