Talk:Galvanic shock

Proposed merge with Galvanic pain

describes same entity Matthew Ferguson (talk) 22:03, 26 October 2015 (UTC)

Pseudoscientific diagnosis?

CFCF where was the consensus to change the infobox of this article to alt med? It is a recognized phenomenon in fairly reliable sources. Conversely where are the reliable sources identifying it as pseudo scientific? Matthew Ferguson (talk) 13:03, 9 February 2017 (UTC)

Also, where is the reliable source stating that the concept of "nocebo" is related to this topic? Matthew Ferguson (talk) 19:33, 10 February 2017 (UTC)

There was a very large report from 2003 which entirely invalidated everything about the disorder, see http://www.regeringen.se/rattsdokument/statens-offentliga-utredningar/2003/05/sou-200353/

Unfortunately the source is only available in Swedish, but I am able to translate any passages you need. Carl Fredrik ^talk 10:05, 26 June 2017 (UTC)

P.S. Found this as well: http://www.dentalwatch.org/hg/myths204.html Carl Fredrik ^talk 10:08, 26 June 2017 (UTC)

CFCF, suggest best way to move forward with this article is to first compile a list of acceptable sources and then go from there. Thank you for posting Dental watch, I was not previously aware of this site and there's a huge amount of reading I want to do now, but for the purposes of WP this is not necessarily a reliable source compared to textbook and papers etc. If the large Swedish report is one of the more important reliable sources for this topic (I vaguely remember searching for literature on this topic in the past, there is a paucity of reliable sources) it may be beneficial to get someone to translate it.

My impression of this topic is that there is a real, albeit rare, underlying process here, when dissimilar metals come into contact in the presence of a conducting medium there will be an electrical current, which in some instances is perceived as pain. This is self limiting as corrosion occurs. For what it's worth (i.e. not a reliable source), I have come across this a few times. Then there is the wider alternative medicine / dentistry view that this process causes other and more chronic symptoms. We need to clearly describe this situation, and I do not think placing alt med banners over the whole article is accurate given it is more complex than that. Regards, Matthew Ferguson (talk) 15:22, 27 June 2017 (UTC)

Quackwatch, which is the parent organization of Dentalwatch is generally considered to be a reliable source and has several times been accepted at WP:RS/N and WT:MED for statements that fall under WP:MEDRS and is used on many medical articles.

The largest report/study I am aware of is the Swedish one, following a large following of people who believed they had the disease in the 90's.

Few other reports exist because the same hysteria never arose outside Sweden (in part because of the existence of the Swedish report).

I'm not aware of any newer decent material, and since falling into obscurity reviews are hard to come by. With that in mind, what do you suggest? Carl Fredrik ^talk 15:34, 27 June 2017 (UTC)

User:CFCF, can you take another look at this article? Right now, the article seems to say that it's undisputed that certain combinations of metals can cause oral discomfort, and that some people claim this leads to headaches, and that "many scientific studies dispute" that pain causes headaches. I very seriously doubt that tension headaches – a perfectly predictable outcome of oral discomfort – are just a myth, so perhaps a re-write is in order?

In fact, as written now, one sentence says that it's undisputed that these combinations of metals could cause "some discomfort", the next says that "oral discomfort" is claimed, and the following sentence says that scientists – probably the same ones who say that pain is whatever the patient says it is – say that this undisputed-and-claimed discomfort is disputed. This is self-contradictory.

Also, the Dentalwatch page doesn't say that oral galvanism doesn't exist; it says that the symptoms aren't caused by systemic mercury poisoning.

I think we may have two things improperly merged together here. One thing is the rational belief that the mouth isn't a physics-free zone, so if you already have a gold filling, then avoid getting a silver or zinc one nearby, and the other is that some people worried about mercury amalgam fillings during the 70s and 80s.

Here's a couple of sources to consider:

