Global Terms: Mouth care is the starting point in Health Care. Why?
In the aget of Internet, it is urgent to communicate globally among health professionals worldwide to break the barriers of regional descriptive terms, which are not indicated for the quality of care and human resources.
How to communicate globally, without all the language barriers?
Is there a specific global language beyond the national borders for easy and precise communication to share data worldwide?
Please note that global terms are for written and/or spoken communication for technology and specifications. They are not for personal communication.
Dr Daryl Beach has developed global terms for health care in collaboration with WHO based on 0 concept reasoning (link here for the post 0 Concept reasoning). His proposal was made to WHO in 1985 (ref: 0RH/EXP.CTTEE.THAI/85.13).
He established the Health Oriented Status & Intervention Index from 0 to 9, where Health or the absence of need for care is the goal, and is represented by the digit 0. Need for care (intervention) is “–” (minus or unwanted). All interventions or deviations from 0 are assessed and indexed digitally from 0 to 9.
These indexes are conceptually in the minus area. For convenience of use, however, interventions in health care records are indexed from 0 to 9 where 0 denotes collecting information on health status and 9 denotes removable replacement of a body part ( Health Oriented Status & Intervention Index).
The effectiveness of health care is assessed in terms of an approach to its goal i.e. absence of need for care (0).
The digital order is based on 0 (zero) based reasoning.
In other words, use of 1 2 3 4 5 6 7 8 9 is defined in relation to definition of 0.
How did global terms come into existence?
“Fields of information are dependent upon specialized terms. They are made of different languages. The type of terminology is a primary factor, affecting objectivity, orderliness and accessibility of information” (ref: WHO proposal).
For translation of information, a person should be bilingual.
Instead of regional terms, “global terms used as the core language of specification minimize the language barriers, the bias and subjectivity inherent in mother tongues” (ref: WHO proposal).
How were they developed?
The global terms consist of a set of digits, which are signaled by one syllable (consonant + vowel), and Cartesian coordinates x, y, z and t (space-time).
“The consonants (m, t,) were selected based upon easy and clear distinction, with least variability among languages and ease of pronunciation. A non-plosive consonant “m” (lips closed) was selected to signal space–related digital sets, and a plosive consonant “t” was selected for digital sets related to energy-based factors”(ref: WHO proposal).
“Five cardinal vowels a,e,i,u,o (in the order of the natural movements of the tongue from forward to backward) are commonly recognized in many languages, therefore the combination of the consonants and vowels give the set of ta, ma, mo, mi, me, te and to which identify and differentiate the meaning of the digital sets”(ref: WHO proposal).
They are pronounced as follows:
a like in ‘ah’
e like in ‘eh’
i like in ‘be’
u like in ‘rule’
o like in ‘oh’
Here we use the Roman script: instead, it is also possible to convert and to print them in different regional languages giving the same sounds. For example:
ma – English
ம – Tamil
These global terms are in written form and spoken form with global sounds.
Global terms structure
Digits are universally used and therefore global: a global communication becomes possible through a digital language.
Almost everyone knows how to calculate and appraise conditions with 10 digits. Therefore well-ordered digital sets are a global base for learning (acquiring clinical skills) and specifying settings & actions.
Health care is a good example to start with, as it concerns all.
How is the order of digital sets decided?
It is based on deductive reasoning from general to specifics.
An approach to solve a problem is evaluated in relation to the goal. The goal ‘0’ (Zero) of health care is health or absence of need for care.
In mouth care, there are 5 related elements to deal with:
1. Mouth problems
2. Treatment procedures
3. Body conditions of the care provider
4. Body conditions of the care receiver
5. Settings (equipment/instruments/surroundings that affect above #3 and #4).
These 5 elements are linked through global terms: the digital language which is formed through logically ordered digits from 0-9.
This combination of the digital terms makes health care easily understandable and communicable.
Let’s discover the logical order to name the systems of the human body, which is the first digit of 5 digits to name their parts.
The top of the head is skin, so 1 is integumentary system, the skull bone is next to the skin, so 2 is musculo-skeletal system. Below the skull bone is the brain, so the nervous system is 3. Likewise, counting the systems from the top of the head down into the gravity axis (Z), the mouth (our specialty) called “digestive system” is 6.
All relevant information is in digital form.
Contrary to special terms that are conventionally taught, rote memory is not needed. We can deduce the meaning based on the reason for order.
