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"The simplest propositions can be combined with each other to form new and more complex propositions through the use of logical operators and quantifier connectors. These tools of logic allow us to construct broader statements starting from basic concepts, thus facilitating the formulation of theorems and proofs in mathematics and other disciplines that require precision and rigor. | "The simplest propositions can be combined with each other to form new and more complex propositions through the use of logical operators and quantifier connectors. These tools of logic allow us to construct broader statements starting from basic concepts, thus facilitating the formulation of theorems and proofs in mathematics and other disciplines that require precision and rigor. | ||
The fundamental logical operators include: | The fundamental logical operators include: | ||
'''Conjunction''', denoted by the symbol <math>\land</math> (and): represents the logical operation "AND". A compound proposition formed by two propositions joined with "and" is true only if both propositions are true. | '''Conjunction''', denoted by the symbol <math>\land</math> (and): represents the logical operation "AND". A compound proposition formed by two propositions joined with "and" is true only if both propositions are true. | ||
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In addition to the confirmations derived from the medical language logic discussed in the previous chapter, the dentist acquires further instrumental data that strengthen his diagnosis. These tests include the analysis of axiographic traces, obtained through the use of a custom-made functional paraocclusal fork. This tool allows for the visualization and quantification of the condylar paths during masticatory functions. As shown in Figure 4, the flattening of the condylar traces on the right side, both in the mediotrusive masticatory kinetics (indicated in green) and in the opening and protrusion cycles (in grey), confirms the anatomical and functional flattening of the right TMJ during the dynamics of mastication. | In addition to the confirmations derived from the medical language logic discussed in the previous chapter, the dentist acquires further instrumental data that strengthen his diagnosis. These tests include the analysis of axiographic traces, obtained through the use of a custom-made functional paraocclusal fork. This tool allows for the visualization and quantification of the condylar paths during masticatory functions. As shown in Figure 4, the flattening of the condylar traces on the right side, both in the mediotrusive masticatory kinetics (indicated in green) and in the opening and protrusion cycles (in grey), confirms the anatomical and functional flattening of the right TMJ during the dynamics of mastication. | ||
---- | ---- | ||
In addition to axiography, surface electromyography on the masseter muscles is performed (see Figure 6), during which the patient is asked to exert maximum muscle force. This type of electromyographic analysis, called 'EMG Interferential Pattern', is characterized by the high-frequency content of the peaks showing phase interference. Indeed, Figure 6 highlights an asymmetry in the recruitment of motor units between the right masseter (upper trace) and the left masseter (lower trace).<ref>{{cite book | In addition to axiography, surface electromyography on the masseter muscles is performed (see Figure 6), during which the patient is asked to exert maximum muscle force. This type of electromyographic analysis, called 'EMG Interferential Pattern', is characterized by the high-frequency content of the peaks showing phase interference. Indeed, Figure 6 highlights an asymmetry in the recruitment of motor units between the right masseter (upper trace) and the left masseter (lower trace). | ||