• O'Brien, William J., ed. (2002). Dental materials and their selection (3rd ed ed.). Chicago: Quintessence International Publishing Group. pp. 184–186. ISBN 0867154063. OCLC 49322454. A well-known and frequently recognized phenomenon in the early life of an amalgam restoration is the "galvanic pain" due to galvanic action of amalgam restorations in combination with other metallic restorations in interproximal or occlusal contact (Fig. 12-13). Clinical studies have found that this type of pain occurred only in a small percentage of cases and was generally not serious; it usually occurred in the first hours and in no instance did it last longer than a few weeks after the insertion of the material. It is also possible that the galvanic currents produced could have a harmful effect on the soft tissues or on the organism as a whole; however, the frequency of the occurrence of these effects is supposed to be low or absent... {{cite book}}: |edition= has extra text (help)
• Preti, Giulio (2008). Prosthetic Rehabilitation. Quintessence Publishing. p. 92. ISBN 9781850971665. The most relevant clinical consequence of electrolytic corrosion is galvanic pain: Intermittent contacts between metallic restorations of different materials allow the creation of an electrical circuit that causes painful stimulation of the nerve endings in the dental pulp.
• Davis, Joseph R. (2003-01-01). Handbook of Materials for Medical Devices. ASM International. p. 224. ISBN 9780871707901. Galvanic pain results from contacting dissimilar allog restorations either continuously or intermittently (Ref 9, 12).... No harmful ions or corrosion products can be generated such that toxicological conditions result.... Dental-alloy oral-environment interactions have the potential for generating such conditions as metallic taste, discoloration of teeth, galvanic pain, oral lesions, cariogenesis, allergic hypersensitive dermatitis and stomatitis, endodontic failures, dental implant rejection...
• Eliades, George (2003). Dental Materials in Vivo: Aging and Related Phenomena. Quintessence Publishing Company. p. 74. ISBN 9780867153996. Despite the attention given to "oral galvanism" in the literature, a practical long-term effect on dental amalgam restorations is usually negligible because the rate of the galvanic interaction sharply decreases with electrical resistance in the current path between the dissimilar metals.
• Schmalz, Gottfried; Bindslev, Dorthe Arenholt (2008-10-10). Biocompatibility of Dental Materials. Springer Science & Business Media. ISBN 9783540777823. Voltages between different alloys in the oral cavity without permanent contact (oral galvanism) have been cited as the cause of subjective complaints in some patients. In Chap. 2, the relevance of voltage readings is critically reviewed based on the scientific literature. A permanent contact between different alloys, however, can cause symptoms in rare cases, such as metallic taste due to increased corrosion.

All of these dental textbooks indicate that this problem is real, usually self-limiting, accepted by mainstream medical authorities, and not even remotely related to mercury poisoning. I don't think this is actually an "altmed" thing. By contrast, this book reports a Scandinavia-specific, time-limited instance of epidemic hysteria in which people claimed to have these symptoms and used this name. The fact that a round of epidemic hysteria latched onto this problem doesn't mean that the real version doesn't exist.

I think there are two reasonable paths forward:

1. we re-write the article to say that it's real, usually temporary, and caused by physics, and add a section ==Society and culture== section at the end to talk about the Scandinavian epidemic hysteria from the 1970s and 1980s, or
2. we split the article and end up with one article about the Scandinavian worries and a separate article about why your dentist is unlikely to recommend putting different metal fillings in adjacent teeth.

What do you all think is best? WhatamIdoing (talk) 22:24, 5 July 2018 (UTC)

This is a prime example of when textbooks lagg scientific consensus. There is no such phenomenon as galvanic pain caused by currents between fillings of different alloys. I have restored the sourced text, and suggest we stick to reporting the only high-quality scientific review of the phenomenon, which totally discredits that it exists. Dentalwatch not only discredits that it has anything to do with mercury, but that it is a somatic disorder entirely. (I had unfollowed the article and it had been changed, followed again). Carl Fredrik ^talk 15:38, 9 July 2018 (UTC)

Upon rereading and cleaning up the article it becomes more clear that what is in dispute is not that currents exist, but that they matter whatsoever. There is evidence they are completely negligible with regards to ... anything. I hope the article conveys this now WhatamIdoing. Carl Fredrik ^talk 16:46, 9 July 2018 (UTC)

It does cause symptoms, albeit rarely, but I would highly doubt anything more than mild paroxysmal type discomfort. Perhaps hard to quantify in research because new metal fillings quickly tarnish in the mouth and break the "circuit". Abosultely ask many patients with recent metal fillings to bite on tinfoil and some will experience something like galvanic pain. However admittedly that is different since it is not 2 different metal alloy restorations contacting. Also hard to untangle galvanic type symptoms from regular pulpitic symptoms caused by recent caries excavation, loss of insulation around the pulp chamber/ failure to provide sufficient base/lining material in a deep filling, and flexure of unsupported cusps (amalgam is not adhesive but dovetailed into the tooth). Perhaps these everyday causes of symptoms following recent filling are incorectly attributed to oral galvanism?

With regards the current state of the article, would also advise to remove the "Pseudomedical diagnosis" and "Risks: Nocebo" infobox since the article is titled "oral galvanism" not "galvanic pain". Also CFCF never provided a reliable source for the claim that nocebo was related to this topic. Matthew Ferguson (talk) 21:03, 9 July 2018 (UTC)

The review concludes that galvanic currents do not cause symptoms. It concludes that the association of what may very well be everyday symptoms to belief in galvanic pain is associated with psychiatric illness. Nocebo is a general risk when it comes to somatization disorders that rely on false medical beliefs, of which this is. Carl Fredrik ^talk 21:21, 9 July 2018 (UTC)

This is the swedish review? Is it dealing with patients experiencing chronic symptoms which they are attributing to galvanism? Or is it dealing with the short term state which the text books are referring? I feel given the number of textbooks discussing the topic, it is not representing the available sources to over-rely on this one source. Even if we conclude that it does not cause on occasiona, self-limiting symptoms, it does not seem that "the profession" or mainstream thought has let this go. The encyclopedia article should not seek to correct this state of affairs or take sides. How about a more balanced coverage of the topic. Matthew Ferguson (talk) 21:41, 9 July 2018 (UTC)

I feel you are being inaccurate in stating that there is scientific consenus on this topic when there are a number of contradictory sources. This would not appear to be so. Matthew Ferguson (talk) 21:43, 9 July 2018 (UTC)

Both are taken into account. I can translate relevant passages if you enquire on what you want.