Global terms with syllables and digits
to signal 9 fields of information:
|- Space based elements-|
|ma||gross and micro anatomy (of care receiver)|
|me||setting components including instruments|
|mi||skill anatomy –ie. body sections, positions, surface lines and points, etc. (of care provider)|
|mu||planes, lines and points of ‘me’ items|
|mo||procedure anatomy – ie. tissues and parts of body parts (of care receiver)|
|- energy based elements -|
|ta||clinical records based on the health-oriented index|
|te||steps of procedure including start, en-route and stop|
|to||magnitudes or scales including weight, temperature, applied force, color, sound, etc.|
|XYZ –T : coordinate-based measurements – time
Here are a few examples of digital terms of anatomy with a focus on mouth care.
Example: ma (anatomy care receiver)
0 – zero is nothing or everything!
From top down:
- 0-Entire human body
- 3-Nervous system
- 4-Endocrine system
- 5-Respiratory system
- 6-Digestive system
- 7-Circulatory system
- 8-Uro-genital system
- 9- Embryonic system
60 – Digestive system
- 61 – lips, tongue, oral cavity
- 62 – dento-alveolar arches
- 63 – oesophagus
- 64 – stomach
- 65 – small intestine
- 66 – large intestine
- 67 – salivary glands
- 68 – liver, gall bladder
- 69 – pancreas
620 –Dento-alveolar arches
- 6200 – dento-alveolar arches (ISO & FDI standard)
- 6201 – maxilla
- 6202 – mandible
- 6203 – upper right sextant
- 6204 – upper mid sextant
- 6205 – upper left sextant
- 6206 – lower left sextant
- 6207 – lower mid sextant
- 6208 – lower right sextant
6210 – Upper right quadrant
- 6211 – upper right central incisor
- 6212 – ” second incisor
- 6213 – ” canine
- 6214 – ” 1. premolar
- 6215 – ” 2. premolar
- 6216 – ” 1. molar
- 6217 – ” 2. molar
- 6218 – ” 3. molar
- 6219 – ” supernumerary
62110 – Tissues of upper right central incisor
- 62111 – mucosa
- 62112 – gingiva
- 62113 – enamel
- 62114 – dentin
- 62115 – pulp
- 62116 – periodontal ligament
- 62117 – hard bone
- 62118 – soft bone
To avoid unnecessary repetitive information, knowing that we are in the mouth, the first digits “62” can be omitted in the clinical record of mouth care.
Example: ta (treatment procedure based on Health Oriented Index)
What is the reason for order?
From Ø we can make a scale in digital order:
We know the scale of digital order through 0 Concept reasoning in health care from 0 to 9:
0 collection of data, closest to 0 Health , while 9 is permanent dependence or disability, the most unwanted condition.
From the scale, the treatment procedures are termed in digits.
Example for a filling
ma|2|7| | | | ta|5|4|1|1|6 on the second left upper molar filling in the
occlusal surface with composite
Control of fingers in 0 Concept
Example: mi (anatomy care provider).
Points on hand and fingers for precise contacts are denoted by 3 digits.
Through a proprioceptive sense of denominating the operating hand, and assuming it has 4 surfaces:
1st digit denotes fingers
What comes first to your mind if you have to give the number 1? Most of people will say the thumb (right one if you are right handed and reverse if you are left handed.
No 2? The index and so on till 10. Non operating 5th finger10 is denoted by a star( *).
From there, we can go on to more details
2nd digit denotes the surface
What comes first to your mind have to say which surface is no 1? Most of people will say the palm. Why? Probably because is the surface with which we take things!
No 2? The upper side as people flip it over naturally.
No 3? The upper surface vertically they see directly.
No 4? The lower surface they don’t see directly.
This is a pd sense of order in your body.
3rd digit denotes the trisectors (of each finger)
The segment is counted from the tip (lines in between the joints).
Ex: mi311 = a point on the operating 3rd finger, palmar surface, 1st trisector counting from the tip).
The digitalization for “mi” follows this logic and is based on “pd”.
Example for a precise point: mi 300 (tip of the operating (right) middle finger
Global Sounds: Global terms are spoken with global sounds
These 10 global terms can be both written/printed in each regional language and spoken through global sounds.
They comprise of one syllable (consonant l or p + vowel a e i u o) assigned for digits 0-9.
They are the shortest which:
- have meaning
- are universal
- are easy and fast to learn
They follow the same logical structure:
- ma me mi mu mo ta te to
- 10 spoken digits (global sounds)
- coordinates xyz t
Example for verbal control between 2 Dental Health Workers about a scaling to do on the upper permanent right molar in the optimal condition (0 condition) using the tip of the scaler at the deepest point near the gingiva in the middle of the palatine surface of the first upper maxillary molar.
Connection of digital sets
All sets of digits are interrelated for a complete range of information through global terms.
Example: Finger control of care provider in relation to instrument and patient (care receiver)
Finger / hand points for precise contacts
(Written) (Spoken) (DescriptiveEnglish)
|mi300 ma41 mo33||milulala malole molulu||Tip of the third right operating finger resting on the 1st right lower central incisive on the vestibular surface|
So global terms deducted by this logic simplify the communication without language barriers in written words or spoken digits.