| | <ref>{{cite book | ||
| | | autore = Castroflorio T | ||
| | | autore2 = Talpone F | ||
| | | autore3 = Deregibus A | ||
| | | autore4 = Piancino MG | ||
| | | autore5 = Bracco P | ||
| url = https://pubmed.ncbi.nlm.nih.gov/15189308/ | | titolo = Effects of a Functional Appliance on Masticatory Muscles of Young Adults Suffering From Muscle-Related Temporomandibular Disorder | ||
| volume = | | url = https://pubmed.ncbi.nlm.nih.gov/15189308/ | ||
| | | volume = | ||
| | | opera = J Oral Rehabil | ||
| | | anno = 2004 | ||
| | | editore = | ||
| ISBN = | | città = | ||
| PMID = 15189308 | | ISBN = | ||
| PMCID = | | PMID = 15189308 | ||
| DOI = 10.1111/j.1365-2842.2004.01274.x | | PMCID = | ||
| oaf = <!-- | | DOI = 10.1111/j.1365-2842.2004.01274.x | ||
}}</ref><ref>{{cite book | | oaf = <!-- qualsiasi valore --> | ||
| | }}</ref><ref>{{cite book | ||
| | | autore = Maeda N | ||
| | | autore2 = Kodama N | ||
| | | autore3 = Manda Y | ||
| | | autore4 = Kawakami S | ||
| | | autore5 = Oki K | ||
| | | autore6 = Minagi S | ||
| url = http://ousar.lib.okayama-u.ac.jp/files/public/5/56938/20190821181112825794/73_4_357.pdf | | titolo = Characteristics of Grouped Discharge Waveforms Observed in Long-term Masseter Muscle Electromyographic Recording: A Preliminary Study | ||
| volume = | | url = http://ousar.lib.okayama-u.ac.jp/files/public/5/56938/20190821181112825794/73_4_357.pdf | ||
| | | volume = | ||
| | | opera = Acta Med Okayama | ||
| | | anno = 2019 | ||
| | | editore = Okayama University Medical School | ||
| ISBN = | | città = Okayama, Japan | ||
| PMID = 31439959 | | ISBN = | ||
| PMCID = | | PMID = 31439959 | ||
| DOI = 10.18926/AMO/56938 | | PMCID = | ||
| oaf = <!-- | | DOI = 10.18926/AMO/56938 | ||
}}</ref><ref>{{cite book | | oaf = <!-- qualsiasi valore --> | ||
| | }}</ref><ref>{{cite book | ||
| | | autore = Rudy TE | ||
| url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2190318/pdf/anesthprog00262-0036.pdf | | titolo = Psychophysiological Assessment in Chronic Orofacial Pain | ||
| volume = | | url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2190318/pdf/anesthprog00262-0036.pdf | ||
| | | volume = | ||
| | | opera = Anesth Prog | ||
| | | anno = 1990 | ||
| | | editore = American Dental Society of Anesthesiology | ||
| ISSN = 0003-3006/90 | | città = | ||
| ISBN = | | ISSN = 0003-3006/90 | ||
| PMID = 2085203 | | ISBN = | ||
| PMCID = PMC2190318 | | PMID = 2085203 | ||
| DOI = | | PMCID = PMC2190318 | ||
| oaf = <!-- | | DOI = | ||
}}</ref><ref>{{cite book | | oaf = <!-- qualsiasi valore --> | ||
| | }}</ref><ref>{{cite book | ||
| | | autore = Woźniak K | ||
| | | autore2 = Piątkowska D | ||
| | | autore3 = Lipski M | ||
| | | autore4 = Mehr K | ||
| url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3673808/pdf/medscimonit-19-416.pdf | | titolo = Surface electromyography in orthodontics - a literature review | ||
| volume = | | url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3673808/pdf/medscimonit-19-416.pdf | ||
| | | volume = | ||
| | | opera = Med Sci Monit | ||
| | | anno = 2013 | ||
| | | editore = | ||
| ISBN = | | città = | ||
| E-ISSN = 1643-3750 | | ISBN = | ||
| PMID = 23722255 | | E-ISSN = 1643-3750 | ||
| PMCID = PMC3673808 | | PMID = 23722255 | ||
| DOI = 10.12659/MSM.883927 | | PMCID = PMC3673808 | ||
| oaf = <!-- | | DOI = 10.12659/MSM.883927 | ||
}}</ref><center> | | oaf = <!-- qualsiasi valore --> | ||
}}</ref><center> | |||
==2nd Clinical Approach== | ==2nd Clinical Approach== | ||
(Hover over the images) | (Hover over the images) | ||
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The dentist presents the following statement: | The dentist presents the following statement: | ||
<math>\Im</math>: Following the personalized techniques suggested by Xin Liang et al.<ref>{{cite book | <math>\Im</math>: Following the personalized techniques suggested by Xin Liang et al. | ||