As for your second suggestion; the following from MEDRS is relevant:

High-quality textbooks can be a good source to start an article, and often include general overviews of a field or subject. However, books generally move slower than journal sources, and are often several years behind the current state of evidence. This makes using up-to-date books even more important.

These books are all from the early or mid 00's, to me that does no qualify as up-to-date, considering the review came in '03. Carl Fredrik ^talk 22:14, 9 July 2018 (UTC)

Carl, since my grasp of Swedish is distinctly limited at best, can you tell me exactly what you mean by "somatic symptoms"? I specifically want to know if "somatic symptoms" includes only having a metallic taste in your mouth while your fillings are corroding. Imagine that you have a person who says "Dr Dentist, you put in this gold filling a little while ago, and I had a slightly weird taste in my mouth for a week or two after that", and Dr Dentist says, "Look at that! The filling is visibly corroding. I'll bet that having metal amalgam corroding in your mouth caused that weird taste". Does the Swedish review say that just never happens – that nobody with corroding fillings ever has a weird taste in his mouth? Or are they debunking any connection between symptoms like, "I'm just tired all the time, and my brain is fuzzy, my knees hurt, I'm constipated, and I feel bad overall"? WhatamIdoing (talk) 00:38, 10 July 2018 (UTC)

Somatic symptoms are those that are not psychiatric in nature. I can respond in depth later in the day. Carl Fredrik ^talk 06:28, 10 July 2018 (UTC)

Iowasmiles, you seem to misstate me in saying that there is any association between currents and symptoms. Currents exist in all biological systems, including the mouth — their presence is not the definition of oral galvanism. The association of currents to symptoms is the definition. There is unequivocally no connection as per the sources we cite. If you truly suggest there is a connection you will need to get newer MEDRS compliant sources. Carl Fredrik ^talk 22:25, 9 July 2018 (UTC)

Perhaps we need to talk about what, exactly is "the definition of oral galvanism". Maybe you are talking about something different from what the rest of us are talking about. WhatamIdoing (talk) 00:45, 10 July 2018 (UTC)

For an additional source see "The Environment and Mental Health: A Guide for Clinicians", page 119. (For whatever reason Google told me that was from 2013, but it is from 1998.)
From what I can read, the topic was so thoroughly killed through the 2003 report that it has been withdrawn from modern textbooks without so much as a refutation. Early editions of "Dental Care and Oral Health Sourcebook — Basic Consumer Health Information" picked up the topic and discredited it, but the 4th edition doesn't even cover it. Carl Fredrik ^talk 23:06, 9 July 2018 (UTC)

I cited two advanced reference books above that were published in 2008, which is plenty of time for a 2003 review to have been considered. Also, they're both books about materials science, so whether or not galvanic currents produce corrosion in these materials is something they should be considered highly relevant experts for.

See also

• Nallaswamy, Deepak (2017-09-30). Textbook of Prosthodontics. JP Medical Ltd. p. 32–33. ISBN 9789351524441. Symptoms of oral galvanism: * Sensation of pain * Ulceration of mucosa * Corrosion and discolouration
• Manappallil, John J. (2015-11-30). Basic Dental Materials. JP Medical Ltd. ISBN 9789352500482. "Direct contat of the implant with a dissimilar metal crown is avoided to prevent galvanism" and "Galvanism: Another cause for sensitivity is the small currents created whenever two different metals are present in the oral cavity. The presence of metal restorations in the mouth may cause a phenomenon called galvanic action or galvanism."

The subject still appears in the current dental literature, too: PMID 29847047, PMID 28258269, PMID 24457849, PMID 25882976... WhatamIdoing (talk) 01:08, 10 July 2018 (UTC)

Do these sources give anything more than a passing mention? Why this is relevant is made clear in Consumer Health 9th edition (Barrett, 2012) and More Harm than Good (Ernst, 2018) . Refutation of false medical diagnosis is very rarely if ever made — with the common praxis being to ignore the false diagnosis. A source that in depth discusses the topic as well as one that focuses over 100 pages on the topic trump a mention that is less than a single paragraph.

There is also a divide between in materials science detecting presence of galvanic current (not disputed) and that it is clinically relevant (disputed and disproven). As for the 2008 books, I think you'll find that is not ample time to include studies written in different languages, and for this reason I think we ought to look to sources from the 2010s. You have linked 4 case reports, which are notoriously unreliable for reporting of adverse effects. The association between symptoms and that which is claimed to have resulted in the adverse effects is often dubious, and these do not reach MEDRS standard.

