Draft:Introduction - fr

Nous aimerions que notre lecteur ait une perception immédiate des sujets qui seront débattus dans Masticationpedia ; nous passerons en revue quelques-unes des questions les plus actuelles concernant l'évolution épistémologique de la science en général, et de la médecine ainsi que de la médecine dentaire en particulier...

Dans cette phase nous considérerons les deux aspects fondamentaux du Progrès de la Science, selon les Paradigmes de Kuhn, et de l'Epistémologie qui remet en question les concepts d'"Inférence Statistique" et d'"Interdisciplinarité". Ces deux thèmes, qui semblent apparemment en conflit l'un avec l'autre, comme le premier a besoin de discipline pour mettre en évidence les « Anomalies du Paradigme » et le second a besoin d'« Interdisciplinarité », ils vont s'intégrer à travers un élément de résolution qui consiste en « échafaudages ", c'est-à-dire des passerelles cognitives entre disciplines spécialisées. Dans ce contexte, le lecteur pourra donc mieux apprécier l'approche stochastique de l'un des sujets les plus controversés des rééducations masticatoires, comme la "Malocclusion", d'où proviennent la plupart des procédures de rééducation masticatoire telles que l'orthodontie, la prothèse et chirurgie orthognathique. Ainsi, en plus d'anticiper l'aspect scientifique et philosophique de Masticationpedia, nous nous concentrerons enfin sur des sujets tels que les "Systèmes Complexes", le "Comportement Emergent" des Systèmes Complexes et la "Cohérence des Systèmes" : étapes nécessaires pour introduire des sujets cliniques scientifiques qui apportent avec eux des doutes, des interrogations et en même temps des innovations paradigmatiques tendant à changer le statu quo de la routine de pensée clinique déterministe et réductionniste, devant une logique de langage stochastique et interdisciplinaire.

 

Article by  Gianni Frisardi

 

Ab ovo

Avant d'entrer dans le vif du sujet du traitement Masticationpedia, une prémisse s'impose, qui concerne principalement deux aspects de la réalité sociale, scientifique et clinique de l'époque actuelle et de l'époque immédiatement précédente.

Les phases de changement de paradigme selon Thomas Kuhn

Au siècle dernier, on a assisté à une croissance exponentielle des "Innovations" technologiques et méthodologiques spécifiquement en dentisterie; ces innovations ont en quelque sorte influencé les stratégies de prise de décision, les opinions, les écoles de pensée et les axiomes afin d'améliorer la qualité de vie, comme l'indique le "Exposure Science in the 21st Century". Cependant, cette croissance exponentielle entraîne, implicitement, des zones grises conceptuelles (en pratique des « effets secondaires ») parfois sous-estimées, mais qui peuvent remettre en cause certaines Certitudes Scientifiques ou les rendre moins absolues et plus probabilistes.

Les deux aspects sensibles de la réalité sociale, scientifique et clinique actuelle (qui semblent s'opposer, mais comme nous le verrons à la fin de cette lecture seront complémentaires) sont le "Progrès de la Science" selon Kuhn et le " Épistémologie".

Les progrès de la science selon Thomas Kuhn

Thomas Kuhn, dans son ouvrage le plus célèbre, déclare que la science passe cycliquement par certaines phases indicatives de son fonctionnement. Selon Kuhn, la science est paradigmatique et la démarcation entre science et pseudoscience remonte à l'existence d'un paradigme. L'évolution du progrès scientifique est assimilée à une courbe continue qui subit une discontinuité dans les changements de paradigme.

En bon solutionneur de problèmes, le scientifique essaie de résoudre ces anomalies.

Les phases de Kuhn en Dentisterie

Kuhn, au contraire, divise l'évolution d'un paradigme en cinq phases ; c'est un processus fondamental pour Masticationpedia, mais pour rester à l'écoute du projet nous nous limiterons à décrire les trois phases les plus significatives partagées dans le projet et indiquées dans l'index du livre:

