Masticationpedia

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{{main menu
{{main menu}}
|link to German= Hauptseite
 
|link to Spanish= Pàgina Principal
{{ArtBy|
|link to French= Page d'accueil
| autore = Gianni Frisardi
|link to Italian= Introduzione
| autore2 = Riccardo Azzali
| autore3 = Flavio Frisardi
}}
}}


{{ArtBy|autore=Gianni Frisardi}}
== Medical language is an extended natural language==
==Ab ovo<ref>Latin for 'since the very beginning'</ref>==
Language is essential in the medical field, but it can sometimes lead to misunderstandings due to its semantically limited nature and lack of coherence with established scientific paradigms. For instance, terms like "orofacial pain" may have significantly different meanings if interpreted through classical logic rather than formal logic.
 
The transition from classical to formal logic is not just an additional step, but it requires precise and accurate description. Despite advances in medical technology—such as electromyographs, cone beam computed tomography (CBCT), and digital oral scanning systems—there remains a need for refinement in medical language.
 
It's crucial to distinguish between natural languages (like English, German, Italian, etc.) and formal languages (like mathematics). Natural languages emerge spontaneously within communities, while formal languages are artificially created for specific applications in fields like logic, mathematics, and computer science. Formal languages have well-defined syntax and semantics, whereas natural languages, despite having grammar, often lack explicit semantics.


Before delving into the analysis of Masticationpedia, we must first introduce some preliminary considerations, particularly regarding two fundamental dimensions—social, scientific, and clinical—that characterize both the present era and the one immediately preceding it.
To keep the analysis dynamic, an exemplary clinical case will be examined through different language logics:


=== The phases of paradigm change according to Thomas Kuhn ===
Over the past century, technological and methodological innovations<ref>{{cita libro
| autore = Heft MW
| autore2 = Fox CH
| autore3 = Duncan RP
| titolo = Assessing the Translation of Research and Innovation into Dental Practice
| url = https://www.ncbi.nlm.nih.gov/pubmed/31590599
| volume =
| opera = JDR Clin Trans Res
| anno = 2019
| editore =
| città =
| ISBN =
| LCCN =
| DOI = 10.1177/2380084419879391
| OCLC =
}} Oct 7:2380084419879391</ref> have exponentially increased, especially in dentistry. These developments have significantly impacted decision-making, schools of thought, and fundamental principles, with the explicit goal of improving quality of life, as emphasized in the "Science of Exposure in the 21st Century".<ref>{{cita libro
| autore =
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| autore3 =
| autore4 =
  | autore5 =  
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  | titolo = Exposure Science in the 21st Century. A Vision and a Strategy
  | titolo = Exposure Science in the 21st Century. A Vision and a Strategy
  | url = https://www.ncbi.nlm.nih.gov/books/NBK206806/pdf/Bookshelf_NBK206806.pdf
  | url = https://www.ncbi.nlm.nih.gov/books/NBK206806/pdf/Bookshelf_NBK206806.pd
| volume =
| opera =
| anno =
| editore = Committee on Human and Environmental Exposure Science in the 21st Century; Board on Environmental Studies and Toxicology; Division on Earth and Life Studies; National Research Council.
| città =
| ISBN = 0-309-26468-5
| LCCN =
| DOI =
| OCLC =
}}</ref> However, this exponential growth hides conceptual ambiguities—or, practically speaking, "side effects"—that, though often underestimated, can challenge scientific certainties, making them more probabilistic.<ref>{{cita libro
| autore = Liu L
| autore2 = Li Y
| titolo = The unexpected side effects and safety of therapeutic monoclonal antibodies
| url = https://www.ncbi.nlm.nih.gov/pubmed/24524104
| volume =
| opera = Drugs Today
| anno = 2014
| editore =
| città = Barcellona
| ISBN =
| LCCN =
| DOI = 10.1358/dot.2014.50.1.2076506
| OCLC =
}} Jan;50(1):33-50</ref> These sensitive aspects of current social, scientific, and clinical reality, seemingly in conflict, will ultimately prove to be complementary by the end of this analysis. This evolution follows the concept of "Progress of Science," according to Kuhn’s interpretation of "Epistemology."