I will look in to the issue of corrosion a bit more, so thanks for the book links, however this is not a result of the galvanism causing symptoms, and with the Canadian source I linked it seems pretty much refuted. Carl Fredrik ^talk 06:28, 10 July 2018 (UTC)

Would be interesting to hear if the review refuting the condition is dealing with symptoms in patients claiming chronic syndrome type illnesses and incorrectly attributing their symptoms to galvanism, or the short term, self limited symptoms when two opposing metal alloy restorations are in contact (which the other textbook sources describe). I suspect the former (not least as I have encountered this phenomenon rarely). As is so often for these fringe areas, there is a core of scienfically valid literature which is surrounded by exaggerated alt med beliefs. Here we can state that there can be a demonstrable current and corrosion of contacting dissimilar metal alloys, which may rarely cause mild, transient symptoms such as metallic taste and paroxysmal discomfort, however it is not possible for this to cause chronic symptoms since corrosion products quickly build up and insulate the surfaces of the alloy. Matthew Ferguson (talk) 22:04, 10 July 2018 (UTC)

As I stated before, it goes into both those topics, and bar corrosion, of which it did not find any — there were no symptoms that could be linked to presence of currents, neither short-term self-limiting symptoms or chronic ones. I can read more and find some specific citations tomorrow, but it is a 150 page report with 8 supplemental chapters of each 20-50 pages, and tied to a number of other reports, including the CADTH one that I have cited here, there is a wealth of material with little to no mention of corrosion. I will look into it further. I would also suggest looking for high quality recent sources to support those statements Matthew. Carl Fredrik ^talk 23:16, 10 July 2018 (UTC)

Yes it's a very long document, and addresses safety of dental materials in general, particularly amalgam. And google translate is imperfect. Thus far I found much discussion about hypersensivity reactions, lichenoid reactions, chronic symtpoms attributed to "amalgam illness". I have found no mention of galvanism apart from this mention of corrosion in terms of gold containing alloys:

"Gold alloys are relatively difficult to solve, despite some corrosion in the oral cavity. Corrosion increases in the presence of other metals, for example There are other metals in the oral cavity. Leakage of metal ions from Gold alloys also increase due to high pH, ​​oxidative environment and presence of sulfur-containing amino acids. Metallic gold can be released in saliva and gold levels in the blood are correlated to the amount of dental gold in the individual. "

Have not looked at the supplementary chapters. Have concern that these sources are relavent to this topic if they do not discuss galvanism? Matthew Ferguson (talk) 00:33, 11 July 2018 (UTC)

Getting the impression that it would be more encyclopedic to present this article in terms of "This condition is said to ..., however this report refutes its existence" rather than outright labeling it as pseudoscientific, which does not represent what all the sources are saying. Matthew Ferguson (talk) 00:37, 11 July 2018 (UTC)

I'm getting the impression that the words following "is said to..." are the exact words that we're having trouble with.

AFAICT, Carl might finish that sentence this way:

• "Oral galvanism is said to... produce wildly implausible, long-term, whole-body symptoms in people who are caught up in a hysterical, culture-specific panic about mercury poisoning".

AFAICT, the modern dental sources would finish that sentence this way:

• "Oral galvanism is said to... cause corrosion in some fillings, and which will rarely cause some short-term symptoms for a small minority of patients (but the real problem is that uncorrected corrosion causes tooth loss; the tiny tingle or slight metallic taste that's temporarily annoying the patient is unimportant)".

I don't think we'll make any progress here until we agree on a definition. Is oral galvanism just a normal, everyday physics kind of thing that predictably happens if you stick a gold filling next to a silver-tin filling in the mouth, resulting in corrosion of the filling? Or is it all about anxious people panicking that their fillings are poisoning their entire bodies, and who declared that they must be suffering from 'oral galvanism' because they think that sounds more logical and respectable (and potentially treatable) than a psychiatric diagnosis? WhatamIdoing (talk) 02:20, 11 July 2018 (UTC)

You seem to misunderstand, "a tiny tingle" or "metallic taste", even temporary, is not associated to amalgam per the reports I have cited. Beyond the Swedish 2003 report this is further supported by the Canadian 2006 HTA report which I've also cited. Whether or not any effects are considered clinically relevant does not matter, because the reports, as well as a Norwegian guideline conclude: "No adverse effects have been found" — which includes effects that are temporary, self-limiting and negligible. In fact what has been found in an unrelated HTA report from another Swedish agency (which I have not cited because it isn't fully applicable here) is that amalgam, regardless of which type of alloy is used, or which combinations exist in a mouth — is more reliable than ceramic or polymer fillings, but has become less used (SBU, 2010 page 283) . Whether there are any recent articles or sources looking at the issue from a purely material science viewpoint discussing clinically relevant corrosion as a result of electric currents — is not something I have looked in to. If any such sources exist that pass MEDRS we may include them, but I haven't seen any suggestions that are <10 years old. Carl Fredrik ^talk 16:17, 11 July 2018 (UTC)

Okay, are you trying to tell me that:

1. Normal physics produces metal corrosion everywhere else, but it doesn't produce corrosion in the mouth, or
2. Corroded fillings don't count as an adverse effect?