	Phase 2, ou la Science normale Par exemple, dans la phase 2 des paradigmes de Kuhn, appelée science normale, les scientifiques sont considérés comme des résolveurs de problèmes, qui travaillent à améliorer l'accord entre le paradigme et la nature. Cette phase repose en effet sur un ensemble de principes de base dictés par le paradigme, qui ne sont pas remis en cause mais qui, en effet, se voient confier la tâche d'indiquer les coordonnées des travaux à venir. Dans cette phase, les instruments de mesure avec lesquels les expériences sont faites sont développés, la plupart des articles scientifiques sont produits et ses résultats constituent une croissance significative des connaissances scientifiques. Dans la phase scientifique normale, les succès et les échecs seront atteints ; les échecs sont appelés par Kuhn des anomalies, ou des événements qui vont à l'encontre du paradigme.
	Phase 4, ou la Crise du paradigme En conséquence de la crise, différents paradigmes seront créés au cours de cette période. Ces nouveaux paradigmes ne proviendront donc pas des résultats obtenus par la théorie précédente, mais plutôt de l'abandon des schémas préétablis du paradigme dominant. En suivant ce chemin, dans Masticationpedia, la crise du paradigme de la réadaptation masticatoire sera discutée en passant en revue les théories, les théorèmes, les axiomes, les écoles de pensée et les critères de diagnostic de recherche, puis l'accent sera mis sur la phase 5.
	Phase 5, ou la Scientifiques extraordinaires La phase 5 traite de la révolution (scientifique). En période d'activités scientifiques extraordinaires, une discussion s'ouvrira au sein de la communauté scientifique sur quel nouveau paradigme accepter. Mais ce ne sera pas forcément le paradigme le plus "vrai" ou le plus efficace qui s'imposera, mais celui qui saura capter l'intérêt d'un nombre suffisant de scientifiques et gagner la confiance de la communauté scientifique. Les paradigmes qui participent à ce choc, selon Kuhn, n'ont rien en commun, pas même les bases et, par conséquent, ne sont pas comparables (ils sont « incommensurables »). Le paradigme est choisi, comme on l'a dit, sur une base socio-psychologique ou biologique (les jeunes scientifiques remplacent les plus âgés). La bataille entre les paradigmes résoudra la crise, le nouveau paradigme sera nommé et la science sera ramenée à la phase 1. Pour le même principe de Phase 4, Masticationpedia proposera, dans le chapitre intitulé Extraordinary science, un nouveau modèle paradigmatique dans le domaine de la rééducation du Système Masticatoire discutant de ses principes, motivations, expériences scientifiques cliniques et, surtout, un changement radical de le domaine du diagnostic médical. Ce changement est essentiellement basé sur l'inférence du système, plutôt que sur l'inférence des symptômes, donnant principalement une valeur absolue à l'objectivité des données.

Il est presque évident que la philosophie scientifique kuhnienne préfère la discipline, car une anomalie dans le paradigme génomique sera mieux remarquée par un généticien que par un neurophysiologiste. Or ce concept semblerait en contraste avec l'évolution épistémologique de la Science, aussi vaut-il mieux s'y arrêter une minute en détail.

Epistemology

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 the swans are white? Really?
	Kuhn used optical illusion to demonstrate how a paradigm shift can cause a person to see the same information in a completely different way: which animal is the one here aside? Sure?

---

Epistemology (from the Greek ἐπιστήμη, epistème, "certain knowledge" or "science", and λόγος, logos, "speech") is that branch of philosophy which deals with the conditions under which scientific knowledge can be obtained and the methods for achieving such knowledge. The term specifically indicates that part of gnoseology which studies the foundations, validity and limits of scientific knowledge. In English-speaking countries, the concept of epistemology is instead mainly used as a synonym for gnoseology or knowledge theory — the discipline that deals with the study of knowledge.

Incidentally, the basic problem of epistemology today, as in Hume’s time, remains that of verifiability.

The Hempel paradox tells us that each sighted white swan confirms that crows are black; that is, each example not in contrast with the theory confirms a part of it:

$A\Rightarrow B=\lnot A\lor B$

According to the objection of falsifiability, instead, no theory is ever true because, while there are only a finite number of experiments in favour, there is also theoretically an infinite number that could falsify it.

But it’s not all so obvious...