In his most famous work, Thomas Kuhn argues that science advances through distinct cycles reflecting its operational dynamics.<ref>[[wikipedia:Thomas_Kuhn|Thomas Samuel Kuhn]] (Cincinnati, 18 luglio 1922 – Cambridge, 17 giugno 1996) was an American philosopher of science.</ref><ref>{{cita libro
===Clinical case and medical language logic===
| autore = Kuhn Thomas S
The patient, Mary Poppins (fictitious name), has been receiving multidisciplinary medical attention for over a decade, involving dentists, general practitioners, neurologists, and dermatologists. Her medical history is summarized as follows:
| titolo = The Structure of Scientific Revolutions
| url = https://en.wikipedia.org/wiki/The_Structure_of_Scientific_Revolutions
| volume =  
| opera =  
| anno = 2012
| editore = Univ. of Chicago Press
| città = Chicago
| ISBN = 9780226458113
| LCCN = no99080311
| DOI =
| OCLC =
}}</ref> Kuhn posits that science is structured around paradigms and establishes a clear demarcation between science and pseudoscience based on the presence of a shared paradigm. The evolution of scientific progress is depicted as a continuous curve interrupted by discontinuities, represented by paradigm shifts.


In these periods of crisis, scientists act as problem solvers, seeking to resolve anomalies. These "scientific revolutions" occur when the existing paradigm can no longer interpret new anomalies, pushing the scientific community toward new paradigms that better align with observations.
<blockquote>At 40, Mrs. Poppins noticed small spots of abnormal pigmentation on the right side of her face. Ten years later, after a skin biopsy during dermatology hospitalization, she was diagnosed with localized facial scleroderma (morphea) and prescribed corticosteroids. By age 44, she experienced involuntary contractions of the right masseter and temporal muscles, which increased in frequency and duration over time. At her first neurological evaluation, her face showed significant asymmetry and hypertrophy of the right masseter and temporal muscles. Various diagnoses were made, illustrating the limitations of medical language.</blockquote>


===='''Kuhn's phases in Dentistry'''====
After several investigations—such as anamnesis, stratigraphy, and computed tomography (Figures 1, 2, and 3)—the dentist diagnosed "Temporomandibular Disorders" (TMD).<ref>{{Cita libro | autore = Tanaka E | autore2 = Detamore MS | autore3 = Mercuri LG | titolo = Degenerative disorders of the temporomandibular joint: etiology, diagnosis, and treatment | url = https://pubmed.ncbi.nlm.nih.gov/18362309 | opera = J Dent Res | anno = 2008 | DOI = 10.1177/154405910808700406 }}</ref><ref>{{Cita libro | autore = Roberts WE | autore2 = Stocum DL | titolo = Part II: Temporomandibular Joint (TMJ)-Regeneration, Degeneration, and Adaptation | url = https://pubmed.ncbi.nlm.nih.gov/29943316 | opera = Curr Osteoporos Rep | anno = 2018 | DOI = 10.1007/s11914-018-0462-8 }}</ref><ref>{{Cita libro | autore = Lingzhi L | autore2 = Huimin S | autore3 = Han X | autore4 = Lizhen W | titolo = MRI assessment and histopathologic evaluation of subchondral bone remodeling in temporomandibular joint osteoarthritis: a retrospective study | url = https://pubmed.ncbi.nlm.nih.gov/30122441 | opera = Oral Surg Oral Med Oral Pathol Oral Radiol | anno = 2018 | DOI = 10.1016/j.oooo.2018.05.047 }}</ref> Meanwhile, the neurologist diagnosed "Neuropathic Orofacial Pain" (nOP), minimizing TMD as the primary cause. For objectivity, we refer to her condition as "TMDs/nOP."
Thomas Kuhn identifies five distinct phases in the evolution of a scientific paradigm—a process crucial for Masticationpedia. However, to align with the project’s scope, we will focus on the three most significant phases, as indicated in the book’s index.