| | <ref>{{cite book | ||
| | | autore = Liang X | ||
| | | autore2 = Liu S | ||
| | | autore3 = Qu X | ||
| | | autore4 = Wang Z | ||
| | | autore5 = Zheng J | ||
| | | autore6 = Xie X | ||
| | | autore7 = Ma G | ||
| | | autore8 = Zhang Z | ||
| | | autore9 = Ma X | ||
| url = https://pubmed.ncbi.nlm.nih.gov/28732700/ | | titolo = Evaluation of Trabecular Structure Changes in Osteoarthritis of the Temporomandibular Joint With Cone Beam Computed Tomography Imaging | ||
| volume = | | url = https://pubmed.ncbi.nlm.nih.gov/28732700/ | ||
| | | volume = | ||
| | | opera = Oral Surg Oral Med Oral Pathol Oral Radiol | ||
| | | anno = 2017 | ||
| | | editore = | ||
| ISBN = | | città = | ||
| PMID = 28732700 | | ISBN = | ||
| PMCID = | | PMID = 28732700 | ||
| DOI = 10.1016/j.oooo.2017.05.514 | | PMCID = | ||
| oaf = <!-- | | DOI = 10.1016/j.oooo.2017.05.514 | ||
}}</ref> that focuses on the quantitative microstructural analysis of the bone value fraction, trabecular number, trabecular thickness, and trabecular separation on each slice of a TMJ CT, it appears that Mary Poppins is affected by Temporomandibular Disorders (TMDs) and the consequence causes orofacial pain. | | oaf = <!-- qualsiasi valore --> | ||
}}</ref> that focuses on the quantitative microstructural analysis of the bone value fraction, trabecular number, trabecular thickness, and trabecular separation on each slice of a TMJ CT, it appears that Mary Poppins is affected by Temporomandibular Disorders (TMDs) and the consequence causes orofacial pain. | |||
However, to further confirm the diagnosis, the dentist presents a series of additional assertions that should pass the compatibility filter described above, thus establishing a coherent basis for the diagnosis of TMD in Mary Poppins. | However, to further confirm the diagnosis, the dentist presents a series of additional assertions that should pass the compatibility filter described above, thus establishing a coherent basis for the diagnosis of TMD in Mary Poppins. | ||
<math>\delta_1=</math> Bone remodeling: The flattening of the axiographic traces shown in Figure 5 indicates the joint remodeling of Mary Poppins' right TMJ. This report can be related to a series of research and articles confirming how malocclusion can be associated with morphological changes of the temporomandibular joints, particularly if related to age. Indeed, the presence of chronic malocclusion can aggravate the scenario of bone remodeling.<ref>{{cite book | <math>\delta_1=</math> Bone remodeling: The flattening of the axiographic traces shown in Figure 5 indicates the joint remodeling of Mary Poppins' right TMJ. This report can be related to a series of research and articles confirming how malocclusion can be associated with morphological changes of the temporomandibular joints, particularly if related to age. Indeed, the presence of chronic malocclusion can aggravate the scenario of bone remodeling. | ||
| | <ref>{{cite book | ||
| | | autore = Solberg WK | ||
| | | autore2 = Bibb CA | ||
| | | autore3 = Nordström BB | ||
| | | autore4 = Hansson TL | ||
| url = https://pubmed.ncbi.nlm.nih.gov/3457531/ | | titolo = Malocclusion Associated With Temporomandibular Joint Changes in Young Adults at Autopsy | ||
| volume = | | url = https://pubmed.ncbi.nlm.nih.gov/3457531/ | ||
| | | volume = | ||
| | | opera = Am J Orthod | ||
| | | anno = 1986 | ||
| | | editore = | ||
| ISBN = | | città = | ||
| PMID = 3457531 | | ISBN = | ||
| PMCID = | | PMID = 3457531 | ||
| DOI = 10.1016/0002-9416(86)90055-2 | | PMCID = | ||
| oaf = <!-- | | DOI = 10.1016/0002-9416(86)90055-2 | ||
}}</ref> The provided scientific references support the compatibility of the assertion. | | oaf = <!-- qualsiasi valore --> | ||
}}</ref> The provided scientific references support the compatibility of the assertion. | |||
---- | ---- | ||
