Difference between revisions of "Conclusion of the ‘Normal Science’ section"

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 ==Introduction==
-We have reached the conclusion of the 'Normal Science' section, which essentially corresponds to phase 2 of Kuhn's 'Paradigms' in which the status quo of the paradigm in the field of Orofacial Pain (OP) and Temporomandibular Disorders (TMDs) has been presented and a series of diagnostic issues not yet classifiable as 'Anomalies' but only as critical elements to be evaluated in the context of the chapter have been highlighted.
+We have reached the conclusion of the 'Normal Science' section, which essentially corresponds to Phase 2 of 'Kuhn's Paradigms'. This phase has presented the status quo of the paradigm in the field of Orofacial Pain (OP) and Temporomandibular Disorders (TMDs), and concurrently highlighted a series of diagnostic issues not yet classifiable as 'Anomalies' but only as critical elements to be assessed within the context of the chapter.
-The conditions of chronic 'OP' can be particularly difficult to diagnose and treat due to their complexity and limited understanding of the mechanisms underlying their etiology and pathogenesis. A frequent characteristic of 'OP' is the multifactorial nature of the pathology, which makes diagnosis even more complex. TMDs, for example, which are termed in various ways in English-speaking countries such as Temporo-Mandibular Disorders (TMDs), Cranio Facial Pain (CFP), and Temporo-Mandibular Joint Dysfunction (TMJ dysfunction), sometimes present diagnostic difficulties. Orofacial pain caused by TMDs is often overlapped, as symptoms and clinical signs, with pain disorders that may be a manifestation of other forms of headache in which organic neurological-systemic diseases may coexist. This clinical picture can make differential diagnosis difficult at least in the early stages of the disease. In a percentage of patients suffering from functional disorders of the stomatognathic apparatus, some peripheral risk factors, i.e., occlusal, and a series of central biopsychosocial risk factors regarding dysfunctions of the Central Nervous System, have been identified.
+The conditions of chronic 'OP' can be particularly difficult to diagnose and treat due to their complexity and the limited understanding of the mechanisms underlying their etiology and pathogenesis.<ref>NASEM Temporomandibular Disorders: Priorities for Research and Care The National Academies Press,, Washington, DC (2020), 10.17226/25652</ref><ref>B.J. Sessle. Chronic orofacial pain: models, mechanisms, and genetic and related environmental influences. Int J. Mol. Sci., 22 (2021), p. 7112, 10.3390/ijms22137112</ref> A common characteristic of OP is the multifactorial nature of the pathology, which further complicates diagnosis. TMDs, for instance, which are termed variously as Temporo-Mandibular Disorders (TMDs), Cranio Facial Pain (CFP), and Temporo-Mandibular Joint Dysfunction (TMJ dysfunction) in Anglo-Saxon countries, occasionally present diagnostic challenges. The orofacial pain caused by TMDs is often overlaid with clinical symptoms and signs similar to those of other painful disorders that may be manifestations of other neurological-systemic organic diseases. This clinical picture can make differential diagnosis difficult at least in the early stages of the disease.<ref>Sollecito T.P., Richardson R.M., Quinn P.D., Cohen G.S.: Intracranial schwannoma as atypical facial pain. Case report. Oral Surg Oral Med Oral Pathol. 1993;76:153-6</ref><ref>Shankland W.E.: Trigeminal neuralgia: typical or atypical? Cranio. 1993;11:108-12.</ref><ref>Graff-Radford S.B., Solberg W.K.: Is atypical odontalgia a psychological problem? Oral Surg Oral Med Oral Pathol. 1993;75:579-82.</ref><ref>Ruelle A., Datti R., Andrioli G.: Cerebellopontine angle osteoma causing trigeminal neuralgia: case report. Neurosurgery. 1994;35:1135-7.</ref> In a percentage of patients suffering from functional disorders of the stomatognathic apparatus, some peripheral risk factors, i.e., occlusal factors, have been identified<ref>B.C. Cooper Temporomandibular disorders: a position paper of the International College of Cranio-Mandibular Orthopedics (ICCMO) Cranio, 29 (2011), pp. 237-244, 10.1179/crn.2011.034</ref><ref>M.S. Nguyen, T. Jagomägi, T. Nguyen, M.Saag, Ü. Voog-Oras Occlusal support and temporomandibular disorders among elderly Vietnamese Int J. Prosthodont, 30 (2017), pp. 465-470, 10.11607/ijp.5216</ref><ref>M.S. Nguyen, M. Saag, T. Jagomägi, Q.H.Nguyen, Ü. Voog-Oras The impact of occlusal support on temporomandibular disorders: a literature review Proc. Singap. Healthc., 31 (2021), pp. 1-12, 10.1177/2010105821102</ref><ref>T.R. Walton, D.M. Layton Mediotrusive occlusal contacts: best evidence consensus statement J. Prosthodont, 30 (S1) (2021), pp. 43-51, 10.1111/jopr.13328</ref><ref>A. Kucukguven, M.D. Demiryurek, I.Vargel Temporomandibular joint innervation: anatomical study and clinical implications Ann. Anat., 240 (2022), Article 151882, 10.1016/j.aanat.2021.151882</ref> as well as a series of central biopsychosocial risk factors regarding Central Nervous System dysfunctions.