{|
We are thus faced with several questions that deserve thorough discussion, as they pertain to clinical diagnostics.
|-
| <blockquote>'''Phase 2''', or '''Normal Science''':
In this phase, scientists solve problems to strengthen the correspondence between the paradigm and natural reality. This phase establishes the principles on which future research is based, and it produces most of the scientific literature. Here, "anomalies" arise—events that contradict the dominant paradigm.</blockquote>
|-
| <blockquote>'''Phase 4''', or the '''Crisis of the Paradigm''':
During this phase, new paradigms emerge as the dominant one is rejected. Masticationpedia will address the crisis in masticatory rehabilitation by reviewing theories, axioms, and diagnostic criteria, leading to Phase 5.</blockquote>
|-
| <blockquote>'''Phase 5''', or the '''Scientific Revolution''':
During this period, the scientific community debates which paradigm to adopt. The chosen paradigm might not be the "truest" but the one gaining the most support. In Masticationpedia, a new model in masticatory rehabilitation will be introduced, focusing on data-driven inferences rather than symptom-based models.</blockquote>
|}


Kuhn’s concept gives priority to discipline-specific expertise, yet this contradicts the interdisciplinary nature of modern science. A detailed analysis of this discrepancy is therefore appropriate.
Medical language falls into a hybrid category—it arises from the expansion of everyday language by incorporating technical terminologies such as "neuropathic pain," "Temporomandibular Disorders," or "demyelination." This evolution does not separate it from the inherent ambiguity of natural language, which often lacks precision in critical contexts. For example, the term "disease," crucial in nosology, research, and practice, remains vague in its definition, which can lead to diagnostic uncertainty.


----
A core question arises: is disease related to the patient as an individual, or does it pertain to the system as a whole (i.e., the organism)? Can a patient who is deemed healthy at a given time <math>t_n</math> coexist with a system that was structurally compromised at an earlier point <math>t_{i,-1}</math>?


==Epistemology==
This perspective urges a reconsideration of disease as an evolutionary process rather than a static condition. The dynamic nature of health and disease demands a sophisticated, possibly quantitative, interpretation that factors in temporal variations across biological and pathological systems.
<center>
{|
|-
| align="right" width="250" |<small>''The black swan symbolizes one of the historical problems of epistemology: if all the swans we have seen so far are white, can we decide that all swans are white?''</small>
| align="center" |[[File:Black_Swan_(Cygnus_atratus)_RWD.jpg|175px|center]]
|-
| align="center" |[[File:Duck-Rabbit illusion.jpg|203px|center]]
| width="250" |<small>''Kuhn used optical illusion to demonstrate how a paradigm shift can cause a person to see the same information in a completely different way.''</small>
|}
</center>


'''Epistemology''' (from Greek ἐπιστήμη, epistēmē, meaning "certain knowledge" or "science", and λόγος, logos, "discourse") is the branch of philosophy that studies the necessary conditions for acquiring scientific knowledge and the methods through which it is achieved.<ref>The term was coined by Scottish philosopher [[:wpen:James Frederick Ferrier|James Frederick Ferrier]], in his ''Institutes of Metaphysic'' (1854); see Internet Encyclopedia of Philosophy, ''[https://www.iep.utm.edu/ferrier/ James Frederick Ferrier (1808—1864)]''.</ref> Specifically, it refers to the investigation of the foundations, validity, and limits of scientific knowledge. In English-speaking countries, the term "epistemology" is often synonymous with the theory of knowledge or gnoseology, which examines the study of knowledge in general.
<blockquote>The notion of "language without semantics," treated as irrelevant, highlights a significant issue. Language's inherent semantic interdependence is vital for effective communication.<ref>{{Cita libro | autore = Sadegh-Zadeh Kazem | titolo = Handbook of Analytic Philosophy of Medicine | url = https://link.springer.com/book/10.1007/978-94-007-2260-6 | anno = 2012 | editore = Springer }}</ref></blockquote>


The central problem of epistemology, today as in the times of Hume,<ref>[[wikipedia:David_Hume|David Hume]] (1711–1776) was a Scottish philosopher.</ref><ref>{{cita libro
In short, the debate on whether the patient is ill, or if it is her masticatory system exhibiting pathology, requires a detailed analysis from a medical standpoint. Distinguishing between systemic pathology (masticatory system as a whole) and localized pathology (e.g., TMJ) is key.
| autore = Srivastava S
| titolo = Verifiability is a core principle of science
| url = https://www.cambridge.org/core/journals/behavioral-and-brain-sciences/article/verifiability-is-a-core-principle-of-science/D46462A598492AFDB7AFB4975A313446#
| volume =
| opera = Behav Brain Sci
| anno = 2018
| editore = Cambridge University Press
| città = Cambridge
| ISBN =
| LCCN =
| DOI = 10.1017/S0140525X18000869
| OCLC =
}} Jan;41:e150.</ref> is the issue of verifiability. According to Hempel’s paradox, every example that does not contradict a theory confirms it, which is described as:


<math>A \Rightarrow B = \lnot A \lor B</math>
<center>
 
==Clinical approach==
No theory can be definitively true; while there are finite experiments to confirm it, an infinite number could refute it.<ref>{{cita libro
(hover over the images)
| autore = Evans M
</center>
| titolo = Measuring statistical evidence using relative belief
<center><gallery widths="350" heights="282" perrow="2" mode="slideshow">
| url = https://www.ncbi.nlm.nih.gov/pubmed/26925207
File:Spasmo emimasticatorio.jpg|'''Figure 1:''' Representation of a patient complaining of "orofacial pain" on the right side of the face.
| volume =  
File:Spasmo emimasticatorio ATM.jpg|'''Figure 2:''' Stratigraphy of the patient's TMJ showing condylar flattening and the presence of osteophytes.
| opera = Comput Struct Biotechnol J
File:Atm1 sclerodermia.jpg|'''Figure 3:''' Computed tomography of the TMJ corroborating the stratigraphy findings shown in Figure 2.
| anno = 2016
</gallery></center>
| editore =  
| città =  
| ISBN =  
| LCCN =  
| DOI = 10.1016/j.csbj.2015.12.001
| OCLC =
}} Jan 7;14:91-6.</ref>
 
{{qnq|But it’s not all so obvious...}}
 
...because epistemology evolves continually, even in medicine:


{|
==Understanding of Medical Terminology==
|-
Understanding what "meaning" signifies is a complex topic. The Cambridge Dictionary defines it as "what something expresses or represents."<ref>[https://dictionary.cambridge.org/dictionary/english/meaning Cambridge Dictionary online]</ref> But this definition remains broad and leads to further questions, as different theories offer varied perspectives without a definitive answer.<ref>{{Cita libro | autore = Blouw P | autore2 = Eliasmith C | titolo = Using Neural Networks to Generate Inferential Roles for Natural Language | url = https://pubmed.ncbi.nlm.nih.gov/29387031 | opera = Front Psychol | anno = 2018 | DOI = 10.3389/fpsyg.2017.02335 }}</ref><ref>{{Cita libro | autore = Green K | titolo = Dummett: Philosophy of Language | anno = 2001 }}</ref>
|
*'''P-value''': In medicine, for example, we rely on statistical inference to confirm experimental results, specifically the P-value, a "significance test" that assesses data validity. Yet, even this entrenched concept is now being challenged. A recent study highlighted a campaign in the journal "Nature" against the use of the P-value.<ref>{{cita libro
| autore = Amrhein V
| autore2 = Greenland S
| autore3 = McShane B
| titolo = Scientists rise up against statistical significance
| url = https://www.ncbi.nlm.nih.gov/pubmed/30894741
| volume =
| opera = Nature
| anno = 2019
| editore =
| città =
| ISBN =
| LCCN =  
| DOI = 10.1038/d41586-019-00857-9
| OCLC =  
}} Mar;567(7748):305-307.</ref> Signed by over 800 scientists, this campaign marks a "silent revolution" in statistical inference, encouraging a reflective and modest approach to significance.<ref>{{cita libro
| autore = Rodgers JL
| titolo = The epistemology of mathematical and statistical modeling: a quiet methodological revolution
| url = https://www.ncbi.nlm.nih.gov/pubmed/20063905
| volume =
| opera = Am Psychol
| anno = 2010
| editore =
| città =
| ISBN =
| LCCN =
| DOI = 10.1037/a0018326
| OCLC =
}} Jan;65(1):1-12.</ref><ref>{{cita libro
| autore = Meehl P
| titolo = The problem is epistemology, not statistics: replace significance tests by confidence intervals and quantify accuracy of risky numerical predictions
| url =
| volume =
| opera =
| anno = 1997
| editore =
| città =
| ISBN =
| LCCN =
| DOI =
| OCLC =
}}</ref><ref>{{cita libro
| autore = Sprenger J
| autore2 = Hartmann S
| titolo = Bayesian Philosophy of Science. Variations on a Theme by the Reverend Thomas Bayes
| url =
| volume =
| opera =
| anno = 2019
| editore = Oxford University Press
| città = Oxford
| ISBN =
| LCCN =
| DOI =
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}}</ref> The American Statistical Association contributed to this discussion by releasing a special issue of "The American Statistician Association" titled "Statistical Inference in the 21st Century: A World Beyond p < 0.05." It offers new ways to express research significance and embraces uncertainty.<ref name="wasser">{{cita libro
| autore = Wasserstein RL
| autore2 = Schirm AL
| autore3 = Lazar NA
| titolo = Moving to a World Beyond ''p'' < 0.05
| url = https://www.tandfonline.com/doi/full/10.1080/00031305.2019.1583913
| volume =
| opera = Am Stat
| anno = 2019
| editore =
| città =
| ISBN =
| LCCN =
| DOI = 10.1080/00031305.2019.1583913
| OCLC =
}} 73, 1–19.</ref>
|-
|
*'''Interdisciplinarity''': Solving science-based problems increasingly demands interdisciplinary research (IDR), as underscored by the European Union’s Horizon 2020 project.<ref>European Union, ''[https://ec.europa.eu/programmes/horizon2020/en/h2020-section/societal-challenges Horizon 2020]''</ref> Yet IDR poses cognitive challenges, partly due to the dominant "Physical Paradigm of Science" that limits its recognition. The "Engineering Paradigm of Science" has been proposed as an alternative, focusing on technological tools and collaboration. Researchers need "metacognitive scaffolds"—tools to enhance interdisciplinary communication and knowledge construction.<ref name=":0">{{cita libro  
| autore = Boon M
| autore2 = Van Baalen S
| titolo = Epistemology for interdisciplinary research - shifting philosophical paradigms of science
| url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6383598/
| volume =
| opera = Eur J Philos Sci
| anno = 2019
| editore =
| città =
| ISBN =
| LCCN =
| DOI = 10.1007/s13194-018-0242-4
| OCLC =
}} 9(1):16.</ref><ref>{{cita libro  
| autore = Boon M
| titolo = An engineering paradigm in the biomedical sciences: Knowledge as epistemic tool
| url = https://www.ncbi.nlm.nih.gov/pubmed/28389261
| volume =
| opera = Prog Biophys Mol Biol
| anno = 2017
| editore =
| città =
| ISBN =
| LCCN =
| DOI = 10.1016/j.pbiomolbio.2017.04.001
| OCLC =
}} Oct;129:25-39.</ref>
|}