<math>\delta_2=</math> Sensitivity and Specificity of the Axiographic Measurement: | <math>\delta_2=</math> Sensitivity and Specificity of the Axiographic Measurement: | ||
A study was conducted to evaluate the sensitivity and specificity of the data obtained from a sample of patients with temporomandibular joint disorders, using the ARCUSdigma axiographic system.<ref>[https://www.kavo.com/de-de/ KaVo Dental GmbH, Biberach / Ris]</ref> The results showed a sensitivity of 84.21% for the right TMJ and 92.86% for the left TMJ, with a specificity of 93.75% and 95.65%, respectively.<ref>{{cite book | A study was conducted to evaluate the sensitivity and specificity of the data obtained from a sample of patients with temporomandibular joint disorders, using the ARCUSdigma axiographic system. | ||
| | <ref>[https://www.kavo.com/de-de/ KaVo Dental GmbH, Biberach / Ris]</ref> | ||
| | The results showed a sensitivity of 84.21% for the right TMJ and 92.86% for the left TMJ, with a specificity of 93.75% and 95.65%, respectively. | ||
| | <ref>{{cite book | ||
| | | autore = Kobs G | ||
| | | autore2 = Didziulyte A | ||
| url = https://sbdmj.lsmuni.lt/072/072-03.pdf | | autore3 = Kirlys R | ||
| volume = | | autore4 = Stacevicius M | ||
| | | titolo = Reliability of ARCUSdigma (KaVo) in Diagnosing Temporomandibular Joint Pathology | ||
| | | url = https://sbdmj.lsmuni.lt/072/072-03.pdf | ||
| | | volume = | ||
| | | opera = Stomatologija | ||
| ISBN = | | anno = 2007 | ||
| PMID = 17637527 | | editore = | ||
| PMCID = | | città = | ||
| DOI = | | ISBN = | ||
| oaf = <!-- | | PMID = 17637527 | ||
}}</ref> These scientifically validated data support the compatibility of the statement in the dental field, given the consistency of related studies.<ref>{{cite book | | PMCID = | ||
| | | DOI = | ||
| | | oaf = <!-- qualsiasi valore --> | ||
| | }}</ref> These scientifically validated data support the compatibility of the statement in the dental field, given the consistency of related studies. | ||
| | <ref>{{cite book | ||
| | | autore = Piancino MG | ||
| | | autore2 = Roberi L | ||
| | | autore3 = Frongia G | ||
| volume = | | autore4 = Reverdito M | ||
| | | autore5 = Slavicek R | ||
| | | autore6 = Bracco P | ||
| | | titolo = Computerized axiography in TMD patients before and after therapy with 'function generating bites' | ||
| | | volume = | ||
| ISBN = | | opera = J Oral Rehabil | ||
| PMID = 18197841 | | anno = 2008 | ||
| PMCID = | | editore = | ||
| DOI = 10.1111/j.1365-2842.2007.01815.x | | città = | ||
| oaf = <!-- | | ISBN = | ||
}}</ref> | | PMID = 18197841 | ||
| PMCID = | |||
| DOI = 10.1111/j.1365-2842.2007.01815.x | |||
| oaf = <!-- qualsiasi valore --> | |||
}}</ref> | |||
<math>\delta_3=</math> Alteration in Condylar Paths: | <math>\delta_3=</math> Alteration in Condylar Paths: | ||
Urbano Santana-Mora and colleagues<ref>{{cite book | Urbano Santana-Mora and colleagues | ||
| | <ref>{{cite book | ||
| | | autore = López-Cedrún J | ||
| | | autore2 = Santana-Mora U | ||
| | | autore3 = Pombo M | ||
| | | autore4 = Pérez Del Palomar A | ||
| | | autore5 = Alonso De la Peña V | ||
| | | autore6 = Mora MJ | ||
| | | autore7 = Santana U | ||
| url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5674825/pdf/sdata2017168.pdf | | titolo = Jaw Biodynamic Data for 24 Patients With Chronic Unilateral Temporomandibular Disorder | ||
| volume = | | url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5674825/pdf/sdata2017168.pdf | ||
| | | volume = | ||
| | | opera = Sci Data | ||
| | | anno = 2017 | ||
| | | editore = | ||
| ISBN = | | città = | ||
| PMID = 29112190 | | ISBN = | ||
| PMCID = PMC5674825 | | PMID = 29112190 | ||
| DOI = 10.1038/sdata.2017.168 | | PMCID = PMC5674825 | ||
| oaf = YES<!-- | | DOI = 10.1038/sdata.2017.168 | ||
