Talk:Dental amalgam controversy
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[edit] Archive
Talk:Dental amalgam controversy/archive1
[edit] Nice work
I've got to hand it to the editors on this one, but for a few points where it reads like a yeah-but-no-but, you've done a good job handling the subject.
[edit] What about particles of amalgam which are ingested during the proceedure?
Twice I have had amalgam fillings. his is mainly because both dentists have reported having difficulty getting the composite resin to stick and that both of my fillings went down to the nerve (pulp) which they claim increases temperature sensitivity with the composite.
However, both times I find peices of the amalgam in my mouth, and smaller peices will chip away from the occlusal surface itself. I have still yet to find any sources that shed light on this fact.
Is there any danger for amalgam to be ingested?
- Yes there is that is why it is necessary to use a number of precautions when amalgam is removed. 1) A properly installed rubber dam to seal the area and prevent accidental ingestion or inhalation of amalgam particulate matter 2) A separate source of medical air to the nose to avoid inhalation of mercury vapor etc.... Consult the IAOMT recommended protocols at www.iaomt.org for the details. It is thus important that your dentist be aware of such protocols. Dr. Imbeau
Are you sure, Dr. Imbeau, about the ingestion of particulate matter? I have no reference, but I was told in dental school that set amalgam will pass through the digestive tract intact. The digestive tract is a poor absorber of mercury also, it absorbs less than 0.1% of ingested Hg (0.04%) (af Geijersstam et al, J. Dent. Res. 2001 Sep;80(9):1793-6. This study used 1g of powdered amalgam => higher than normal dose and increased surface area and found an absorption rate of 0.04% but still found this to be significant. I wouldn't agree with that assessment). I wholeheartedly agree with you about use of rubber dams and adequate suction and water. I always thought this was to prevent inhalation/swallowing of unamalgamated mercury vapour that arises during condensation or removal of amalgam. --Dr-G - Illigetimi nil carborundum est. 17:09, 8 August 2006 (UTC)
- Dr. G. The presence of amalgam particulate matter in the GI tract can have adverse effect on the microbial flora, a potential factor in gut dysbiosis, a rather common problem associated with inflammatory bowel diseases, irritable bowel syndrome ect.... Dr. Imbeau 03:53, 9 August 2006 (UTC)
- Dr-G - Illigetimi nil carborundum est. Further to your comments I would suggest you look at the following study:
Gastrointestinal and in vitro release of copper, cadmium, indium, mercury and zinc from conventional and copper-rich amalgams. Brune D, Gjerdet N, Paulsen G. Scand J Dent Res. 1983 Feb;91(1):66-71. Here is the abstract:
Particles of a conventional lathe-cut, a spherical non-gamma 2 and a copper amalgam have been gastrointestinally administered to rats for the purpose of evaluation of the dissolution resistance. The animals were sacrificed after 20 hrs. The contents of copper, cadmium, indium, mercury and zinc in kidney, liver, lung or blood were measured using nuclear tracer techniques. From a copper amalgam an extreme release of copper was demonstrated. This study stimulates the clinical condition of elemental release from swallowed amalgam particles after amalgam insertion or after removal of old amalgam fillings. Specimens of the same types of amalgams were also exposed to artificial saliva for a period of 10 days. The amounts of copper and mercury released were measured with flame and flameless atomic absorption spectrophotometry respectively. The levels of copper and mercury released from the copper amalgam were approximately 50 times those of the two other amalgam types studied.
Dr. Imbeau 23:10, 14 August 2006 (UTC)
[edit] Still No Dental Amalgam Controversy
This article is so poorly written as to defy explanation.
The title of this article is "Dental Amalgam Controvery".
This is an article about the controversies surrounding the use of dental amalgam.
The controversies are simple:
1. Dental amalgam has never been safety tested by the FDA, and yet is widely used.
2. Scrap dental amalgam must be stored in a covered jar in a dental office.
3. Scrap dental amalgam may not be flushed down the drain.
4. Dental amalgam emits mercury vapor.
5. Only the ADA is responsible for the safety of dental amalgam, and has never studied it for safety.
The "editors" of this article have ruined this piece, as usual. When someone reads this "edited" work, they do not see any "controversy" but rather the same B.S. history we have heard about "since 1820 blah, blah, blah".
Who cares what happened in 1820? The controversies exist, are real, and are being suppressed.
[edit] Article rewrite
I am currently in the process of rewriting this article to present the arguments succintly but accurately and conform to WP:NPOV and WP:Verifiability as much as possible. I hope that the result will be (1) more readable, (2) more encyclopedic, and (3) fair to all views. My goal is to post the rewritten article by the end of this week (i.e., the end of February). - Jersyko·talk 01:23, 20 February 2006 (UTC)
- I have posted a re-organized, cleaned up version of the article that I think presents the applicable arguments in general terms but fairly. I removed information that is already covered in the dental amalgam article and information that did not conform to WP:Verifiability, though in some instances I left the information in with a "citation needed" tag. I am certain that the article could be expanded, but any expansion must adhere to WP:NPOV, WP:Verifiability, and should retain a general organization that was completely lacking in the older version of the article (or on this talk page, for that matter). - Jersyko·talk 18:40, 21 February 2006 (UTC)
I agree that this is a tremendously significant improvement and that the NPOV is clearly there. I thank the editors on behalf of all citizens for allowing for the first time in recorded history, an article about the controversy around dental amalgam which is shown without taking any sides. —This unsigned comment was added by 65.92.59.238 (talk • contribs) .
[edit] Swedish Ban on Mercury
I think it might be important to note that the new Swedish ban is on all uses of Mercury, not specifically on dental amalgam. This is significant because it seems to be an environmental issue, not a medical one, and so does not really strengthen any claims that the solid amalgam is dangerous to humans, but that Mercury in its liquid state can make quite a mess if mishandled. I think mentioning it in a sub-section is more appropriate than putting it in the intro. -- Vary | Talk 23:54, 28 March 2006 (UTC)
[edit] Article organziation
Though my goal in February was to remove POV, original research, and generally organize this article when I rewrote it, I'm still not satisfied with the current organization of the article, though I think it's better than it was. Do any editors have suggestions on a better organizational structure for the article? I feel that the first two sections (history, overview, and governmental involvement + regulation) could be split into more sections, but how should that be done? - Jersyko·talk 00:05, 29 March 2006 (UTC)
[edit] Links
There are two links regarding the swedish notification.
http://www.kemi.se/templates/News____3036.aspx
The above is from the Swedish Chemicals Inspectorate and contain additional links to up to date data and information used by the swedish government to arrive at it's decision.
http://www.sweden.gov.se/sb/d/6233/a/57435
The above is the one I provided earlier to the Swedish Governement Offices.
I think you should put the links after the name of the coutry to allow reader to browse if they wish to. Especially since you have a link to the FDA webpage..... NPVO —This unsigned comment was added by Dr. Imbeau (talk • contribs) .
- The second link is already in the article after the Sweden link in the "History, overview, and governmental involvement" section of the article. As the first link is merely a short summary of what the second link is describing, is it really necessary? Please sign your comments on talk pages, you can do so with ~~~~. Thanks. - Jersyko·talk 00:27, 29 March 2006 (UTC)
Dear Jersiko;
The second link to the Swedish Chemicals Inspectorate is the more detailed one with regards to additional information and the basis for the ban.
The first link is more clearly a government related site.
If you need to choose one then the link to the SCI would be preferable.
Dr. Imbeau 00:51, 29 March 2006 (UTC)
- Fair enough. Since the SCI appears to be a quasi-EPA (forgive my U.S.-centric parochialism), linking to their summary is fair, in my opinion. - Jersyko·talk 01:59, 29 March 2006 (UTC)
Dear Jersyko. Agreed. Especially since the SCI summary is a lot more balanced and less politically motivated than the FDA one. The Swedish are progressive and dealing with the issue in a more comprehensive manner. A good lesson for the FDA which by the way does not have a great reputation for impartiality. Also the FDA statement is dated 2002 while the Swedish one is actual and there has been interesting scientific evidence in the last 4 years... and more to come.
By the way I was involved indirectly in the New Zealand government assessment on dental amalgam as used by the FDA in their summary. Things were not as simple as they are being presented.... Dr. Imbeau 09:09, 29 March 2006 (UTC)
[edit] In answer to Vary
Vary;
I think you are drawing premature conclusions on the basis for the Swedish ban. If you look into it further you will notice that the swedish goverment is well aware of health concerns regarding amalgam and that amalgam is the source for about 30% of all mercury used.... Of course mercury is the main problem in amalgam and mercury in general, whatever it's sources, is a danger both to the environment and the creatures that inhabit it since they to are part of the environment. —This unsigned comment was added by Dr. Imbeau (talk • contribs) .
Dear Vary;
I am not sure what your background is and how you arrive at your comments regarding what you call solid amalgam. You should be aware, if you are involved in editing this article, that there is no doubt whatsoever that amalgam does release mercury vapor on an ongoing basis. This is a scientific fact and as such totally NPOV.
Even before this was proven beyond a shadow of a doubt, it was still TRUE. Of course it is only when the evidence became overwhelming that the ADA accepted the fact. Before thay had been adamant that mercury was totally bound in amalgam and did not escape. I still hear this fallacy today. Denial is a strong motivator. —This unsigned comment was added by Dr. Imbeau (talk • contribs) .
- Since we are on the topic of NPOV, let us keep in mind that the medical/dental consensus is currently that amalgam releases mercury vapor, and (in spite of that) amalgam is a safe, effective material for dental restorations. Both points should be clear in the article. - Dozenist talk 01:26, 29 March 2006 (UTC)
[edit] More on POV
Dear Dozenit;
Welcome back into the discussion. If you really wish to be NPOV than you have to state that amalgam is " still considered " safe by the same people who stated adamantly before that mercury did not escape from amalgam.... until science proved them wrong.
There is a difference you see, since an opinion ( or point of view ) does not make something true. And that is all about POV.
Of course any well informed person knows that this earlier opinion was wrong all along. And by experience I can tell you that the opinion that amalgam is safe is just that, an opinion, because the more scientific evidence we gather the more troubling questions are raised about the safety of amalgam.
Of course we will still need to address the political implications for everyone involved so that will take some tip toeing and circumvolutions.... but it will happen, in fact it has already begun....
Cheers
Dr. Imbeau
[edit] SCI ( KemI ) / FDA
Dear Jersyko;
One more point regarding the text under the REGULATION heading.
While you mention " Some countries, such as Japan, Norway, and Sweden, have banned or stringently regulated the use of mercury in dental amalgams, citing health concerns "
This does not have the same weight has the text: " The FDA maintains a web page on the use of amalgam, however, on which it states, "no valid scientific evidence has shown that amalgams cause harm to patients with dental restorations, except in the rare case of allergy."[5]. "
I suggest that you add a phrase taken from the KemI Report to give balance to the article and maintain NPVO: " The Swedish Chemicals Inspectorate ( KemI ) judges that there are strong grounds for banning amalgam for environmental reasons. From a health point of view there is every reason to apply a precautionary approach. " I would place a link to the report.
Readers who will consult the report will soon see that 1) there is valid scientific evidence to support the KemI decision. This will put things into perspective with regards to the FDA statement which is 1) outdated 2) not as comprehensive as the KemI statement.
Dr. Imbeau 23:48, 29 March 2006 (UTC)
[edit] Metal release from amalgam
Dear Jersyko;
The text below needs revision:
" Similarly, some proponents feel that the mercury contained in amalgam fillings is safer than pure mercury compounds due to the differences between pure metals and alloys. Many of the discussions on this topic have centered on whether the amalgam mixture is stable or whether any metals are released from the fillings after being placed in the oral cavity."
Since it is a fact that mercury is released on an ongoing basis from amalgam there is no foundation to have a discussion about whether or not metals are released from amalgam. Apart from mercury there are many metallic corrosion by-products also release from amalgam. All NPVO and science based.
Will you fix it ?
Dr. Imbeau 01:17, 30 March 2006 (UTC)
[edit] Another sticky one...
Dear Jersyko;
The following text needs reworking:
" Most dentists, however, still feel that while, when placing the fillings, both patient and dentist are exposed to a small amount of mercury and mercury vapor, once the alloy has hardened (which takes less than a minute), most of the mercury is captured in the filling and, being bound in the alloy, cannot get out except in small amounts they would not deem significant except for the hyper-sensitive. Opponents and some alternative medicine practitioners, on the other hand, disagree, and recommend that patients with amalgams have them removed or risk serious health effects. "
While it is true that many dentists still feel amalgam is safe to use , it is mainly because they have no training in toxicology and do not understand the effects of mercury in biological systems. Of course whether they deem the amount of mercury vapor released from amalgam significant or not is an opinion from professionals who have no basic qualifications to make that call ( unless they have post-graduate training, in which case they are probably amongst the dentists who know that amalgam is not a suitable dental material - and keep in mind that the number is constantly growing ).
As far as opponents recommending wholesale removal of amalgam in all patients that is not factual. It would be more accurate to state that medical and dental practitioners who are knowledgeable about amalgam and mercury toxicity recommend the use of biologically compatible dental materials instead of amalgam, They also advocate the safe removal of amalgams and detoxification ( using standardized protocols ) in patients suffering from micromercurialism.
Dr. Imbeau 01:34, 30 March 2006 (UTC)
- This is where I get off the bus. You're now claiming that *knowledgeable* dentists and doctors recommend doing one thing, which obviously implies, actually explicitly states, that dentists and doctors who use amalgams or recommend their use are merely ignorant of the true knowledge. So are the people who have conducted some studies that demonstrate that amalgam is safe completely lacking in post-graduate degrees? My point is that there is evidence on both sides, and stating that the evidence for your side is the result of some kind of "true knowledge" that the other side is ignorant of because of lack of education or the like is crossing the line into viewpoint advocation. I'm not pro-amalgam, like Dozenist, and I'm not anti-amalgam, like yourself. I merely want to have a neutral encyclopedia. In my view, there is some evidence supporting both sides on this issue, but the scientific consensus, if there is one (and that's not certain), actually appears to be the opposite of what you claim it to be. Nonetheless, for the purpose of neutral point of view and in the interest of writing an encyclopedia article, this article cannot concede to the quasi-consensus. The edits you have suggested up till this point have aided this goal, but this one does not, I'm afriad. - Jersyko·talk 01:50, 30 March 2006 (UTC)
Dear Jeryko;
Getting of the bus will not solve anything. I think you are over reacting. I have used amalgam myself for many years so I have a small idea of what I am talking about. With what I know today after years of learning, I have taken a different course of action. Knowledge is something that grows and not being informed or aware of an issue does not means that a person is acting in bad faith, it simply means that that person has not yet acquired the knowledge and to acquire it , an open mind is required... As far as studies showing that amalgam is safe, please can you produce one study proving that amalgam is safe ? I would certainly be interested in reading it and would appreciate greatly the opportunity.
As far as neutral point of view. I agree with the goal of a neutral point of view but that should not be done at the expense of the facts that we know are true.... An erroneous point of view can be stated for information purposes but if it is proven that it is erroneous there is nothing wrong in saying so. In fact a credible encyclopedia will not only present both sides but will also have a basis on factual evidence. Need I give examples ?
Dr. Imbeau 02:08, 30 March 2006 (UTC)
- Well, the article itself cites the FDA statement on the issue, which says "no valid scientific evidence has shown that amalgams cause harm to patients with dental restorations, except in the rare case of allergy." Ok, so that doesn't prove it is safe, but it certainly casts doubt on your belief that there are studies that prove it is not. Again, this does nothing, as far as I'm concerned, but merely muddy the issue, meaning that neither side can really prove their points. - Jersyko·talk 02:29, 30 March 2006 (UTC)
- About the FDA statement, I would not put to much emphasis on it. It was written 4 years ago and since then a lot of new research has been done. Again PLEASE PROVIDE ME WITH A STUDY ( JUST ONE ) THAT PROVES AMALGAM IS SAFE. It is too easy to claim adamantly that amalgam is safe without providing proof while at the same time requiring insistently evidence that it is unsafe. You also have to take into account the fact the the Swedish government considers that there is every reason to be cautious when amalgam is concerned... Certainly they would not say that if amalgam was as safe as being claimed by the pro-amalgam lobby...
Dr. Imbeau 03:08, 30 March 2006 (UTC)
One more thing.... if you have not realized that the consensus, as you call it, has started to shift, then you definitely need to learn more about what is going on...
Finally thank you for informing me that as an editor you have taken the position of a judge ( may be that will be in your future career ) about what is NPVO and what is acceptable facts or not. Sadly you are far from possessing a good graps of the facts involved and seem to be struggling with your perception of the issue.
Dr. Imbeau 02:20, 30 March 2006 (UTC)
- Cool. Well, you're certainly winning me over for your side, I'll tell you that much. - Jersyko·talk 02:22, 30 March 2006 (UTC)
Do I need to win you on my side in order to have an article that is based on the most up to date facts ?
If you simply consider the long history behind this issue you should realize in what direction it is going...
Dr. Imbeau 02:36, 30 March 2006 (UTC)
Dear Vary;
On the issue 2 and 3 in the above comment:
There as been some misunderstanding about this one: 1) What I wrote was part of a discussion between Jersyko and me and not intended to be placed in the article. He himself advised me to put my comments in the DISCUSSION section. I did mention this in a further comment stating that I fully agreed with avoiding any wording that implied that dentists using amalgam do not care about their patients because this is not what I wrote or implied. Also I agree that a general statement concerning the lack of understanding about Hg toxicology in dentists using amalgam should not be included in the article. I repeat this was simply part of a discussion since individual knowledge of each dentists is something that can vary significantly depending on his/her basic training and post-graduate training. And I am not ready at present to make an extensive survey of all dental school curriculums to see where and if they offer training in heavy metal toxicology to undergraduate dentists now or where and if it was offered in the past 5, 10, 15 years etc...
The texts that I suggested for inclusion in the article is : " Medical and dental practitioners who are concerned about the use of amalgam and the potential effects of mercury on human health recommend the use of non-amalgam materials that should be tested for biocompatibility. They also recommend proper amalgam replacement and heavy metal detoxification in patients who are diagnosed with micromercurialism."
I suggested this text to Jersyko in place of " Opponents and some practitioners, particularly alternative medicine practicioners, on the other hand, disagree, and recommend that patients with amalgams have them removed and replaced or risk serious health effects." and was expecting to have a discussion on that proposed text and not a " getting off the bus " reaction. I now understand there was a misunderstanding and I should have expressed myself more clearly to help avoid such.
The basic reason for suggesting the change is that it is not factual. Practitioners who do not support the use of amalgam do not recommend that all their patients proceed with wholesale removal of their amalgams, as implied in the text as it is written. They do not however use amalgam in their practice or recommend that patients have amalgam placed. In individuals who have experiencing problems with amalgam / mercury related problems than they will recommend proper replacement of amalgam and refer or collaborate with a health practitioner for further treatment to remove stored mercury. They will also provide information on amalgam and mercury ( as required in certain states and elsewhere ) so that each patient can make up his own mind. That is called informed consent by the way and should be done not only for amalgam but also other dental materials and procedures.
Finally I have included a few links of more recent studies for you to check if you wish ( not for inclusion in the article... I should emphasize ) . I have no problem with the fact that there is a controversy because that is a fact. I am sure that those supporting the continued use of amalgam will do their part to provide evidence and justification and I do not see that as my role but I am not either trying to remove information that is true. But to dismiss the evidence that is available because the US aligned consensus is at present that amalgam does not cause harm to patient with dental restorations except in rare cases of allergy is not my idea of NPOV. I say US aligned because other countries have expressed concerns that, based on the available evidence, there is valid reasons to be cautious, especially in individuals that may have a reduced ability to cope with low level Hg exposure. Thus they have been pro-active in protecting these individuals by contra-indicating the use of amalgam in children, pregnant women, people with impaired kidney function, people with mercury sensitity ( who decides who is sensitive and who is not ? ) and people with other metals in their mouth ( because that causes increased galvanic corrosion and Hg vapor release... ) etc....
I could explain how mercury can indirectly affect health by affecting other organs systems which lead to symptoms that are diagnosed as something else... but that is another matter.
I hope that helps to clarify the situation so we can continue to make positive progress :-)
--Dr. Imbeau 07:26, 30 March 2006 (UTC)
- "proper amalgam replacement and heavy metal detoxification" = "have them removed and replaced"; I cannot see how you can claim otherwise. Please enlighten. - Jersyko·talk 13:54, 30 March 2006 (UTC)
- Dear Jersyko, the text, as written, leaves the impression that " opponents and some practitioners, particularly alternative medicine practicioners... " automatically and in all cases " recommend that patients with amalgams have them removed and replaced or risk serious health effects. " Things are not so black and white because there are a lot of variations in individual abilities to metabolise and excrete Hg. Some individuals needs to have their amalgam replaced for immediate health reasons ( at the very least there is consensus on those who experience a sensitivity or allergic reaction ) while others may do it simply because they do not wish to carry their own reservoir of Hg while others may not be concerned and wish to keep their amalgams but not have new ones place in while other simply think that amalgams are safe and are quite happy to have more and that is all fine as long as people are well informed. The same way that there are people today who still choose to smoke in spite of the NOW overwhelming evidence that smoking is a risk factor for many health problems. Mind you it took a long time and many battles to get to that consensus.
As for the qualification " proper amalgam replacement and heavy metal detoxification ". This is quite different than just have the amalgam removed and replaced. 1) When amalgam is cut with a dental drill there is an increase in mercury vapor release that can exposed both dental staff and patient to a peak Hg exposure so there are known precautions and techniques to protect the patient and dental staff against that mercury vapor 2) if amalgam replacement is indicated for reasons of Hg related toxicity, it is because Hg has accumulated in that person's tissues so amalgam replacement as such will simply eliminate future exposure but will not remove what is already in the tissues 3) A suitable restorative material that demonstrate excellent biocompatibility should be used.
Again I hope that will clarify my point. --Dr. Imbeau 21:08, 30 March 2006 (UTC)
-
- It sounds like Imbereau has an issue with the statement that all mercury-free dentists recommend removal of all amalgam fillings, when many feel it's better to leave the existing fillings alone and just not add any more. Is that right? I've adjusted the section in question to make it clear that removal of amalgam fillings is generally recommended only if they seem to be causing a problem. Better? -- Vary | Talk 20:47, 30 March 2006 (UTC)
- Dear Vary, You are getting there. The point is that all mercury-free dentists do not recommend the wholesale removal of all amalgams in all individuals with amalgams. Being mercury-free means not using amalgam or mercury containing materials in practice. There are other issues of course as briefly mentioned in my answer to Jersyko. --Dr. Imbeau 21:08, 30 March 2006 (UTC)
- Dear Vary, as I said we are getting there, but recommendation for amalgam removal and replacement is not simply made on symptomatology. It involves a clinical and laboratory assessment to confirm the presence of elevated Hg in the patient's body and correlation with symptomatology. it also involves the use of proper protocol before , during and after the removal. So it is not just. Eh you have symptoms that fit this list so lets go and remove all your amalgams !!--Dr. Imbeau 21:31, 30 March 2006 (UTC)
[edit] Negligible amount in air ?
Dear Jersyko;
I see that you have problem grasping some of these issues.
Before editing you should become better informed.
For example in Sweden which has a much smaller population than the US
1- In 2003 mercury supplied for amalgam was estimated to be 100 kilograms ( 220 pounds ) 2- Amalgams are the single biggest source of mercury in the sewage sludge. Almost half of this is mercury released from amalgam fillings while they are in the mouth, and another large part comes from incomplete separation of amalgam from dental surgeries including mercury in waste pipe sediments. ( http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12449334&query_hl=3&itool=pubmed_docsum ) 3- The swedish EPA calculated emission of mercury from crematoria as 123 kg ( 271 pounds ) in 2003.
If you know a bit amount mercury toxicity that is a HUGE amount.
I do wish to assume good faith on your part but your quick tendency to edit out what you claim is point of view when it is fact and to leave point of view over fact is a cause of concern ...
