|Year : 2016 | Volume
| Issue : 2 | Page : 31-33
Etiology-based diagnostics for improvement of treatment
Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
|Date of Web Publication||9-Jun-2016|
Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, 20 Nørre Alle, DK-2200 Copenhagen N, København
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kjaer I. Etiology-based diagnostics for improvement of treatment. Dent Hypotheses 2016;7:31-3
In this communication, focus will be given to definition of diagnosis, to the different way of diagnosing, to the question concerning etiology of a disease or condition, and to the way this Journal, Dental Hypotheses, can improve diagnostics. Last but not least, examples will be given, demonstrating how etiology-based diagnostics can improve dental and medical treatments.
| Definition of Diagnosis|| |
Several definitions have been given of the word "diagnosis." It is generally accepted that a diagnosis distinguishes one disease from another and determines the nature of a disease. Dental caries is a diagnosis, which gives associations to etiology, a bacterial attack. Meanwhile, many diagnoses in odontology cannot be convincingly associated with an etiology such as arrestment in eruption, tooth transpositions, or root resorption.
| Different Ways to Diagnose|| |
Several affixes have been attached to the word diagnosis. Thus, we are all familiar with clinical diagnosis, which is based on signs, symptoms, and/or laboratory findings. Furthermore, biological diagnosis, cytohistologic diagnosis, anatomic-pathological diagnosis, differential diagnosis, and physical diagnosis are well known. Again several diagnoses within specific fields such as roentgen diagnosis, orthodontic diagnosis, genetic diagnosis, and serum diagnosis are generally used. These diagnoses and several others, including diagnosis performed by exclusion are generally recognized and defined in Dorland's illustrated medical dictionary. 
What does not appear systematically in overviews of different ways to diagnose is the word etiology-based diagnosis. This type of diagnosis requires that the etiology is well known.
| Etiology of Disease|| |
Etiology means cause in Greek. Etiology studies are studies or theories of the factors that cause disease or reveal the origin of a disease or disorder. Thus, accordingly etiology-based diagnostics of, for example, arrested eruption highlights the cause of arrestment. When the cause is known, the treatment is optimal. In the medical literature, a recent proposal for etiology-based diagnosis of adult starvation and disease-related malnutrition has been given.  The goal was to reveal factors in the pathophysiologic malnutrition.
Etiology can indicate inherited and acquired conditions. According to Spranger et al.'s classification,  the inherited conditions can be malformation or dysplasia, and the acquired conditions can be disruption or deformations.
| How Can This Journal Improve Etiology-Based Diagnostics?|| |
Research in human development is limited, not only because of limited access to material but also due to methods available for human research. Therefore, it is very important to have a journal like Dental Hypotheses, where ideas and hypotheses can be discussed. Important inputs to odontology arise often from different medical disciplines such as endocrinology, embryology, human pathology, neurology, and neuropsychiatry. Those diagnostics and treatment problems in odontology, arising on the borderlines between different scientific disciplines, are often difficult to solve, due to limited scientific insight into neighboring disciplines.
The following are diagnostic examples, demonstrating a search for improvement of treatment.
| Dental Treatments|| |
Example 1: The tooth eruption process is not yet fully understood. Therefore, it is important to analyze how eruption hypotheses can explain different types of arrest in eruption. A recent study explains how primary and secondary retention can be understood.  Accordingly, the treatment in these two types of arrestment is different.
Example 2: The general agreement is that juvenile periodontitis is caused by attack from bacteria or virus. Meanwhile, a recent hypothesis has suggested that the reduced level of alveolar bone in the initial stages of juvenile periodontitis is explained not by infection but by local arrestment in alveolar bone growth.  This difference in etiology influences the treatment.
Example 3: Root resorption occurring without influence from external forces has been unexplainable. New studies have demonstrated that a periroot-sheet composed by different tissue types exists.  This observation can explain why different conditions (different tissue types) can be associated with root resorption. This is the first step to suggests a treatment plan.
| Medical Treatments|| |
Example 1: Based on a mapping of tooth agenesis and tooth malformations in the three conditions, cleft lip, isolated cleft palate, and combined cleft lip and cleft palate, different etiologies for the three conditions have been proposed.  How this will interfere with treatment and with neurologic signs and symptoms will be revealed in the future.
Example 2: neuroradiological investigations of a child with a single median maxillary central incisor  have demonstrated that the incisor region is associated with the frontal lobes of the hemispheres. This observation explains the occurrence of a possible interrelationship between mental retardation and SMMCI. This is a neuropsychological aspect, which cannot be elucidated only by dentists but also by neurologists and neuropsychiatrists.
Example 3: macrodontic maxillary incisors are in some cases associated with minor mental disabilities. Dentists cannot alone, but only in a future collaboration with neuropsychiatrists improve the understanding of this inter-relationship. 
| What Now?|| |
Still many more unsolved questions exist in odontology. One example is dental transposition. What is the etiology behind this condition, and will a hypothesis behind this condition influence the treatment? In cases like this, it is very important to continue the ongoing phenotypic description of different types of transposition. Phenotypic descriptions are in all conditions important for suggesting a hypothesis. Focus should in the future also be given to etiology-based diagnostics, which is essential for optimal treatment.
| References|| |
Taylor EF, editor. Dorlands Medical Illustrated Dictionary. Philadelphia: WB Saunders Co.; 1988.
Jensen GL, Mirtallo J, Compher C, Dhaliwal R, Forbes A, Grijalba RF, et al.
Adult starvation and disease-related malnutrition: A proposal for etiology-based diagnosis in the clinical practice setting from the International Consensus Guideline Committee. Clin Nutr 2010;29:151-3.
Spranger J, Benirschke K, Hall JG, Lenz W, Lowry RB, Opitz JM, et al.
Errors of morphogenesis: Concepts and terms. Recommendations of an international working group. J Pediatr 1982;100:160-5.
Kjær I. Mechanism of human tooth eruption: Review article including a new theory for future studies on the eruption process. Scientifica (Cairo) 2014;2014:341905.
Kjær I. Can the reduced level of alveolar bone in the initial stages of juvenile periodontitis anterior to the first molar be explained as arrest in alveolar bone growth. Dent Hypotheses 2013;4:44-9.
Kjær I. External root resorption: Different etiologies explained from the composition of the human root-close periodontal membrane. Dent Hypotheses 2013;4:75-9.
Riis LC, Kjær I, Mølsted K. Dental anomalies in different cleft groups related to neural crest developmental fields contributes to the understanding of cleft aetiology. J Plast Surg Hand Surg 2014;48:126-31.
Kjaer I, Wagner A, Thomsen LL, Holm K. Brain malformation in single median maxillary central incisor. Neuropediatrics 2009;40:280-3.
Kenrad AB, Kjær I. The interrelationship between permanent maxillary incisors and neuropsychiatric conditions. J Neuropsychiatry 2016;2:1-3.