Masticationpedia

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{{main menu
{{main menu}}
|link to German= Hauptseite
|link to Spanish= Pàgina Principal
|link to French= Page d'accueil
|link to Italian= Introduzione
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{{ArtBy|autore=Gianni Frisardi}}
{{ArtBy| | autore = Gianni Frisardi | autore2 = Riccardo Azzali | autore3 = Flavio Frisardi }}
==Ab ovo<ref>Latin for 'since the very beginning'</ref>==


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.
==Introduction to the Logic of Medical Language== In the previous chapter on the "[[Logic of medical language|Logic of Medical Language]]", we shifted the focus from symptoms or clinical signs to an encrypted machine language. The arguments of Donald E. Stanley, Daniel G. Campos, and Pat Croskerry are relevant, especially when linked to time '''<math>t_n</math>''' as an information vector and to the idea of a message as machine language rather than verbal. <ref>{{Cite book | autore = Stanley DE | autore2 = Campos DG | titolo = The logic of medical diagnosis | url = https://pubmed.ncbi.nlm.nih.gov/23974509/ | volume = | opera = Perspect Biol Med | anno = 2013 | editore = }}</ref><ref>{{Cite book | autore = Croskerry P | titolo = Adaptive expertise in medical decision making | url = https://www.tandfonline.com/doi/abs/10.1080/0142159X.2018.1484898?journalCode=imte20 | volume = | opera = Med Teach | anno = 2018 }}</ref>


=== The phases of paradigm change according to Thomas Kuhn ===
Nevertheless, clinical history based on pseudo-formal verbal language remains essential. The idea of a machine language and system logic offers an opportunity to validate Medical-Diagnostic Science.
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 =
| autore2 =
| autore3 =
| autore4 =
| autore5 =
| autore6 =
| autore7 =
| 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
| 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
{{q2|Could classical language logic solve the dilemma of poor Mary Poppins?|A bit of patience, please}}
| autore = Kuhn Thomas S
| 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.
We cannot limit ourselves to conventional answers. Science progresses through questions and reflections. This drives us to explore key topics, such as "'''Craniofacial Biology'''".


===='''Kuhn's phases in Dentistry'''====
'''Craniofacial Biology'''
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.
An influential study by Townsend and Brook<ref name=":0">{{Cite book | autore = Townsend GC | autore2 = Brook AH | titolo = The face, the future, and dental practice | url = https://onlinelibrary.wiley.com/doi/epdf/10.1111/adj.12157 | volume = | opera = Aust Dent J | anno = 2014 }}</ref> challenges research paradigms in "Craniofacial Biology", especially with the interdisciplinary approach. Innovations such as gene sequencing, CT, MRI, laser scanning, and image analysis are transforming the field. <ref>{{Cite book | autore = Sperber GH | autore2 = Sperber SM | titolo = The genesis of craniofacial biology | url = https://onlinelibrary.wiley.com/doi/epdf/10.1111/adj.12131 | volume = | opera = Aust Dent J | anno = 2014 }}</ref>


{|
The complexity of biological systems is also recognized, influenced by diversity and epigenetics.<ref>{{Cite book | autore = Brook AH | autore2 = Brook O'Donnell M | titolo = General and craniofacial development | url = https://onlinelibrary.wiley.com/doi/epdf/10.1111/adj.12158 | opera = Aust Dent J | anno = 2014 }}</ref> The role of epigenetics in craniofacial biology has been critically explored, especially in dental and craniofacial disciplines.<ref>{{Cite book | autore = Williams SD | autore2 = Hughes TE | titolo = Epigenetics: a new frontier in dentistry | url = https://onlinelibrary.wiley.com/doi/epdf/10.1111/adj.12155 | opera = Aust Dent J | anno = 2014 }}</ref>
|-
| <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.
Phenomics (the study of the interaction between genetics and environment) is fundamental to understanding dental development.<ref>{{Cite book | autore = Yong R | autore2 = Ranjitkar S | titolo = Dental phenomics: advancing genotype to phenotype correlations | url = https://onlinelibrary.wiley.com/doi/epdf/10.1111/adj.12156 | opera = Aust Dent J | anno = 2014 }}</ref> Moreover, Irma Thesleff’s work on transient signaling centers in dental epithelium underlines the complexity of tooth development.<ref>{{Cite book | autore = Thesleff I | titolo = Current understanding of tooth formation | url = https://onlinelibrary.wiley.com/doi/epdf/10.1111/adj.12102 | opera = Aust Dent J | anno = 2013 }}</ref>


----
Other researchers have explored dental development processes and the contribution of stem cells and tissue engineering in periodontal regeneration.<ref>{{Cite book | autore = Peterkova R | autore2 = Hovorakova M | titolo = Three‐dimensional analysis of the early development of the dentition | url = https://onlinelibrary.wiley.com/doi/epdf/10.1111/adj.12130 | opera = Aust Dent J | anno = 2014 }}</ref><ref>{{Cite book | autore = Han J | titolo = Stem cells, tissue engineering and periodontal regeneration | url = https://onlinelibrary.wiley.com/doi/epdf/10.1111/adj.12100 | opera = Aust Dent J | anno = 2013 }}</ref>