==Interdisciplinarity==
In linguistic theory, terms act as labels for objects, either concrete or abstract. For example, the word "apple" evokes a clear image of a fruit. But expressions like "orofacial pain" acquire different meanings depending on the context—for a dentist, a neurologist, or for the patient, Mary Poppins, herself.
A superficial view might suggest a conflict between the disciplinarity of the "Physics Paradigm of Science" (which highlights anomalies) and the interdisciplinarity of the "Engineering Paradigm of Science" (focused on metacognitive scaffolds). However, these perspectives are not in conflict; they are complementary and drive "Paradigmatic Innovation" in science.


It could be said that "Innovations" represent "Progresses of Science," as illustrated in the article "Scientific Bases of Dentistry" by Yegane Guven, which explores the impact of biological and digital revolutions on dentistry.<ref>{{cita libro
In the case of Mary Poppins, the neurologist will frame "pain in the right half of the face" using terms like synapses and action potentials, while the dentist will focus on teeth and occlusion. This variation in meaning highlights the importance of context in diagnosis.
| autore = Guven Y
| titolo = Scientific basis of dentistry
| url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5624148/
| volume =
| opera = J Istanb Univ Fac Den
| anno = 2017
| editore =
| città =
| ISBN =
| LCCN =
| DOI = 10.17096/jiufd.04646
| OCLC =
}} 51(3): 64–71. Published online 2017 Oct 2. PMCID: PMC5624148 - PMID: 29114433 </ref> True scientific progress is not solely achieved through "Incremental Innovations" or "Radical Innovations" but through "Paradigmatic Innovations."