Dr. Imbeau 01:56, 30 March 2006 (UTC)
- Yet your quick tendency to assume your knowledge of this subject is somehow superior to the majority of scientists that have studied the subject (with your constant insistence that I, dentists, and doctors are merely ignorant on this subject) is extremely off-putting. Point of view can be expressed through selective presentation of fact. For instance, the article mentions that one organziations opposed to amalgam use claims to have over 65,000 studies on file implicating amalgam fillings in diverse health conditions. Reporting on each and every one of those studies in this article would be (1) impossible and (2) violative of neutral point of view as it would completely ignore all the studies that have demonstrated contrary conclusions. I see you've chosen a convenient study to cite in the information you posted above. I have a feeling there is some evidence to the contrary, just like there is regarding most of the arguments surrounding amalgam. Our job here is to not present "facts" taken selectively from studies as truth, but to point out that there is valid disagreement on these issues. As far as I'm concerned, there is no objective "truth" regarding amalgams except that for which there is nearly universal agreement (i.e., the content of amalgams, what countries they are used in, etc.). Everything else in this article must be presented as debated, presenting arguments for both sides. Your suggestion would have me accept your POV as truth, which I'm not willing to do. - Jersyko·talk 02:19, 30 March 2006 (UTC)
Dear Jersyko;
I do not assume to know more than the majority of scientists and if you do read the scientific evidence you will note that as more evidence is gathered that the preponderance of evidence is gradually shifting. I do assume that I know more about this issue than you unless you can prove otherwise. As far as debating all the studies , I agree. This does not detract from the fact that the information I posted is not POV but factual evidence. It is easy to claim that I make selective evidence of the facts as you do and I understand why when reading the history and archived discussion , there is such a problem with control in this article. In fact there are very instances where you have not edited the work of other editors...
I have tried to heed your advice have a discussion with you based on factual evidence and found that you are struggling and reaching conclusions before taking the time to understand what is involved.
Dr. Imbeau 02:29, 30 March 2006 (UTC)
- Once again, it seems that all I need is greater understanding to come to the true knowledge that you possess. I'll work on that, k? - Jersyko·talk 02:32, 30 March 2006 (UTC)
Sarcasm.... It is too easy to claim impartiality and be quick to discard information that does not suit a pre-established framework.... A good way to railroad the issue. As far as knowledge whether true or not, I am sure you have more knowledge on other issues than I do and I certainly do not have a problem with it.....
Dr. Imbeau 02:47, 30 March 2006 (UTC)
[edit] Amalgam, mercury and sewage
Dear Jeryko;
You can do a quick check on PubMed to see for yourself. For example search under " mercury from amalgam and sewage sludge " and you will see a good dozen studies showing amalgam to be a significant source of mercury in the environment.
Of course this mercury can also find it's way back into humans... interesting loop effect, don't you think ?
Of course this evidence is the reason why many US states are now legislating to control this issue.... Not POV just the reality that is actually unfolding...
Just to show I am not using one study in isolation... as you assumed.
Dr. Imbeau 03:32, 30 March 2006 (UTC)
- I know it's not in isolation. As I said above, there's 65,000 or so. But there's also a lot of reputable organizations (see FDA, which has not changed its stance since the statement was issued, WHO, etc.) that disagree. See? That's why this is a controversy--there is evidence for both sides. Regardless of whether one side is "correct" in the long run, as there is disagreement now, the article cannot adopt the evidence for one side as true when it is disputed by the other side. - Jersyko·talk 04:14, 30 March 2006 (UTC)
[edit] Still struggling as I can see
Dear Jersyko;
It is your description of the stance of opponents that I see as POV and not an accurate description of what the " opponents " are actually recommending.
While I agree that a wording implying that pro-amalgam dentists do not care for their patients should not be used ( remember I use to insert amalgam and I would like to think that I did care for my patients then as I do now ). It is also important to provide an accurate description of the concerns and recommendations of health professionnals who do not support amalgam use.
The article clearly states that most dentists think amalgam is safe and not a problem and that, I think, is probably still true but from my contact with colleagues I also know that this is changing but I do not know when the majority shift will occur. I also known that the description of what " opponents " recommend does not refelct the current reality of most dentists who are not supporting th continued use of amalgam.
Would something like:
" Medical and dental practitioners who are concerned about the use of amalgam and the potential effects of mercury on human health recommend the use of non-amalgam materials that should be tested for biocompatibility. They also recommend proper amalgam replacement and heavy metal detoxification in patients who are diagnosed with micromercurialism."
Is that fair enough in your opinion ?
Dr. Imbeau 04:25, 30 March 2006 (UTC)
- I think now is the point at which I recommend that you get a blog, a website (I see that your organization already has one), or use some other forum to announce your viewpoint and make your arguments. I recommend taking a look at what Wikipedia is not, particularly the section regarding Wikipedia is not a soapbox. Thanks. - Jersyko·talk 04:30, 30 March 2006 (UTC)
- Thank you for your recommendation. However this is not about my point of view but simply about getting a balanced presentation of the issue. If I simply wanted to have my own point of view I would want to remove anything that support the continued use of amalgam and I am not trying to do so at all. I have only tried to edit information that was incorrect ( providing proof of such ) and have a fair presentation of issues based on up to date scientific evidence. I do not see why it is so difficult for you to accept that those not supporting the use of amalgam ( and there are many ) have a positive approach in reducing exposure to mercury which, everyone agrees is a toxic metal and why you want to depict them as less than those who support the use of amalgam ?
So if you do not mind I will still continue to provide a contribution based on facts. Thank you.
Dr. Imbeau 04:47, 30 March 2006 (UTC)
I have requested that another user comment on this discussion and will file a request for comment, asking other users to comment on it. I hope you consider Wikipedia's policies when editing this article. - Jersyko·talk 04:50, 30 March 2006 (UTC)
- Of course. That is why I heeded your advice and have discussed proposed changes and made suggestions as part of the discussion process instead of reverting the text. All the best
Dr. Imbeau 05:00, 30 March 2006 (UTC)
- Imbeau, you'll need to provide references that a majority or large minority of dentists or medical professionals recommend the steps you mention above. Considering that most findings have not shown significantly higher levels of mercury in the blood or hair of patients with amalgam fillings than those without, and significantly less than those with accidental exposure, and that Chelation therapy is normally used for acute poisoning, not just slightly higher than average levels of mercury, this isn't a claim that should go in the article without some solid references. I understand that you are a practicing dentist, but personal experience and discussions with your colleagues fall under Original Research.
- This paper may have been brought up already; I don't see it in the current page, but I didn't check the archive. In December 2004 (a little over a year ago for those keeping score) LSRO did review of more than 300 papers published since 1996 on the effects of mercury amalgam. Experts in immunotoxicology, immunology and allergy; neurobehavioral toxicology and neurodevelopment; pediatrics; developmental and reproductive toxicology; toxicokinetics and modeling; epidemiology; pathology; and general toxicology participated in the review; to avoid possibility of bias, no dentists or persons involved in dentistry were involved. Highlights from the findings:
- There is insufficient evidence to support a correlation between dental amalgam exposure and kidney or cognitive dysfunction; neurodegenerative disease, specifically Alzheimer's disease and Parkinson's disease; or autoimmune disease, including multiple sclerosis.
- Various non-specific complaints attributed to dental amalgam have not been shown to be due to increased mercury release and absorption from dental amalgam.
- Another goal of the review was to identify research gaps that, when filled, will allow the issue to be settled conclusively, which it has done. So at this point, the issue is officially unsettled, but seems to be leaning heavily towards the safety of dental amalgam.
- Press release from the LSRO summarizing the findings: [1] and a few articles on the review: [2] [3]-- Vary | Talk 04:55, 30 March 2006 (UTC)
- Dear Vary;
First I have never written nor said that a large majority of dental or medical practitioners recommend the steps I mention above. I have written that " Medical and dental practitioners who are concerned about the use of amalgam... " and that is not trying to quantify or imply that it is a majority. There are a growing percentage of dentists who do not use amalgam at all. They do not proceed with wholesale removal of amalgam in all the patients they see. You can still place non-amalgam fillings without removing those already in place... I also did not suggest putting in the article my own experience with other colleagues, this was purely part of the process of discussion with Jersyko.
Of course the recommendation of using dental materials that have been properly tested for biocompatibility is a sound and prudent recommendation. The more evidence of safety we can have before implanting a dental material in a person's body, the better...
As far as getting into a debate on the up to date scientific evidence, I could, but was clearly told that this was not acceptable and not the purpose of the article , which I accept. But I would like to point out that even if there is insufficient evidence as you wrote , it also means that there is some evidence.... A few decades ago there was virtually none and the evidence if gradually being gathered so that it will be deemed sufficient in due course. Of course who decides that it is sufficient ?
I would finally like to address your comment : " Considering that most findings have not shown significantly higher levels of mercury in the blood or hair of patients with amalgam fillings than those without, and significantly less than those with accidental exposure... " It is quite understandable that patient with amalgams and low level mercury exposure have low blood and/or hair levels of mercury since most people exposed to a low level will excrete only some of the mercury after it has been processed through the cytochrome P-450 pathway and the glutathione conjugation pathway. The amount of Hg in the blood that the liver cannot process at a given time will not stay in the blood stream but will be stored elsewhere in the body. If there is no subsequent re-exposure than this store Hg will eventually be re-mobilized and gradually processed and eliminated. However, if there is ongoing low level re-exposure, then there is going to be gradual accumulation of Hg in tissues... The worst case scenario is a person with reduced hepatic, kidney and instestinal function who has very limited abiliyt to process and eliminate heavy metals and has low level hair and urine Hg levels. These individuals are more at risk. This is why many countries have contra-indicated the use of amalgam in patient with renal problems for example.
Of course the ability to metabolise and excrete mercury in each individuals depends on many variables.
Thank you for asking.
Dr. Imbeau 05:24, 30 March 2006 (UTC)
[edit] Proposed changes
The following is a summary of changes currently being discussed on this page. Feel free to add links to any new conversations, or strikeout issues once they're resolved, but don't feel you have to, either, as I'm keeping it up to date for my own benifit and will get to adding new things eventually. I can see four requested changed by Imbeau in several above sections. They are, in brief:
SCI ( KemI ) / FDA - relating to 'regulation' heading, addressed by JersykoMetal release from amalgam, also addressed by Jerskyo- Another sticky one... - essentially alleging that dentists who use amalgam do so only because they don't understand the toxicology of mercury. This is POV, probably original research, and bordering on libel. A statement like this needs a source - if there is an actual study that proves that there is a direct relationship to lack of understanding of toxicology and the continued use of mercury amalgam, it might be appropriate to include the information.
Still struggling as I can see - requesting the inclusion of recommended treatment. I don't see what place this has in the article, as it's about the use of amalgam itself, not how dentists who are against using it treat patients who have amalgam fillings. But, again, if consensus determines that it should be included, it should be sourced, as I requested above. Please see WP:V for a discussion of sources.Environmental Impact Added 21:39, 30 March 2006 (UTC)- Recent changes About a few different edits made w/o discussion on talk page. Added 02:13, 4 April 2006 (UTC)
- Health effects generally - Concern expressed that the section spends too long describing claimed health affects of amalgam without providing opposition's response. Request to add a short statement of said response in first paragraph. Added 02:13, 4 April 2006 (UTC)
It seems that the first two have been addressed and hopefully settled. The second two at best need some work before they can be incorporated into the article. Please try to keep this section simple. The items above can, I think, continue to be discussed in the sections where they were first mentioned. Any further issues need their own sections, too.
-
- Initial issues settled, additional concerns raised in Amalgam waste disposal.
I would appreciate if any new headings would please be kept to the topic of discussion contained therein, or the name of the section of the article being worked on, and not be used for commentary on other editors. Thanks. -- Vary | Talk 06:26, 30 March 2006 (UTC)
[edit] Environmental Impact
The section on Environmental Impact needs some reworking as well. The recent scientific evidence regarding the contribution of amalgam in Hg to the environment is a lot less controversial the the health issue.
Mind you it is a bit comical that there is clear concern for mercury in the external environment with clear science showing damage to numerous biological systems and so much resistance to the risk of Hg to the human internal environment....
It does remind me of other controversial debates such as the one with global warming... 20 years ago those who raised the alarm where met with cynicism.... Of course when it start to be in your face it is somewhat more difficult to ignore...--Dr. Imbeau 21:22, 30 March 2006 (UTC)
- What specific problems are there with this section? The article currently states that both sides agree Mercury is dangerous if improperly disposed of, and also references the concerns of those opposed to the use of dental amalgam that it is sometimes not properly disposed of. What in particular do you feel needs to be changed? If there is additional material that you feel needs to be referenced in the article, please provide links. Thanks. -- Vary | Talk 21:38, 30 March 2006 (UTC)
- Dear Vary; I said need some reworking. The way some of the text is worded is not comparable with some other part of the text where US government agencies are involved. For example:
It is written that the EPA " considers amalgams removed from teeth to be toxic waste " and else where in the article it is writtent the FDA states... There is a difference between a statement and a consideration... In fact the EPA says that amalgam removed from teeth is a toxic waste... it is not a consideration is a a statement of fact.
This is one example of biais in this article when two equally credible government sources are presented in a different light to minimize the effects the amalgam may have.
Finally it is quite true that NOW those supporting the continued use of amalgam accept that Hg is bad for the environment. The question is what have they done in the last 150 years to protect the environment from exposure to mercury from amalgam.... until those concerned raised the issue against definitive resistance... ?--Dr. Imbeau 22:21, 30 March 2006 (UTC)
- That's really splitting hairs, and I don't see any bias there, but how about 'classifies amalgams removed from teeth as toxic waste'? -- Vary | Talk 22:37, 30 March 2006 (UTC)
- Hmm, I agree with Vary that there is not really any bias there at all. I'm about to go ahead and make the change she suggested, though. - Jersyko·talk 22:44, 30 March 2006 (UTC)
- Why is it so difficult to use the word " states " ? After all it is the same as the FDA phraseology and a statement is more than a classification. As far as not seeing the bias you would of colurse both agree since you share the same perception on the issue... --Dr. Imbeau 22:50, 30 March 2006 (UTC)
- How exactly would you word it, Imbeu? I can't think of any way to use the word 'states' that, in this context, wouldn't come out as POV against the EPA. What's wrong with the wording I proposed? We don't have to use exactly the same words for both agencies to give them both the same weight.
- And as to your accusations of POV, I'm not a dentist, and I don't have any strong connections with any dentists apart from visiting with one every now and again, and I don't have any fillings of any kind, so dental amalgam isn't actually something I have any strong feelings about. This is an article about a controversy, and as such, it needs to avoid leaning to one side or another, and whether you realize it or not, your early edits to this article were not NPOV. That's why we're having this conversation. -- Vary | Talk 23:11, 30 March 2006 (UTC)
- Dear Vary; Good on you ! Please explain how using the word "states" for EPA would be a POV " against the EPA ?--
Dr. Imbeau 00:33, 31 March 2006 (UTC)
- Dear Vary. By the way if you just check the definition of both words the meaning is substantially different.
Classify: To arrange or organize according to class or category
Statement: A declaration Declaration: An explicit formal announcement either oral or written.
I assume that when the EPA is suing a dentist for polluting the environment with amalgam they do a bit more than classify. They make a statement to the fact that amalgam is a cause of mercury pollution and that they will not tolerate it. I am sure Jersyko can see the difference in the wording.--Dr. Imbeau 00:47, 31 March 2006 (UTC)
- This is your business, is it not, Dr. Imbeau? You accuse Vary and me of simply not understanding this issue and/or coming to it with pre-conceived notions. You fail to mention, however, that you have a vested interest in presenting the information in a manner that furthers your business. I'd like to hear your thoughts on whether your think your own "perception of the issue" instead of a desire to adhere to NPOV is the reason you're suggesting these changes. - Jersyko·talk 00:06, 31 March 2006 (UTC)
- Dear Jersyko. I have certainly not tried to hide the fact that 1) I am a dentist 2) I do not support the use of amalgam. 3) hide my name by using a pseudonym.... 4) try in any way to promote myself or my practice. 5) Try to imply or state that I am impartial. In fact I have stated that I did not support amalgam use and as far as my " business " you did your own search to find the website as I did not provide it. And if you look at the website you will see that there is not a lot of info on amalgam itself since it is only one of many issues. So if we can get down to the article and getting a fair balance and accurate fact that would be great. As far as not understanding the issue of amalgam, as far as I know you both do not have any dental or medical qualifications and no real clinical experience in diagnosis and treatment but you act as censors to control what you deem NPVO. The simple fact of that using the same word for too equally credible US goverment agencies is such a protracted issue ...is quite telling. Please also note that I have read the archived discussion and know what has happened in the past. Any progress in the article has been painstaking and only after repeated reversions of many past contributors.
Yes, my profession is to treat people who have dental and oral health problems whether related to infection, trauma, toxins etc... I am proud of it and not hiding it. That however is not the point of my effort to contribute to improving this article that you so intently control. --Dr. Imbeau 00:27, 31 March 2006 (UTC)
-
- I appreciate that you are trying to improve the article; that's what everyone else is trying to do, too. I don't know what's 'telling' about the fact that I can't find a way to incorporate a particular word that you want included in the article, and I do not see what is wrong with the new wording.
-
- I do actually know the meanings of both words, and I did not state that the words had identical meanings: I said they were equally strong. The fact that they're not interchangeable is exactly the problem. The word 'states' would be out of place in the context of the line about the EPA, while the word 'classifies' fits well. The phrase 'the EPA states that mercury is toxic waste' is awkward, and the word 'states' is actually weaker there than it is in the FDA sentence. It's the EPA's job to decide what's dangerous to the environment and what has to be disposed of carefully. If they classify something as toxic waste, tha'ts what it is. And as I said earlier, we do not have to use precisely the same words for both agencies in order to treat them with equal weight. -- Vary | Talk 01:43, 31 March 2006 (UTC)
- Dear Vary. Fair enough. I can see your point and can go along with the changes you have made. This said you are probably aware that in the world today there is still a long way to go before amalgam is disposed of properly. Stating that" some amalgams " are not disposed of properly is understating the problem as it stands today ( it was of course much worse a decade ago ). Hopefully as more governments legislate the issue and make it mandatory for dental clinics to be properly equipped with amalgam separation systems then the wording some amalgam will be true.... I hope that by being realistic it will not be seen as POV. Keeping also a non US centered point of view, of course.--Dr. Imbeau 02:46, 31 March 2006 (UTC)
[edit] Dental schools curriculum and toxicology courses
Out of curiosity I checked the curriculum for the DMD or DDS program at various dental schools in the USA. I checked about 15 but only 8 had the curriculum posted on their web site. None of them offered any course in Toxicology, oral toxicology, heavy metals toxicology, mercury toxicology or any other type of course with the name toxicology in it... Here is the list of the schools ( if interested ).
- North Carolina School of Dentistry
- Kentucky College of Dentistry
- New Jersey School of Dentistry
- Harvard School of Dental Medicine
- Pennsylvania Dental School
- Boston University Goldman School of Dental Medicine
- Connecticut School of Dental Medicine
- Texas Health Sciences Dental School
Of course it is possible that training in heavy metals toxicology is given in a course with another name. I did check the content of a few courses when available and could see nothing related to Hg toxicology or similar. Given the fact that so many statements are made about the safety of amalgams with regards to mercury... it is interesting that the pre-graduate training of so many important US dental schools does not appear to include Hg Toxicology courses....
I would appreciate your comments....--Dr. Imbeau 12:12, 31 March 2006 (UTC)
- User:Dozenist is a dental student, perhaps he can answer your question. - Jersyko·talk 13:26, 31 March 2006 (UTC)
- If this is about your comments above suggesting that dentists who use amalgam do so only because they do not understand toxicology, as I said, it's unsupportable, highly POV, and can not go into the article. The fact that you've found eight dentistry programs who do not offer a specific toxicology course does not support this claim per WP:V. -- Vary | Talk 15:10, 31 March 2006 (UTC)
- Dear Vary; No it is not as support of any claim and there is no need to be on the defensive. Simply part of a discussion to shed more information on the issue. As I wrote, if you check, I did not think such as statement should be in the article. However I have, lets say, a certain experience, of what is taught in a dental curriculum and, out of curiosity, wanted to do a quick check to see if I could find an updated curriculum who offered a more substantial program in the field of toxicology , since after all the issue of amalgam safety is very much an issue of Hg toxicology... It is just eight dental schools out of 43 in Canada and USA so it is just 19% of the total. I also clearly wrote that it was quite possible that some training on the issue was offered in other course or courses. Still it is interesting, at the risk of repeating myself that a proper course in heavy metals toxicology is not part of the curriculum of the above dental schools when the dental profession is a major user of mercury...--Dr. Imbeau 21:10, 31 March 2006 (UTC)
- But if you're not writing about something that you think should be in the article, there's really no reason for us to be having this discussion here, is there? This is an encyclopedia, not a soapbox. - Jersyko·talk 21:28, 31 March 2006 (UTC)
- Dear Jersyko. Apologies. I stand corrected by you and I will keep to issues strictly on changes to the article to avoid facts and information that is not for discussion on items to be inserted in the article. I did not want to upset you again.
- -)--Dr. Imbeau 21:42, 31 March 2006 (UTC)
- There is no sense, from an academic viewpoint, to have an entire course solely devoted to heavy metal toxicology. Courses that include toxicity of various metals, including mercury, are: pathobiology, general/systemic pathology, and oral/maxillofacial pathology. Additionally, one of the biomaterials classes focuses on amalgam and its safety. - Dozenist talk 19:04, 31 March 2006 (UTC)
- Dear Dozenist; Whether it makes sense or not from an academic point of view is entirely a point of view on your part. While I am fully aware that dental school curriculums offer courses in pathobiology, general/systemic pathology, and oral/maxillofacial pathology ( remember I did the courses and more plus I just checked ~ 20% of the curriculums ) I am far from convinced that there is any substantial material on Hg toxicology in them. If you can provide me with more detailed information as to such a content, I will be pleased to see it as I do think that proper training in heavy metal toxicology in the dental profession should be a pre-requisite. When any group in society has the control over approx. a third of a well known toxic metal ( as well as other toxic compounds ) it does make sense, in my opinion, that such group be composed of individuals who are very well versed in the subject of toxicology. And that,logically, does justify a proper course on the subject since the implications for society are significant and the dental profession is relied and trusted upon by society to do the right thing.--Dr. Imbeau 21:10, 31 March 2006 (UTC)
- I do not think it is necessary for me to convince you of the quality of any of the classes in the curriculum. The school is fully accredited and thus meets all the standards set forth by the Southern Association of Colleges and Schools, so this is not some online college with questionable standards and a hollow degree. - Dozenist talk 23:31, 31 March 2006 (UTC)
- Good way to avoid the question... Based on that reply I now think including information on training in toxicology by pre-graduate dentists should be considered for addition in the article. I thus refer you to Dr. Boyd Haley and his testimony on 23 May 2001 to the Committee on Government Reform,U.S. House of Representatives.Washington, D.C. where he states " Dentists are not trained to do basic research, nor are they trained in toxicology ". As far as I am aware no one came forward to prove that his statement was incorrect. Of course I could contact him to verify if needed. I am sure a link can be found to that official document. I would thus appreciate your comments. --Dr. Imbeau 23:57, 31 March 2006 (UTC)
- I disagree with your assessment that the information belongs in the article for the reasons previously stated, and I take issue with your implication that you are now pushing for including this assertion in the article purely out of spite towards Dozenist because he 'avoided' your question. Dozenist was in no way obligated to respond to your question about the curriculum at his university, and his responses would not have had any bearing on the article even if he had chosen to do so. -- Vary | Talk 00:08, 1 April 2006 (UTC)
- Dear Vary. You are reaching pre-mature conclusions. My suggestion to include information on training in toxicology as part of the dental curriculum in the article is not based on spite as you say but simply on the fact that since I have not able to find any information to support that FACT that there is training in toxicology as part of the basic dental curriculum and I have found evidence that it is NOT, then in all neutrality, it becomes a relevant matter in an article on the controversy of amalgam since statements are made by both sides of the issue. Training on Hg toxicology in that context is a relevant issue. On the other hand refusal to consider this would not meet NPOV. So I have no problem with Dozenist refusing to answer my question, it his is prevogative but without any real evidence provided on toxicology training, it is a real issue whether YOU think it is or not.--Dr. Imbeau 00:22, 1 April 2006 (UTC)
- My conclusion is based on this statement "Good way to avoid the question... Based on that reply I now think including information on training in toxicology by pre-graduate dentists should be considered for addition in the article." And this after you had already conceded the point that this claim did not belong in the article.[5] Whether you intended it or not, it sounds like you changed your mind about the issue because you did not like the perceived tone of Dozenist's response.