...because the very concept of epistemology meets continuous implementations, like in medicine:

$P-value$: In medicine, for example, to confirm an experiment, a series of data coming from laboratory instruments or from surveys, the "Statistical Inference" is used, and in particular a famous value called "significance test" (P-value). Well, even this concept, now part of the researcher's genesis, is wavering. In a recent study, attention was focused on a "Campaign" conducted on "Nature" against the concept of "significance tests". With over 800 signatories supporting important scientists, this "campaign" can be considered an important milestone and a "Silent Revolution" in statistics on logical and epistemological aspects. The campaign criticizes the too simplified statistical analyses that can still be found in many publications to date. This eventually led to a discussion, sponsored by the American Statistical Association, which spawned a special issue of "The American Statistician Association" titled "Statistical Inference in the 21st Century: A World Beyond p <0,05", containing 43 articles by forward-looking statisticians. The special question proposes both new ways to signal the importance of research results beyond the arbitrary threshold of a P-value, and some guides to conduct of research: the researcher should accept uncertainty, be reflective, open and modest in his/ her statements. Future will show whether or not those attempts to statistically better support science beyond the significance tests will be reflected in future publications. In this field too, we are on the same wavelength as the Progress of Science according to Kuhn, in that we are talking about the re-modulation of some descriptive statistical contents within the scope of disciplinarity.

Interdisciplinarity: In science policy, it is generally recognized that science-based problem solving requires interdisciplinary research (IDR), as proposed by the EU project called Horizon 2020. In a recent study, the authors focus on the question why researchers have cognitive and epistemic difficulties in conducting IDR. It is believed that the loss of philosophical interest in the epistemology of interdisciplinary research is due to a philosophical paradigm of science called "Physics Paradigm of Science", which prevents recognition of important IDR changes in both the philosophy of science and research. The proposed alternative philosophical paradigm, called "Engineering Paradigm of Science", makes alternative philosophical assumptions about aspects such as the purpose of science, the character of knowledge, the epistemic and pragmatic criteria for the acceptance of knowledge and the role of technological tools. Consequently, scientific researchers need so-called metacognitive scaffolds to assist them in the analysis and reconstruction of how "knowledge" is constructed in different disciplines. In interdisciplinary research, metacognitive scaffolds help interdisciplinary communication analyse and articulate how the discipline builds knowledge.

P-value vs. Interdisciplinarity

Given the above, on a superficial view of the epistemic evolution of the Science, the two aspects of disciplinarity ("Physics Paradigm of Science", highlighting the anomaly) and Interdisciplinary ("Engineering Paradigm of Science", metacognitive scaffold), might seem to be in conflict with each other; in reality, however, as we are just going to see right in this chapter, they are two sides of the same coin because both tend to generate "Paradigmatic Innovation" without any conflict at all.

Now we could conclude that the "Innovations" are already "Progress of Science" in themselves, as stated in the article "Scientific basis of dentistry" by Yegane Guven, in which the effect of biological and digital revolutions is considered on dental education and daily clinical practice, such as personalized regenerative dentistry, nanotechnologies, virtual reality simulations, genomic information and stem cell studies. The innovations mentioned by Guven are obviously to be considered as technological and methodological in nature; however, the Progress of Science does not move forward with this kind of Innovations, which are called "Incremental Innovations" and "Radical Innovations", but it occurs substantially through "Paradigmatic Innovations".

In the strictest sense of the phrase, "Paradigmatic Innovations" are essentially a change of thought and awareness that pervades the whole of humanity, starting from different social strata, from the Copernican scientific revolution to the current trend of Stochastic approach to the biological phenomenon.

In this epistemological context (in addition to other initiatives such as the Research Diagnostic Criteria in the field of the Temporomandibular Disorders — RDC/TMDs), of the Evidence Based Medicine (and other), the Masticationpedia project inserts itself in order to highlight the dialectics dynamism about the progress of the masticatory rehabilitation science. Masticationpedia tends, moreover, to highlight the anomalies that inevitably stimulate a change of thought and therefore a "Paradigmatic Innovation".

Before proceeeding, it could be appropriate to observe a very concrete and significant case.

Malocclusion

Malocclusion: it literally means a bad (malum, in Latin) closure of the dentition. The closure is easy to understand, we believe, but the epithet "bad" must be understood with care as well, because it is not as simple as it seems.