"Paradigmatic Innovations" represent a change in thinking that spreads through humanity, affecting society on many levels, from the Copernican revolution to the stochastic methods applied to biological phenomena.<ref>{{cita libro
A deeper exploration of modern philosophy of meaning, such as Gottlob Frege's distinction between "extension" (all entities sharing a characteristic) and "intension" (attributes that define an idea), sheds light on how diagnostic errors may occur.<ref>[[:wikipedia:Gottlob_Frege|Wikipedia entry]]</ref>
| autore = Zhao XF
| autore2 = Gojo I
| autore3 = York T
| autore4 = Ning Y
| autore5 = Baer MR
| titolo = Diagnosis of biphenotypic acute leukemia: a paradigmatic approach
| url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2776262
| volume =
| opera = Int J Clin Exp Pathol
| anno = 2010
| editore =
| città =
| ISBN =
| LCCN =
| DOI =
| OCLC =
}} Prepublished online 2009 Oct 10. PMCID: PMC2776262 - PMID: 19918331. 3(1): 75–86.</ref>


This epistemological context, which includes initiatives like the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and Evidence-Based Medicine, aligns with Masticationpedia’s aim to highlight anomalies that stimulate changes in scientific thought, ultimately leading to "Paradigmatic Innovation."
For example, "pain" is a broad term with high extension but low intension. However, focusing on specific pain types (dental implants, pulpitis, neuropathic pain) increases intension and reduces extension.<ref>{{Cita libro | autore = Porporatti AL | autore2 = Bonjardim LR | titolo = Pain from Dental Implant Placement, Inflammatory Pulpitis Pain, and Neuropathic Pain Present Different Somatosensory Profiles | url = https://pubmed.ncbi.nlm.nih.gov/28118417 | opera = J Oral Facial Pain Headache | anno = 2017 | DOI = 10.11607/ofph.1680 }}</ref>


== Dental Malocclusion==
This shows how the vulnerability of medical language to semantic and contextual ambiguity can lead to significant diagnostic challenges.<ref>{{Cita libro | autore = Jääskeläinen SK | titolo = Differential Diagnosis of Chronic Neuropathic Orofacial Pain | url = https://pubmed.ncbi.nlm.nih.gov/31688325 | opera = J Clin Neurophysiol | anno = 2019 | DOI = 10.1097/WNP.0000000000000583 }}</ref>


"Malocclusion" derives from the Latin "malum," meaning "bad" or "wrong," and refers to improper closure of the teeth.<ref>Attributed to [[:wpen:Edward Angle|Edward Angle]], the father of modern orthodontics, who coined it as a specification of ''occlusion''.</ref> The notion of "closure" may seem intuitive, but "bad" requires careful consideration in a medical context.
== Ambiguity and Vagueness in Medical Language==
Ambiguity in medical language occurs when terms have multiple meanings, leading to errors and inconsistencies in diagnosis. Both ambiguity and vagueness are underexplored in clinical practice, despite their significant impact on clinical guidelines.<ref>{{Cita libro | autore = Schick F | titolo = Ambiguity and Logic | anno = 2003 | editore = Cambridge University Press }}</ref><ref>{{Cita libro | autore = Teigen KH | titolo = The language of uncertainty | anno = 1988 }}</ref>


A search for "Malocclusion" on PubMed yielded 33,309 articles,<ref>Pubmed, ''[https://www.ncbi.nlm.nih.gov/pubmed/?term=%22malocclusion%22 Malocclusion]''</ref> reflecting a lack of consensus on the term. Smaglyuk and colleagues’ study underscores the importance of an interdisciplinary approach to diagnosing malocclusions.<ref>{{cita libro  
Doctors' interpretations of vague medical terms often differ, reducing uniformity in clinical practices compared to guidelines.<ref>{{Cita libro | autore = Codish S | autore2 = Shiffman RN | titolo = A model of ambiguity and vagueness in clinical practice guideline recommendations | url = https://pubmed.ncbi.nlm.nih.gov/16779019/ | anno = 2005 }}</ref>
| autore = Smaglyuk LV
| autore2 = Voronkova HV
| autore3 = Karasiunok AY
| autore4 = Liakhovska AV
| autore5 = Solovei KO
| titolo = Interdisciplinary approach to diagnostics of malocclusions (review)
| url = https://www.ncbi.nlm.nih.gov/pubmed/31175796
| volume =
| opera = Wiad Lek
| anno = 2019
| editore =
| città =
| ISBN =
| LCCN =
| DOI =
| OCLC =
}} 72(5 cz 1):918-922.</ref>


{{q2|Diagnosis, treatment strategies, and prevention of anomalies and dento-facial deformities should be approached by considering the organism as a whole. This is especially important in children, whose physical structure is still forming. The interconnectedness of various organs and systems is crucial for effective treatment planning.}}
This leads to inefficiencies in decoding the "machine message" transmitted by the system, as in the case of Mary Poppins' orofacial pain. Next, we delve into the concept of "encrypted machine language" in the subsequent chapters.