- You do not have evidence that there is no training in toxicology. You have found that %20 of dentistry programs in the US and Canada do not require a toxicology course (and why would they, when toxicology can be covered in other courses), and an unsupported statement made in a speech. You need to verify your claim with a published, reputable source. Had Dozenist offered details of the courses he's taken that cover toxicology, that information would not have been usable in the article, as it's one student's experience in one school; ie, Original Research. Thus he, quite rightly, chose not to enter into a debate with you over the merits of the education he is receiving. -- Vary | Talk 00:41, 1 April 2006 (UTC)
- The problem, Dr. Imbeau, is that you have shifted from suggesting reasonable changes to enhance the article's neutrality and broaden its scope to pushing ideas that, if known and believed by the general public, might greatly enhance your business. Can we maybe turn back the clock, hmm? - Jersyko·talk 00:46, 1 April 2006 (UTC)
- Lets address the above one item at the time: 1) " Good way to avoid the question... " is not a spiteful reply. He did not answer my question which I asked because I would certainly like to have evidence that there is good training in toxicology. Is that such a spiteful crime ? 2) I did not ask Dozenist for information about HIS curriculum but rather about info on courses in toxicology in dental curriculums in general... there is a difference. 3) I have no problem accepting that I did change my mind on this issue. Initially, although I knew from personal experience that training in toxicology in dental curriculum is a deficiency, I had no evidence so I rightly agreed that this was not to be considered for inclusion. I now have some evidence from a highly qualified scientist giving testimony in an official governement organisation. 4) I know that you have a problem with my business but then you do not seem to have a problem with those who promote the use of amalgam, furthermore you might try to make insinuations, not for the first time, but that is again not relevant to the topic at hand. I have made changes to the article based on facts. I am quite happy to discuss best wording but facts are facts. 5) It does appears that the burden of proof is one sided..... I make an honest effort to provide proof and evidence so as to correct factual errors or lack of balance in the article but so far I have not seen any evidence or proof from you three to support your actions ( coincidentally this has similarity with those supporting the use of amalgam having failed to provide clear evidence of safety for amalgam while adamantly demanding uncontrovertible evidence of safety from those not supporting continued use of amalgam. 5) Finally a fact is a lot more than an idea. If people and the public being informed of factual information is a bad thing then there are serious questions to be addressed. --Dr. Imbeau 01:16, 1 April 2006 (UTC)
- The burden is not on Dozenist, or any other editor, to prove to you that dentists are sufficiently informed to make decisions about the safety of dental amalgam. It's on you, to prove they're not.
- We're not making any progress here. I need you to give us precisely the language you feel needs to go into the article, along with reputable sources for your claims, so we can discuss this properly. Vague suggestions are not helpful here - for all I know, I could have a completely different idea of what you have in mind than you actually do.
- Please do not put anything relating to this topic into the article before the changes have been discussed on this talk page. Thanks. -- Vary | Talk 01:41, 1 April 2006 (UTC)
- Dear Vary. I do appreciate your position. I have already provided one credible reference as to the lack of training in toxicology as part of the basic dental curriculum. Certainly I will keep an eye open for more. I will also look at presenting a suggested phraseology as I have done before that will respect a balanced neutral point of view. My point was it is too easy to say this is not a valid issue until I prove it is while those saying it is not valid will not provide any information to support their position. I, for one, would gladly accept that dental students are well trained in toxicology if I can find a curriculum that contains the details of such training. In fact I am personnaly convinced that a deeper understanding of the toxicogical issues involved by a majority of my colleague would significantly help ease the controversy. I have tried to find information on toxicolody training in the content on various relevant courses like pharmacology, basic pathology, maxillofacial pathology etc.. but to no avail so far. No for lack of looking at this stage. So I yes I would appreciate help in finding this information.--Dr. Imbeau 07:12, 1 April 2006 (UTC)
- Your business is relevant to this topic in a similar way that this made news around here a couple months ago. When an editor has a strong incentive to edit specific articles in such a way that it conforms to their point of view, then they make edits or attempt to edit those specific articles in a manner consistent with their point of view, red flags do and should go up. That's my only point in continuing to point out your business. In fairness, Dozenist and other dentists have a financial incentive to edit this article in such a way that it makes amalgams appear completely safe, though, since amalgam use is widespread (i.e., it's not the alternative treatment, but the norm), the incentive is not as strong. Of course, Dozenist is not editing or attempting to edit the article at present. If he did, I would read his edits with a critical eye. - Jersyko·talk 02:41, 1 April 2006 (UTC)
- On a completely unrelated side note, I would like to thank you, Dr. Imbeau, for remaining civil in large part, though it's clear that disagreement abounds here. I was just looking back through the the archive for this page, and remembered the insanity that this used to fill it. Your relative calmness has cast the anti-amalgam movement is a quite different light in my mind, anyway. - Jersyko·talk 02:56, 1 April 2006 (UTC)
- Dear Jersyko. Thank you for being civil yourself and making an effort to see the basis for my contribution. I do appreciate your comments. To ease you concern about my business I can assure you that I have no intention of trying to promote it through this article. In fact my practice, as more accurately define the place where I exercice my profession, is not even in the US. I hope this will assuage your concerns. Furthermore if you think it is necessary, I am quite willing to use a pseudonym in my contribution. I normally do not hide behind one in matters regarding my profession and have certainly done nothing to incite you to do any research on me or my practice. That aside my goal again is to have the article reflect up to date factual information. If it is true, even if it does not suit me, I am quite willing to have it in the article. I would expect that the same would go for the pro-amalgam supporters so that true information will not be blocked or railroaded. Unless I am mistaken, and please correct me if so, an encyclopedia like Wikipedia is about correctly informing the public without taking side and presenting all sides, if there are more than one, based on factual evidence.--Dr. Imbeau 07:12, 1 April 2006 (UTC) * One more item regardig the sometimes lack of civility on this controversy. It can certainly be on both sides. One frequent tactic of some pro-amalgamists is to attack the credibility of those would would like to ban amalgam. This is done by various insinuation about pecuniary motivations and otherwise. As if dentists using amalgam had not financial motives or consideration whatsoever... Of course there are a range of motivations involved depending on the individuals, on both side of the issue. Taking cheap shots, in my opinion and it is an opinion, does nothing to progress the issue. FInally you should be aware that the use of amalgam is declining steadily and the use of alternative materials rising steadily. I did not check the latest figures but would not be surprised if alternative fillings are not about to become the norm in the near future. Certainly, in Sweden, amalgam will be defunct by 2007. Cheers.--Dr. Imbeau 07:25, 1 April 2006 (UTC)
- "Finally you should be aware that the use of amalgam is declining steadily and the use of alternative materials rising steadily." Yes, I am aware of that. Putting aside the health issue for a moment, I hope that this trend continues, as amalgam fillings are just . . well . . . incredibly ugly. Perhaps the trend toward use of alternative fillings is partially motivated by health concerns, but the aesthetic interest has to be one of the dominant considerations for a large portion of patients. - Jersyko·talk 15:43, 1 April 2006 (UTC)
- Dear Jersyko. They are ugly and that is so obvious that AT LEAST this is something that everyone can agree on. The stance for banning amalgam is in fact much more comprenhensive. It is about eliminating a major source of Hg in the internal and external environment. Concentrating on whether or not we have definitive proof that it does cause health problems is somewhat mssing the real point... May be that point should be worded in NPOV and included in the article. It should be a neutral issue since, defensiveness aside, both side would agree that since mercury is bad for the environment, eliminating all sources as much as possible is of benefit.... Any suggestion ?--Dr. Imbeau 21:27, 1 April 2006 (UTC)
- That is covered, I think. In the intro: There is no debate on the danger of high concentrations of mercury in any form, and both sides agree that amalgam may cause an allergic reaction in mercury-sensitive individuals. And in the environment section: Proponents counter that, while mercury is bad for the environment, amalgams do not harm the environment if they are disposed of properly.;;
- The latter sentance says to me that the pro-amalgam side does not agree that eliminating the use of Mercury is necessary, but rather that it should be properly handled and disposed of. True of any useful but potentially dangerous substance.
- And I'm with you both on the appearance issue. I think I was scarred for life when I was little and I first saw someone with a great big dark colored filling in their mouth. Ick. But I don't think we need to dig out up-to-the-minute figures on mercury-free dentists vs. those who use amalgam fillings, and certainly not how many use alternates because they're prettier, vs. those who use them because they feel amalgam is unsafe, as it's really not all that relevant to the content of the article. This is about what each side thinks, not statistics, and I doubt that reliable, worldwide figures would be easy to find anyway. -- Vary | Talk 22:08, 1 April 2006 (UTC)
- Dear Vary; You should not hold your breath. An association ( the ADA ) that has maintained that amalgam is safe since 1859 and until around 1984 that it did not leak any mercury at all, is very unlikely to say that amalgam should be banned or that eliminating the use of Hg in routine dental health care is necessary... History shows that only what is uncontrovertible is admitted, and rather grudgingly at that. And that is the reason for the controversy. One side will only accept overwhelming evidence while the other side says, we are getting more evidence that this material can be a problem, at least in a percentage of the population and that it is a source of Hg pollution to the planet we all depend on, so let's be wise and move to something better as we now have the means and technology. What is actually happening is that, to save face, allow dentists in general to catch up and manufacturers to come up with better materials, there is a gradual shift to non-amalgam materials with concerns for the environment and aesthetics being the main reasons provided to the public. Welcome to human reality --Dr. Imbeau 00:21, 2 April 2006 (UTC)
- Dear Vary. Please have a look at the study below:
It does look like composite resins are now the dominant restorative material as a matter of fact :-) --Dr. Imbeau 22:29, 1 April 2006 (UTC)
- 1)Does the study state that this is because most dentists think amalgam is unsafe? Because which is more attractive is not the point of this article. The abstract does not give the reason for the change, and once again I don't seem to be able to access the study itself. And 2) How do you hope for this to be incorporated into the article? I need you to start posting proposed changes, and not just links and information, if we're going to make any headway. -- Vary | Talk 22:37, 1 April 2006 (UTC)
- Dear Vary. You can access the full article by going to the web service ( there is a link in the pubmed page and you can download it from there. There maybe a fee to do so. Wording that could be incorporated in the article : " As the use of amalgam is steadily declining in favor or composite resin materials, the controversy is likely to gradually resolve itself." or something of that ilk.--Dr. Imbeau 22:51, 1 April 2006 (UTC)
- Dr. Imbeau, to use your language, I "avoid[ed] the question" because there is no reason for me to have to defend my professional training to you. I already mentioned the classes in which metal toxicity is addressed, and thus there is no need for us to have an entire course on that single topic. But again, that is not even the issue. Although you may have done it unintentionally, you are esentially poisoning the well by questioning my training, and the great irony is that at least my comments agree with the majority of dental research and the dental establishment. If I did not, then the burden would be on me to demonstrate my beliefs. - Dozenist talk 03:17, 1 April 2006 (UTC)
- Dear Dozenist. As I wrote earlier I have no problem with you deciding not to answer the question. You have your reasons. At the same time it does not help me to find evidence about the exact nature and extent of any toxicological training for dental students. As I wrote earlier my question was not about YOUR training specifically but about the training of dental student in general. The fact that you took it that way would explain the perceived offense. I am not questionning YOUR training. I can certainly question my training in Hg toxicology while I was a dental student, if that is OK with you. Again I would certainly appreciate help in finding information about training in toxicology for dental students IN GENERAL. I do not see why this would be a secret in any way. Finally I am happy for you that you find solace in having the majority of dental research and the dental establishment in agreement with you. I have, however, learned long ago that it is medical and scientific research that is more relevant on this issue. Furthermore it will not be the first time that the majority in a given group has been proven wrong. Whether they can admit it is another matter. Case in point the totally erroneous stance, for decades, of the ADA regarding mercury being completely bound in amalgam. It is not dental research that had them change their stance....--Dr. Imbeau 07:12, 1 April 2006 (UTC)
[edit] Biocompatibility
Dear Jersyko;
Dental meterial biocompatibility testing, while not legally necessary, it certainly recommended. In the late 1970's the ADA, jointly with ANSA, issued document # 41 about " Recommended standards for biological evaluation of dental materials ". I do not agree that it POV to state that biocompatibility is an important issues for dental materials. I can agree on the issue of wording that would indicate that this is mandatory.... The word " necessary : is not a good one as it is POV. I think it is necssary but accept the fact that it is not MANDATORY. There is a difference. Finally may I suggest that you also use the discussion section before reversing text... Works both ways you know.--Dr. Imbeau 21:56, 31 March 2006 (UTC)
- I haven't changed it because I don't know much about it. It seems fairly neutral my my perspective as it is, but it was brought to my attention that it is not one of the main issues regarding alternative filling material. In any event, I don't think it's important enough of a quibble to change it, so I haven't. - Jersyko·talk 22:28, 31 March 2006 (UTC)
- Is the ISO referred to in the article this ISO, or a different organization? Didn't want to wikilink it when I wasn't completely sure what organization was being referenced. -- Vary | Talk 22:30, 31 March 2006 (UTC)
- Yes it it this ISO.--Dr. Imbeau 22:40, 31 March 2006 (UTC)
- Fair enough. Amalgam has slipped under the radar as it was in use before these recommended standards were issued and since it is only a recommendation, it continues to fly under the radar, so to speak. In any case I think the re-wording by Vary has improved the text but there is still one problem since biocompatibility testing is recommended for ALL dental materials, not just alternative ones. I realize that it is under the heading of ALTERNATIVE, so I am open to suggestion as to how best to address this item.--Dr. Imbeau 22:39, 31 March 2006 (UTC)
- Yes, 'all dental materials' was added a while back, and I dropped it unintentionally while I was moving things around. It's back now. -- Vary | Talk 23:01, 31 March 2006 (UTC)
[edit] One possible reason for wanting to continue to use amalgam..
Another item that is not included in the article is the issue of training in using composite resins. The recent peer-reviewed article below is about this issue. As a matter of discussion is it possible that " the limited skills of todays' dentists in placing posterior composite resin restorations " as per Dr. Carl Leinfelder is one reason for continued support of dental amalgam in spite of the fact that 1) they are ugly 2) controversial ? The issue of NPOV may be raised but please note that it is not me saying what is in the article.[7]
Again I would welcome your comments.--Dr. Imbeau 22:17, 1 April 2006 (UTC)
- I don't see any way of accessing the actual article, although that wouldn't help me much since it's in Dutch, and I don't read dutch. But the summary states that the article warns against an abrupt shift towards resin fillings - ie, forcing all dentists worldwide to stop using amalgam tomorrow - would be bad, since they don't all know how to use resin or other filling materials. That doesn't really support either position. Any dentist who wants to stop using amalgam is free to learn new methods, right? -- Vary | Talk 22:27, 1 April 2006 (UTC)
- Dear Vary; Article in a foreign language is an obstacle to information becoming quickly available to english only speakers. The point I was trying to make is that Dr. Leinfelder says that many dentists have limited skills in placing posterior composites. And this can certainly be a good reason why there is resistance to a ban on it's use. What else would they use ???
As far a being free to learn new methods and actually doing it , there is a difference... It may not be a simple as you make it sound. It is also a bit awkward to say I do not want to stop using amalgam because I cannot use composite resin properly .....--Dr. Imbeau 22:42, 1 April 2006 (UTC)
-
- I don't think it would be non-neutral to mention that dentists may not be properly trained to place non-amalgam fillings, and that this might be a reason why some are resistant to a ban on amalgam. There are two questions I would like to know an answer to, however, (1) how different is placing a filling made of alternative filling material from placing an amalgam filling? and (2) are dental students currently being taught how to use these alternative fillings? I'd actually like to hear from both Imbeau and Dozenist on this. Oh, and please provide links if you can, WP:NOR, and all. - Jersyko·talk 22:47, 1 April 2006 (UTC)
- Dear Jersyko. I realise it is a touchy issue but it is nonetheless a true issue. 1) There are major differences in design, techniques and materials between amalgam restorations and composite resin restorations. That in itself could be the subject of a complex article. 2) Yes dental students in many dental schools are now taught how to use composite resins, in fact some dental schools have stopped teaching amalgam restorations altogether. A few years ago I was visiting a colleague in the biomaterial department at NYU and he confirmed that they were planning to phase out teaching the use of amalgam.
--Dr. Imbeau 23:00, 1 April 2006 (UTC)
- Imbeau, I understand your point, but there's a difference between reporting a fact (some dentists don't know how to use resin) and drawing a conclusion based on that fact (they'd use resin if they knew how). That's discounting the possibility that amalgam may simply be their preferred material, and they haven't learned to use resin because they don't feel it's necessary. The information actually presented in the article needs to be sourced - that is, you need to find a published source that makes the claim that dentists only use amalgam because they don't know how to use resin, even though they believe amalgam to be unsafe. This abstract states that the article recommends phasing out amalgam over a longer period (I believe it said ten years?) rather than eliminating it completely and immediately. The article does not appear to claim that amalgam is currently used as much as it is only because no one knows how to use resin.
- To give a parallel example, I don't know how to drive a car. I happen to live in a city with a very good public transportation system, and find it preferable to driving. Some people assume that I use public transportation because I can't drive, when in fact the reverse is true: I don't drive because I like public transportation.
- And, in fact, the abstract you recently linked to above states that %95 of anterior restorations and %50 of posterior ones use resin. This suggests that at least %95 of dentists do know how to use resin, and continue to choose to use amalgam for %50 of all posterior restorations. -- Vary | Talk 23:03, 1 April 2006 (UTC)
- Dear Vary: The last phrase " This suggests that at least %95 of dentists do know how to use resin, and continue to choose to use amalgam for %50 of all posterior restorations " is an invalid assumption. Dentists have been trained for longer on how to use non-amalgam materials in anterior teeth because of obvious aesthetic concerns. Although I do see patients with amalgam fillings on their anterior teeth ( ICK as you wrote ). Placing posterior composite is not as simple as placing anterior composites... That is a much more likely explanation for the statistics above than your assumption. You see it does help to actually being doing these things in real life and not only talking about it on the Internet..--Dr. Imbeau 00:54, 2 April 2006 (UTC)
Dear Vary. You are certainly good at playing the devil's advocate. I never wrote it WAS a reason but that it COULD be a POSSIBILITY. This makes me wonder if you really look at the issue with a neutral point of view rather than attempting to demolish anything that MAY explain why amalgam, a material containing approx.40-50% mercury, is still being used in spite of the fact that we have valid and reliable alternatives...--Dr. Imbeau 23:16, 1 April 2006 (UTC)
- That's not what I'm doing at all. The problem is that you can not take a supported fact, draw a conclusion from that supported fact, and put that conclusion in the article, because that's original research. I am not trying to 'demolish' anything, but the assertion that dentists use amalgam because they don't know how to use resin can not go into the article unless it is sourced. -- Vary | Talk 23:23, 1 April 2006 (UTC)
- Dear Vary, I have never requested that the assertion that dentists use amalgam because they don't know how to use resin goes into the article in that wording. The peer-reviewed reference supports: 1) The fact that today's dentists have limited skills in placing amalgam 2) That because of this situation it is concluded that a gradual changeover from amalgam towards composite resin is preferred. Supported and referenced facts - NPVO. The reader of the article can make up their own mind without our guidance. Wording like: " The issue of skills in placing composite resin has been raised by certain dentists and as a reason why a gradual change over from amalgam to composite resins is preferred. "--Dr. Imbeau 23:48, 1 April 2006 (UTC)
- One more point: While I am trying to bring this article up to date and doing my best to put NPOV wording in it and peer-reviewed references in it. I find it is a very protracted exercice because you do not provide many positive suggestions but rather provide ongoing criticism and no new information to update the article and certainly no scientific evidence either one way or the other. I have no problem discussing wording and pro and cons of any item, but the pros should come from you guys also and more constructive wording suggestions as well. If your role is solely as censors then it should be clearly stated.--Dr. Imbeau 00:36, 2 April 2006 (UTC)
- How do you reconcile the claim that many dentists do not understand how to place resin fillings with the statement made here that %95 of anterior fillings are done with resin? -- Vary | Talk 00:47, 2 April 2006 (UTC)
- Dear vary: See four bullet points above...--Dr. Imbeau 00:58, 2 April 2006 (UTC)
- Great, that clarifies things. Is the fact that placing posterior composites are more complicated than anterior significant enough for inclusion? And I'm not clear from the context - is the increased difficulty an amalgam vs. resin issue, or a posterior vs. anterior issue? If it's just that posterior fillings are more involved somehow than anterior ones, then never mind, I doubt that needs to be mentioned.
- Also, I've moved some words around in the two lines that were recently introduced. Thoughts or concerns, anyone? -- Vary | Talk 01:07, 2 April 2006 (UTC)
- Dear Vary. The issue is that, at least some, dentists who do not have good results placing posterior composites have a tendency to blame composite materials instead of their technique ( human nature is it not ? ), thus they choose amalgam because they get a better result with it, purely from a physico-mechanical point of view of course. The other issue is one of seal. Mechanical caries removal techniques ( with the so called drill ) leave microscopic fragments and bacterial contamination on the prepared surface. Most composites do not contain bactericidal compounds ( like Hg and Ag ) so this residual bacterial contamination can be a problem with post-operative sensitivity and recurrent caries. Amalgam on the other hand is definitely bactericidal and self-seals itself with a layer of corrosion from oxidized metals. This corrosion process was initially responsible for excessive expansion of amalgams and spontaneous fractures of teeth in people's mouths. The ongoing bactericidal action is seen by many dentists as beneficial to slow down bacterial activity and thus decay.... Of course there are medical and scientific studies who show that the same bacterical activity is also at work in the gut of people with amalgam and can play a role in what is called gut dysbiosis which can lead to intestinal candidiasis etc.... It probably is getting too technical already but I am sure you can see that it is not a simple black and white issue thus the difficulty. If the emphasis is purely on physico-mechanical performance than amalgam does the job. If emphasis is a balance of biological and physico-mechanical properties than amalgam fall behind very quickly compared with the best composite resin materials available today since these material actually restore a great part of the lost structural integrity of the damaged tooth as well as being more biocompatible. A win-win situation in my opinion.
Some of the above could go into the text but the question is how to do it and reference it simply.
Your rewording as improved the text further and I do appreciate your skills in that regards. I think this is an area were your professionals qualifications are quite useful. --Dr. Imbeau 01:34, 2 April 2006 (UTC)
Also have a look at [Leaky Gut Syndrome] on Wikepedia and you may begin to see the implications...--Dr. Imbeau 01:50, 2 April 2006 (UTC)
-
- Posterior composites are placed in the same manner as composites placed in the front of the month. There may be more difficulty in keeping the tongue and saliva out of the way, but the principles remain the same. There is another reason why dentists do not place nearly as many composites in the back of the mouth compared to the front of the mouth. The ADA policy has been that smaller fillings in the back of the mouth can be done with composites. Larger fillings should not be done with composites because composites are not strong enough to handle the forces in the posterior of the mouth for a long enough time. Essentially, the composites just wear away. This guideline has kept many dentists from placing posterior composites (at least in the U.S.). Though materials have been constantly improving, I do not know if there has been an official change by the ADA. We would need to look for that if so. - Dozenist talk 13:42, 2 April 2006 (UTC)
- The issue of wear for posterior composite is "rehash" of old data. The newer materials have a wear rate that is very similar if not the same as human enamel. Furthermore, unlike amalgam, composites do restore a significant portion of the structural integrity of the damaged tooth. As far as the basic technique being the same for anterior and posterior composite being the same , I agree in principle. However placing posterior composites is definitely more complex because of issues of access, moisture control, soft tissue control, occlusion etc.... There is also the issue of the configuration of the preparation of the cavity. Placing composites in an cavity that was designed for amalgam demand a reconfiguration of the design prior to composite insertion. There are other issues of course but this is not a course in restorative dentistry.--Dr. Imbeau 21:56, 2 April 2006 (UTC)
[edit] Amalgam waste disposal.
I think there is a need to clarify that phrase regarding proper disposal of amalgam waste. It seem to imply that there is no problem as amalgam waste is properly disposed of. This is does not reflect the present reality. While it it true that more government bodies are regulating amalgam waste disposal and implementing by regulation or law ISO standard in that regard, on a world-wide basis there is still a good way to go before amalgam waste is properly disposed of. Suggested wording ? : " Proper disposal of amalgam is a situation in progress as various governmental bodies are gradually legislating the handling and disposal of amalgam waste ".--Dr. Imbeau 02:34, 2 April 2006 (UTC)
- "The ISO has issued standards regarding the the handling and disposal of amalgam waste; however, enforcement of these standards are left up to local governing bodies. Such legislation is either in place or in progress in (many/most?) developed nations."