To briefly grasp the concept, in this first introductory reading we will try to present a simple but highly debatable question that involves a series of other questions in the field of masticatory rehabilitation and especially in orthodontic disciplines: what is "Malocclusion"? Bear in mind that in 2019, a Pubmed query about this term returned a result of "only" 33,309 articles, which says it all about the hypothetical terminological agreement on the subject; and, therefore, very meaningful conclusions could be drawn every now and then from these articles, such as the ones we reproduce in full from an article by Smaglyuk and collaborators, a somewhat "sensational" article that deals with the interdisciplinary approach in the diagnosis of malocclusions:

«The diagnostics, treatment tactics and prevention of dento-facial anomalies and deformations should be considered in the context of the integrity of the child's unformed organism, the interdependence of the form and functions of its organs and systems»

Another noteworthy fact is that if in the same 2019 Pubmed was questioned on interdisciplinarity in the diagnosis of malocclusions, the result dropped drastically to just four articles.

These premises to the "Malocclusion” question indicate, on one hand, an alert about anomalies that tend to activate Kuhn phase 4 and, on the other, a bifurcation in the epistemic choice on the subject: one that generates Incremental Innovations (others 33,309 articles, perhaps) and another that prefers a new gnoseological path of "Paradigmatic Innovation”.

Let’s try to approach part of the concept that considers the "Paradigmatic Innovation” as essential, asking ourselves for example:

Figure 1a:
Patient with malocclusion, open bite and right posterior crossbite who in rehabilitation terms should be treated with orthodontic therapy and / or orthognathic surgery.

What does "Malocclusion" mean?

We will answer this question by reporting a clinical case of evident “Malocclusion”.

Patient is with an occlusion that orthodontists call “Malocclusion” because it has a posterior unilateral crossbite and anterior openbite; it is a malocclusion that can be treated with a fixed orthodontic therapy and possibly in combination with an orthognathic intervention. Crossbite is another element of disturbance in normal occlusion because of which it is obligatorily treated together with the openbite.

It is self-evident that an observer with a deterministic mindset facing a phenomenon of such evident occlusal incongruity considers crossbite and openbite the cause of malocclusion (cause/effect) or vice versa; and it is obvious, as well, that the observer recommends an orthodontic treatment to restore a “Normocclusion”. This way of reasoning means that the model (masticatory system) is “normalized to occlusion”; and if read backwards, it means that the occlusal discrepancy is the cause of malocclusion and, therefore, of disease of the Masticatory System. (Figure 1a).

But let's hear what the two players say, the dentist and the patient, in the informative dialogue.

Figure 1b: Motor evoked potential from electrical transcranial stimulation of the trigeminal roots. Note the structural symmetry calculated by the peak-to-peak amplitude on the right and left masseters.

The dentist tells the patient that he is suffering from severe malocclusion and that it should be treated to improve its aesthetics and chewing function. The patient, however, replies firmly: «No way, I haven't the slightest idea to do it at all, doctor, because I might even have an unrepresentative smile, but I eat very well.» The dentist’s reply is ready, so the practitioner insists by saying: «but you have a serious malocclusion with an openbite and a unilateral posterior crossbite, you should already have problems with bruxism and swallowing, as well as posture.» The patient closes the confrontation in a decisive way: «absolutely false: I chew very well, I swallow very well and at night I snore alot so I don’t grind; besides, I’m a sportsman and I don’t have any postural disturbance».

Now the conclusion remains very critical because we might be finding ourselves in front of a verbal language of the patient which is misleading because it is not specific and does not respond to a detailed physiopathogenetic knowledge of the occlusal state; or, paradoxically, we are otherwise facing a machine language converted into verbal language which guarantees the integrity of the system. At this point the situation is truly embarrassing because neither the patient nor the observer (dentist) will be able to say with certainty that the System is in a “Malocclusion” state.

Figure 1c: Mandibular reflex evoked by percussion of the chin through a triggered neurological hammer.
Note the functional symmetry calculated by the peak-to-peak amplitude on the right and left masseters.

It is precisely at this moment that one remembers the criticism of the American Statistician Association titled “Statistical inference in the 21st century: A World Beyond p <0.05”, which urges the researcher to accept uncertainty, be sensible reflective, open and modest in his statements: which basically translates into a search for interdisciplinarity.

Interdisciplinarity, in fact, could answer such a complex question; but it is nonetheless necessary to interpret the biological phenomenon of "“Malocclusion”" with a stochastic forma mentis of which we will discuss in detail later.