Another notable observation from PubMed queries on interdisciplinary malocclusion diagnostics is the drastic drop to only four articles.<ref>Pubmed, ''[https://www.ncbi.nlm.nih.gov/pubmed/?term=interdisciplinary+diagnostics+of+malocclusions interdisciplinary diagnostics of malocclusions]''</ref>
===Encryption===
Imagine a brain sending a message in machine language (wave trains, ion field packets), and that this carries a message like "Ephaptic," which must be decrypted to translate into verbal language. Both the patient, with epistemic vagueness, and the doctor, constrained by their field of expertise, contribute to the distortion of the machine's original message.


These findings suggest the emergence of phase 4 in Kuhn’s model, indicating a potential paradigmatic shift. Some prefer incremental innovations, while others favor a new path of "Paradigmatic Innovation."
Often, the system's message remains encrypted until symptoms become severe enough for a diagnosis to be made.


[[File:Occlusal Centric view in open and cross bite patient.jpg|alt=|thumb|'''Figure 1a:''' Patient with malocclusion, open bite, and right posterior crossbite who should be treated with orthodontic therapy and/or orthognathic surgery.|500x500px]]
{{q2|Why is the patient's key the REAL one?|Answer: Consider the Gate Control phenomenon.}}


{{qnq|What does "Malocclusion" mean?|}}
In the case of encrypted language, much like in computers, the brain also encrypts and decrypts information. For example, researchers have explored how synaptic memory might be digitally stored in the brain.<ref>{{Cita libro | autore = Petersen C | autore2 = Malenka RC | titolo = All-or-none potentiation at CA3-CA1 synapses | url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC22559/pdf/pq004732.pdf | anno = 1998 }}</ref>


In this clinical case of malocclusion, characterized by a unilateral posterior crossbite and anterior open bite, orthodontic appliances and possibly orthognathic surgery are recommended.<ref>{{cita libro  
==Final Considerations ==
| autore = Reichert I
Language's role in diagnosis is a critical issue in medicine. The ICD-9 lists 6,969 disease codes, which increased to 12,420 in ICD-10.<ref name=":0">{{Cita libro | autore = Stanley DE | autore2 = Campos DG | titolo = The Logic of Medical Diagnosis | url = https://pubmed.ncbi.nlm.nih.gov/23974509/ | opera = Perspect Biol Med | anno = 2013 }}</ref> Studies estimate that diagnostic errors contribute to 40,000 to 80,000 deaths annually.<ref>{{Cita libro | autore = Leape LL | titolo = What Practices Will Most Improve Safety? | anno = 2002 }}</ref>
| autore2 = Figel P
| autore3 = Winchester L
| titolo = Orthodontic treatment of anterior open bite: a review article--is surgery always necessary?
| url = https://www.ncbi.nlm.nih.gov/pubmed/23949448
| volume =
| opera = Oral Maxillofac Surg
| anno = 2014
| editore =
| città =
| ISBN =
| LCCN =
| DOI = 10.1007/s10006-013-0430-5
| OCLC =
}} Sep;18(3):271-7.</ref> The crossbite requires concurrent treatment due to its functional relationship with the open bite.<ref>{{cita libro  
| autore = Miamoto CB
| autore2 = Silva Marques L
| autore3 = Abreu LG
| autore4 = Paiva SM
| titolo = Impact of two early treatment protocols for anterior dental crossbite on children’s quality of life
| url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5962250/pdf/2176-9451-dpjo-23-01-00071.pdf
| volume =
| opera = Dental Press J Orthod
| anno = 2018
| editore =
| città =
| ISBN =
| LCCN =
| DOI =
| OCLC =
}} Jan-Feb; 23(1) 71–78.</ref>


In this case, the patient refused treatment, insisting that their chewing function was fine. The dentist responded by explaining the long-term risks of leaving the malocclusion untreated, but respected the patient's decision to decline treatment.
Charles Sanders Peirce's triadic approach—abduction, deduction, and induction—emphasizes that diagnostic errors often result from misinterpretations of clinical signs.<ref>{{Cita libro | autore = Vanstone M | titolo = Experienced Physician Descriptions of Intuition in Clinical Reasoning: A Typology | url = https://www.degruyter.com/document/doi/10.1515/dx-2018-0069/pdf | anno = 2019 }}</ref>
 
The case illustrates the complexity of diagnosing malocclusion, which involves more than occlusal discrepancies. Specific electrophysiological tests, such as the motor-evoked potential and jaw reflex tests, can reveal functional symmetry in the masticatory system despite occlusal issues.
 