- That's super-wordy, but there's a lot of information to get in. -- Vary | Talk 02:43, 2 April 2006 (UTC)
- Dear Vary. The wording as to allow for the fact that in some areas there is NO legislation on proper disposal of amalgam yet.--Dr. Imbeau 02:51, 2 April 2006 (UTC)
- Right, hence the qualifications 'in progress' and 'many/most'. Not sure what the figures are, so I don't know which terms are most appropriate. -- Vary | Talk 02:55, 2 April 2006 (UTC)
- I'm still not happy with the wording of this, especially the word 'gradually.' If we don't have any specific figures about the rate of adoption of legislation, we shouldn't use terms like this. Imbeau, are your concerns settled by the qualifiers 'in progress' and 'many/most', and if not, what do you propose? -- Vary | Talk 14:02, 2 April 2006 (UTC)
- The wording " most " is not accurate from a world perspective and the word " many " is not either because it does not quantify in any way but can imply a majority or a great number. At least gradually means there is a process involved where the number is increasing. As far as regulation ,in the USA, it has been done mainly, as far as I am aware, on a state by state basis. I have posted a link about NY state for example. The situation is not the same in all countries and the US,as mentioned elsewhere, has not been in a position of leadership on this issue.--Dr. Imbeau 21:41, 2 April 2006 (UTC)
- If many or most are no good, that leaves 'some.' 'Gradually' sounds like a value judgement (ie, 'not bloody fast enough if you asked me') and also suggests that all or almost all world governments are working on such legislation, albeit slowly. -- Vary | Talk 22:04, 2 April 2006 (UTC)
- And it's true that dental amalgam disposal regulations are set by the states in the US. I saw a page recently with a state-by-state list of regulations and guidelines, but I didn't bookmark and can't find it now for the life of me. I'll check my browsing history on my work computer tomorrow. -- Vary | Talk 22:12, 2 April 2006 (UTC)
- Of course it is true. I do not have a problem with " some " myself but others may say it is more than some and it could imply that only a few government bodies have legislated when there is in fact more than a few at the moment and the numbers are increasing all the time. It is a " gradual " process as opposed to all at once. Any value judgement is one made from the perspective of a reader. If he is pro-amalgam he will says that the disposal of amalgam waste is being actively addressed so that the issue will soon be a non-issue. If he is pro-ban he will see that process is not fast enough and the fact that it is still happening shows that amalgam waste is not yet really disposed of properly. Either way you cannot stop people from having their own point of view, whether that point of view is correct and factual is another matter entirely.--Dr. Imbeau 22:47, 2 April 2006 (UTC)
- What about a reader who doesn't yet have a POV on the issue?
- Dear Vary: Well they can certainly form their own point of view by having access to factual information. That is the purpose of the article. For years the information on amalgam has been under the umbrella of the ADA which regulated, by it's code of ethics, what dentists were allowed to discuss with their patients on the issue. It is only recently that the overt influence of the ADA on dentists has been corrected in part by court cases which some dentists have won in the name of free speech. Mind you the ADA being clearly pro-amalgam to the core it not my idea of a neutral body of opinion. So let's continue to work on providing the facts. We all know the ADA is pro-amalgam and it is clearly pointed out in the article. We are now getting a better balance in the article so that the readers will know that other credible bodies are NOT in favor of the continued use of amalgam. That there are dental schools and clinics who do not use amalgam at all and that it is possible to do so with good results. AND THAT IS A FACT THAT NEEDED TO BE IN THE ARTICLE and that none of you had made any effort to include, as far as I can tell from the previous history.--Dr. Imbeau 01:35, 3 April 2006 (UTC)
- Doesn't the word 'some' (which says that it's not happening everywhere) and the phrase 'in place or in progress' (which says that where it is happening, it's not happening overnight) do the same job? Even if you don't see a POV leaning in the word, it's superfluous. -- Vary | Talk 00:17, 3 April 2006 (UTC)
- Okay, you know what? Whatever, and never mind. I'm tired of looking at this sentence and want to get it out the door, as it were. How's this: "The ISO has issued standards regarding the the handling and disposal of amalgam waste; and legislation to enforce these standards is being adopted gradually worldwide, with laws already either in place or in progress in some developed nations."
- Dear Vary. How about "The ISO has issued standards regarding the handling and disposal of amalgam waste; and legislation to enforce these standards is being adopted gradually, with laws already either in place or in progress in some developed nations." Is fine with me. I am not sure worlwide is correct as it is likely that there is nothing done at all in at least some countries. Of course that is just my opinion and I have no data to support it. I have also noted that you have removed the word : " proper " from the wording of the phrase now in the text. Is it because you have concerns that the fact that readers might conclude that the previous sentence is a somewhat self-serving statement from proponents of amalgam use and designed to re-assure that there is no real problem there?--Dr. Imbeau 01:09, 3 April 2006 (UTC)
- Dear Jersyko. If you read the last comment of Vary and her suggested wording she actually included "gradually" in her own suggested sentence.... --Dr. Imbeau 21:04, 3 April 2006 (UTC)
- Dear Jersyko. Your last comment could be applied both ways. I actually thought about it before but refrained from using it. As for Vary I do not have a crystal ball and do not know why she changes her mind and she has changed her mind in the past fro various reasons...--Dr. Imbeau 22:59, 3 April 2006 (UTC)
[edit] Phasing out Amalgam
- "Teaching of amalgam techniques to dental students is thus being phased out in favour of composite resin techniques with at least one dental school having removed it entirely from it's curriculum as of 2001.[8]"
This needs a little more work than I want to do by being bold. I'm concerned that this wording implies that all dental schools are phasing out amalgam, and I'm not sure that we know that's true.
Propose: "Teaching of amalgam techniques to dental students is declining in some schools in favor of composite resin, and at least a few programs have eliminated dental amalgam from the curriculum alltogether.[9]
I'd be interested to know if, when Dozenist was shopping for dental schools, he noticed any US schools that only taught resin? I think it's probably safe to say there's more than one - 'at least one' sounds so odd that I hope we can avoid using it. -- Vary | Talk 02:55, 2 April 2006 (UTC)
Dear Vary; The more references we can find the better. I will keep looking. I simply stated that facts that I can prove even if it is odd. There is always a first one. Like Sweden being to first to notify a ban on amalgam. Regrettably on this issue the US has not provided leadership.--Dr. Imbeau 03:05, 2 April 2006 (UTC)
- Dear Vary; how about: " Teaching of amalgam techniques to dental students is thus being phased out in some dental schools in favour of composite resin techniques with at least one dental school having removed it entirely from it's curriculum as of 2001 ". I have a study showing that in Canada out of 10 dental schools all taught composite resins but 5 emphasise amalgam more, 3 do both equally and 2 emphasise composite more. No info if other schools are amalgam free. But it does support my revised wording.[10] --Dr. Imbeau 03:14, 2 April 2006 (UTC)
- Concerning the Canadian study to which you referenced, the sentence about 5 emphasizing more, 3 equally, and 2 composite more does not refer to the whole dental school, but instead the pediatric programs. The full text of the article is available online and the results they received from the operative and restorative departments of the undergraduate programs were: It appears that curricula within all dental faculties are designed to educate students about the optimal use of both materials. Comments included “There is a place for all restorative materials” and “Both materials have their place.” Many course directors stated that they provide guidelines on choosing the most appropriate material according to the particular clinical circumstances, with the patient making the ultimate (informed) choice in the faculty clinics. Vary, in regards to your question, the one dental school referred to above that has phased out amalgam is in the Netherlands. I am pretty sure that all the dental schools in the United States teach both materials, considering the ADA stance on the safety of amalgam and the limited use of posterior composites. - Dozenist talk 13:58, 2 April 2006 (UTC)
- Thanks, Dozenist. Do you recommend any changes or additions here?
- About the change discussed a few comments up: the word 'thus' doesn't fit here because it doesn't directly refer to anything, and in this context 'phased out' is weak, and I think unnecessary. This sentence should support the previous one, rather than the other way around: the previous sentence says that amalgam can't be eliminated without allowing time for more dentists to be trained properly in using resin, and this sentence explains how that is beginning to happen. How about this:
- "Teaching of amalgam techniques to dental students is declining in some schools in favor of composite resin, and at least one school had eliminated dental amalgam from the curriculum entirely as of 2001.[11]"
- Considering the earlier discussion about Sweden's mercury ban, it seems that there may be more concern about and legislation against amalgam in that part of the world than in some other areas. Is it worth noting that the school that has eliminated teaching of amalgam is in the Netherlands? -- Vary | Talk 14:25, 2 April 2006 (UTC)
- If it is noted in the article that one dental school has phased out teaching amalgam, then I think it is important to mention it is the Netherlands. It would be impossible for me to say, but probably the political and/or social situation there allows for that to be the case. As long as there are people in the U.S. who cannot afford an esthetic restoration like composites or porcelain, then amalgam is going to be taught in the schools to provide a long-lasting, non-harmful, cheap alternative. If for some reason amalgam is banned in the U.S. or if the government decides to pay for everyone's esthetic dental restorations, then schools may begin to change their curriculum. As of yet, neither situation seems likely to occur any time soon. - Dozenist talk 15:03, 2 April 2006 (UTC)
- How's this: "Teaching of amalgam techniques to dental students is declining in some schools in favor of composite resin, and at least one school, University of Nijmegen in The Netherlands, had eliminated dental amalgam from the curriculum entirely as of 2001.[12]"
- I think that is a better way to word it in the article. I am going to have to look at the full text of the article some time to see if the writers say the reasons for this change. We would need to be careful of the context this sentence is placed in the article because it could imply that the reason for the change was for health reasons alone. It could be for health reasons, but as of yet I do not know. - Dozenist talk 16:18, 2 April 2006 (UTC)
- Crawls out of self-imposed Final Four daze I think that wording is fair, Vary. Slinks back - Jersyko·talk 16:21, 2 April 2006 (UTC)
- I think that is a better way to word it in the article. I am going to have to look at the full text of the article some time to see if the writers say the reasons for this change. We would need to be careful of the context this sentence is placed in the article because it could imply that the reason for the change was for health reasons alone. It could be for health reasons, but as of yet I do not know. - Dozenist talk 16:18, 2 April 2006 (UTC)
- How's this: "Teaching of amalgam techniques to dental students is declining in some schools in favor of composite resin, and at least one school, University of Nijmegen in The Netherlands, had eliminated dental amalgam from the curriculum entirely as of 2001.[12]"
- If it is noted in the article that one dental school has phased out teaching amalgam, then I think it is important to mention it is the Netherlands. It would be impossible for me to say, but probably the political and/or social situation there allows for that to be the case. As long as there are people in the U.S. who cannot afford an esthetic restoration like composites or porcelain, then amalgam is going to be taught in the schools to provide a long-lasting, non-harmful, cheap alternative. If for some reason amalgam is banned in the U.S. or if the government decides to pay for everyone's esthetic dental restorations, then schools may begin to change their curriculum. As of yet, neither situation seems likely to occur any time soon. - Dozenist talk 15:03, 2 April 2006 (UTC)
- I have no issue with mentioning the name of the University that is amalgam-free. I do not agree with the word " declining " as it implies that amalgam techniques are still taught in all dental schools when this is not the case. The evidence available indicates that there are dental schools who have stopped teaching amalgam techniques or will do so in the near future. Please try to keep on world perspective on this issue. I have not done any research in Sweden but logic would dictate that dental schools there will stop, if not already, teaching amalgam techniques.--Dr. Imbeau 21:46, 2 April 2006 (UTC)
- I think that's what the sentence I proposed says, actually. The fact that some schools are not teaching amalgam at all is covered in the statement that 'at least' one school has eliminated it from the curriculum. What word would you prefer in place of 'declining?'
- How about my concerns, above, about the way the sentence relates to the one preceding it? -- Vary | Talk 22:03, 2 April 2006 (UTC)
- I do not see a problem with the wording " phased out " as it, is because this is what is actually happening. The rate of phasing out can vary but the trend is clear whether for aesthetic, environmental, functional etc... reasons. The sentence also explain the previous sentence based on the peer-reviewed article that suggests a gradual changeover from amalgam towards composite resin. The best way to do a gradual change over is to phase out one technique in favor of the other. Again it is important to look at the world situation and not only a US centric view.--Dr. Imbeau 22:37, 2 April 2006 (UTC)
- You misunderstand me. The current issue isn't about content - or about being US centric - but about word usage. What I'm proposing is saying the same thing: keeping the intent of the sentence, but changing the way that intent is expressed. Yes, the content of the sentence does explain the previous one, but the current wording is getting in the way of that.
- The only change to this section that I felt needed to be discussed here, which has already been made, was the addition of a qualifier to avoid implying that all dental schools were eliminating amalgam from their curriculum. I'm only holding off from making the other changes now because you seem to feel strongly that they're not right.
- Maybe I have missed some of your previous comments. Can you please put the phrase that you suggest so I can have a better idea of what it is ?--Dr. Imbeau 23:06, 2 April 2006 (UTC)
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- "Phased out" implies active policy changing by dental schools and other relevant organizations. "Declining" use doesn't necessarily imply such activism. We would need some evidence of active "phasing out" to use that phrasing in the article, more, anyway, than a general trend away from the use of amalgam and the banning of amalgam in a few countries. - Jersyko·talk 23:09, 2 April 2006 (UTC)
-
- Dear Jersyko. Welcome back from your self imposed daze ! OK. Let's look at the present wording: " Teaching of amalgam techniques to dental students is thus being phased out in some dental schools in favor of composite resin techniques with at least one dental school, University of Nijmegen in The Netherlands, having removed it entirely from it's curriculum as of 2001 ". The comment " phased out " is qualified with the word " some ". This is actually true and referenced. With that qualification any reader will know that it is not a general world wide country wide process but a localized process limited to certain schools. Evidence is provided that one dental school has completed that process already and the notified ban in Sweden supports the fact that more are either in the process of or have also completed it. Of course if there is another word that will convey what is actually truly happening then fine. And again please if any of you guys can provide additional references or peer-reviewed evidence, I am all for it !--Dr. Imbeau 23:19, 2 April 2006 (UTC)
- The most recent version is this:
- "Teaching of amalgam techniques to dental students is declining in some schools in favor of composite resin, and at least one school, University of Nijmegen in The Netherlands, had eliminated dental amalgam from the curriculum entirely as of 2001." Link omitted because we all know what it is by now.
- And the reasons for the changes I've suggested, in case those have been overlooked or forgotten, too, were I think put most clearly here:
- About the change discussed a few comments up: the word 'thus' doesn't fit here because it doesn't directly refer to anything, and in this context 'phased out' is weak, and I think unnecessary. This sentence should support the previous one, rather than the other way around: the previous sentence says that amalgam can't be eliminated without allowing time for more dentists to be trained properly in using resin, and this sentence explains how that is beginning to happen.
- As to the conversation above about activism: 'phased out' does, now that I think of it more in terms of implication, seem to imply 'activism', as Jersyko says. While that is, as you say, qualified by the word 'some', it also implies that schools are either specifically phasing out amalgam, or not making any changes to the curriculum, while 'declining' includes schools that are deliberately removing amalgam from the curriculum for the reason mentioned in the preceding paragraph, and those who simply are finding resin more in demand or more useful to their students, or are changing their curriculum for whatever other reason they might have. I have rather the same issue with the word 'thus' - it implies that that is the reason that all of the schools who are 'phasing out' amalgam are doing it, rather than allowing the sentence to do its job, showing that the increase in training on resin techniques called for in the previous citation is happening already. -- Vary | Talk 00:11, 3 April 2006 (UTC)
- Good point about " thus ". It can be removed as it is not really necessary in the sentence. As far as the interpretation of " phase out" and linking it with activism this is a point of view that is not necessarily supported by definition of the words. DECLINING see [13], PHASE OUT see [14]. " Phase out " is simply to bring or come to an end, one stage at a time or to terminate gradually. " Declining " is less descriptive of the actual process because. for whatever reasons, dental schools that put emphasis on composite or have eliminated amalgam techniques have do so on purpose, not incidentally.--Dr. Imbeau 00:31, 3 April 2006 (UTC)
Hey. I said we should read the article to find out if the authors mentioned any reason why this school in the Netherlands removed amalgam from their curriculum. Well, I read through the article, and this is what it said.
- "The reduced need for preparation and the strengthening effect on the remaining tooth were the principal reasons for the shift from dental amalgam to adhesive dentistry with resin composite at Nijmegen dental school. This decision was not influenced by the better aesthetics of tooth-coloured materials compared to amalgam and possible adverse side effects of this material. In a report of the committee on dental restorative materials of the Health Council of the Netherlands from 1998 it was concluded that there are no indications that any type of restorative material, including dental amalgam, will provoke systemic-toxic reactions. The environmental effects of amalgam are low as amalgam separators are installed in every Dutch dental practice."
It continues on, but these sentences state the most important facts. At least now, we can make sure to mention this school within the correct context. - Dozenist talk 01:49, 3 April 2006 (UTC)
- Great. All that is fine. I fully agree that modern composites offer better more conservative and better strenghtening of teeth ( I wrote so earlier in the section " One possible reason for wanting to continue to use amalgam... " Of course it does more than that, but that reason in itself is sufficient enough to justify the switch. It is also of interest that the article implies that in the Netherlands all dental clinics have amalgam separators, which is not yet the case in the US. Still in spite of that they do acknowledge that there is still a low impact on the environment instead of none. No impact is better and that can be achieved by avoiding the use in dental medicine of amalgam and mercury based compounds. The Dutch show that you do not need amalgam, as claimed by the ADA, and that properly done modern composites will perform in a very acceptable manner clinically. Finally this section is not about health effects based on 1998 research or 2006 research for that matter but about the use of alternative materials, such as composite resins, as a valid alternative to amalgam. In fact the dutch article demonstrate further that the statement by amalgam proponents that amalgam is stronger than composite resins is questionable. It is true that it is what they say but is what they say true ?? Thanks for your contribution Dozenist--Dr. Imbeau 02:14, 3 April 2006 (UTC)
- One more item on environmental impact: The last edition of Time Magazine has an interesting article on how urgent action is becoming regarding the impact of human activity on the planet's ecosystems. While this used to be controverial a decade or more ago with the scientist sounding the alarm being accused og being alarmists, we have now ( AT LAST) reached a consensus that THIS IS SERIOUS and the damage is starting to unfold at a rate much greater than even anticipated by those who initially sounded the alarm. So anything we all can do to reduce or stop pollution of the environment is of benefit to us and to the future inhabitants of our wonderful planet. I hope we can all agree on that.--Dr. Imbeau 03:03, 3 April 2006 (UTC)
- Oh, absolutely, global warming is an extemely important issue that must be addressed by every nation in the world immediately. I'm quite ashamed at my own government's response to the issue thus far, but sincerely hope that the example set by others will be followed by the United States soon. I emphatically disagree, however, that mercury, and especially amalgam fillings, have much if any relevance to the issue of global warming. If the argument is by analogy only, I think it's quite a bit too broad to have much impact on the content of this article. I do agree, however, that we should all do more to protect the environment, in any event. - Jersyko·talk 03:09, 3 April 2006 (UTC)
- Dear Jersyko. There was absolutely NO implication in my last item about mercury being involved in global warming. This is a conclusion you have drawn your own. Is it possible that you think that I blame all our problems on mercury ??? If so let me re-assure you I know a few other things apart from mercury and amalgam and I live on the same planet as well. The only emphasis is that if we are in the present situation it is because we have neglected the impact that we have by our actions. Whether it is mercury pollution of CO2 pollution, any pollution can have undesirable effects on the environment, whether we see it now or not. Global warming is just one of many manifestations. MY POINT IS " anything we all can do to reduce or stop pollution of the environment is of benefit to us and to the future inhabitants of our wonderful planet ". Avoiding sources of mercury pollution is part of such pro-active behaviour. Again on the issue of global warming as on the issue of mercury control the US is lagging behind the leaders in this world.--Dr. Imbeau 03:29, 3 April 2006 (UTC)
- I read it the first time. Not an analogy. Just saying we need to be more pro-active in eliminating pollution and that includes mercury pollution from amalgam. The link with the global warming issue, if you want one, is that the same "laissez faire " behavior is at work in issues related to pollution, whether it is CO2, Hg, dioxin, PCBs and so on. A lot of people tend to take action only when they are against the wall ( sick, faced with disaster etc.... ). The recommendation to separate and safely collect amalgam waste was certainly not an initiative from the ADA and most of membership have been polluting the environment for 150 plus years with amalgam waste until the pro-ban raised the issue with vigor. In King County they initially tried voluntary measures for amalgam separation and collection and found out that it did not work and had to legislate to make it mandatory. That is relevant to this article but not worded in NPOV. Do I need to reference that last point ? However I am glad that you agree that we should all do more to protect the environment, in any event.--Dr. Imbeau 04:17, 3 April 2006 (UTC)
- Dear Dozenist. If you want to have an idea how impressed dentists attending the 2003 BDA Conference were by the amalgam-free approach at the Dutch dental school see the following link: [15]--Dr. Imbeau 06:30, 3 April 2006 (UTC)
- I have made the change proposed above because disucssion here seems to have shifted towards other topics, and because the only non-minor change has I requested had already been agreed upon. -- Vary | Talk 02:17, 4 April 2006 (UTC)
[edit] ASDS support for dental amalgam ?
I found this link [16] which is a timeline from 1836-1849. The information on that page says that on 17 May 1840 ( the ASDS was founded 18 August 1940 ) Baltimore Dental College graduates swore not to use mercury amalgam. Baltimore Dental College was the first dental college in the US. I find this quite at odd with the statement that the ASDS supported the use of dental amalgam.... The fact that the statement is not referenced should cast a doubt on it's veracity. I have not been able to find any support for it either. So initially I placed a [citation needed] after it but with this new information I have decided to remove it until I, or someone else can provide a reference to support veracity. --Dr. Imbeau 08:15, 3 April 2006 (UTC)
[edit] Recent changes
Were all of these changes (the dif is my edit, not Imbeau's) discussed here before being placed in the article? If so, my apologies for not objecting before now. If not, well, why not?? - Jersyko·talk 13:03, 3 April 2006 (UTC)
- Dear Jersyko. While you were in a dazed state, we actually did discuss the issue. I have provided a link to information from the British Dental Association about a conference where dentists were impressed by evidence provided by study done at the dental school at the University of Nijmegen . The study proved that in skilled hands composite resin fillings were more conservative, strengthened the tooth and had a surviral rate of five-year that is the same as amalgam. I see now how trigger happy you are with accusation of POV and with reverting text. The above study is not my POV it is simply a fact that has been agreed by dentists who are members of the BDA.
I also made a point earlier that so far it appears that you have not really provided any positive information, reference or data to improve the content of the article. Your contribution seem to be mostly centered on reverting and criticism. You know contribution to improving an article of this type is not simply about policing the content...--Dr. Imbeau 20:57, 3 April 2006 (UTC)
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- If that is the result of the study at Nijmegen, it should be presented as the result of the study at Njmegen, not an unreferenced fact. "In skilled hands" and "more conservative restorations" seem POV-laced. Does the study use that language? In any event, Dozenist has provided a counter-argument above, giving the ADA position, stating that composites "just wear away" if placed in rear teeth, if I'm not mistaken. If you are correct in your assessment of the Nijmegen study, the article should at least mention that other reputable organizations disagree.
Second, you added "Because of the significant differences in technique and materials" in front of this sentence, "some experts caution against a too-sudden shift towards resin to allow time for dentists to acquire the skills needed to properly place resin fillings." This wording hasn't been discussed here.
Finally, yes, my contribution to this article is limited to criticism and reverting . . . except for the fact that I re-wrote the whole thing over a month ago, which was absolutely horrible by any measure (full of POV, bad writing, and absolutely no organization) in the first place. I'm not saying that the article is perfect now, far from it, but, please, don't try to minimize my contribution to this article merely because I disagree with your POV-pushing. - Jersyko·talk 21:13, 3 April 2006 (UTC)
- If that is the result of the study at Nijmegen, it should be presented as the result of the study at Njmegen, not an unreferenced fact. "In skilled hands" and "more conservative restorations" seem POV-laced. Does the study use that language? In any event, Dozenist has provided a counter-argument above, giving the ADA position, stating that composites "just wear away" if placed in rear teeth, if I'm not mistaken. If you are correct in your assessment of the Nijmegen study, the article should at least mention that other reputable organizations disagree.