}}</ref> conducted a study on 24 adult patients suffering from severe chronic unilateral pain, diagnosed with Temporomandibular Disorders (TMD). The research focused on the analysis of various functional and dynamic factors, including masticatory function, the remodeling of the temporomandibular joint (TMJ) or condylar paths (CP), and lateral jaw movement or lateral guidance (LG). | | oaf = YES<!-- qualsiasi valore --> | ||
}}</ref> conducted a study on 24 adult patients suffering from severe chronic unilateral pain, diagnosed with Temporomandibular Disorders (TMD). The research focused on the analysis of various functional and dynamic factors, including masticatory function, the remodeling of the temporomandibular joint (TMJ) or condylar paths (CP), and lateral jaw movement or lateral guidance (LG). | |||
---- | ---- | ||
The CPs were evaluated using conventional axiography, while the LG was examined through kinesiographic tracing analysis.<ref>[https://www.myotronics.com/ Myotronics Inc., Kent, WA, US]</ref> It was found that seventeen patients, corresponding to 71% of the total sample, habitually preferred to chew on one side. The mean and standard deviation of the CP angles were 47.90 (± 9.24) degrees, while the mean of the LG angles was 42.95 (± 11.78) degrees. | The CPs were evaluated using conventional axiography, while the LG was examined through kinesiographic tracing analysis. | ||
<ref>[https://www.myotronics.com/ Myotronics Inc., Kent, WA, US]</ref> | |||
It was found that seventeen patients, corresponding to 71% of the total sample, habitually preferred to chew on one side. The mean and standard deviation of the CP angles were 47.90 (± 9.24) degrees, while the mean of the LG angles was 42.95 (± 11.78) degrees. | |||
The study results contributed to the definition of a new paradigm for TMDs, suggesting that the side affected by the disorder might coincide with the habitual chewing side, especially when the lateral mandibular cinematic angle is flatter. This parameter further supports the dental assertion regarding the correlation between chewing habits and the development of TMDs. | The study results contributed to the definition of a new paradigm for TMDs, suggesting that the side affected by the disorder might coincide with the habitual chewing side, especially when the lateral mandibular cinematic angle is flatter. This parameter further supports the dental assertion regarding the correlation between chewing habits and the development of TMDs. | ||
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<math>\delta_4=</math> EMG Interference Pattern: | <math>\delta_4=</math> EMG Interference Pattern: | ||
M.O. Mazzetto and collaborators<ref>{{cite book | M.O. Mazzetto and collaborators | ||
| | <ref>{{cite book | ||
| | | autore = Oliveira Mazzetto M | ||
| | | autore2 = Almeida Rodrigues C | ||
| | | autore3 = Valencise Magri L | ||
| | | autore4 = Oliveira Melchior M | ||
| | | autore5 = Paiva G | ||
| url = https://www.scielo.br/scielo.php?script=sci_arttext&pid=S0103-64402014000100054&lng=en&nrm=iso&tlng=en | | titolo = Severity of TMD Related to Age, Sex and Electromyographic Analysis | ||
| volume = | | url = https://www.scielo.br/scielo.php?script=sci_arttext&pid=S0103-64402014000100054&lng=en&nrm=iso&tlng=en | ||
| | | volume = | ||
| | | opera = Braz Dent J | ||
| | | anno = 2014 | ||
| | | editore = | ||
| ISBN = | | città = | ||
| PMID = | | ISBN = | ||
| PMCID = | | PMID = | ||
| DOI = 10.1590/0103-6440201302310 | | PMCID = | ||
| oaf = <!-- | | DOI = 10.1590/0103-6440201302310 | ||
}}</ref> demonstrated that there is a positive correlation between the electromyographic activity of the anterior temporal muscles and the masseter and the 'Cranio-Mandibular Index' (CMI), with a value of <math>P=0,01</math>. This suggests that the use of CMI to quantify the severity of Temporomandibular Disorders (TMD) and electromyography (EMG) to assess the function of the masticatory muscles can represent a significant diagnostic and therapeutic element. Such scientific references support the compatibility of the assertion. | | oaf = <!-- qualsiasi valore --> | ||