I'm not feeling like there are any logical alternatives to those two statements.

I've given you links to multiple reference works and textbooks that were published very recently, i.e., 2015 and 2017. There are also multiple recent primary sources on this. Have you read any of the sources I've listed? WhatamIdoing (talk) 23:50, 11 July 2018 (UTC)

Now, that is a straw-man argument. I have never suggested either of the things you accuse me of saying. What is far more important is that we need to follow some of the fundamental rules of Wikipedia and stick to the sources we cite:

1. We rely on quality sources to make any statements, even those that might be physically possible. (WP:NOTBLUE, WP:OR)
2. There are no such sources from the last 10 years that make anything more than a passing mention, no medical sources that are of higher standard, and no materials science sources have been suggested that fall within those frames. (WP:MEDRS)
3. Corroded fillings would be classified as an adverse effect, but they have either not been reported, or not associated with presence of galvanic current in the sources. (WP:SYNTH)
4. I pointed to Ernst's and Barrett's excellent textbooks for these very reasons, that we should not fall into the trap that: "something is not physically impossible, ergo it must exist". That something has certain undeniable plausibility as construed by editors, not sources — is not relevant, and is a typical tactic of non-refutability of alt-med: "But it could"... Well, yeah, ... "but it doesn't — and all the empirical evidence says it doesn't". (WP:FRINGE)
5. You seem to equate "oral galvanism" with "presence of measurable currents". This is a false likeness. The presence of clinically insignificant currents is not at dispute, and the article does not dispute them. It only says they don't matter, neither from a perspective of adverse effects (of which corrosion would be one, if it had been reported) and that they do not make up the definition of galvanism. (WP:WORDISSUBJECT)
6. I have now performed a thorough review of the materials science sources discussing oral galvanism, and found none from the last decade that fulfill MEDRS, and only scant sources that even discuss the topic at any level of evidence. I do not think I have missed anything, but feel free to take a look yourself and suggest sources. (WP:REDFLAG)
7. As for the books you have linked, I have already stated why these are poor sources: 10-15 year old books that haven't had time to take in more recent evidence are horrible sources, and the use of book sources must take into account how the fast the field moves per WP:MEDBOOK. It is extremely telling that no books post 2010 discuss the topic. (WP:FALSEBALANCE)

Currently, this is a non-debate, and I implore you to suggest better sources if you wish to discuss further.

Carl Fredrik ^talk 06:28, 12 July 2018 (UTC)

I am unsure, it seems that you are performing a degree of original research in making such a conclusion about an apparent scientific consensus, and not being entirely neutral. 2003 is also quite old by the same standards... did you manage to find where the exact discussion about oral galvanism is in the large source provided? I am still waiting to confirm if report deals with chronic symptoms or addresses the possibility of self limiting galvanic symptoms shortly after placement of contacting (i.e. adjacent or opposing) dissimilar metal alloys. If the report deals with chronic symptoms, that is all well and good, however if it does not address what the textbooks are discussing then how does that report refute the condition? Matthew Ferguson (talk) 23:00, 12 July 2018 (UTC)

The reports deal with all symptoms. Carl Fredrik ^talk 06:46, 14 July 2018 (UTC)

Amalgam disease synonymous with Oral galvanism / galvanic pain?

Where is the source to support this? Matthew Ferguson (talk) 20:35, 13 July 2018 (UTC)

2003 SoU report, will provide translation as soon as I get home tonight. Carl Fredrik ^talk 06:47, 14 July 2018 (UTC)

That would be really appreciated. I am struggling to assess this source with google translate. Can't even find the section of it that discussed corrosion. Matthew Ferguson (talk) 08:08, 14 July 2018 (UTC)

Search for korro in the pdf. There isn't really "a section" on it. It just mentions it here and there. WhatamIdoing (talk) 05:29, 17 July 2018 (UTC)

What is the scope of this article?

I feel this article should not cover all aspects of potential reactions of the oral environment (and more alt med view point would say the whole body) to metals and metal alloys, and be limited purely to electrogalvanism of metal alloys in the mouth, and also seems sensible to discuss whether this has any signs and symptoms. I am assuming that there is another encyclopedia article somewhere that discusses "amalgam illness" and we should not cover that here. Interestingly one source I was reading yesterday distuished between normal corrosion (reaction of the alloy with saliva?) and galvanic corrosion (reaction between 2 dissimilar alloys in presence of saliva?). That raises the question whether "regular corrosion" should be discussed here. Arguably not, without renaming the article. Matthew Ferguson (talk) 08:08, 14 July 2018 (UTC)

There is no logic in saying that galvanism is the same as amalgam illness. Firstly galvanism is alleged to be involved with any 2 dissimilar metal alloys and is not related to the presence of amalgam by itself (although amalgam by itself will undergo corrosion, this is not the same as electrogalvanic corrosion). There is said to be 2 different metal alloys needed to set up the electrogalvanic cell. Secondly the health concerns about amalgam related to leaching of mercury into the body causing "subclinical" mercury toxicity attributed to various chronic complaints. This is not the same as galvanism.