==Epistemology==
Variations in tooth development, morphology, and the role of tongue pressure on craniofacial growth further highlight the significance of interdisciplinary approaches.<ref>{{Cite book | autore = Brook AH | titolo = The Dentition: The Outcomes of Morphogenesis | url = https://onlinelibrary.wiley.com/doi/epdf/10.1111/adj.12160 | opera = Aust Dent J | anno = 2014 }}</ref><ref>{{Cite book | autore = Kieser JA | titolo = The role of oral soft tissues in swallowing function | url = https://onlinelibrary.wiley.com/doi/epdf/10.1111/adj.12103 | opera = Aust Dent J | anno = 2013 }}</ref>
<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.
Practical Case
Returning to Mary Poppins, diagnosed with TMD, the dentist’s conclusions about her condition are based on classical language logic, but questions arise. Through the analysis of diagnostic data, such as stratigraphy, axiography, and electromyography, it becomes clear that these findings diverge from the conventional approach. Figures 1b, 1c, and 1d illustrate this discrepancy, showing symmetrical motor evoked potentials and mandibular responses that challenge the traditional malocclusion diagnosis.


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
<gallery widths="350" heights="282" perrow="2" mode="slideshow"> File:Occlusal Centric view in open and cross bite patient.jpg|Figure 1a: Malocclusion case File:Bilateral Electric Transcranial Stimulation.jpg|Figure 1b: Motor evoked potential File:Jaw Jerk .jpg|Figure 1c: Mandibular evoked reflex File:Mechanic Silent Period.jpg|Figure 1d: Mechanically evoked silent period </gallery>
| autore = Srivastava S
Mathematical Formalism
| titolo = Verifiability is a core principle of science
To understand the complexity of diagnosing Orofacial Pain, mathematical logic can clarify how classical language may fail. Using propositions, we construct formal arguments that either confirm or contradict the dentist's diagnosis.
| 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>
Propositions in Dental Context
If Mary Poppins' TMJ stratigraphic exam shows signs of TMD, the dentist deduces that she suffers from Orofacial Pain caused by TMD. This can be represented mathematically as:


No theory can be definitively true; while there are finite experiments to confirm it, an infinite number could refute it.<ref>{{cita libro
<math>A(\text{x}) \rightarrow B(\text{x})</math> implies that a positive TMJ exam leads to a diagnosis of TMD. However, proof by contradiction can challenge this. If it were possible that someone with a positive exam does not have TMD, the dentist’s argument would not hold.
| autore = Evans M
| titolo = Measuring statistical evidence using relative belief
| url = https://www.ncbi.nlm.nih.gov/pubmed/26925207
| volume =
| opera = Comput Struct Biotechnol J
| anno = 2016
| 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...}}
Compatibility and Incompatibility of Statements
The dentist’s conclusion is based on several statements: TMJ bone remodeling, sensitivity and specificity of axiographic measurements, and EMG interference patterns. Each statement supports the diagnosis of TMD.


...because epistemology evolves continually, even in medicine:
However, these assertions can be contested. For example, a neurologist might propose that Mary’s Orofacial Pain is neuromotor in origin, not related to TMD. Using logical tools, we analyze whether the two sets of statements—dental and neurological—are compatible. If they are incompatible, the dentist's diagnosis could be invalid.


{|
Final Considerations
|-
The application of mathematical logic strengthens the dentist's deductive reasoning. Still, as research evolves, new theories could emerge that align with the neurologist’s position. For now, classical logic favors the dentist’s interpretation, but future findings might shift this understanding, leading to a re-evaluation of Orofacial Pain diagnostics.
|
*'''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 =
| OCLC =
}}</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==
{{q2|Should we adopt a probabilistic approach?|It’s possible.}} {{Bib}} {{apm}} <onlyinclude> </onlyinclude>
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
| 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
| 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."
 
== Dental Malocclusion==
 
"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.
 
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
| 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.}}
 
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>
 
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."
 
[[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]]
 
{{qnq|What does "Malocclusion" mean?|}}
 
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
| autore = Reichert I
| 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.
 
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?}}
 
{{Bib}}
 
{{apm}}[[Category:Introduction]]
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Latest revision as of 13:04, 17 October 2024

Correction chapters

 

Masticationpedia

 

==Introduction to the Logic of Medical Language== In the previous chapter on the "Logic of Medical Language", we shifted the focus from symptoms or clinical signs to an encrypted machine language. The arguments of Donald E. Stanley, Daniel G. Campos, and Pat Croskerry are relevant, especially when linked to time as an information vector and to the idea of a message as machine language rather than verbal. [1][2]

Nevertheless, clinical history based on pseudo-formal verbal language remains essential. The idea of a machine language and system logic offers an opportunity to validate Medical-Diagnostic Science.