- Dear Jersyko. 1)An actual sample of the wording of the study is " The reduced need for preparation and the strengthening effect on the remaining tooth " " " qualified dentists "etc.... Since we should not copy textually I used different words to convey the same i.e reduced need for preparation = more conservative preparation ect.... If you wish to discuss the wording , fine with me but wholesale reverting is far from doing that. Dozenist provided a quote of the study earlier. 2) I think that the following phrase in the text " Proponents of amalgams, however, counter that amalgams are stronger, more durable, and less expensive than most of the available alternatives. " exemplify the position of the ADA quite clearly, If you wish to replace proponents with ADA that is fine with me. 3) The fact that there are signficant differences in technique and materials is a FACT that is well known in the dental profession. Again you are confusing your lack of real expertise in this field with your quick tendency to use the POV argument. I do not need to get your express approval for everything that goes into the article as you certainly do not wait for my approval to revert , cut and censor. 4) I mentioned earlier I accept the fact that we are all trying to improve the article. A positive contribution requires to provide up to date facts, new elements, data and references for the article and that is what I have been trying to do. I did not go in and revert or remove things that do not suit me or that I think are POV. If the item is supported or I know it is true than no problem. So far I have removed only one item because of it's dubious veracity based on available information. I have added information that I have supported either directly in the article or indirectly in the discussion section and I have corrected information that was inaccurate with references. 5) While you have re-written the article it does not give you ownership over it as clearly stated in the rules of Wikipedia.--Dr. Imbeau 21:39, 3 April 2006 (UTC)
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- You're absolutely correct in saying that I don't own the article. Of course, that criticism would only make sense if (1) I reverted every change you made to this article (clearly not true) and (2) had stated no basis for any of my reversions (which i stated in my last comment). As you have completely written off my concerns regarding the language in this article, let's see if Dozenist agrees with you on these points then, as you seem willing to engage criticism from someone that's in a similar profession. - Jersyko·talk 21:48, 3 April 2006 (UTC)
- Sorry, I started working on this a little while ago and didn't get a chance to finish and post it, and more discussion has taken place since I started, so I'm responding to multiple sets of comments at once here.
- I see the link, but I don't see any discussion or proposed language. I agree that the addition was not entirely NPOV. In particular I take issue with the tone of the phrase 'in skilled hands'. Also, I have to say that the article, a report from an annual dental conference, has a distinctly informal, chatty style not really in keeping with a scientific paper, and please note that it expresses the opinion of a single individual whose credentials are never mentioned.
- I've made my feelings clear on the 'gradually' issue, so I don't need to say that I agree with Jersyko there, and good call on removing the extra 'in place or in progress', as removing 'gradually' makes that part of the sentence superfluous as well. I propose another minor change "...disposal of amalgam waste, and legislation to enforce these standards is currently being adopted in some nations." I honestly don't know why I put 'developed' in there to begin with - I think that was back when the sentence included 'many' rather than 'some', but if we're saying 'some,' I don't think that 'developed' adds anything.
- As for Imbeau's statement that Jersyko is 'trigger happy' and not providing positive contributions, I refer him to the article's edit history. As he mentioned above, Jersyko has put a lot of work into reorganizing and clarifying this article, which I agree was frankly a confusing mess.[17] One does not need to add content to an article to be making a 'positive' contribution - articles do have to be readable to be useful and informative to the reader. -- Vary | Talk 21:58, 3 April 2006 (UTC)
- Dear Jersyko; 1) I have not completely written off your concerns as I said that I was fine with discussing the wording. I have however pointed out that the wording I have added was based on factual evidence which I explained, again, for your benefit. 2) I am quite willing to discuss things with Dozenist and I have before, if you just read the various items in the discussion section you will be able to see that. 3) There is a message at the top of the article stating that expert contribution is needed for the article. As I am a qualified dentist with experience both in the use of amalgam and posterior composite resin, amongst many other things, I think I do qualify as someone with , at least, some real expertise in this field. Having also treated a large number of individuals who experienced health problems with amalgam and other dental issues and witnessed their health improvements and having written testimonials from such patients is also useful in my understanding of the issue.
As for Vary's comments. The issue is not what the article was in the past but what it is now. No problem with making the article more readable and I have stated that before. And while it is not necessary to always provide data, references and new info to contribute, it is nice to do so once in a while. As I said before if someone role is purely as a censor of the information being place in it should be specified.--Dr. Imbeau 22:05, 3 April 2006 (UTC)
- Jersyko is a longtime contributor to this site, and an excellent wikipedian, and his past contributions to this article show that he is dedicated to keeping it neutral and encyclopedic. Please do not use the word 'censor' again, it's not accurate. Whether you realize it or not, your edits are frequently not NPOV, and it's important to have other sets of eyes to help keep things neutral. And while it might be 'nice' for Jersyko and I to make other contributions to this article, we frankly have our hands full right now trying to work with you to make the additions you want made NPOV. -- Vary | Talk 22:11, 3 April 2006 (UTC)
- I think that the problem is what is NPOV. If I say skilled hands you say it is POV but when Dr. Leinfeilder says " limited skills " than it is fine. If I write based on the word of another colleague who is quoted by a third colleague writing an article distributed to all BDA members regarding the difference between students skills and qualified practitioners skills as with regards to composite resins then it is not enough even if it actually is a report on the actually results of the study that I have referenced earlier. If I write " significant differences in technique and materials " you say POV whether you know if it is true or not. If you have your hands full it may also be because you assume POV too easily when it is not necessarily so but is simply an issue of how the wording is perceived. If I copy a referenced text directly, it is not acceptable, if I word it with different words meant to say the same thing, then it is POV... The article contains many item with regards to the support of amalgam who are not referenced at all but I do not question them because I know that this is what the proponents actually say. However when i put an item in support of discontinued use of amalgam it is assumed that it is POV unless fully referenced. And the interesting thing is that you have time to actually check the references but have no time to look for new ones..... While I discuss wording an have gone along with proposed changes, it seem to be more unilateral than evenly balanced....--Dr. Imbeau 22:36, 3 April 2006 (UTC)
- As i've noted numerous times before, however, your presentation of facts, i.e., statements on the issue that have been widely reported and re-stated by one or more of your colleagues or dentistry-related institutions, is selective. It is not the "facts" themselves that are necessarily POV, but your selective use of facts that are only supportive of your position. If you were providing counter-arguments where appropriate, or even acknowledging that what you're saying isn't necessarily the view of the dental community at large, I would not be so adamant about this. As for my contribution to this article, I'll be the first to admit that I am not a dentistry expert. You are undoubtedly superior to me in this regard, Dr. Imbeau, as you understand these issues better than I ever will. On the other hand, while I may not be an expert, I am extremely familiar with Wikipedia policy. My contribution here is to insure that this article conforms to the relevant policies. - Jersyko·talk 00:28, 4 April 2006 (UTC)
- Dear Jersyko. We are going around in circle and that does not address for example the lack of references for statement made by proponents of amalgam. Case in point :" Proponents of amalgams, however, counter that amalgams are stronger, more durable, and less expensive than most of the available alternatives. " NO REFERENCE - However I know it is true that it is what they say ( even if I also know it is not all true what they say ) so I accept it because it does represent their point of view. Above I provided information and a reference to show that available alternatives are being used successfully by dentists who have been trained in that regard ( skilled ) in lieu of amalgam. The study proved that in skilled hands composite resin fillings were more conservative, strengthened the tooth and had a surviral rate of five-year that is the same as amalgam. The wording can be refined but it is what the study concluded. NOT MY STUDY - NOT MY CONCLUSION. However my addition is labeled POV - summarily deleted ( even when referenced in the discussion ) which you did not even look at. On the other hand the proponent's item is all fine without a single scientific reference....
And YOU accuse me of being selective with facts. Come on.. Get serious --Dr. Imbeau 07:51, 4 April 2006 (UTC)
- A few more " selective " facts for you:
[18]. In this 2004 study two composite materials show similar wear resistance and abrasiveness to amalgam.
[19] This 8 years ago from Dr. Christensen a highly respected US dentist.
[20] Failure rate for amalgam very similar to direct composite resin in posterior teeth in this 2001 study.
[21] In this 2004 study failure of amalgam is very similar to direct composite resins in posterior teeth
NEED MORE - HOW MANY STUDIES ARE NEEDED so that is not my POV ? Of course we can look at study dating 10 or 15 years + and we can find a lot showing amalgam is more durable but we are in 2006...--Dr. Imbeau 08:43, 4 April 2006 (UTC)
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- Thanks for demonstrating my point for me. I haven't waded into the battle of the studies because I'm not experienced in this area. However, after a cursory search, I came across this result, which is from 2004: "For VHN, DoxaDent was harder than glass-ionomer, better than composite except at 1 hour and less than amalgam."[22]
- I am not skilled enough to read these studies to determine what they're saying for the most part. I am, however, fairly certain, given the position of multiple reputable dental organizations on amalgam and Dozenist's above comments on the issue, that the strength and durability of amalgam relating to other filling materials is not nearly as cut and dried as you make it. That is why your selectiveness is POV. - Jersyko·talk 13:02, 4 April 2006 (UTC)
- Do you have a problem with this change? If so, what's wrong with it? - Jersyko·talk 13:29, 4 April 2006 (UTC)
- The proposed change does not accurately describe the situation. It is well accepted that amalgam is cheaper ( at least for the time being since when the extra cost of amalgam separation and recycling and proper handling of amalgam will be added that may change ). The fact that amalgam is automatically stronger than alternative materials is not true. The fact that amalgam is more durable is now in the process of being re-assessed. As the better alternative materials are being in patient's mouth for longer we are getting data of 10 - 15 years to compare with amalgam longevity or durability.--Dr. Imbeau 19:35, 4 April 2006 (UTC)
- Dear Jersyko; And what a mastery in conclusion !
1) Doxadent is not a composite resin materials......Opps 2) Of course there are materials that wear faster and materials that wear less than amalgam... That is not controverial in any way and well known. 3) The point is not that ALL alternative materials are better than amalgam 5) The point is that there are alternative materials ( for example the brand of composite materials that are proven so ) available from manufacturers that have similar failure rate and wear rate than amalgam. Of course these materials have to used properly by people who have been trained and are skilled in their use.... whether you like it or not, THAT IS A FACT.
At least I congratulate you on your effort to look for some valid reference but I am afraid you a) missed the point b) confused materials.
As for your self-proclaimed neutrality do not make me laught. Case in point the test below taken from the archived discussion:
" As a result, we can conclude that according to the editors of this Wikipedia article, there is no "controversy" around dental amalgam, instead just a bunch of people with vivid imaginations "
Of course in your thinking any selective choice of evidence is probably the result of a vivid imagination.... Thanks for making my point.--Dr. Imbeau 19:26, 4 April 2006 (UTC)
- Look, Imbeau, here's what Dozenist said earlier reagarding the ADA's position on exactly what you're talking about, "The ADA policy has been that smaller fillings in the back of the mouth can be done with composites. Larger fillings should not be done with composites because composites are not strong enough to handle the forces in the posterior of the mouth for a long enough time. Essentially, the composites just wear away. This guideline has kept many dentists from placing posterior composites (at least in the U.S.). Though materials have been constantly improving, I do not know if there has been an official change by the ADA. We would need to look for that if so." If this is still the ADA position, and since you've presented no evidence that that position has changed, it is a valid counter-argument to the information you're presenting. Yes, it is the position of an organization rather than the presented result of an experimental study. Since the organization is widely recognized as expert in the field, however, it cannot be discounted, as you so readily do. The article currently describes the situation as follows, "Proponents of amalgams, however, counter that amalgams are stronger, more durable, and less expensive than most of the available alternatives, though opponents point out that some newer composite materials have demonstrated durability on par with amalgam." This is accurate. I hope your insistence on belittling me, even going to the archive of this talk page to bring in a comment made by someone who accused anyone who disagreed with him/her of being an ADA secret agent, is bringing you satisfaction. - Jersyko·talk 19:40, 4 April 2006 (UTC)
- In another cursory search, I found this study which supports the proponent argument,
- [23] "Amalgam showed the lowest wear rates with both methods." vs. composites and glas ionomers 1996
References need to be provided for many of the article's claims. I've just had a thought, though, that I think might make things a bit clearer here. Wikipedia's neutral point of view policy says that debates should be characterized and described, but not engaged in. It seems to me that by citing studies on either side and presenting these studies, the debate is being engaged in. However, by describing the argument made, i.e. "proponents argue x, while opponents argue y", with links not to studies that support these conclusions, but to websites or books that actually make the argument, this article can adhere to NPOV. As it is now, we're simply rehashing the debate on this talk page that we don't need to be re-arguing, but merely describing. When the article says "proponents state that . . ." it should be followed by, for instance, a link to an ADA article that states the position. When it says "opponents state that . . ." it should be followed by, for instance, a link to an anti-amalgam organization's website. Using studies as reference material, however, creates an engagement in the debate that is supposed to be being undertaken by proponents and opponents, not Wikipedia. - Jersyko·talk 20:10, 4 April 2006 (UTC)
- [23] "Amalgam showed the lowest wear rates with both methods." vs. composites and glas ionomers 1996
- In another cursory search, I found this study which supports the proponent argument,
- Again for the nth time. The point is not that all alternative materials are as good or better than amalgam but that there are choices of alternative materials that have been proven to have a similar failure rate and wear rate, of course they have to be done properly and that is also part of the problem when assessing performance of a material. I accept that amalgam wear less than certain materials and more than others. Hope I do not have to repeat that again. As far as not enganing in the debate that is fine in principle but quite difficult when editing based on a self justification of neutrality is overlooking accurate depiction of the situation based on their knowledge of the so-called majority view, especially as represented by the ADA. When that happens one can only raise science and proven facts in order to provide knowledge that , hopefully, will bring a more balance view of the situation to editors.--Dr. Imbeau 20:23, 4 April 2006 (UTC)
- Dear Jersyko: I am not disputing that this is what the ADA is saying. So I have no problem with their point of view being included in the article. Whether their position is correct or reflecting up do date knowledge and available materials is another story altogether. Recent studies, including the one I referenced above, demonstrate scientifically as opposed to a point of view, that there are brands of composite materials, who perform in a similar manner to amalgam in posterior application and not only for small fillings ( Class I ) but also for Class II applications. That is a fact and the point I have been making all along.
As for the ADA being credible. That is a matter of point of view. They are certainly not credible for everyone, especially if you know a bit about history and about the issues. An organisation founded on the basis of amalgam use and safety that disregarded published scientific evidence ( see below in " health effect generally" ) for 102 years.... Red flags... anyone ?
Finally I take no satisfaction at being constantly critizised based on erroneous assumptions and interpretation of a situation that is far more subtle and complex that you are willing to allow. No satisfaction in my contribution regularly labeled POV when I do the best I can to base it on facts, not on opinions. If these facts contradict the official, almost sacro-saint, position of the ADA, SO BE IT. I am proud to be pro-ban as I consider this to be a responsible, pro-active and scientifically valid position but being pro-ban does not mean that I am in denial of the current political reality. It does not mean either that I will bow down and go along with whatever is being touted as a majority view simply because the majority says so.--Dr. Imbeau 20:11, 4 April 2006 (UTC)
-
- In no way am I attempting to dissuade you from your point of view. Neither am I trying to make you stop making suggestions for this article. I criticize and bring up NPOV for one reason — it is the foundation of Wikipedia, having been described as "non-negotiable" by the founder of Wikipedia, Jimbo Wales. I have a definite point of view when it comes to U.S. politics, which usually comes down on the side opposite from our current national leader. Considering that, and knowing that I would be tempted to present facts in a potentially biased way if I edited his article, I have stayed away from the George W. Bush article, even though I know quite a bit about politics. A large number of Wikipedians stay away from articles that they have a strong POV regarding for the same reason. You've chosen to engage in editing an article that you have strong feelings about. Nothing prevents you from doing that, per se. However, given that NPOV is non-negotiable and the foundation of Wikipedia, your point of view as well and motive for editing is extremely relevant to this discussion. That is why I have responded to your comments criticially at times. Please note, however, that I have made several changes, as well, based on your suggestions. The article is better now than it was before this discussion began. - Jersyko·talk 20:33, 4 April
2006 (UTC)
- Dear Jersyko. I am in agreement on your last comment and have no problem with NPOV as a basic principle in Wikipedia. The question is in such a complex and controverial issue, it is somewhat too easy to jump to the conclusion that something is POV when the facts and underlying factors are not well understood. I, for one, would gladly stay away from this article if I felt it was a fair, accurate and balanced description of the up to date situation. Sadly it is not and it was in need of someone with real life expertise in the field and someone having been on both sides of the issue as I used to be an amalgam user and also a proponent ( believe it or not ). The proponents have put in place a lot of mechanisms to insure that their point of view ( not neutral ) has been prominent. That is changing however because the public in general can now have access to information on both side of the issue and make up their own mind. My guiding principle is that a well informed person will be able to make the right choice for herself and since the proponents have had their way for a long time , I do not see it as my task to support their point of view ( as Dozenist said HE is in the majority ( his POV ) so it is for ME to prove my point ). Of course that is the same old theme - we are right because we are the majority so we do not have to prove anything to you but you have to prove to US that you are right and that WE are wrong ( and by the way WE also decide what is acceptable evidenc and what is not ). Convenient is it not ?--Dr. Imbeau 21:06, 4 April 2006 (UTC)
- Dear Jersyko, I had a quick look at the George W. Bush and can see your point. That is why proven facts are important. In politics there are a lot of opinions, as you know, and people can have a very emotional point of view, either way. Facts on the other hand do not have an opinion even if people tend to have an opinion aboutthe facts. For example I can be of the opinion that George is a lier, saying one thing and doing another, but I cannot say that in an article unless I have proven facts to support that opinion. This transforms the opinion into something that is true, whether it please the opinion or not of one group or the other.--Dr. Imbeau 22:05, 4 April 2006 (UTC)
[edit] Health effects generally
This section seems to tilt too far towards supporting the claim that amalgam causes "neurodegenerative diseases, birth defects, and mental disorders", in that it isn't until more than halfway in that the opposition's opinion on the matter is mentioned. In a section as long as this one, the first paragraph should be serving as a general introduction, so I propose the following change:
- Dental amalgams have been suspected by some medical practitioners, particularly of integrative or alternative medicine, of causing many physical and/or psychological problems. They reason that, since mercury is poisonous, amalgams in the mouth that contain mercury are poisonous. These persons argue that amalgams may cause neurodegenerative diseases, birth defects, and mental disorders. While it is true that mercury exposure can cause health problems such as these, a comprehensive review of papers on the subject published in peer-reviewed journals during the years of 1996-2004 found that the evidence presented did not support such a connection. [24]
This is a minor change to the current final sentence of the first paragraph, and an additional sentence explaining the pro-amalgam's view on these claims, with citation. Comments? -- Vary | Talk 01:59, 4 April 2006 (UTC)
- Hmm, must have missed that one before. I agree, Vary. I'm not married to your wording (not that it's bad), as I'm sure it will be protested. - Jersyko·talk 02:33, 4 April 2006 (UTC)
- I agree with the change because it is not as much of change than as an elaboration, which is needed as a first paragraph to the section. - Dozenist talk 03:24, 4 April 2006 (UTC)
- it is so nice to see all three so quickly in agreement with each other. Why should I protest ? The wording is fine and the information is correct although the following has been overlooked:
1) There is nothing to mention a counterpart of the LSRO report, the German review of research up to 2005 which has drawn different conclusions [25] and also the fact that the LSRO review has been challenged [26].
2) The fact that " they reasons that amalgam in the mouth is poisonous " is a generalisation that certainly does not include all those who are for a ban on amalgam, me included. Rather it is the mercury released from the amalgam that is poisonous. If mercury was permanently bound in amalgam , as stated previously by the ADA, then mercury poisoning from amalgam would not be an issue. And I think that would go a great way to end the controversy ( or may be this is POV of me AGAIN ). Bad Bad bad.
Oh, I forgot that I did mention it before.... silly me. In any case, since you are so diligent in applying the rules of Wikipedia, you would have surely found that " an enquiry into the scientific analysis of this filling for teeth was done in 1880 by Dr. Eugene S. Talbot of Chicago.
The startling result was a discovery of a quality in amalgam composition capable of producing salivation and all the other symptoms of poisoning. Dr. Talbot investigated his theory that mercury vapor was the cause, and in a series of groundbreaking experiments in 1880 proved that amalgams constructed at that time “send off vapor of mercury. This has been proved conclusively by chemical tests and the destruction of vegetable and animal life. Mercury poisoning by inhalation of vapor causes much more serious effects than ingestion through the stomach.”
This was published in the Ohio State Journal of Dental Science in 1882. It is for Dr. Talbot the honor of being the first modern scientist to document the dangers of amalgam. "
And I suppose that it is POV that there is historical evidence that it was demonstrated 126 years ago that amalgam does release mercury vapor and that it was reported in a respected dental journal 124 years ago ! And I suppose it it not relevant in an article about the controvery of dental amalgam ?
HERE IS THE ABSTRACT:
Talbot E.S., "The chemistry and physiological action of mercury as used in amalgam fillings", The Ohio State J. Dent. Sci., 2(1):1-12, 1882.
Résumé
There are in the market many varieties of amalgams. Evaporation does not depend upon quality or age, but all amalgams will send off the vapor of mercury. This has been proved conclusively by its destruction of animal and vegetable life, and by chemical tests. Evaporation is facilitated by an increase of surface, consequently a greater amount of vapor would arise from several small fillings than from one large filling. The facility with which mercury is taken into the lungs by continued inhalations and the rapidity with which it enters the blood, requires less mercury to produce systemic effects than when taken into the stomach. In order to produce systemic effects from metallic mercury, it must be rubbed up with an excipient, to reduce the particles to a size capable of entering the capillary system, or it must be taken into the lungs in the form of vapor.
NOT MY OPINION - NOT MY STUDY - NOT MY FACTS ..... I suppose Dr. Eugene S. Talbot, bless his soul, is selective with his facts and POV in his wording....
That raises the question: why did the ADA claim that mercury did not escape from amalgam when it was proven in 1880 that it did ? Why wait until the evidence became overwhelming in 1984 - 102 years later - to admit what was already known and published in 1882? OR is it being partial to ask the question ?.--Dr. Imbeau 05:58, 4 April 2006 (UTC)
- I would like to have some feed back on the above. I do not want to make changes to the article now and then get into the same lengthy, protracted debate on what is POV or not.--Dr. Imbeau 21:25, 4 April 2006 (UTC)
- It's clear that the ADA has a vested interest in promoting the safety of amalgam. Your question is valid, provided that you accurately described what happened. Perhaps this is where the ADA and anti-amalgam movement conflict, i.e., the characterization of what was "known" at given times? If the description is accurate, I don't know the answer, nor could I speculate on the answer. Has the ADA released a statement explaining its action or lack thereof? - Jersyko·talk 22:15, 4 April 2006 (UTC)
-
- Quote from an article on the history of dentistry: "When the French Crawcour brothers emigrated to the United States in 1833, they introduced Taveau's amalgam. The poor quality of the amalgam led to its condemnation by many dentists, kicking off the so-called "amalgam war," a 10 -year period from 1840 to 1850 of bitter controversy about the merits and deficiencies of mercury amalgam. Numerous experiments were made from the 1860s through the 1890s to develop improved amalgam filings materials. The Chicago, Illinois, dentist G. V. Black (1836-1915) finally standardized both cavity preparation and amalgam manufacture in 1895."[27] Odd choice of file name, IMO.
-
- It sounds as though Talbot's study was on lower quality materials than are used today, or even those that were used at the turn of the century. From the passage, it sounds like the anti-amalgam side felt that there was no way that amalgam could be made safe, while the pro-amalgam side saw potential and thought it was worth it to continue studying the material unill they eventually (in 1895 or perhaps a bit earlier, from the sound of things) found methods that they found satisfactory. If that's the case, I'm sure you're aware that amalgam isn't used in precisely the same way today as it was in 1882.
Dear Vary / Jersyko; Please have a look at the full text of the paper written by Dr. Talbot at [28]. From my readings of the history , amalgam proponents were considered to have poor standards by the better dentists of the time including Dr. Harris, the founder of the first dental school in the world, and eminent dentists such as Dr Taft. The driving force for amalgam use was money as it was easier and cheaper to use and proponents advertised quite a bit with less than professional decorum.
As for the issue of amalgam quality, ther is no doubt that improvements were made over a number of decades. Of course it did not stop proponents from using the worse stuff right from the start, in their patient, with little concerns for the warning of their colleagues. Also I would like to point out that there is NOW a consensus on mercury vapor release from amalgam. This, of course, simply affirms that what was true 126 years ago is still true today and will always be true. Whatever the ADA says.
There is no way that the ADA in 1882 could NOT be aware of the study by Dr. Talbot as it was published in a reputable dental journal of the time. The logical conclusion is that they choose to disregard it. Furthemore they chose to claim that mercury did not escape from amalgam in spite of the available scientific evidence. Thus the next logical conclusion is that the ADA chose to lie to the public about it because it would otherwise have been bad for business. Of course that is a point of view since I do have have a document stating the ADA has lied to the public, however connecting the dot in that instance show a pattern. How is that for credibility ?