It seems that that the scope of this article was widened to include "amalgam illness" rather than specifically galvanism. This was done without consusens as far as I can see. Since we have the encyclopedia article Dental_amalgam_controversy why cover that material in 2 places? Given the title of this article is galvanism we should stick to the topic of galvanism not the wider health concerns about amalgam. Matthew Ferguson (talk) 09:16, 15 July 2018 (UTC)

I agree that we need to figure out the answer to this question. Your idea of splitting the "amalgam illness" stuff off to the article on that section is IMO a good one. We'd need to connect the articles (perhaps a brief section saying, more or less, "Some folks worried that this would produce mercury poisoning, but it doesn't"?). WhatamIdoing (talk) 05:31, 17 July 2018 (UTC)

Discussion about which sources are reliable for this article

Mystkowska 2018

• "Amalgam used for tooth restoration has a high tendency to react electrochemically and is able to interact with other metals in the oral cavity [65]. The occurrence of the potential difference also causes the flow of current between the gums, tongue, and mucous membranes [66]. If this phenomenon occurs over longer periods, it causes lesions known as electrometallosis, the symptoms of which are inflammatory changes of the tongue, mouth, periodontium, and mucous membranes. There is also an imbalance in salivary secretion and other local and general changes in the body. Subjective symptoms reported by patients include burning of the tongue and mucous membranes and a sense of a metallic taste. The described phenomena are the cause of changes in the oral mucosa, especially dangerous precancerous states, e.g., leukoplakia. This is a result of constant stimulation caused by galvanic currents leading to keratotic changes, inflammation, erosion, and ulcerations. The currents can also be caused by BMS (burning mouth syndrome) [67], which is a neuropathic pain. BMS is a chronic condition of various sensations and discomfort in the oral cavity without any visible changes on the mucous membrane. One of the possible causes of BMS may be micro-injuries of sensory nerve endings resulting in spontaneous discharges without stimulation of their endings."

References

Passing mention based only on:

65. Sutow E.J., Maillet W.A., Taylor J.C., Hall G.C. In vivo galvanic currents of intermittently contacting dental amalgam and other metallic restorations. Dent. Mater. 2004;20:823–831. doi: 10.1016/j.dental.2003.10.012.

66. Hampf G., Ekholm A., Salo T., Ylipaavalniemi P., Aalberg V., Tuominen S., Alfthan G. Pain in oral galvanism. Pain. 1987;29:301–311. doi: 10.1016/0304-3959(87)90045-5.

Two sources that have been either undermined by newer evidence (the 1987 article, which was refuted in 1988, see the SoU report) or in the case of the 2004 source, missed newer evidence. The only mention of pain is from the 1987 source which is thoroughly debunked, so this just seems like the authors cherry-picking what to cite. I can not think that they were not aware of the more recent refutations.

As a Swede who has been through this debate in among other things popular media in the early 2000's, with all manner of quacks defending the concept — I am shocked to see that there are some who still stick to the false belief and defend it in the face of overwhelming evidence. If you have a hard time with the Swedish reports, I suggest you read the Canadian one.

The thing is, there is no winning for you here — there is either: (1) I get tired and let poor science slip — or (2) you badger me until we cite 10 HTA reports and escalate this to the fringe noticeboard, wasting loads and loads of everyone's time. Carl Fredrik ^talk 06:54, 14 July 2018 (UTC)

The paper is related to corrosion, agree not all content in the paper relates. However this is so far the most recent source we have, is a review paper and appears in a peer reviewed journal. As far as criticising the sourcing within the paper, not convinced we should do this heavily as this borders on original research. Would comment on this that I do not feel cherry picking of sources is going on. The literature seems to contain hundrends of sources which discuss this phenomenon, and I have seen only one or two sources that refute it. Such could easily be missed in a literature review, particluarly if in another language. Somewhat cautious of this source as it mentions cancer in the abstract, however in the text this refers to leukoplakia, a premalignant condition. I was not aware that this was one potential cause of leukoplakia, I knew we could get lichenoid reactions from amalgam very rarely. Overall I feel thsi article is a suitable source in conjunction with other sources. Matthew Ferguson (talk) 08:00, 14 July 2018 (UTC)

The reason you did not know that leukoplakia was related is because it isn't. It was debunked as early 1986, and has not been touched upon since then:

• Det rekommenderades att amalgamfyllningar i direkt kontakt med lokala lichenförändringar (vita strimmor på slemhinnan) skulle avlägsnas. I de flesta fall ansågs dock symtomen vara orsakade av annat än amalgam. Det poängterades att patienternas besvär och symtom skulle tas på allvar och att kontakt med läkare kunde behövas. p 37

[The 1986 guidelines] recommended that amalgam fillings in direct contact with local lichenoid changes (white bands in the squama) should be removed. In most cases the symptoms were seen to be caused by other causes than amalgam. It was pointed out that issues and symptoms perceived by patients should be taken seriously and that contact with a physician could be necessary.