«Could classical language logic solve the dilemma of poor Mary Poppins?»
(A bit of patience, please)

We cannot limit ourselves to conventional answers. Science progresses through questions and reflections. This drives us to explore key topics, such as "Craniofacial Biology".

Craniofacial Biology An influential study by Townsend and Brook[3] challenges research paradigms in "Craniofacial Biology", especially with the interdisciplinary approach. Innovations such as gene sequencing, CT, MRI, laser scanning, and image analysis are transforming the field. [4]

The complexity of biological systems is also recognized, influenced by diversity and epigenetics.[5] The role of epigenetics in craniofacial biology has been critically explored, especially in dental and craniofacial disciplines.[6]

Phenomics (the study of the interaction between genetics and environment) is fundamental to understanding dental development.[7] Moreover, Irma Thesleff’s work on transient signaling centers in dental epithelium underlines the complexity of tooth development.[8]

Other researchers have explored dental development processes and the contribution of stem cells and tissue engineering in periodontal regeneration.[9][10]

Variations in tooth development, morphology, and the role of tongue pressure on craniofacial growth further highlight the significance of interdisciplinary approaches.[11][12]

Practical Case Returning to Mary Poppins, diagnosed with TMD, the dentist’s conclusions about her condition are based on classical language logic, but questions arise. Through the analysis of diagnostic data, such as stratigraphy, axiography, and electromyography, it becomes clear that these findings diverge from the conventional approach. Figures 1b, 1c, and 1d illustrate this discrepancy, showing symmetrical motor evoked potentials and mandibular responses that challenge the traditional malocclusion diagnosis.

  • Figure 1d: Mechanically evoked silent period

Mathematical Formalism To understand the complexity of diagnosing Orofacial Pain, mathematical logic can clarify how classical language may fail. Using propositions, we construct formal arguments that either confirm or contradict the dentist's diagnosis.

Propositions in Dental Context If Mary Poppins' TMJ stratigraphic exam shows signs of TMD, the dentist deduces that she suffers from Orofacial Pain caused by TMD. This can be represented mathematically as:

implies that a positive TMJ exam leads to a diagnosis of TMD. However, proof by contradiction can challenge this. If it were possible that someone with a positive exam does not have TMD, the dentist’s argument would not hold.

Compatibility and Incompatibility of Statements The dentist’s conclusion is based on several statements: TMJ bone remodeling, sensitivity and specificity of axiographic measurements, and EMG interference patterns. Each statement supports the diagnosis of TMD.

However, these assertions can be contested. For example, a neurologist might propose that Mary’s Orofacial Pain is neuromotor in origin, not related to TMD. Using logical tools, we analyze whether the two sets of statements—dental and neurological—are compatible. If they are incompatible, the dentist's diagnosis could be invalid.

Final Considerations The application of mathematical logic strengthens the dentist's deductive reasoning. Still, as research evolves, new theories could emerge that align with the neurologist’s position. For now, classical logic favors the dentist’s interpretation, but future findings might shift this understanding, leading to a re-evaluation of Orofacial Pain diagnostics.

«Should we adopt a probabilistic approach?»
(It’s possible.)
Bibliography & references
  1. ↑ Stanley DE, Campos DG, «The logic of medical diagnosis», in Perspect Biol Med, 2013». 
  2. ↑ Croskerry P, «Adaptive expertise in medical decision making», in Med Teach, 2018». 
  3. ↑ Townsend GC, Brook AH, «The face, the future, and dental practice», in Aust Dent J, 2014». 
  4. ↑ Sperber GH, Sperber SM, «The genesis of craniofacial biology», in Aust Dent J, 2014». 
  5. ↑ Brook AH, Brook O'Donnell M, «General and craniofacial development», in Aust Dent J, 2014». 
  6. ↑ Williams SD, Hughes TE, «Epigenetics: a new frontier in dentistry», in Aust Dent J, 2014». 
  7. ↑ Yong R, Ranjitkar S, «Dental phenomics: advancing genotype to phenotype correlations», in Aust Dent J, 2014». 
  8. ↑ Thesleff I, «Current understanding of tooth formation», in Aust Dent J, 2013». 
  9. ↑ Peterkova R, Hovorakova M, «Three‐dimensional analysis of the early development of the dentition», in Aust Dent J, 2014». 
  10. ↑ Han J, «Stem cells, tissue engineering and periodontal regeneration», in Aust Dent J, 2013». 
  11. ↑ Brook AH, «The Dentition: The Outcomes of Morphogenesis», in Aust Dent J, 2014». 
  12. ↑ Kieser JA, «The role of oral soft tissues in swallowing function», in Aust Dent J, 2013». 
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