As for how and where to use the study, I have no idea at the moment and submit the information to you both for suggestion. As you say I have my point of view on it so I am open to input. --219.89.170.5 00:42, 5 April 2006 (UTC)
- Also I had a look at the ADA web site and the section on history in dentistry [29] and there is nothing to mention the study by Dr. Talbot or no mention that Dr. Chapin Harris, co-founder of the Baltimore Dental College, was opposed to amalgam use. There is a mention of the controvery triggered by the Crawford brothers but worded in a way that suggests it was more an issue related to these invididuals than the material. An emasculated version of history to suit the ADA, perhaps ?--Dr. Imbeau 00:51, 5 April 2006 (UTC)
- I don't see any reason to include the Talbot study, honestly. I think the history section is one of the more solid parts of this article right now, and I see no reason to add to it, and as I said, I don't think it has any real bearing on amalgam safety today, due to the changes in methods in the past 100 years. I'm sure there's something else we could spend our time improving.
- Also, could we please keep the discussion to the actual improvement of the article, and try not to engage in debate over the merits of the two opinions we are meant to be trying to express neutrally and equally? Thanks. -- Vary | Talk 06:08, 5 April 2006 (UTC)
- Dear Vary: Did I miss something here, has the article been renamed SAFETY OF AMALGAM ?
This is article about Dental amalgam controversy. The safety issue is one of many. I think that a) the history section needs improvement. I have already made some improvements by correcting some errors or dubious sentences. b) the Talbot study is at the core of the controversy because it shows that scientific evidence of mercury release dates back to 1880 vs repeated statements by the ADA for 102 years since that mercury was bound in amalgam. c) the history section does not explain that eminent dentists of the time were opposed to amalgam which was instead promoted by less reputable elements.
I do not think it is a show of neutrality to ignore an historical scientific landmark i.e the first study that proved mercury release from amalgam as of 1880. In fact that suggest a preference for the ADA version of events.
As far as the change in method:
1) In all neutrality it has not stopped mercury vapor release . 2) In all neutrality, there are scientific reviews on both side of the safety issue ( you have yet to include the German review, which is the most recent, in your proposed wording ). 3) In all neutrality amalgam use is being increasingly controlled for various reasons 3) In all neutrality amalgam is being banned in one country while being restricted in others while in others like the US there is no restrictions. 4) In all neutrality there are NOW direct restorative alternative materials who have been proven to perform as well as amalgam, and look better while doing it. 5) In all neutrality while legislator are in the process of regulating the proper handling of amalgam waste to protect the environment, there is still many areas where it is still not properly disposed of. 6) In all neutrality there were factual errors in the history section and there are omissions as well etc...
In all neutrality none of the above points were introduced by you.
In all neutrality wording like : " Until 1984 the ADA maintained that mercury was bound in amalgam. This position changed when numerous scientific studies in the 1970's demonstrated that a small amount of mercury vapor was constantly being released from amalgam, corroborating the first such study published in 1882 by Dr. Eugene S. Talbot.[30]does represent the historical facts.
It' your job to be neutral so please can you be more cooperative with items that do not support the so-called majority view as per ADA. Thanks User:Dr. Imbeau|Dr. Imbeau]] 08:58, 5 April 2006 (UTC)
- It's your job to be neutral, too, and the above comments are unnecessarily argumentative. You complain that I have not done enough research on points that support your POV. I would contend that you're doing enough of that for all of us. Please read the WP:NPOV policy, especially the sections on undue weight. We need to spend a roughly equal amount of time discussing both sides of the issue. You are, once again, trying to convince me of something, and assuming that you know my current position. And let me tell you in all honesty that, while I don't know the effect it's having on others watching this talk page, your tone and belligerent attitude are not helping your case with me.
I'm in the process of reviewing the additions you made overnight. I haven't changed anything yet, but you can't honestly tell me that you think wording like 'unscrupulous methods" is acceptable. -- Vary | Talk 15:50, 5 April 2006 (UTC)
-
- The "unscrupulous methods" phrase was pulled directly from the ADA website. I'm sure you'll mention this fact in your response to Vary, Dr. Imbeau, but I wanted to write a quick note about it beforehand. First, simply citing the agreement of the opposing side on an issue does not mean that the presentation of the issue is therefore neutral. "Unscrupulous methods" is a POV-packed phrase, no matter who is using it. The methods should be described, not characterized. Second, while I think some of the addtions you made recently were helpful, some of them, especially in the history section, gave undue weight to your side of the issue without complementary views from the opposing side. - Jersyko·talk 16:06, 5 April 2006 (UTC)
-
-
- Ah, yes, I do see that now. I must have mistyped the word when I searched the document for it. Agree that the term doesn't really belong in the article regardless of the source. And as I said earlier, I think the history section was already very well balanced. -- Vary | Talk 19:46, 5 April 2006 (UTC)
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- Dear Vary; As I said earlier discussion on improved wording and phrasing is all fine with me. In fact I have included many of your suggestions myself in the article, if you wish to be neutral in your assessment. I am certainly for finding the best way to put the relevant facts into the article. I have used the word " unscrupulous " not only because it is on the ADA website but because it also represent what the other side of the issue was saying at the time. ( NOT MY OPINION ) Since there appeared to be a consensus on the facts around the Crawcours brothers, I thought that it was accepted by both sides so that it was not argumentative. If you have a better wording to suggest , fine with me. Please let me know.
As far as balance in the history section, I do not agree with your point of view here because if you read the history it is clear there there was a major controversy at the time to the point of leading to the demise of the first dental association, This is at the foundation of today's situation so it is very relevant and readers should know about it.
Finally you first raise the issue of neutrality ( should I assume that you also posted the warning in the article as and ADMIN or is it someone else ? ) and I pointed out that there are two sides to the argument, in all neutrality. While the two sides cannot be both correct, they should be explained and I have certainly not tried to remove items representing the other side of the argument ( pro-amalgam ). There is room for improvement.
Finally I am trying to explain the basis for my contribution as well as show that it is based in factual evidence. If that is unacceptable please let me know. Second I have noticed that when I raise a point indicating an opposite view as to the ADA supported view ( with evidential proof of course ), you frequently make comments to minmize it's importance or relevance .... Or is it just my impression ?--Dr. Imbeau 20:59, 5 April 2006 (UTC)
- The issue is that, per the NPOV policy, we need to spend the same amount of time on both sides. I don't know if you have a law like this where you are, but in the US, during political campaigns, media outlets have to give equal time or coverage to all major candidates in a given race. This is sort of the same situation - in addition to the wording being neutral, the weight of evidence presented on both sides needs to be roughly equal.
- Yes, I did add the NPOV tag to the article. I did not do so as an admin, but as an editor. Any editor can add or remove tags like that at any time, and it really should have been added way back when this whole discussion started.
- Imbeau, the reason I often argue against additions, or argue for toning down language, or look for counter arguments, is because you clearly feel very strongly about this issue. It's difficult to remain neutral about an issue on which you have a strong opinion. As there is no editor currently attending to this article who feels as strongly about using amalgam as you seem to about not using it, if no opposing point of view on the issue were presented, we would probably end up with an extremely one-sided article.
- There are plenty of issues discussed on Wikipedia about which I do have strong opinions. I avoid editing those articles. This is not an article about which I have any strong opinion, other than the opinion that it should be neutral. -- Vary | Talk 21:52, 5 April 2006 (UTC)
- Great! I agree 100% with presenting both sides with equality. Then can you make suggestions as to how best include the relevant historical and present day facts. As mentioned before with regards to the word " unscrupulous " since both sides agrred on it I did not see it as POV on my part or as unfair to either side. Can you also comment on that or make suggestion as to a word that would characterise both views on that specific item ? Please do so, as this will help progress the issue beyond the discussion page, which I assume is what we can all agree on.
I accept your statement that you aim to be neutral. However you did jump to conclusions about my using the word " unscrupulous "....
As for contributing to this article, I have already explained it to Jersyko. I have no problem discussing the facts with proponents of amalgam. I have been transparent in all things with regards to my contribution, however the format of Wikipedia does allow for contribution by individual who do not disclose their true identity or other potentially relevant factors. THis may be the reason why there is vandalism and other less savoury activity requiring constant policing.... Could that be a relevant issue --Dr. Imbeau 22:27, 5 April 2006 (UTC)
- Dear Jersyko: I would also appreciate your view on the above. Thanks--Dr. Imbeau 22:53, 5 April 2006 (UTC)
- In what regard? Are you insinuating that I'm not disclosing my true identity? I'll assume good faith and assume that you only want my opinion on your comment as a whole. Since most of your comment is related to the use of the word "unscrupulous", I'll simply refer to my comment a few paragraphs down from this one. Regarding disclosure of identity on Wikipedia, I agree, the fact that anonymous editors are allowed to edit here does lead to a lot of vandalism (Vary is actually one of the better admins around here in regard to fighting vandalism). By the same token, however, anonymous contributors often make valuable contributions to Wikipedia, and these good contributions certainly outweigh vandalism, which is usually reverted within a few minutes anyway. Regarding an editor not revealing his/her true identity, so long as that editor is not actively misleading anyone regarding his/her identity, I don't have any problem with someone witholding such information. I mean, I understand some editors wanting to avoid the wrath of Daniel Brandt, even if I'm not particularly afraid of revealing such information myself. How is this relevant to this article, though? - Jersyko·talk 23:50, 5 April 2006 (UTC)
- Oh yes one more question for both of you about the above: How do you draw the line between political correctness and true facts ? From my reading of history there does not seem to be any disagreement that the Crawcours brothers were not qualified to practice as dentists and that their behaviour and use of Taveau's amalgam triggered a heated controversy which we are still in the process of trying to resolve today. Should facts agreed by both sides be omitted because it does not look good for one side of the controversy ?--Dr. Imbeau 23:20, 5 April 2006 (UTC)
- If that is the historical record recarding the Crawcours, then we should describe the historical record and allow the reader to draw his/her own conclusion regarding their scruples. The conclusory adjective "unscrupulous" is the problem, not the fact that might well have been exactly that. - Jersyko·talk 23:38, 5 April 2006 (UTC)
- Dear Jersyko: I was not referring to you specifically but to the fact that anonymity in general, while allowing people to express views without fear of being judged, it also allow then to act in a less than responsible manner or to hide other factors which would be relevant in understanding their writing. If anonymity is seen as desirable it can also be an indication that people are not as free to express themselves ( or at least think they are not ). The only relevance to this article is that I know by experience that there are colleagues who will not express themselves publicly on this issue for fear of possible actions by the dental establishement, especially in the USA. Of course I am not saying at this stage that this should be in the article since it is personal experience. As for the Crawcours brothers, as mentioned earlier, I am quite happy for any suggestion for better wording. I do think from what I have read that there is a consensus on them and their role in triggering the dental amalgam controversy from both sides.
As for your own identity I am not requesting that you disclose it, as you have your reasons to use a pseudonym. In all good faith it it however true that you have taken opportunity from the fact that I did disclose my last name, to research my full identity and used that information in the discussion process. Mind you I have no problem in you knowing who I am. As I said I have been fully transparent in my contribution and am I proud of my stance on the issue. May be that is one reason why anonymity is part of Wikipedia ?
Finally thank you for making the effort to understand and for working with me to help improve the neutrality of the article. I do appreciate this approach much more and feel that this provide a more positive environment. Hopefully we can get the article back on track and everyone involved can be satisfied that it is neutral.--Dr. Imbeau 01:03, 6 April 2006 (UTC)
- Just to let you known that I have made some others changes to try improve wording and flow and also put more emphasis on pro-amalgam view. Work in progress.--Dr. Imbeau 23:28, 5 April 2006 (UTC)
- I'm still not sure about addition about the Crawcours. As it is, it doesn't add anything, but it does suggest that there's something that should be added. Does history even tell what their full names were? We should try to be more specific about why the things they did caused controversy. How did they advertise it, for example?
- I think we need more information about these guys than just a brief mention in a time line. The article as it is leaves me very curious about why the Crawcours had such an effect on things, without giving me any way of finding out answers. As it is, it's way to vague, and I don't think it should stay in unless we can find more specific information. Did their methods give the product a bad name? Did they use particularly low quality amalgam? They gave it rather an odd name - did they deliberately omit the word 'mercury' so they could convince people it was made of something else?
- And as to the comments about anonymity, I still don't understand why you feel it's germane to the discussion at hand. Can you perhaps either be more specific, or allow us to consider the matter closed? -- Vary | Talk 01:35, 6 April 2006 (UTC)
- Dear Vary: See below for my reply to your questions on the Crawcours etc... Thanks --Dr. Imbeau 05:00, 6 April 2006 (UTC)
Looking at this section:
- Two recently released comprehensive reviews of papers published in peer-reviewed journals arrived at opposite conclusions. One released in December 2004 in the US, and based on papers published up to 2004, found little evidence to link mercury fillings to health problems [31] while the other, release in March 2005 in Germany, and based on papers published up to 2005, found removal of dental amalgam leads to permanent improvement of various chronic complaints in a relevant number of patients in various trials and that available data suggests that dental amalgam is an unsuitable material for medical, occupational and ecological reasons. [32].
The bit on the second study deals only with both findings and reccommendations, which isn't what's being discussed in this section, and feels like a digression. The paragraph also needs a wrap-up:
- Two recently released comprehensive reviews of papers published in peer-reviewed journals arrived at opposite conclusions. One released in December 2004 in the US found little evidence to link mercury fillings to health problems [33] while the other, release in March 2005 in Germany found removal of dental amalgam leads to permanent improvement of various chronic complaints in a relevant number of patients in various trials. [34] Because of the consistantly conflicting results of such studies, research on the matter is ongoing.
-- Vary | Talk 02:32, 10 April 2006 (UTC)
[edit] Crawcour brothers
- I agree that it would be good to have more information on them. I will do more research and if you can do the same then we should be able to address your concerns. What I know at this stage is that they made claims about the property of Royal Mineral Succedaneum that were seen as excessive by what is described as the better dentists of the time ( Dr. Harris, Dr. Taft for example ). The material was not only considered dangerous but really ugly and substandard compared to the techniques and materials in use at the time. Furthermore the Crawcours did not appear to be qualified dentists. In today's environment it would be impossible for a non-qualified person to practice dentistry as they would be sued under the law but, apparently, things were more lax in 1833. Also within the profession the subject of advertising has always been touchy, In many areas it has been regulated for a long time with strict guidelines about what a licensed dentist can advertise. Clearly the french brothers were considered to have breached the advertising etiquette of the day and were seen as " charlatans " as described in the ADA web site who were only interested in money.
Even today there are colleagues who push the envelope with advertising and they can be seen with less favorable eyes by members of the academia, however from my readings of the Crawcours they really crossed the line in many ways. With today's environment imagine for example if I developed a very cheap radioactive fluid ( let's call it Elexshield ) and claimed with great fanfare ( without any scientific evidence whatsoever ) that this liquid is safe and when I apply this Elexshield on your teeth with my special equipment, I can fix all your cavities and you will never have any cavities in the future. Plus imagine that I am not a trained dentist and that the overt promotion and use of this Elexshield give me a very unfair commercial advantage over my other colleagues... Cheap, fast, painless - a patient's dream come true. What do you think the dental profession would do today ?
Does the above help your understand a bit better their role and why it triggered such a debate ?
As for the topic of anonymity you can consider it closed for the purpose of this article.--Dr. Imbeau 02:02, 6 April 2006 (UTC)
- Have a look at this page [35] under Chapter 5 – Corruption of the Promise. The first name of the Crawcours is not provided but it does explain the various factors that triggered the controversy. It seems the the Crawcours brothers were more ruthless businessmen than qualified dentists, placing a poorly developed materials withput even removing decay in teeth. Of course that was a lot cheaper and easier both for them and their patients and their business thrived. However their activity did hurt the business of established dentists and that was also part of the problem.
Another link about how the Crawcour brothers operated [36]
Another web site written by a german dentist - Approx the 9th paragraph down there is information about the Crawcours [37]
The following site mentions the two types of dentists at the time, " the medical doctors trained to practice both medicine and dentistry, called medical-dentists. Then there were craftsmen-dentists. The craftsmen-dentists were those who were engaged in some other trade such as barbering, wood or metal carvers, blacksmiths....etc. [medical doctors trained to practice both medicine and dentistry, called medical-dentists. Then there were craftsmen-dentists. The craftsmen-dentists were those who were engaged in some other trade such as barbering, wood or metal carvers, blacksmiths....etc. "[38] I think this can be relevant as a factor in the controvery as it seem that the medical-dentists were opposed to amalgam while the craftsmen-dentists favored amalgam because it was cheaper and easier to use thus allowing them to very effectively compete against those not using it.
With improved formulation and gradual adoption of earlier amalgam formulations by many dentists, mainly for financial reasons it seems and not because amalgam was superior to gold, amalgam became widely accepted in the dental profession ( everyone could have a share in the pie, so to speak ). The article also mention the work of Dr. Alfred Stock in 1926 who again raised the issue of mercury vapor and health concerns. He was not a dentist but a chemist and so on....--Dr. Imbeau 02:31, 6 April 2006 (UTC)
- I will look at the Crawcour stuff, but not tonight. I have a new show opening at work, and don't have a huge amount of time to dedicate to this right now. Also, it's 1am where I am. -- Vary | Talk 05:07, 6 April 2006 (UTC)
- Dear Vary. OK. Have a good night sleep and all the best for your new show :-) --Dr. Imbeau 05:09, 6 April 2006 (UTC)
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- I've done some work on the Crawcour section. It's not ready for primetime, but it's a start.
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- Taveau's formula had many practical problems, including a tendency to expand after setting, which lead most dentists to return to using older materials, finding that these issues outweighed amalgam's lower cost and greater malleability. Taveau's formula would eventually be improved upon; however, in 1833 two Frenchmen, the Crawcour brothers, arrived in the United States and began practicing dentistry using Taveau's amalgam under the name "Royal Mineral Succedaneum". The Crawcours were not formally qualified as dentists. The brothers apparently learned of Taveau's methods while in France, and decided to take advantage of the material's cost-effectiveness, and of the fact that it was not yet in use in the United States. They touted the material's lower cost and the speed with which a filling could be placed.
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- Now it needs to be linked to the next section, and lead into the Harris quote, which I've also rearranged a bit:
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- Dr. Chapin Harris, who in 1840 co-founded the Baltimore College of Dental Surgery, the first dental school in the US, said in his opening address: "It is one of the most objectionable articles for filling teeth that can be employed, and yet from the wonderful virtues ascribed to this pernicious compound by those who used it, thousands were induced to try its efficacy". Despite this, many dentists found the new material practical and useful.
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- I really wish I could get my hands on the full text of that New Scientist article. As soon as I read some of the more in-depth info, I recognized the story, and I'm sure I've read something about these guys before. I had a subscription to Smithsonian magazine for ages, so I'll see if I can find something there. I'm inclined to say that the excerpt from the New Scientist would be good for the inline, and the longer work should probably go under 'external links' if it's not there already. From that excerpt, it sounds like the Crawcours' clientele started out with people who couldn't afford regular dentistry, but the dental community began to really take notice when their own patients began seeing the Crawcours instead.
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- I guess the main reasons they 'sparked a controversy' were a) because didn't really know what they were doing, and b) because they introduced the material to the US when it had already been determined that the formula was not quite right. Anyway, I'll get back to this eventually, and I hope to find a copy of the New Scientist in my local library to see if there are any more specifics - I'm particularly interested in what finally happened to them, and when and why the eventually stopped practicing 'dentistry', for lack of a better word - 'The Greatest Lie Ever Told' kind of glosses over the specifics on that point. But I wanted to post what I had so far. -- Vary | Talk 16:02, 6 April 2006 (UTC)
- Dear Vary: I think we are making good progress and should arrive at a wording that reflects the events. My understanding is the the Crawcours were "driven" out of NY and the US, how I do not know. I am not really sure if they were really french because Crawcour is not really a french name and also they actually came from the Crawcour family in London, who was apparently practicing dentistry there. Interestingly I also found another Crawcour brother who emigrated to Australia in 1850 - his father sent him in search of opportunities. As I mentioned before the heated controversy started by the brothers action is definitely because of a) because didn't really know what they were doing, and b) because they introduced the material to the US when it had already been determined that the formula was not quite right but also because c) they made outlandish claims about the material d) They actually had a very nice practice, asthetically speaking, and were very well mannered so attracted a lot of the wealthy clientele from other reputable dentists in NY by offering cheaper, quick and mostly painless dentistry ( they simply inserted their material in the hole of the tooth and left it to the toxic metals to kill the bacteria in the carious lesion ) d) physician-dentists began seeing cases of severe Hg toxicity -I read of a death case which a court of law found was actually caused by amalgam.
It should also be note that Taveau's amalgam was a very flawed material and that there was no indication that it could be improved at the time. Furthermore there is indication that, later between 1840 and 1895, many other dentists began using various formulations that were not necessarily much better. Of course the main incentive was ease and cost since they did not heed the advice of medically trained colleagues who raised concerned about the potential effects of Hg... If they were craftmen-dentists then it is quite unlikely that they had the training required to even understand the issue of Hg toxicity.. It seems that the ease of use and low cost became very attractive for many dental practitioners and they were not willing to wait until the formulation was standardized.... Of course this is not the first situation were commercial imperatives have led to a premature use of materials and products....
I realise that to maintain a neutral approach it is important not to overemphasize the seriousness of the situation however it is also important to depict events as they occurred. As mentioned earlier if a similar situation happened today the Crawcours would be quickly taken to court under mutiple counts - such as fraudulent practice of dentistry, use of a dangerous substance -pollution of the environment, misleading advertising, making health claims without evidence etc.... --Dr. Imbeau 21:16, 6 April 2006 (UTC)
- I have worked on your proposed text above and I have posted the re-worked version below:
" Taveau's formula had many practical problems, including a tendency to significantly expand after setting but offered lower cost and ease of use compared to existing material such as gold. In 1833 two Europeans, the Crawcour brothers, arrived in the United States and began practicing dentistry using Taveau's amalgam under the name "Royal Mineral Succedaneum". The Crawcours were not formally qualified as dentists and had apparently learned of Taveau's methods while in France, so they decided to take advantage of the material's cost-effectiveness, ease of use, and the fact that it was not yet in use in the United States, to open a practice in New York. They claimed with great fanfare that the material allowed them to make a tooth good as new, painlessly and in just two minutes. A feat possible only because they did not actually remove the decayed tissue before filling the tooth. Since they actually had an elegant treatment room and were very well mannered, they quickly attracted a lot of the wealthy clientele from the many reputable dentists who were using gold, and made a fortune from this very profitable business.[39] This very lucrative approach was subsequently adopted by many other dentists who found the material practical and useful.
However other dentists, notably those with medical training, began to oppose the Crawcour brothers and their followers. Dr. Chapin Harris, who in 1840 co-founded the Baltimore College of Dental Surgery, the first dental school in the US, said in his opening address: "It is one of the most objectionable articles for filling teeth that can be employed, and yet from the wonderful virtues ascribed to this pernicious compound by those who used it, thousands were induced to try its efficacy". Despite this, many dentists continued to use the material."
I hope we are getting closer to a consensus. Let me know what you think ?--Dr. Imbeau 03:56, 7 April 2006 (UTC)
- Taveau's formula offered lower cost and greater ease of use compared to existing material such as gold, but had many practical problems, including a tendency to significantly expand after setting. Because of these problems, this formula was abandoned in France. In 1833, however, two Europeans, the Crawcour brothers, brought Taveau's amalgam to the United States under the name "Royal Mineral Succedaneum". They set up an elegant, well appointed office in New York and began aggressively advertising their practice, claiming to be able to completely and painlessly restore a tooth in just two minutes. Despite their lack of any formal qualification and their substandard methods - they were known to leave the bulk of the decayed tooth intact, counting on the liquid amalgam to kill any infection - their practice thrived and they were soon attracting many wealthy clients from the area's best dental practices.
- Their success attracted a great deal of attention. Those dentists with medical training, who treated welthier patients who could afford their services and the more expensive gold fillings that were in use at the time, were [
shocked? dismayed? um something descriptiveoutraged?] to find their patients turning to two untrained [and here is the place for a stronger word, if we think of one, but for a lack of a better term, men] using untested and potentially dangerous materials. There was a second class of dentists at the time, however; the craftsman-dentists. Craftsman-dentists had no medical qualifications, but were usually trained in trades such as carpentry or metalwork, and treated poorer patients, mainly handling extractions. They saw in the Crawcour's material an opportunity for affordable fillings for their patients which required less skill to use than gold, as evidenced by the success of the untrained Crawcours, and so began to adopt amalgam in their own practices.
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- I don't know if 'aggressively advertised' is quite right. Flamboyantly? We've all seen those 'miracle cure' advertisements from this time period. What's a good way to describe that without sounding like we're judging? Now that we're explaining exactly what they did, a term like 'charlatan' is seeming less inappropriate, but I'm still uncomfortable including it. Even if they clearly fit the dictionary definition, it's such a loaded word now that it's unencyclopedic.