}}</ref> demonstrated that there is a positive correlation between the electromyographic activity of the anterior temporal muscles and the masseter and the 'Cranio-Mandibular Index' (CMI), with a value of <math>P=0,01</math>. This suggests that the use of CMI to quantify the severity of Temporomandibular Disorders (TMD) and electromyography (EMG) to assess the function of the masticatory muscles can represent a significant diagnostic and therapeutic element. Such scientific references support the compatibility of the assertion. | |||
<math>\delta_n=?</math> | <math>\delta_n=?</math> | ||
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In essence, considering the compatibility of the assertions <math>(\delta_1,\delta_2,.....\delta_n)</math>, consistently supporting that Orofacial Pain is caused by a Temporomandibular Disorder might become incompatible if another set of equally coherent assertions <math>(\gamma_1,\gamma_2,.....\gamma_n)</math> emerged. This scenario would pave the way for a new interpretation <math>\Im</math>: Mary Poppins could be suffering from Orofacial Pain due to a Neuromotor Disorder (<sub>n</sub>OP), not directly from Temporomandibular Disorders. Within the current medical language, such assertions remain purely theoretical, given that prevailing beliefs and opinions do not facilitate a rapid paradigm shift. | In essence, considering the compatibility of the assertions <math>(\delta_1,\delta_2,.....\delta_n)</math>, consistently supporting that Orofacial Pain is caused by a Temporomandibular Disorder might become incompatible if another set of equally coherent assertions <math>(\gamma_1,\gamma_2,.....\gamma_n)</math> emerged. This scenario would pave the way for a new interpretation <math>\Im</math>: Mary Poppins could be suffering from Orofacial Pain due to a Neuromotor Disorder (<sub>n</sub>OP), not directly from Temporomandibular Disorders. Within the current medical language, such assertions remain purely theoretical, given that prevailing beliefs and opinions do not facilitate a rapid paradigm shift. | ||
Considering also the risk associated with such a change, the analysis of recent studies on the epidemiology of Temporomandibular Disorders<ref>{{cite book | | Considering also the risk associated with such a change, the analysis of recent studies on the epidemiology of Temporomandibular Disorders | ||
<ref>{{cite book | autore = LeResche L | titolo = Epidemiology of temporomandibular disorders: implications for the investigation of etiologic factors | url = https://pubmed.ncbi.nlm.nih.gov/9260045/ | volume = | opera = Crit Rev Oral Biol Med | anno = 1997 | editore = | città = | ISBN = | PMID = 9260045 | PMCID = | DOI = 10.1177/10454411970080030401 | oaf = <!-- qualsiasi valore --> }}</ref> could prove useful. These studies indicate that, despite methodological and sampling differences, pain in the temporomandibular region is relatively common, affecting about 10% of the population. Therefore, it is reasonable to hypothesize that Mary Poppins could fall within this percentage, classifying her as a patient suffering from Orofacial Pain due to Temporomandibular Disorders (TMD). | |||
In conclusion, adopting a classical dichotomous approach in medical language, which tends to categorize conditions in black or white, fails to capture the numerous nuances present in clinical realities. Therefore, exploring a more flexible and suitable linguistic approach is necessary... | In conclusion, adopting a classical dichotomous approach in medical language, which tends to categorize conditions in black or white, fails to capture the numerous nuances present in clinical realities. Therefore, exploring a more flexible and suitable linguistic approach is necessary... |
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