Please WP:Dropthestick and trust me, it has ALL been debunked.

We need to get on board with levels of evidence, and that HTA reports and major reviews are vastly superior and more authoritative than single sources that just WP:perpetuate nonsense. Carl Fredrik ^talk 08:49, 15 July 2018 (UTC)

Do you have link to the canadian source? Many thanks Matthew Ferguson (talk) 08:00, 14 July 2018 (UTC)

As stated above, it is used as a source in the article. Carl Fredrik ^talk 08:49, 15 July 2018 (UTC)

Chaturvedi 2009

"When two or more dental prosthetic devices/restorations made of dissimilar alloys come into contact while exposed to oral fluids, the difference between their corrosion potential results in a flow of electric current between them. An in vivo galvanic cell is formed and the galvanic current causes acceleration of corrosion of the less noble metal. The galvanic current passes through the metal/metal junction and also through tissues, which causes pain. The current flows through two electrolytes, saliva, or other liquids in the mouth and the bone and tissue fluids."

References

Please take my word for it and stop wasting time — that article doesn't even cite where it gets that statement from, only saying:

It has been proven that small galvanic currents associated with electrogalvanism are continually present in the oral cavity.

The closest source to that statement is Kirkpatric CJ, Barta S, Gerdes T, Krump-Konvalinhova V, Peters K. Pathomechanisms of impaired wound healing metallic corrosion products. Mund Kiefer Gesichtschir 2002;6:183-90. (DOI: 10.1007/s10006-002-0371-x) — which only says that there is literature on the topic and that there might be related symptoms.

Allein auf dem europäischen Markt befinden sich zurzeit mehr als 3000 verschiedene Arten, sodass die Permutationen der möglichen Wechselwirkungen (u. a. auch elektrogalvanische Prozesse) kaum überschaubar sind. Klinische Folge dieser Wechselwirkungen sind verschiedene pathologische Veränderungen, welche in der Regel Entzündungsprozesse und Störungen der Gewebereparation beinhalten. In der vorliegenden Arbeit wird der aktuelle Wissensstand in Bezug auf metallinduzierte zelluläre Reaktionen und metallinduzierte Störungen der periimplantären Heilung erörtert. Darüber hinaus werden experimentelle In-vitro-Modelle vorgestellt, welche Rückschlüsse auf Pathomechanismen in vivo zulassen.

That article in turn cites nothing.

If you think this source is on par with what we cite — you need to read WP:Weight. Carl Fredrik ^talk 08:36, 15 July 2018 (UTC)

Dental watch / Wahl 2001

"Molin et al compared a group of patients with subjective symptoms of "oral galvanism" (dry, burning mouth, mouth pain, and/or metallic taste) to a group of controls [16]. Although there was a correlation of plasma levels of Hg with the number of surfaces of amalgam fillings in all the patients, there were no differences in the levels of plasma-selenium, erythrocyte glutathione-peroxidase, and numerous other blood parameters between the patients and the controls.

Herrström and Högstedt studied 142 women and 76 men with self-diagnosed "oral galvanism" and found no cases of mercury intoxication. Instead, 42.7% of the patients had a mental disorder, including generalized anxiety disorder or panic disorder. Amalgam removal was recommended to some patients, mainly for psychologic reasons (but none improved), but also for oral conditions. They concluded, "The clinical conditions behind the concept of oral galvanism seem to be explicable in terms of general medicine, and no generalized toxic effect of amalgam fillings need be suspected." [17]"

References

• Appears that it is a duplication of material published in a journal. Arguably we should use the journal version as the source not the dental watch souce (but to increase in accessibilty for readers we can link with "available" to dental watch website if tfull text can be read there). A little old, but given the genereral paucity of sources I think we should use this source. However I feel that only the quoted 2 paragraphs above are of relevance to this topic. It will be a good way to discuss the research from 1987 and 1993 via a secondary sources. Current use of this source in the article seems to be attached to content it does not entirely support. For example, it does not state that "Any existence of galvanic pain or association of either currents or mercury to presence of symptoms has been disproven", neither does it say that amalgam illness and galvanism are the same thing. It says "a multitude of conditions, sometimes collectively called "amalgam illness,". Neither does it state "any symptoms associated with currents between oral fillings are likely to be psychosomatic in nature." ... what it actually states is pasted above in the quotation. I feel this source should only be used for content it actually supports and that more neutral and representitive language should be used. Matthew Ferguson (talk) 10:43, 15 July 2018 (UTC)

If you wait for me to translate passages we can quote those from the SoU report, and then build from there. My current take is that the entire article will likely need rewriting. Carl Fredrik ^talk 10:54, 15 July 2018 (UTC)

Should not base the whole article on just one source... it should represent all available reliable sources. Matthew Ferguson (talk) 13:49, 15 July 2018 (UTC)

Restarting the discussion

The above discussion is not very fruitful and I believe there is a need to restart the entire discussion since it is currently all-over-the-place. I have found some discussion of corrosion in the SoU report that I need to read up on, and summarize. I am going to respond to the following:

• Quality of sources
• Article scope
• Corrosion
• Presence of galvanic currents and:
  • Systemic symptoms
  • Local symptoms
  • Corrosion
• Pseudoscientific aspects

Once I have translated citations to all of these and if there are no protests I will archive the above discussion. I would suggest waiting with new comments until I have done this, simply to ensure that we stick to discussing the issues. We have argued around each-other for a while and I think we have both missed some aspects. I think it is good to cool it down and structure the debate a bit.