<gallery mode="slideshow">
File:Bilateral Electric Transcranial Stimulation.jpg|'''Figure 1b:''' Motor-evoked potential test showing symmetry in the right and left masseter muscles.
File:Jaw Jerk .jpg|'''Figura 1c:''' Jaw reflex test revealing functional symmetry in the masticatory system.
File:Mechanic Silent Period.jpg|'''Figura 1d:''' Evoked mechanical silent period showing balanced neuromuscular dynamics despite malocclusion.
</gallery>
 
These electrophysiological results challenge conventional interpretations of malocclusion, highlighting the importance of interdisciplinary diagnostics that consider neuromuscular function as well as occlusal discrepancies.
 
<blockquote>''Occlusal Dismorphisms and Not Malocclusion ......which, as we will see shortly, is an entirely different matter.''</blockquote>
 
==Conclusion==
Before concluding, we must clarify that the masticatory system is a "Complex System"<ref>https://en.wikipedia.org/wiki/Complex_system</ref>, not a simple biomechanical mechanism focused solely on dental occlusion. Occlusion is just one subset within a broader context that includes periodontal receptors, neuromuscular spindles, motor units, the central nervous system, and the temporomandibular joint. This interaction creates "Emergent Behavior," or masticatory behavior.
 
Emergent behavior cannot be fully explained by analyzing a single subset; instead, the integrity of the entire system must be assessed. A notable intellectual movement addressing this challenge is Kazem Sadegh-Zadeh’s work, "Handbook of Analytic Philosophy of Medicine."<ref>{{cita libro  
| autore = Sadegh-Zadeh Kazem
| titolo = Handbook of Analytic Philosophy of Medicine
| url = https://link.springer.com/book/10.1007/978-94-007-2260-6
| volume =
| opera =
| anno = 2012
| editore = Springer
| città = Dordrecht
| ISBN = 978-94-007-2259-0
| LCCN =
| DOI = 10.1007/978-94-007-2260-6
| OCLC =
}}.</ref>
 
The masticatory system's various subsets, such as teeth, occlusion, joints, and muscles, exhibit "Coherence" with the Central Trigeminal Nervous System, as shown in the electrophysiological tests. Therefore, "malocclusion" may not be the appropriate term; "Occlusal Dysmorphisms" would be more accurate.
 
{{q2|Viewing the masticatory system as a "Complex System" doesn’t deny existing rehabilitative therapies like prosthetics or orthodontics but instead aims to enrich them by considering a broader interdisciplinary perspective.}}
 
This approach, exemplified in OrthoNeuroGnathodontic treatments, integrates aesthetic and neurophysiological aspects to achieve "Occlusal Stability" and prevent "Relapses."<ref>Essam Ahmed Al-Moraissi, Larry M Wolford. [https://pubmed.ncbi.nlm.nih.gov/27371873/ Is Counterclockwise Rotation of the Maxillomandibular Complex Stable Compared With Clockwise Rotation in the Correction of Dentofacial Deformities? A Systematic Review and Meta-Analysis]. J Oral Maxillofac Surg.. 2016 Oct;74(10):2066.e1-2066.e12.doi: 10.1016/j.joms.2016.06.001. Epub 2016 Jun 11.
</ref><ref>J Hoffmannová, R Foltán, M Vlk, K Klíma, G Pavlíková, O Bulik. [https://pubmed.ncbi.nlm.nih.gov/19537679/ Factors affecting the stability of bilateral sagittal split osteotomy of a mandible].Prague Med Rep. 2008;109(4):286-97.
</ref> While not replacing traditional treatments, this model seeks to expand medical knowledge and interdisciplinary practices in dentistry.
 
In the meantime, let us pause with a question from Linus Sapiens, our curious yellow figure on the left. He reminds us of the importance of remaining open to new perspectives in masticatory science.
 
[[File:Question_2.jpg|left|150px]]
 
{{qnq|What do we mean by “Complex Systems” when we are talking about masticatory functions?}}


In this chapter, we shifted from discussing clinical signs to machine language and non-verbal signals. The next chapters will delve deeper into logic, time, and assembler codes.
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