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- Yes, I know I've used 'untrained' twice in a few sentances. There are another few things that could be smoother, too, but I think it should all be accurate, based on the handful of sources I've looked at that deal with the matter in any depth. I know this is long, but it's way too complicated an incident to gloss over quickly. -- Vary | Talk 18:51, 7 April 2006 (UTC)
- I think we are getting close. Thanks for your improved version above. I have made some additional changes as below , for your consideration:
/ Taveau's formula offered lower cost and greater ease of use compared to existing material such as gold, but had many practical problems, including a tendency to significantly expand after setting. Because of these problems, this formula was abandoned in France. In 1833, however, two Europeans, the Crawcour brothers, brought Taveau's amalgam to the United States under the name "Royal Mineral Succedaneum". They set up an elegant, well appointed office in New York and began aggressively advertising their practice, claiming to be able to completely and painlessly restore a tooth in just two minutes. Despite their lack of any formal qualification and their substandard methods - they were known to leave the bulk of the decayed tooth intact, counting on the liquid amalgam to kill any infection - their practice thrived and they were soon attracting many wealthy clients from the area's best dental practices. Their success attracted a great deal of attention, both from the medically trained dentists and the craftsmen-dentists, who represented the two types of dentists at the time.
Those dentists with medical training, who treated wealthier patients able to afford the more expensive gold fillings that were in use at the time, were outraged to find their patients turning to two unqualified opportunists using untested and potentially dangerous materials. Dr. Chapin Harris, who in 1840 co-founded the Baltimore College of Dental Surgery, the first dental school in the US, said in his opening address: "It is one of the most objectionable articles for filling teeth that can be employed, and yet from the wonderful virtues ascribed to this pernicious compound by those who used it, thousands were induced to try its efficacy". However many dentists, including the craftsman-dentists who were usually trained in trades such as carpentry or metalwork, and treated poorer patients, mainly handling extractions, saw in the Crawcour's material an opportunity for affordable fillings for their patients which required less skill to use than gold, as evidenced by the financial success of the untrained Crawcours, and so began to adopt amalgam in their own practices. /
Vary, I have removed “ their services “ in the line about medically trained dentists as I think it is not necessary – the rest of the sentence implies it. I have replace “ untrained “ with unqualified opportunists. I think in the circumstances it describes their actions without using charlatans or quacks ( even if the New Scientist article uses it ). I have reworked the text so that the context of the first dental school ( who began the trend for standardized training ) and the speech of Dr. Harris be included. I have also allowed for the possibility that dentists from both types may have adopted amalgam. History shows that the opponents of amalgam at the time eventually lost the battle of numbers which is why, of course, amalgam is in used today. Finally I have added the word financial to success at the end because the Crawcours were a success only financially not professionally.
Please let me know if that latest version is acceptable for inclusion in the article. --Dr. Imbeau 21:27, 7 April 2006 (UTC)
- Pretty darn close. I was wondering where the Harris quote would wind up, and that's a good place for it. I've moved 'first dental school' to before the school's name for flow. First paragraph's fine, except I think we could probably do without the last clause, since they're going to find out all about the two types of dentists in the next paragraph. Here's a slightly altered second paragraph:
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- Most dentists with medical training, who treated wealthier patients able to afford the more expensive gold fillings that were in use at the time, were outraged to find their patients turning to two unqualified opportunists using untested and potentially dangerous materials. Dr. Chapin Harris, who in 1840 co-founded the first dental school in the US, the Baltimore College of Dental Surgery, said in his opening address: "It is one of the most objectionable articles for filling teeth that can be employed, and yet from the wonderful virtues ascribed to this pernicious compound by those who used it, thousands were induced to try its efficacy". However many dentists, including the more affordable craftsman-dentists who were usually trained in trades such as carpentry or metalwork, and mainly handled extractions, reacted differently. They saw in the new amalgam a filling material that even the poor could afford, which required less skill to use than gold, as evidenced by the financial success of the untrained Crawcours, and so began to adopt amalgam in their own practices.
- I added 'most' to the bit about medical dentists because, as you noted, some medical dentists apparently did begin using amalgam. I think 'most' should be safe enough, even without formal statistics. I broke up the last sentence into two because it was seven clauses long, and longer sentences can be hard for some people to follow. Also tried to make it clearer that fillings were not an option at all for the poor at the time, which helps explain why they were particularly willing to put up with problems like the occasional 'surprise, your filling has doubled in size overnight!' -- Vary | Talk 21:54, 8 April 2006 (UTC)
Dear Vary: I agree. I have posted the proposed text below:
Taveau's formula offered lower cost and greater ease of use compared to existing material such as gold, but had many practical problems, including a tendency to significantly expand after setting. Because of these problems, this formula was abandoned in France. In 1833, however, two Europeans, the Crawcour brothers, brought Taveau's amalgam to the United States under the name "Royal Mineral Succedaneum". They set up an elegant, well appointed office in New York and began aggressively advertising their practice, claiming to be able to completely and painlessly restore a tooth in just two minutes. Despite their lack of any formal qualification and their substandard methods - they were known to leave the bulk of the decayed tooth intact, counting on the liquid amalgam to kill any infection - their practice thrived and they were soon attracting many wealthy clients from the area's best dental practices. Their success attracted a great deal of attention.
Most dentists with medical training, who treated wealthier patients able to afford the more expensive gold fillings that were in use at the time, were outraged to find their patients turning to two unqualified opportunists using untested and potentially dangerous materials. Dr. Chapin Harris, who in 1840 co-founded the first dental school in the US, the Baltimore College of Dental Surgery, said in his opening address: "It is one of the most objectionable articles for filling teeth that can be employed, and yet from the wonderful virtues ascribed to this pernicious compound by those who used it, thousands were induced to try its efficacy". However many dentists, including the more affordable craftsman-dentists who were usually trained in trades such as carpentry or metalwork, and mainly handled extractions, reacted differently. They saw in the new amalgam a filling material that even the poor could afford, which required less skill to use than gold, as evidenced by the financial success of the untrained Crawcours, and so began to adopt amalgam in their own practices.
Assuming that the last proposed version is agreeable, I will place it in the article.--Dr. Imbeau 00:38, 9 April 2006 (UTC)
- Please let me now if there is other items which you feel are not presented with equality and neutrality.--Dr. Imbeau 00:46, 9 April 2006 (UTC)
- Not really a neutrality issue, but see the above section. I meant to work that one out earlier, but I got rather sidetracked with the Crawcours. -- Vary | Talk 02:34, 10 April 2006 (UTC)
- Dear Vary. OK. I have made the changes as per your point in the above section. I dropped the last sentenced because the text already is, as of yet, unresolved and the readers can see that reviews do to arrive at opposite results, which is part of the problem getting a consensus on the health issue. While the issue of amalgam being suitable for medical reasons is relevant in a section on health, it does not have to be inserted there. Readers can draw their own conclusions based on the factual information provided in the article.--Dr. Imbeau 03:34, 10 April 2006 (UTC)
- The article now seem to comply with the NPOV rule with the last issue that you have raised being addressed. So I have removed the NPOV warning. I think that the article is now more informative, with facts providing a good idea of what the issues are with the dental amalgam controversy. It will just need to be updated as new events or information become available.--Dr. Imbeau 03:40, 10 April 2006 (UTC)
[edit] Truth will be removed again
The dental amalgam controversy is a controversy surrounding the legal regulations regarding the use of dental amalgams in modern dentistry.
The controversy concerns the propriety of regulations such as banning the disposal of dental amalgam in wastewater while allowing amalgam use for dental fillings containing mercury. Dental amalgam is an alloy of mercury along with other metals like silver, tin, copper, and zinc. [1] Cadmium, indium and lead have also been found in some amalgam products. [2] Amalgams have been used in dentistry for over 150 years because they are malleable, durable, and more affordable than gold or composites.
Proponents state that dental amalgam is regulated, and that the amount of mercury released by amalgam fillings is negligible, thus there is no danger that mercury will leak from fillings into the body.[3] Critics argue that dental amalgam is not regulated, that the capsule for mixing amalgam has been "grandfathered" by the FDA and mercury can and does leak into the body via amalgams, and that long-term exposure to the low levels of mercury vapor causes neurodegenerative diseases, birth defects, and mental disorders. There is no debate that the US Code regulates amalgam alloys, dental mercury, and the dental amalgam capsule separately instead of the actual product dental amalgam, nor on the danger of high concentrations of mercury in any form, and both sides agree that amalgam may cause an allergic reaction in mercury-sensitive individuals. As the use of amalgam is steadily declining in favor of more natural looking and less controversial composite resin materials, the issue may eventually become moot.[4]
- this intro was rewritten to properly spell out the controversies in the article entitled "dental amalgam controversy". It will be removed again by the "editors" soon, as there is no controversy according to the ADA that amalgam may not be flushed down the drain, and yet can be put in your mouth. Also, to the ADA there is no controversy that amalgam is not a product that is classified, only the components; even though using this logic it is safe to sell dynamite at the corner store as long as the components of dynamite and the container for dynamite are individually regulated. In the real world however, dynamite cannot be sold at the corner store, but amalgam can be, and this is because dynamite had been safety tested while amalgam has not been. —This unsigned comment was added by 70.49.246.107 (talk • contribs) .
- Dear User:70.49.246.107|70.49.246.107: The controversy on amalgam is far from being limited to the disposal of amalgam and FDA classification. This said both topic are already addressed in the article and both sides of the issue is fairly represented. There is more to the article than the short introduction and the historical facts are very relevant because they show that the controversy began in the 19th century and has never really been resolved to this day. Finally the purpose of the article is to explain the issue as concisely as possible and not to defend one side of the issue in particular, whether it is the pro-amalgam or pro-ban side.--Dr. Imbeau 03:56, 26 April 2006 (UTC)
[edit] FDA Oversight
The article on the dental amalgam controversy provides incorrect information about FDA oversight of dental amalgams. It states that, because amalgam is classified as a device, there is no FDA control of changes. The FDA regulates drugs (pharmaceuticals) differently from medical devices but the regulations are analogous and the Center for Devices and Radiological Health (CDRH)has extensive and detailed regulations concerning medical devices. Any change to a medical device that has been approved by the FDA has to be reported. Based on the significance of the change, it may require prior approval, may just require simultaneous notification, olr may only require notification as a part of an annual report. All medical devices are subject to "Government testing", which is not normally performed by the government but is conducted by manufacturers and their contractors to meet FDA requirements before the product can be approved for marketing. The testing that is required varies dependiing upon device type, risk to the patient, intended use, etc. Devices that were on the market before 1976 and those found to be substantially equivalent to devices that were grandfathered in 1976 are subject to different testing requirement but are not exempt from oversight.
While iot is true that dental malagam is regulated as a medical device and not a drug, it is definitely still subject to FDA oversight and regulation and is not exempt from notification and approval of changes to it as a marketed product.DentMat 14:29, 11 August 2006 (UTC)
- DentMat. Regrettably the situation is not as simple and straightforward as your comments would lead one to believe.
The FDA Center on Devices is violating several federal statutes:
1-It refuses to classify encapsulated mercury amalgam, thus violating the Food, Drug and Cosmetic Act; To allow sales without classifying, the Center adopts a subterfuge system of deeming amalgam “substantially equivalent” to a non-mercury powder -- thus allowing sales of a device that is 50% mercury that no manufacturer has ever proved to be safe.
2-Ordered to do an independent review of the amalgam literature but determined not to allow the science to emerge, the Center violated the Federal Acquisition Regulation (FAR) statute by handpicking an unqualified meetings planner as strawperson contractor, then directing that a consultant for Big Tobacco actually write the report – for which the Center provided a blueprint in advance!
3-The Center violates the National Environmental Policy Act by repeatedly refusing to do an Environmental Impact Statement on amalgam – America’s 3rd largest source of mercury.
So the quality of the FDA oversight of amalgam is at best questionable. Dr. Imbeau 05:37, 22 August 2006 (UTC)
I was not attempting to justify the way in which amalgam is regulated by the FDA but merely to refute the statement that it is not regulated because it is a device. Devices have been regulated by the FDA since 1976. Also, there is very little "official government testing" of any medical device. The manufacturers conduct the testing in conformance with applicable FDA requirements and then the FDA and an independent panel of experts evaluates the data and determines whether it is sufficient to confirm safety. The amount of testing that has been conducted on devices that were on the market before 1976 is more limited because they have been, in many cases, grandfathered, although the FDA has begun to go back and look at some of the grandfathered device catagories and asking for more testing and submission of data. I don't think that there is any benefit to leaving the impression that the FDA does not regulate amalgam. The discussion of what has been done and how it has been regulated is different than the claim that it is unregulated. DentMat 16:26, 30 August 2006 (UTC)
- DentMat, has it stands the article does not imply or say that amalgam is unregulated in the USA. It clearly says that it is classified as a device by the FDA. But it also correctly says that as a result of this classification, amalgams have not been subject to official government testing in the United States such as is required for medicines. Of course if the FDA was more transparent about this issue it would certainly help. Dr. Imbeau 21:36, 30 August 2006 (UTC)
[edit] Critics
Dear Jersyko. Yes, critics should be named when the reference used is specifically about a group or organism. In this case the reference is about Quackwatch so it should be said that it is this group who is making the criticism. Ar for pointing out the fact that the QW website is being questioned as to it's accuracy and fairness, that is a point that I am opened to discuss. I suggest you do the same prior to reversing edit that are properly referenced. Dr. Imbeau 13:14, 23 September 2006 (UTC)
- I agree that the Quackwatch should be named and linked in the article text (I didn't realize that it was not). But a paragraph criticizing Quackwatch in this article? Seems so excessive as to be POV. Criticism of Quackwatch belongs in the Quackwatch article (there already seems to be a lot of it there). I don't think it is a stretch to say that every website cited in this article is criticized by somone as to its accuracy and fairness. · j e r s y k o talk · 14:43, 23 September 2006 (UTC)
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- Dear Jersyko. QW is not like "any" other website as it is a web site dedicated to wide-ranging, one sided, criticism. It bunches everything under the quackery and/or fraud label. Regarding the amalgam issue, QW has been at the forefront of criticism with a very one sided presentation of the situation based on selected studies and one-sided opinions. I think that the present article is a very much more balanced presentation of the issue adressing both sides of the fences and referenced with peer-reviewed studies giving a better idea of the state of the science. Readers who are given a reference to QW should be aware that this is far from a neutral scientific - peer-reviewed -reference, so that they can determine the quality of such reference. Another option would be to eliminate QW reference and instead use a more reliable source. preferably independant. What do you think ? Dr. Imbeau 19:52, 23 September 2006 (UTC)
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- Sure, I'm not against replacing it with a different source. Bear in mind, though, that I think your objections could apply to most of the sources cited in this article. My position is that, as long as we're careful about attribution of quotes and information in this article (as we apparently weren't regarding the Quackwatch stuff until you added the name, sorry), and so long as NPOV and verifiability are adhered to, we're fine citing to these types of sources (regardless of what position they take on the issue). But, as I said, I'm fine with citing to another source, too. · j e r s y k o talk · 20:00, 23 September 2006 (UTC)
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- Dear Jersyko. Good. Shall we both look for a suitable reference(s) ? My objective has been to find, as much as possible, independant and reliable references such as references to scientific studies or to credible groups to have a high level of verifiability and present both sides of the issue. Each side have their POV on that issue, that is inevitable and must be included in the article in as NPOV as possible, since this is precisely the purpose of the article. As we rely on science and logic to guide us in the controversy instead of emotions, we will have a better understanding of the issue. Regrettably QW cannot be consirered such a source. Dr. Imbeau 23:13, 23 September 2006 (UTC)
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- Dear Jersyko. I had a look at finding a proper reference, preferably from a peer-reviewed study, to support the statement about scientificaly invalid studies. I have not yet been able to source any. Let me know if you find you. I will keep looking for a while. If nothing comes up, I will delete the statement as poorly referenced unless you have an objection. Dr. Imbeau 08:54, 25 September 2006 (UTC)
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- I have deleted the QW related items as no objection was raised.Dr. Imbeau 07:50, 26 September 2006 (UTC)
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- No objection. I did revert the removal of external links per WP:EL, however, as Wikipedia is concerned about the NPOV of article content, not external links. · j e r s y k o talk · 13:25, 26 September 2006 (UTC)
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- Dear Jersyko. WP:EL says:
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"Links normally to be avoided Except where noted, the below do not override the list of what should be linked to; for example, if the subject of an article has an official website, then it should be linked to even if it contains factually inaccurate material.
Any site that contains factually inaccurate material or unverified original research, as detailed in Wikipedia:Reliable sources."
QW sites have been shown in an indepedant review to be " contaminated with incomplete data, obsolete data, technical errors, unsupported opinions, and/or innuendo," . This clearly fits the above definition.
Please explain why in you opinion these links should remain in the article that we are working hard to maintain balanced and accurate with mainy references to peer-reviewed research ? Dr. Imbeau 20:40, 26 September 2006 (UTC)
- The Quackwatch article linked is actually referenced somewhat thoroughly, actually more thoroughly than most of the anti-amalgam links in the external links section. I'm not saying it is true, I'm merely pointing out that it is referenced. If we're going to make value judgments about the "factual accuracy" of the information contained in our external links in this article, we should delete almost all of them, as anti-amalgam partisans would dispute the pro-amalgam links, and pro-amalgam partisans would dispute the anti-amalgam links. But that kind of defeats the purpose of having an article on the controversy, doesn't it? · j e r s y k o talk · 20:59, 26 September 2006 (UTC)
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- Dear Jersyko. The position made by QW is most definitely better made and presented on ADA webpages and I think these references are of better quality then QW. With QW we have an independant review done by a qualified scientist with the conclusion that the information on QW is not reliable. That in itself is verifiable and should be enough to be cautious about listing QW sites. If we have evidence to support the fact that other websites listed are not reliable then by all means they should also be removed. WR policy is clear: If we have verifiable evidence then the policy should be applied. Dr. Imbeau 21:54, 26 September 2006 (UTC)
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- Dear Jersyko - Just to make sure that my point is clear - it is not about value judgement from editors - it is about verifiable, independant information that is available to editors so that they can apply WP policy correctly. Dr. Imbeau 22:00, 26 September 2006 (UTC)
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- Would you agree that each of the websites linked in the article that have a reasonable amount of internet traffic have been, at one time or another, attacked as factually inaccurate? If not, would you agree that every single anti-amalgam site has, if not specifically, generally been questioned by reports stating the safety of amalgam released by the WHO etc.? If so, then I suppose that the only ones we are left with are links that have not been questioned merely because they are not known. One more thing, you state that Quackwatch has been found to be factually inaccurate in a study by a scientist. Yes, but has the specific page linked in this article been questioned in such a report? · j e r s y k o talk · 00:11, 27 September 2006 (UTC)
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- I apologize for entering into this debate without fully understanding the entire context since I do not have the time to read in full depth all about QuackWatch, but I agree to the objections raised by Jersyko, at least those which I have read. In addition, I see another problem. This article is supposed to explain the controversy, and naturally mention or refer to groups on both sides of the debate. Even though the largest and most influential health/research groups conclude that the information on anti-amalgam sites are unreliable, misleading, or just factually wrong, I believe the article would be incomplete without their representation since that is what this article is specifically about. The article should not leave the impression that incorrect facts are true, but wikipedia is not original research either. Conclusions of scientific consensus should be made clear in this article, and differing opinions may warrant mentioning (of course, depending on the particular issue). From what I have seen, the QuackWatch webpage may well reach the level of deserving mention in this article. I will read through the discussion a little more thoroughly tomorrow, in case I have missed any major discussion points. - Dozenist talk 00:45, 27 September 2006 (UTC)
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- Dear Jersyko and welcome back Dozenist. General statements about websites is not of benefit in this situation. The issue is the application of WP:EP in this particular instance when verifiable and reliable information about the reliability of a specific website , QW, is available to WP editors. The ADA website, the FDA website, the IAOMT website ect... do not have their reliability questionned by a scientific review done by a qualified scientist. If information about the reliability of other webiste listed in this article becomes available, then it should be discussed and a decision made accordingly. This is not a matter of opinion but of WP policy. Treu the article is about controversy and both side of the issue should and must be included, that does not require linking to a website that has been openly questioned in a peer-reviewed article. You are welcome to read the review by Dr. Kauffmann. Dr. Imbeau 01:24, 27 September 2006 (UTC)
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- Dear Jersyko and Dozenist. With regards to WHO reports please have a look at WHO report on mercury in health care - downlaod the report and read it. Very informative. There is a reason why there are many countries that are moving to ban amalgam....Dr. Imbeau 01:30, 27 September 2006 (UTC)
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- I apologize for interrupting again since I have still yet to catch up with the entire conversation in full, but the last response concerning the WHO report on mercury in health care reminded me of something else I have been wanting to mention (in case I have not already). The Consensus Statement on Dental Amalgam by the FDI and WHO is an important read as well. The main reason why countries have restricted the use of amalgam is due to environmental concerns, not with health effects of dental amalgams. Nonetheless, and this was the point I wanted to stress, that all this controversy I think will disappear with time and will eventually be a non-issue. I do not think this will happen because of some previously unknown detrimental health effect of the material coming to light and everyone banning the use of amalgam, but instead it will be phased out because esthetics is becoming a greater and greater concern. Perhaps I should use "expectation" rather than "concern." Since it would be difficult to find anyone who would argue amalgam is esthetic, amalgam will eventually be removed from common use, and I believe the "controversy" will no longer be relevant to anyone. That was just a thought I have been meaning to express. - Dozenist talk 02:25, 27 September 2006 (UTC)
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- Dear Dozenist while the above comment is off topic regarding the WP:EL issue. Mentionning a joint FDI -WHO statement is simply confirmation of what I wrote ie dentists are involved: ( Federation Dentaire Internationale ). Mainstream dentistry will defend their position to the end because there is no other politically viable option ( a simple history lesson shows that clearly )- same as with the tobacco industry. I agree that the issue will gradually resolve itself in a way that is politically not too damaging for dental and political authorities - As far as the health effects you have your opinion but I doubt you have any real experience in treating patient who have health problems related to heavy metal toxicity.... NOW can we get back to the topic being discussed ? Dr. Imbeau 03:17, 27 September 2006 (UTC)
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I'm still waiting to hear about whether the particular Quackwatch article linked has been attacked by a reliable source as factually inaccurate. In the meantime, let's go over WP:EL again. Under "Links normally to be avoided", it says the following: "Except where noted, the below do not override the list of what should be linked to."
One of the things listed under "What should be linked to" is:
"On articles with multiple points of view, a link to prominent sites dedicated to each, with a detailed explanation of each link. The number of links dedicated to one point of view should not overwhelm the number dedicated to any other. One should attempt to add comments to these links informing the reader of their point of view. If one point of view dominates informed opinion, that should be represented first."
One can argue that Quackwatch is one of the prominent sites about this subject (especially given its high amount of internet traffic). Certainly this article contains multiple points of view. So even if Quackwatch, generally, falls under "Any site that contains factually inaccurate material or unverified original research" (I'm not saying it does, but you have presented at least some evidence as such), that doesn't mean it should not be linked. · j e r s y k o talk · 12:57, 29 September 2006 (UTC)
[edit] "a mixture rather than an alloy"
From the WP link to alloy "An alloy is a combination, either in solution or compound, of two or more elements, at least one of which is a metal, and where the resulting material has metallic properties." That doesn't appear to support the distinction claimed, and claimed as a piece of the introduction. Midgley 22:23, 23 September 2006 (UTC)
Midgley, I agree with your above comment. The ADA does use the word "alloy" because, in my opinion and based on the content of their press releases, their purpose is to convey a sense of stability , thus safety, to amalgam. Technically their use of the word alloy for amalgam is incorrect in the same way that the use of the word "silver filling" is incorrect since the most important component of amalgam is Hg. Amalgam is more a solid emulsion of metals bound loosely in mercury.