• Ping Matthew Ferguson 57 WhatamIdoing!

Carl Fredrik ^talk 10:29, 15 July 2018 (UTC)

If, at this stage, you are interested in understanding, rather than finding sources that could withstand a determined onslaught from rules lawyers, then I think you might want to read http://www.mdpi.com/1996-1944/11/1/171/htm#B4-materials-11-00171 It's not very long, and it doesn't mention either mercury or amalgam, so it completely sidesteps everything that you've been so focused on. And, yes, it still finds that certain combinations of metals produce some problems in some people.

As for the 2003 report, I see that it describes galvanic corrosion, e.g., "Korrosionen ökar i närvaro av andra metaller, exempelvis om det finns andra metaller i munhålan" on page 95 ("Corrosion increases in the presence of other metals, for example, when there are other metals in the mouth"). This particular bit, in a section on gold fillings, is followed by a list of symptoms that are caused by gold hypersensitivity. I understand that gold hypersensitivity is very rare), but they say that it is exacerbated by corrosion.

Also, if your statement above about there being no connection between currents and symptoms is based upon this passage: "Socialstyrelsen konstaterade att oral galvanism kunde ge upphov till svaga galvaniska strömmar i munhålan. Någon korrelation mellan symtom och sådana strömmar kunde dock ej påvisas. Någon rekommendation om att rutinmässigt mäta spänningar i munhålan utfärdades därför inte" (page 40 of the report), then I believe you have misunderstood it. It seems to mean that there is no good correlation between the objective measurement of the current and the amount that the current subjectively bothers an individual person. The next sentence makes it clear that there's no point in measuring the strength of the current, because the current strength tells you less about the problem than the patient's self-report about the presence or absence of annoying symptoms, and it tells you much less about corrosion than simply inspecting things properly.

As for what this report is about: I find that mercury is mentioned on ten times as many pages as corrosion. That suggests that this report is really about mercury amalgam illness (which some Swedish people once incorrectly claimed was associated with tiny amounts of mercury released from corroded fillings) rather than the problems of mixed metals that are acknowledged by mainstream dentistry. WhatamIdoing (talk) 05:26, 17 July 2018 (UTC)

I am surprised by the wealth of red herrings thrown at me here — evidence has nothing to do with lawyers. Please, cut that out. My insistance of sticking to high quality sources is based on two things: 1) they are higher quality 2) they exist. We should always strive to cite the best possible source.

I read the section on gold hypersensitivity just prior to starting this subsection, and it is also why I have chosen to read the entire report before commenting further — which is why I asked for time.

The only reason the report at all discusses mercury is because it was suggested that corrosion would lead to leakage of mercury — which is evident if you read the paper (I have already said I will translate this section). Please do not explain how I should interpret the Swedish language, and especially not when you are pulling single sentences out of a 150+ page report. Carl Fredrik ^talk 07:00, 17 July 2018 (UTC)

My point about "rules lawyers" is that the fastest route to obtaining a basic understanding of a subject is not always a MEDRS-style source. Sometimes it's a simpler source that explains things but which wouldn't pass a rigid interpretation of MEDRS. Will that primary source stand up to someone who's pounding on the letter of the MEDRS "law"? Probably no, but I'm not suggesting that you cite it in any article, so that doesn't matter. Will you know more about what mainstream dentistry thinks of galvanic action if you read it? Probably yes, which is why I'm suggesting that you read it.

As a practical matter, when the main question is "Are we even talking about the same thing here?", then reading a single source that is focused on 'thing #1' is unlikely to help you learn anything about 'thing #2', which makes it hard to figure out whether 'thing #2' even exists, much less whether it's the same as 'thing #1'. Or: before you spend several hours reading a 150-page pdf, please spend just 10 minutes reading that short, easily comprehensible paper, so you will be better equipped to figure out whether that long pdf is talking about the same thing as the short paper.

(I don't see how anyone could reasonably be expected to translate what that report says about Mercury. It's not just one "section". It's mentioned on fifty (50) different pages in the first pdf alone.) WhatamIdoing (talk) 23:46, 20 July 2018 (UTC)

Were you able to finish reading that source? WhatamIdoing (talk) 02:26, 6 September 2018 (UTC)

As mentioned in a previous exchange the page is about two separate items - galvanic shock re the interaction between different adjacent metals contained in fillings etc, and a sensitivity to amalgams producing oral lesions. Also as far as I can see these are known and accepted conditions and an alternative medicine infobox is out of place.--Iztwoz (talk) 09:43, 22 May 2022 (UTC)