A stochastic observer may observe that there is a low probability that the patient, at the moment $T_{n}$, is in a state of occlusal disease, as the patient's natural language indicates ideal psychophysical health; he/she then concludes that the occlusal discrepancy could not be a cause of neuromuscular and psychophysical functional disorder. In this case, therefore, the Masticatory System can not only be normalized to the occlusion only, but a more complex model is needed too, so it has to be normalized to the Trigeminal Nervous System. The patient was then served a series of trigeminal electrophysiological tests to assess the integrity of his/her Trigeminal Nervous System in these “"Malocclusion”" clinical conditions.

Figure 1d: Mechanical silent period evoked by percussion of the chin through a triggered neurological hammer. Note the functional symmetry calculated on the integral area of the right and left masseters.

We can see the following output responses, which we report directly in figures 1b, 1c and 1d (with explanation in the caption, to simplify the discussion). These tests and their description by now should only be considered as “Conceptual Rationale” for the “Malocclusion” question; later they will be widely described and their analysis detailed in the specific chapters. It can already be noted in this first descriptive approach to the masticatory phenomenon that there is an evident discrepancy between the occlusal state (which at first would support the orthodoxy of classical orthodontics in considering it as “Malocclusive State”) and the neurophysiological data indicating incredible synchronization and perfect symmetry of the trigeminal reflexes.

These results can be attributed to anything less than a "malocclusion": we are obviously in front of an error of the logic Language in medicine, in this case it is in fact more appropriate to talk about...

Occlusal dysmorphism and not Malocclusion (which, as we shall see a little further on, is quite another thing)

Conclusion

Even before drawing conclusions, conceptual clarity must be made on some fundamental points which of course will be treated in detail in the specific chapters of Masticationpedia.

The Masticatory System should be considered as a “Complex System”, not as a Biomechanical System focused exclusively on dental occlusion, because in this sense the “Occlusion” is nothing more than a subset of the Complex System interacting with the other subsets, such as periodontal receptors, neuromuscular spindles, recruitment of motor units, central nervous system, temporomandibular joint, etc., to give shape to an “Emerging Behaviour”, the masticatory one.

The peculiarity of this concept is that it is not possible to interpret or predict the “Emerging Behaviour” of a System by extracting objective data from a single subset. Instead, the integrity of the System must be quantified in its entirety, and only then can a segmentation of the whole be attempted to make an analytical description of the node itself. There are very important intellectual and scientific movements that are engaging with this issue; in this regard, the extraordinary work of Prof. Kazem Sadegh-Zadeh: Handbook of Analytic Philosophy of Medicine comes to mind.

In the presented case, the question is resolved in the following language logic:

The subsets of the Masticatory System (teeth, occlusion, Temporomandibular joints, muscles, etc.) are in a state of "Coherence” with the Central Trigeminal Nervous System (see figures 1b, 1c and 1d), so the term “Malocclusion” cannot be used, the phrase “Occlusal Dismorphism” should be considered instead.

«This does not mean abolishing prosthetic, orthodontic and orthognathic masticatory rehabilitation treatments: on the contrary, this forma mentis tends to restore medical knowledge to dental rehabilitation disciplines, as well as offering an alternative to the scientific reductionism that converges in a deterministic interpretation of the biological phenomenon.»

Going beyond the specialist perimeters of the disciplines, as previously reported on interdisciplinarity, helps expanding the diagnostic and therapeutic models as it can be seen in the Clinical case in which a patient was treated with the OrthoNeuroGnathodontic method is reported.

In this way, an overall view of the entire Masticatory System is presented in order to gather the aesthetic and functional-neurophysiological components together to determine “Occlusal Stability” and to avoid “Relapses”, especially in orthodontic and orthognathic treatments.

These are just some of the topics that will be covered extensively both in this chapter and in what we call “Extraordinary Science”. Meanwhile, in a fitting diversion our colourful friend Linus Sapiens, the little yellow man on the left, asks us:

 

«What do we mean by “Complex Systems” when we are talking about masticatory functions?» (Not a trivial question, let's start talking, then, about the logic of medical language)

Bibliography & references

Masticationpedia is a charity, a not-for-profit organization operating in dentistry medical research,
particularly focusing on the field of the neurophysiology of the masticatory system
 

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