Difference between revisions of "Are we sure to know everything?"

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+'''Abstract:'''This chapter addresses the diagnostic challenges in the field of Orofacial Pain (OP) and Temporomandibular Disorders (TMDs), conditions that often obscure more severe neurological or systemic pathologies, sometimes delaying diagnosis for years. Research shows a high prevalence of TMD (30-50%) worldwide, yet the variability in these numbers between studies raises questions about study design, statistical methods, and knowledge gaps. This variability has driven the International Scientific Community to seek new paradigms, such as the Research Diagnostic Criteria (RDC), to improve diagnostic and therapeutic accuracy.
+Despite the conceptual advancements of the RDC, its positive predictive values derived from Bayesian models may not capture the full diagnostic complexity in patients presenting with both masticatory system disorders (e.g., TMJ noises, bruxism) and orofacial pain. The limitations of classical statistical methods have prompted the development of a new Consortium Network, with significant contributions from meetings and workshops such as those in Miami, San Diego, and Cape Town. The network aims to integrate multiple diagnostic perspectives, moving beyond traditional approaches to explore more complex, multidisciplinary frameworks.
+A critical issue discussed is the role of context in diagnosis. Classical logic often falls short in understanding complex, overlapping conditions like TMDs, as it operates in isolated scientific contexts (e.g., dental or neurological). The authors propose a fuzzy logic approach, integrating multiple contexts to create a more comprehensive diagnostic framework, reducing diagnostic risk. This model acknowledges that patient symptoms and diagnostic indicators are often not absolute but exist along a spectrum of plausibility and possibility.
+Additionally, the chapter explores the importance of the order of information in diagnosis. In classical Bayesian models, the order of information presentation does not affect the outcome. However, in real-world medical decision-making, the order can significantly influence the diagnostic hypothesis. This insight, borrowed from quantum theory, suggests that diagnostic information should be treated as potentially incompatible, requiring more sophisticated probabilistic models like quantum probability to account for the complexities of medical inference.
+Finally, the chapter concludes that addressing the diagnostic intricacies of TMDs requires a paradigm shift towards interdisciplinary research and cognitive models that better reflect the nuanced nature of clinical decision-making. This approach, as advocated by the International RDC/TMD Consortium, is crucial for advancing both diagnostic accuracy and patient care in the realm of orofacial pain.
 ===Introduction===
 During the previous chapters of Masticationpedia we wanted to highlight the diagnostic complexity in the field of Orofacial Pain and Temporomandibular Disorders (TMDs) which sometimes hide much more serious neurological and/or systemic pathologies with a diagnostic course of decades. One of the most striking data that emerges from research in the literature is the high prevalence of TMD (30%-50%) throughout the world<ref>Ouanounou A, Goldberg M, Haas DA. [https://jcda.ca/h7 Pharmacotherapy in '''Temporomandibular''' '''Disorders''': A '''Review'''.] J Can Dent Assoc. 2017 Jul;83:h7.</ref> combined with their variability between clinical studies (3-20%)..<ref>Poveda Roda R, Bagan JV, Díaz Fernández JM, Hernández Bazán S, Jiménez Soriano Y. '''Review''' of '''temporomandibular''' '''joint''' pathology. Part I: classification, '''epidemiology''' and risk factors. Med Oral Patol Oral Cir Bucal. 2007 Aug 1;12(4):E292-8.</ref><ref>Türp JC, Schindler HJ.Schmerz. Chronic '''temporomandibular''' '''disorders''']. 2004 Apr;18(2):109-17. doi: 10.1007/s00482-003-0279-x.PMID: 15067530 </ref><ref>Fricton JR. The relationship of '''temporomandibular''' '''disorders''' and fibromyalgia: implications for diagnosis and treatment.  Curr Pain Headache Rep. 2004 Oct;8(5):355-63. doi: 10.1007/s11916-996-0008-0.PMID: 15361319 </ref><ref>De Meyer MD, De Boever JA.The role of bruxism in the appearance of '''temporomandibular''' '''joint''' '''disorders'''].Rev Belge Med Dent (1984). 1997;52(4):124-38. PMID: 9709800