Fundamentals of Treatment Planning

CHAPTER ONE

Past, present, and future of treatment planning

"Those who do not learn from history are doomed to repeat it."

George Santayana (1863-1952)

"The past should be read with the eyes of present time."

Charles Darwin (1809-1882)

"The past is never dead. It's not even past."

William Faulkner (1897-1962)

The distant past

The author believes it is important to understand history not so much as a chronicle of events but in terms of the value we attach to and derive from these events. In this way, we arrive at the significance of the events. When we look back, we understand that for long millennia our civilization was not able to conceive or understand much about science, as we know it today. Certainly, in the distant past, people had absolutely no idea what they were doing when treating physical disease and illness.1-4 But once in a while, a gifted individual with a 'beautiful mind' sensed something new, and in this way our knowledge was carried a step or two forward. Slowly there developed the understanding and acknowledgment that the causes of illness and disease were not so much 'divine' as they were natural or human-made, and this understanding was the route to healing them. Of course, the first medical treatments were simple natural herbal remedies, primitive bandages and cream prototypes, coupled with attempts of a philosophical or religious nature to explain and justify all incomprehensible events by relating them to the will of a moody God.5-7

In more recent history, after the 'static' middle ages (from a medical point of view), an increasing awareness of scientific evidence over the past five centuries has allowed for a better understanding of the mechanics of our nature and of the 'innate consciousness' and 'self-awareness' that distinguishes us as a species.8-10 However, compared with other sciences, the development of medicine, including dental medicine, was more difficult because those bright-minded individuals who became involved had to face not only the extreme complexity and difficulty of the subject matter of the human body and mind, but also the limitations imposed by the endless short-sighted and ignorant doctrines of the time.11-13 The intelligent nature of humans means that we need to trust in order to understand; trusting in science means that in time science will explain everything, whereas trusting in a religious sense (having faith) means believing that God will take care of everything. Historically, the development of medical treatment planning has been strongly influenced by this.14,15 Nevertheless, over the last two centuries, science finally gained its autonomy from religion, and today the two areas of human endeavor are separate, to the obvious advantage of medicine.

An important aspect of the renaissance of medical science was the contribution scientists made to laying the anatomical foundations for the understanding of the cause-and-effect relationship that exists in the human body, and how the various parts of the body function and malfunction in relation to each other. This had profound implications for the development of clinical and surgical therapies. This cause-and-effect relationship can be seen as the initial basis for the current treatment planning rationale. Nevertheless, despite all efforts, ignorance about medicine among the general public was rife because society was disconnected and disorganized, and it was difficult and often impossible to teach and impart new medical knowledge and trends. At that time, medical treatment planning was largely unknown, and to the extent that it did exist, it was very primitive and poorly understood. Therefore, due to almost no true medical understanding, epidemics, traumas, infections, and cancers indiscriminately killed hundreds of millions of people. It took other two centuries before anatomy, physiology, and pathology became actual sciences, and the word 'treatment' became a medical term.

So, regardless of all the clever minds, poor transport and communication meant that people were isolated and led an insular way of life. Medicine itself was still largely based on old, inaccurate, and often imaginary notions. Medical practitioners were on the whole pompously dressed, incapable ignoramuses, trying to describe nonexistent diseases with useless Latin words. Original paintings of this medical class show images of fantastic methods and therapies full of enemas, leeches, ointments, and draught potions that were invented and concocted to 'cure' all ailments and diseases.4,16

Only during the 17th and 18th centuries did physicists and chemists boost the curiosity of many people, so that people started to believe that they could follow in the footsteps of these scientists in all scientific matters, driven by their then brand-new practice of scientific research methods and the pursuit of evidence of reality theories. This indirectly contributed to the speeding up of the understanding of medical science and treatment planning. Indeed, probably without realizing it, physicists and chemists at that time were changing the way people thought about medical science.

It can therefore be said that medical treatment planning has its origins in scientists attempting to prove that formulas could explain all scientific elements and, indeed, the world. Over time, it became clear that signs and symptoms were useful and necessary to make a correct diagnosis of illness and disease. In fact, medical treatment planning is entirely based on scientific methodology and evidence. However, while physics, astronomy, mathematics, and biology were progressing at a rapid pace, scarce technologies and immature methods limited people's knowledge of the human body, no matter how curious they were. Also, the slow pace of life and very limited social contact meant that it was difficult to spread news, which created many problems.4,16,17

During the 19th century, medical scientists looking for scientific evidence and using the new scientific instruments of the time discovered more ways to heal and cure, which were perfected with time and passion, although many essential notions were lacking, and there was still no precise understanding of treatment planning.13,18 Universities and medical and dental medical schools began to open and flourish in the USA and in other parts of the developed world, for example, the Baltimore College of Dental Surgery was founded in 1840, the Philadelphia College of Dental Surgery in 1842, Tufts Dental School in 1852, Harvard Dental School in 1867, and the University of Michigan in 1875. Passionate researchers and clinicians started to create the basis of actual medical and dental medical scientific treatments.19 So, by the turn of the 20th century, official medical and dental medical science was starting to be oriented toward what we know today as 'assessed methodology.' The study of anatomy was acknowledged as the basis for understanding medicine, and investigations into the body's functions and malfunctions started to drive more organized and critical laboratory research and clinical practice.18,20 Scientists' curiosity and eagerness for clarification drove them to begin to look for 'evidence' as the starting point. The worst of the religious influence on medicine was part of the past.

20th century to the present

While the 20th century gifted us with geniuses such as Albert Einstein (1879-1955), it also plagued us with two devastating world wars, which had a significant influence on the development of treatment planning in the west. About 20 million lives were lost in the First World War (1914-1918), and about 68 million in the Second World War (1939-1945). Apart from the death toll, war means all kinds of terrible injuries, physical and psychologic, created by all types of weapons. It means traumas, wounds, burns, disfigurements, and epidemics.

The world wars profoundly changed the lives of our grandparents and parents, and forced medical science to find surgical, clinical, and pharmacological solutions to address the sudden, terrible, and urgent traumas they caused. The wide range of injuries and infections, many of them never seen before, meant that the understanding about how to plan the treatment of patients accelerated, both during emergencies on the battlefields and in the clinic.

In addition, the 1918 influenza epidemic (known as the Spanish Flu), largely brought on by the unhygienic conditions of the First World War, left roughly 50 million dead worldwide. Therefore, the total death toll in the almost 50-year period spanning both world wars was about 125 million people, not to mention the millions more who were seriously injured in these wars and who died prematurely later on. On top of this, other local wars and epidemics followed, bringing the death toll to some 13% to 14% of the entire world population at that time.21,22-24

Due to these events, and thanks to the increased number of dedicated medical scientists and facilities, improved communication and media, and the growing body of scientific and medical knowledge that had been slowly accumulating over centuries, medical science made a great leap forward in the first part of the 20th century. The level of awareness and consciousness regarding medical...