Non-communicable diseases in dentistry and medicine include sleep apnea, malocclusion, and caries. Dr. Mark A. Cruz, a Dana Point dentist, and his colleague, Dr. Barry Raphael, are committed to taking a closer look at the root causes of these diseases to help in diagnosing and treating patients effectively. Dr. Raphael is an orthodontist in New Jersey who has 33 years of experience in treating patients with a variety of dental and orthodontic concerns. Dr. Cruz and Dr. Raphael developed the Airway Focused Dentistry Mini-Residency to educate doctors from multiple disciplines about the significant role the airway plays in dentistry.
Dr. Raphael explained the difference between competencies and compensations during one of the sessions. There are natural balancing acts that occur in the body such as the balance of blood sugar. When the body is working properly, it is able to maintain homeostasis and good function. This is called a competency, a function that maintains homeostasis. If there is a change in the context or physiology, and the body is no longer able to perform competently, then it is a compensation. This means the body will find another way to achieve the same goal.
"Competence is the things we are able to do, and the things we inherited from evolution . . . compensations are things we are choosing to do or that we are passing on as behaviors, often through cultural evolutions. Competencies are physiologic functions. Compensations are parafunctions, meaning they are ways of trying to accomplish the function," Dr. Raphael said.
When there is chronic stress or a mechanical flaw in a system, the rest of the body will adapt, to cope by compensation. There are three ways that compensations can work:
- Pain and paresthesia – The body's way of warning us that something is wrong, and alerting us to take action.
- Parafunction – A function that is intended to create the same result as the function, but often may not.
- Anatomic distortions – Created from functions that do not work.
Dr. Raphael then quoted Gavin James, a well-respected mentor of orthodontists and dentists. "All parafunctions, even when destructive, are serving a purpose for [compensation]. Every pattern of wear tells a story. Every malocclusion tells a story. Our job is to understand what it is. We are the Sherlock Holmes of the mouth."
Dr. Raphael tied Dr. James' words to the purpose of the mini-residency, adding, "So that is what we are going to create in you. We are going to create for you the ability to be a Sherlock Holmes, a detective trying to figure out when you see a symptom and when you see a result of that compensation, what is that . . . a sign of? And, what is the body trying to do there?"