It is interesting however that the scientists selected by the FDA have recently rejected the position of the FDA on amalgam safety. Dr. Imbeau 23:18, 23 September 2006 (UTC)
- Midgley. Here is a more detailed definition of dental amalgam: By definition, an amalgam is a mixture of uncharged metal powders in elemental form that is mixed with liquid mercury to form an emulsion that hardens with time. Amalgams are not an alloy similar to steel or bronze. Furthermore, in the case of dental amalgam, all of the elements that are used to form amalgam have totally filled electron shells and form what is known as metallic bonds. Mercury is a liquid because it makes very weak metallic bonds, even with other metals, and this bonding is reversible allowing bound mercury to become unbound and escape as a vaporous atom, Hg0, at a rate that is significant. As such, there does not exist an irreversible covalent bond between mercury and the other metals that is caused by two elements binding to fill in shells with missing electrons. This means that, unlike most chemically bound molecules, the elements that are mixed in an amalgam do not lose their individual elemental properties on release from the amalgam, unless this release is caused by electro-galvanism. Dr. Imbeau 23:29, 23 September 2006 (UTC)
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- Midgley, here is another simpler definition of amalgam as reported in the WHO paper on Mercury in Health Care: "It is a mixture of mercury and a metal alloy." And please before deleting well referenced items on the article such as the information on thimerosal. please discuss on this page. This has worked well in the past to maintain a good standard in the article.NATTO 00:00, 24 September 2006 (UTC)
- "A mixture of Mercury, and a metal alloy" of course would mean something slightly different from "a mixture of Mercury with particles of a previously made alloy of two or more other metals". I suggest that the article, which has not in my view attained a good standard, yet, should include the manner in which Mercury amalgam is regarded as different from an alloy, otherwise it fails to be encyclopaedic. Presumably the assertion is that the particles of alloy retain a separate structure with no Mercury in their interior, while their surfaces are penetrated by Mercury and adhere to each other. (At which point the enquiring reader might wonder if the surface is a mercury tin etc alloy) Midgley 12:46, 1 October 2006 (UTC)
- Thiomersal (this is the correct spelling, the RINN, is not found in dental amalgam, and the inclusion of the remark about it is neither informative, nor does it reflect the argument about Thiomersal, which turns on the view that although mercury is undesirable, the amount in Thiomersal as included in immunisations, is not significant. The piece of text added, as usual without discussion, by User:Ombudsman is thus misleading rather than being simply irrelevant. It should be removed. Midgley 12:46, 1 October 2006 (UTC)
- Full electron shells and bonding. All metals make metallic bonds...the metallic bond is essentially a sharing of electrons among the atoms of the whole piece...elements don't lose their individual properties on release from any compound, ever, at all, under any circumstances (in chemistry - nuclear physics is different) and metal alloys are not covalent... and covalent bonds are not irreversible even for quite small values of irreversibility. Silver, Gold and Iron have a vapour pressure -my chemistry is too old to remember quite how the melting point of a metal depends on its atomic structure, but HgO is not an atom (vapourous or otherwise) nor would I expect it to be liberated from a filling. I think it is generally accepted that Mercury atoms (Hg) evaporate from amalgam. The arguments go around how much, whether it matters, and how else to avoid toothache. It is one of those little ironies of life that there is such a substnatial overlap between people who get greatly excited about amalgam fillings, and those who object tot he fluoridation of water, which vastly reduces the need for it. Midgley 12:46, 1 October 2006 (UTC)
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- The place for detailed technical information about dental amalgam is in its own article. This article is about the controversy in the use of amalgam rather than a detailed explanation of how dental amalgam is made and what it is made of. For the sake of clarity:
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- A true alloy is a substance composed of two or more metals or of a metal and a nonmetal intimately united usually by being fused together and dissolving in each other when molten. Alloy Of course there are different type of alloys such as solid solution alloys when metals are fully solubles into each other and present an entirely homogeneous structure, what could be called a true alloy, and alloys with intermediate phases when the component metals are not fully soluble into each other, such as eutectic alloys, peritectic alloys, intermetallic compounds etc…
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- At best one could possibly call dental amalgam a special alloy , making a special category for it, as some have done. However there is no melting involved when dental amalgam is made in the dental office by mixing ( triturating) mercury with a powder made of an alloy of metals such as silver, copper, tin and zinc and the structure of dental amalgam is far from homogeneous but contain evident voids that are inherent to it’s microstructure. Dental amalgam is thus a complex multi-phase compound which can be the object of detailed and complex discussions that are not relevant to this article.
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- For the sake of brevity defining dental amalgam as a mixture of mercury and a powdered alloy ( either as filings or spheres ) is factually correct.Dr. Imbeau 07:06, 3 October 2006 (UTC)
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- I think the makers of Duralumin would be somewhat suprised by your claim.Geni 11:00, 3 October 2006 (UTC)
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[edit] Consensus
- Dear Jersyko. I have used consensus in editing the article and have discussed the issue in detail on the talk page. I would like to remind you that I am the one who provided most of the science based references in the article. Since there has been no further response from you or Dozenist, I assumed that the issue was settle and removed the links to QW and it's related body, NCAHF. I would point out that you are the one reverting edit without prior discussion on this talk page ( the lastest reversal being an example ). My point to remove the link:
1- QW has been demonstrated in a scientific review, published in a peer-reviewed journal, to be non-reliable so as per WP-EL it should not be used as an external link. This is not a matter of consensus but of WP policy. 2- The name of the article linked to is potentially libellous and in bad taste. This article does not use name calling and unfounded allegations. 3- The NCAHF is closely associated with QW and is not even registered in the state of Massachusetts, where it is supposed to be headquartered.
External links of quality that meet WP:EL are fine and should be in the article, either way. Dr. Imbeau 04:23, 29 September 2006 (UTC)
- I'm still waiting to hear about whether the particular Quackwatch article linked has been attacked by a reliable source as factually inaccurate. In the meantime, let's go over WP:EL again. Under "Links normally to be avoided", it says the following: "Except where noted, the below do not override the list of what should be linked to."
- One of the things listed under "What should be linked to" is:
- "On articles with multiple points of view, a link to prominent sites dedicated to each, with a detailed explanation of each link. The number of links dedicated to one point of view should not overwhelm the number dedicated to any other. One should attempt to add comments to these links informing the reader of their point of view. If one point of view dominates informed opinion, that should be represented first."
- One can argue that Quackwatch is one of the prominent sites about this subject (especially given its high amount of internet traffic). Certainly this article contains multiple points of view. So even if Quackwatch, generally, falls under "Any site that contains factually inaccurate material or unverified original research" (I'm not saying it does, but you have presented at least some evidence as such), that doesn't mean it should not be linked. · j e r s y k o talk · 13:03, 29 September 2006 (UTC)
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- Dear Jersyko. As mentioned earlier, I suggested you read the review yourself to have your own idea. The review was not about this particular article but included 8 articles on diverses health issues familiar to the reviewer, Joel M. Kaufmann, professor emeritus, Ph.D. USP - Faculty and the reviewer found the same pattern. It can be downloaded at [40]. It should be noted that the reliability of information on QW has been raised by many others.
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I know that any progress I have made in this article, since I have begun editing it, has been made only after I have been able to provide clear, independent and usually scientific proof of what I was saying. You may not wish to believe me when I say that the information contained in the QW article listed in the external link, is in the same pattern as the articles reviewed by Dr. Kauffmann, but it is, and it is a subject that I am qualified to assess. QW maybe a prominent site ( and I am not saying that it is ) but that does not make it a reliable site. So what is more important in WP ? More reliable sites such as the ADA website offer information in a more neutral way, without attacking groups or individuals, as the QW article is doing ( as QW does for many of the topic it addresses ). As pointed out earlier with a title " How anti-amalgamists swindle people " one can easily see that it is the opening for a hatchet job not an objective review. You should know by now that there is valid science to justify serious concerns over amalgam, even the FDA review panel appointed by the FDA has disagreed with the FDA position on amalgam safety.
My point is that the any good information that could be on the QW article is available elsewhere and the article can do without the erroneous, biased information that it contains, including the slander. There are plenty a good sources to link to with regards to the amalgam issue, either way. Dr. Imbeau 16:25, 29 September 2006 (UTC)
By the way my dear Jersyko, I see that you have not restored the " quicksilber " link that had been removed by the editor Fyslee. Is it an omission of is it because it is not pro-amalgam ? Dr. Imbeau 04:25, 29 September 2006 (UTC)
- I had no idea it was missing. I won't remove it if you replace it, but isn't there a better website that we could use in its place? · j e r s y k o talk · 13:00, 29 September 2006 (UTC)
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- Is it because you are checking my own edits in particular for some reason ? In any case, it was deleted by the editor Fyslee earlier. I personnally agree that this particular link is not a good one either for other reasons but I re-instated it as part od returning everything as it was after your comment on consensus. The editor Fyslee deleted it again. Dr. Imbeau 16:25, 29 September 2006 (UTC)
- It was deleted while I was asleep. I didn't see that it had been removed until after I made the comment here, as I saw the changes to this talk page before I saw the changes to the article. · j e r s y k o talk · 16:42, 29 September 2006 (UTC)
- Is it because you are checking my own edits in particular for some reason ? In any case, it was deleted by the editor Fyslee earlier. I personnally agree that this particular link is not a good one either for other reasons but I re-instated it as part od returning everything as it was after your comment on consensus. The editor Fyslee deleted it again. Dr. Imbeau 16:25, 29 September 2006 (UTC)
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- Fair enough. I have replied to your comments on the suitability of QW and also posted a comment on your talk page. Looking forward to your reply. Hope you had a good sleep. Dr. Imbeau 16:56, 29 September 2006 (UTC)
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- Dear Jersyko. Shall I expect a reply ??Dr. Imbeau 05:36, 30 September 2006 (UTC)
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In the interest of compromise, how about this? · j e r s y k o talk · 14:33, 30 September 2006 (UTC)
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- Dear Jersyko. That is acceptable. It is an improvement. There is still the issue of the NCAHF, which is basically an extension of QW but at least the name of the article is neutral. Dr. Imbeau 21:14, 30 September 2006 (UTC)
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- Quackwatch is imperfect, however it is a good source and reference particularly on this subject. COntiguity of opinion among small numbers of editors does not constitute a restriction on others, nor on the general policies of WP. This article is tending toward the support of profitable quackery which is a pity since there is good scope for a useful encyclopaedia article. More and more I suspect that any article pruproting to be about a controversy about a thing, rather than about the thing itself, is likely to be bad. Midgley 12:12, 3 October 2006 (UTC)
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- I agree with Midgley, generally, that my compromise edit has no effect on other Wikipedians, as it was supported merely by compromise between two editors, not consensus. Obviously, I stand by my previous comments on the application of policy and guidelines to the links (i.e., I haven't changed my mind about the propriety of having the Quackwatch link, I merely thought one external link wasn't worth discussing anymore so I tried a compromise, but obviously other editors disagree). I disagree with Midgley, however, that this article is trending toward "support of profitable quackery" simply because one external link was removed. · j e r s y k o talk · 13:50, 3 October 2006 (UTC)
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- Dear Jersyko and Midgley. Of course other editors can have a different point of view, that is what the talk page is all about. The removal of the link was made after a proper discussion between the editors that were involved at the time. Jersyko asked for consensus and, following discussion, proposed a compromised that was accepted. All in good order. The reasons put forward to remove the QW link were 1) It does not meet WP:EL policy for reliability based on available evidence ( see quackwatch ) - this is not a matter of POV by editors, but of WP policy 2) The title of the article is highly POV and not in keeping with the overall tone of respect for both sides of the issue in the controversy.
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- Apparently the issue of reliability of information on QW is a sensitive topic amongst some editors and I am sure there are strong point of views on the issue.
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- As for the other comment by Midgley, I fully agree with Jersyko who along with Vary and Dozenist have been positively contributing to this article which, after all, is about the controvery on the use of amalgam and is well referenced. Dr. Imbeau 19:50, 3 October 2006 (UTC)
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- The whole issue of QW and WP:EL is an attempt to suppress opposing POV by painting QW as unreliable, based on Kauffman's so-called "review". He's out of his field, just like Linus Pauling, who also went out of his field and made a fool of himself and ruined his professional reputation. There are differing viewpoints on these matters, and not absolute agreement, and as such both POV should be included, as per Wiki policies. QW articles on the specific topics can often be used in the external links. -- Fyslee 20:18, 3 October 2006 (UTC)
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- Dear Fyslee. Of course if there is a published review demonstrating that the information on QW is accurate, balanced and reliable then it would help. Having factual information on both sides of the issue would make it easier to discuss it. :-) Dr. Imbeau 20:50, 3 October 2006 (UTC)
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- I have to say that this article steps well over the line between information and advocacy (as well as being obsessively US-centric). Compare and contrast the treatment of ASDS, bastions of professionalism and high standards, and ADA, the barber surgeons with their cowboy attitude. You would hardly think from the description that ASDS withered on the vine and no longer exists. NPOV does not mean a compromise between orthodox opinion and the word of advocates, NPOV means reflecting orthodox opinion and describing dissent. Where orthodox opinion changes, as it is slowly doing in the case of amalgam, we should reflect that, too. Also, agreement of a few editors active on a given article is not "consensus". Consensus in terms of content comes from a much wider review - at the very least an article RfC.
- For many years amalgam filling was an effective, widely used treatment. Where is the credible evidence of signifcant health effects in reputable peer-reviewed journals? Sure, it is widely seen as desirable to use more modern alternatives. It's also seen as desirable to use more modern alternatives to steam power, but that doesn't undermine the fact that steam power was, in its day, acceptable. Attitudes to risk change over time, and these days we have controlled large risks (smog, epidemic disease) to the extent that we obsess over small and often negligible risks. How many of the people worrying about dental amalgam are obese, I wonder? Generations of people have grown up with amalgam fillings and no long-term study demonstrates that this as caused measurable harm. Would it be better to use something else? Of course. Does this justify the hysteria devoted to it by certain activists? Hell no. Read the much more measured tone of the last couple of paragraphs. I am minded to do some serious work on this article to fix these issues. Guy 17:30, 3 October 2006 (UTC)
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- Guy, always ready to judge issues. You certainly seem to be an expert in everything... I guess, now that we have "controlled" large risks as you state, we can obsess over trivial things like global warming, chronic diseases, cancers... all of course totally unrelated to pollution.... Maybe England is on another planet ???NATTO 08:52, 4 October 2006 (UTC)
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- As per WP:NPOV : all Wikipedia articles must be written from a neutral point of view (NPOV), representing significant views fairly and without bias. The policy requires that, where there are or have been conflicting views, these should be presented fairly. None of the views should be given undue weight or asserted as being the truth, and all significant published points of view are to be presented, not just the most popular one. Readers are left to form their own opinions.
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- The topic of the article is specifically about the controvery on the issue not about the safety of amalgam per see. It clearly shows the views of the ADA and a majority of dentists but also gives other points of views. The fact that amalgam has been used for over 150 years in itself is a secondary point, after all people have been smoking for a lot longer and it took decades for science to clearly show the dangers, still, in spite of that, many people still choose to smoke, so length of use is not proof of safety. As far as being US centric, the article does mention regulatory activities elsewhere and more information can be added. Dr. Imbeau 21:17, 3 October 2006 (UTC)
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- Yes, articles must be written from a neutral point of view. This one is not. It is a pretty blatant POV fork of dental filling. Guy 21:40, 3 October 2006 (UTC)
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[edit] Mercury fillings enter the age of `unreasonable'
Dear Jersyko and Dozenist:
Below the text of an article recently published in the Chicago Tribune, for your information:
Mercury fillings enter the age of `unreasonable' by Julie Deardorff
"Published September 24, 2006
Considering that millions of Americans have "silver" mercury fillings embedded in their teeth, a recent government hearing on their safety should have been a slam-dunk.
Instead, the advisory panel concluded that a Food and Drug Administration report suggesting that amalgam fillings are safe was "unreasonable" and that further study was needed.
Technically, "unreasonable" doesn't mean unsafe. The American Dental Association still steadfastly maintains that amalgams should be an option for decaying teeth.
But the panel found the safety report was murky and misleading in some areas, which raises some serious questions, such as, "Why do we put a known neurotoxin in teeth?"
It's the same question some were asking nearly 200 years ago, when, in 1843, the American Society of Dental Surgeons, concerned about mercury poisoning, required its members to promise not to use amalgam. In 1859, the rival ADA was formed by dentists who believed amalgam was "safe and effective."
Today, we're left wondering if that's really the case. The FDA panel found a startling lack of research on the safety of fillings, especially when it comes to risk of mercury-filling exposure to pregnant women and children, immune-compromised individuals or other "hypersensitive" populations. Dental amalgam contains about 50 percent elemental mercury, in addition to metals such as copper, tin and zinc. Studies have shown that with time, mercury vapors leach out of the fillings. Some critics contend that they are absorbed into the bloodstream. When not encapsulated, the material itself is considered a hazardous waste.
But most dental experts say that when it's bound to other metals, it doesn't pose a risk.
The bright spot in this 200-year-old controversy is that the use of "silver" fillings has dropped nearly 40 percent since 1979, thanks in part to better oral care that decreased the overall frequency and size of cavities. Better diagnostics allow dentists to find cavities earlier, when they are much smaller and easier to restore with alternative materials."
For those who can see... Dr. Imbeau 05:41, 30 September 2006 (UTC)
- If amalgam fillings are so unsafe, the problems caused by them should have been incredibly obvious long ago: it's not as though this is a procedure that only began to be used recently, as you say, it's been in use for nearly _TWO HUNDRED YEARS_. I don't think anyone would claim that putting mercury in teeth will ever be 100% safe, only that the safety risks are small in the vast majority of cases and hardly worth worrying about. You're almost certainly more likely to die crossing the road than die from mercury poisoning from a filling in your mouth. Mark Grant 23:57, 1 October 2006 (UTC)
[edit] Odd phrase
"dentists with medical training". In the UK dentists would talk about dental training, since they regard themselves as being a profession. Licenced or registered might be better descriptions of the category of dentist referred to, if there were liences, registration or indeed training other than apprenticeship at htat time. Midgley 13:57, 1 October 2006 (UTC)
[edit] much of this page is a fork
The material on the composition of dental fillings belongs in the article on dental fillings which contains a section on dental amalgams whcih adequately covers their composition.
The only relevant material here on that is that they contain mercury.
The reference to other mercury contining compounds is at best superfluous, and so far as thiomersal goes is a marker for weirdness. Better to remove it.
This page does not at present present a controversy, if one actually exists, it is over the relative hazards and efficacy of old and new filling materials. Midgley 21:16, 3 October 2006 (UTC)
- I absolutely agree. The history section was grossly biased, and I pruned it a bit, but the entire article is, to my mind, if not one then a series of POV forks stitched together. It shouts "soapbox" almost by its very existence. Look at Dr. Imbeau's edits yesterday and today, saying that ADA was founded "by 26 dentists", copied from American Dental Association, but missing out the second half of the sentence which says: "by 26 dentists representing various dental societies in the United States, and noting that today it has over 150,000 members. Is that barrow getting heavy, Doc? Guy 20:20, 4 October 2006 (UTC)
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- In the same sentence there is a wiki link to the ADA article for WP readers to consult and get all the details. A lot more could be added to the article and make it substantially longer. It is clear that you have a strong point of view on the issue, please note however that the article was written in collaboration with other editors, including Vary [41] and Jersyko, after extensive discussions on this talk page, as per WP policy. There is always room to improve an article as it was a lot worse initially. Your own editing shows also a tendency to edit according to your POV so is your way of negatively commenting on edits of others. Putting qualifiers like "some: when no evidence is provided is an example. Finally there is a clear trend, for anyone who is up to date with the science, and that trend is that there is growing evidence regarding the adverse impact of dental amalgam, whether on the environment or human health. Dr. Imbeau 22:52, 4 October 2006 (UTC)
[edit] Historical events linked with the amalgam controversy
There are proven historical events who have an impact on the issue of the dental amalgam controversy. I have provided a number or reliable references to that effect. Interestingly Dr. Chapin Harris who was trained in medicine initially, developed an interest in the dental field and became one of the founding member of the dental profession in the USA. In fact he was a co-founder of the first dental college, the first dental association ( ASDS ) and the first dental journal. Quite a feat. He was against the use of amalgam and whether we like it or not, the dental profession was divided in two groups, those with scientific training and others ( as per peer-reviewed reference ). When the ASDS closed he founded another association called the American Dental Convention and was elected its first president in 1856 ( this is well explained in his biography as per reference included in the article ). He died in 1860. I do not know yet what happened with the American Dental Convention but it seems that is also disappeared either before or after his death. Dr. Imbeau 03:53, 5 October 2006 (UTC)
- The history doesn't relate the state of regional associations at the time of ASDS formation. In England around this time the provincial medical associations were beginning to join together, indeed several of them amalgamated to become the BMA. I suspect that social changes related to transport and other communications were involved and that this may have applied in the US as well. The history section seems interesting of itself, and deserving of a place in WP, but in its present form this is not that place. Discussion of the extent to which the ASSDS was formed to oppose amalgam use, at that time presumably accepted by the various regional societies, would be interesting, and relevant here, and also th eextent to which formation of the current association was delayed by a single-issue predecessor and had to wait until that orgnaisation withered and died would be relevant - although less so to this article. Isn't there an article on dental associations in the USA somewhere in WP? If so then this material would look like a fork of it. Midgley 17:53, 8 October 2006 (UTC)
Historical allegiances to particular associations (then in their infancy) have no relation to current associations, nor do they have any bearing on the clinical decision to use amalgam. To suggest otherwise is grossly derogatory to dental professionals as it insinuates that dentists are incapable of making clinical decisions autonomously. This brings the profession into disrepute! I would also like to point out that there are many dentists in the world who are not members of the ADA, or any professional organisation for that matter, nor need they be. Dentists are trained (at least I and my colleagues in Ireland were and are) to ingest, analyze and disseminate scientific information without the help of what you imply to be the 'Big Brother' of the healthcare world. Laughable. Dr-G - Illigetimi nil carborundum est. 23:21, 26 October 2006 (UTC)
[edit] Line one was wrong
I've changed amalgam to mercury. Midgley 21:40, 9 October 2006 (UTC)
- (So it is probably more logical to call the page "The dental mercury controversy".) Midgley 21:41, 9 October 2006 (UTC)
- In a way it is about the use of mercury but since the main (and very common) use of mercury in dentistry is as an amalgam. it is the use of that specific material that has been the focus of the controversy that began in the first half the the 19th century. Of course if dentists used many other products containing mercury, I guess they would also be controverial. So the title as it is is quite descriptive of the real situation. Another word that has been used in the past by various writers is the " Amalgam Wars ", The first occurred at the time of the ASDS , the second before the second World War centered around the work of Alfred Stock ( if I remember the name correctly ) and, of course, the third is ongoing. But Amalgam Wars may not be considered a neutral term :-) Dr. Imbeau 23:59, 9 October 2006 (UTC)
[edit] Limits of analysis?
Would it be correct to say that until 1970 analyses were not sensitive enough to detect the Mercury being emitted, or is it that nobody looked until then? Midgley 20:58, 23 October 2006 (UTC)
Neither. In fact as early as 1882 Dr. Eugene S. Talbot, as explained here, demonstrated that mercury escaped from amalgam, Dr. Alfred Stock also researched the issue before the second world war. The war resulted in the destruction of his lab and most of his research. Dr. Imbeau 23:49, 23 October 2006 (UTC)
- Is that "dog ate homework" or was it generally accepted and respectably published? Midgley 15:38, 28 October 2006 (UTC)
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- Talbot E.S., "The chemistry and physiological action of mercury as used in amalgam fillings", The Ohio State J. Dent. Sci., 2(1):1-12, 1882. Published in the Ohio State Journal of Dental Science. a respectable dental journal of the time. The Ohio State Journal of Dental Science made its appearance in February 1881, and continued until 1902, when it was re-christened the Dental Summary. It was discontinued December, 1925. For many years it was the official organ of the Ohio State Dental Society, and in that capacity--like its contemporaries--disseminated valuable information to the profession in the Middle West and preserved to posterity much information of historical value. [42]Dr. Imbeau 07:57, 29 October 2006 (UTC)
[edit] Request for citation
Just a request for a citation for the line: "there is increasing agreement that over time amalgam should probably be phased out." I don't think you will be able to provide one that is NPOV. If someone can't, I'm removing the line. This statement is simply non-neutral. Dr-G - Illigetimi nil carborundum est. 23:24, 26 October 2006 (UTC)
- I agree it should be better worded so take into account the various situations around the world. In some countries like Sweden, they are already in the process of completing a ban on amalgam, in other countries like Canada they have recommended avoidance in certain population groups like pregnant women, children, people with renal problems ect.., still in other countries like the USA they are still yet debating the need for restrictions although the FDA position on amalgam safety has recently been deemed unreasonable by a panel of scientists hand picked by the FDA, and in other countries it is still business as usual. What wording would you suggest ? Dr. Imbeau 23:39, 27 October 2006 (UTC)
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- There is no wording that is acceptable. A statement informing the reader of various countries positions on this issue is all that is needed, which is already covered in the article. There is no wording of this statement that wouldn't be a particular non-neutral point of view, and this statement is designed to sway the reader.
[edit] Environmental impact
This is not made out to be a point of contention, despite appearing under that main heading. I don't think it is, actually. Nor do I think it adds to the article. Mercury is toxic and should be controlled as well as we reasonmably can, the controversy is not between people who say that no atom of Hg should be in the biosphere and people who want to bathe in it. Midgley 15:36, 28 October 2006 (UTC)