<ref>R.B. Fillingim, R. Ohrbach, J.D.Greenspan, C. Knott, R. Dubner, E. Bair, C. Baraian, G.D. Slade, W. Maixner Potential psychosocial risk factors for chronic TMD: descriptive data and empirically identified domains from the OPPERA case-control study J. Pain., 12 (11 Suppl) (2011), pp. T46-T60, 10.1016/j.jpain.2011.08.007</ref><ref>G.D. Slade, R. Ohrbachm, J.D.Greenspan, R.B. Fillingim, E. Bair, A.E.Sanders, R. Dubner, L. Diatchenko, C.B.Meloto, S. Smith, W. Maixner Painful temporomandibular disorder: decade of discovery from OPPERA studies J. Dent. Res, 95 (10) (2016), pp. 1084-1092, 10.1177/0022034516653743</ref><ref>G.D. Slade, R. Ohrbach, J.D. Greenspan, R.B. Fillingim, E. Bair, A.E. Sanders, R.Dubner, L. Diatchenko, C.B. Meloto, S.Smith, W. Maixner Painful temporomandibular disorder: decade of discovery from OPPERA studies J. Dent. Res, 95 (2016), pp. 1084-1092, 10.1177/0022034516653743</ref> However, these studies have not provided new information on the main causes of TMDs and their implications for managing these patients<ref>P. Svensson, F. Exposto Commentary 2: further evidence for overlaps among chronic pain conditions-but no news about causal relationships J. Oral. Facial Pain. Headache, 34(Suppl) (2020), pp. s6-s8, 10.11607/ofph.2020.suppl.c2</ref> and consequently, a wide variety of mostly conservative treatments have been proposed<ref>C.S. Stohler, G.A. Zarb On the management of temporomandibular disorders: a plea for a low-tech, high-prudence therapeutic approach J. Orofac. Pain., 13 (1999), pp. 255-261</ref><ref>J. Feng, M. Luo, J. Ma, Y. Tian, X. Han, D.Bai The treatment modalities of masticatory muscle pain a network meta-analysis Med. (Baltim. ), 98 (2019), Article e17934, 10.1097/MD.0000000000017934</ref><ref>Z. Al-Ani Occlusion and temporomandibular disorders: a long-standing controversy in dentistry Prim. Dent. J., 9 (2020), pp. 43-48, 10.1177/2050168420911029</ref><ref>C. Penlington, C. Bowes, G. Taylor, A.A.Otemade, P. Waterhouse, J. Durham, R.Ohrbach Psychological therapies for temporomandibular disorders (TMDs) Cochrane Database Syst. Rev., Issue 8(2022), Article CD013515, 10.1002/14651858.CD013515.pub2</ref> but the lack of clinical evidence has allowed the role of occlusion in TMDs to be contested<ref>P. Alanen Occlusion and temporomandibular disorders (TMD): still unsolved question? J. Dent. Res, 81 (2002), pp. 518-519, 10.1177/154405910208100803</ref> although there is no scientific evidence contradicting a causal occlusal role in functional disorders.<ref>P. Kirveskari, T. Jamsa, P. Alanen Occlusal adjustment and the incidence of demand for temporomandibular disorder treatment J. Prosthet. Dent., 79 (1998), pp. 433-438, 10.1016/s0022-3913(98)70158-1</ref><ref>T. de Abreu, C. Bahia, T. Foscaldo, P.Senna, H. de Souza, R. Fischer, P.Kirveskari Effect of occlusal equilibration
-In conclusion, a critical obstacle in understanding TMDs and consequently in differential diagnosis with 'OP' has been the loss of standardized diagnostic criteria for defining subtypes of TMDs, and for this reason numerous studies have been conducted to create a standardized diagnostic evaluation method called Research Diagnostic Criteria (RDC). For more information on the RDC theme, follow the [[Research Diagnostic Criteria (RDC)|specific chapter]].
-Indeed, in previous chapters, we have highlighted critical issues not to be underestimated both for the delay in diagnosis and for the danger of diagnostic errors that can compromise patient health as well documented in the presentation of clinical cases. The prospective clinical study, which we will present in this chapter, will constitute the foundational basis of a new diagnostic paradigm that we will see realized at the end of the editorial drafting of Masticationpedia, precisely in the 'Extraordinary Science' section. Due to the complexity, delicacy, and criticality of the subject, the prospective clinical study lasted 5 years in which the subjects involved were studied, followed, and re-examined at three different times: at a time '''<math>t_0=</math>''' Preliminary diagnostic phase; a time '''<math>t_n=</math>''' Advanced diagnostic phase; and finally a time '''<math>t_{n+1}=</math>''' Definitive diagnostic phase that will close the project from which a protocol called 'Index <math>|\Psi\rangle</math>' which is read 'Index ket Psi' will be modeled.
-The accuracy of the data derived from the prospective study at various evaluation times was correlated to the Bayes model, so it is appropriate to briefly recall it.
 ===Bayes' Theorem===