Global Terms and Global Sounds used in ADCERRA
ADCERRA’s programme to train village women to become Dental Health Workers is based on this innovative method which use“global terms” and “global sounds”.
How does global terms and global sounds help us to train Dental Health Workers?
For an easy learning (of the village women with only primary/secondary school), we are using only 5 fields of information:
ma: anatomy (care receiver)
mi: sections, lines or points on human body surface (care provider)
mo (partly): anatomic subparts, tissues, planes, lines and points
ta : treatment procedure
10 global sounds
Explanations for recording the treatment with global terms
From the complete digital sets, we will see how to derive the recording of treatments.
We select “ma” and “ta”: (refer to the table)
|Global language||Descriptive regional terms|
|ma||Anatomy (dento-alveolar parts including teeth) of the patient|
We know that , we use the digits 0-9 from global to detail.
“ma” gross and micro anatomy (of care receiver) logical order from top-down of the systems
|0 – zero is nothing or everything!|
|0 = Entire human body|
“ma” (anatomy) (dento-alveolar parts including teeth) of the patient from global to detail.
|6||1||Lips, mouth, tongue|
|6||2||1||1||Maxillary right quadrant, tooth 1|
|6||2||1||1||3||Maxillary right quadrant, tooth 1, enamel|
Different dento-alveolar sections
Permanent tooth numbering
Deciduous tooth numbering
6210 – Upper right quadrant
Details of the dento-alveolar structure (tissue)
|62111 – mucosa|
|62112 – gingiva|
|62113 – enamel|
|62114 – dentin|
|62115 – pulp|
|62116 – periodont ligament|
|62117 – hard bone|
|62118 – soft bone|
Further the surfaces on a tooth are defined as
Details are further refined in “ma”, so it goes on…..
Recording “ma” for full mouth light scaling
The first digit represents the – Digestive System:
The second digit is “2” – Mouth. The 1st and 2nd digits direct us to a part of the body:
The 3rd and 4th digits represent the full dento-alveolar structure / part / tooth number)
Here we have “00” for full dento-alveolar structure:
The 5th digit represents the tissue of the body. Here the (free) gingiva:
Now we will move on to see how the treatment part is recorded with the same logical deduction.The above anatomy “ma” recording gives us the details where exactly the work was done. digestive system/mouth/ full dento-alveolar structure/gingival area.
“ta” : clinical records based on the Health-Oriented Index
0 – Absence of need for care to 9 most unwanted condition. These indexes are conceptually in the minus area. For convenience of use, however, interventions in health care records are indexed from 0 to 9.
ta (treatment procedure)
|0 – Absence of need for care|
ta (treatment procedure)
|0 – Absence of need for care|
|0 (e.g. check-up)|
|1 (e.g advise tooth brushing/supply toothbrushes)|
|2 (e.g. scaling).|
|3 (e.g. orthodontia)|
|4 (e.g. periodontia)|
|5 (e.g. carie)|
|6 (eg . endodontia)|
|7 (e.g. surgery)|
|8 (e.g. (fixed prosthodontics)|
|9 (e.g. removable prosthodontics)|
For example, recording “ta” treatment procedure for a cavity:
TREATMENTS have 5 digits:
1st & 2nd digits represent “NEED OF INTERVENTION”
3rd & 4th digits represent “SURFACE”
5th digit represents “MATERIALS”
5 is Restoration
The 3rd & 4th digits represent the SURFACES
Surfaces of the tooth:
|3rd & 4th digits for ta 5, 8:|
“1” represents a single surface the other “1” represents the actual surface which is Occlusal, now we have the third and fourth digits.
As per the surface the 3rd and 4th digits are recorded:
The 5th digit represents “MATERIALS” used for the filling:
|5th digit for ta53-57, 83-85, 93-96:|
|1||tissue(cultured or donated tissue/organ)|
|2||resin-unfilled (zinc oxide)|
|3||ceramic (glass ionomer)|
|5||metal (chemical set) (amalgam)|
|7||resin & metal|
|8||ceramic & metal|
For a ceramic filling for eg:, it will be the “3”, now we have the fifth digit
The above treatment “ta” recording gives us the information that a restoration has been done on the occlusal surface (single) with a ceramic filling.
So the treatment record from consultation to restoration with (ma-ta) will be as follows:
ANATOMY : ma – tooth number with 5 digits
TREATMENTS : ta – restoration surfaces and material with 5 digits
53 indicates – early caries
54 indicates – later caries
55 indicates – extended/repaired caries
ta (treatment procedures by Health Workers)
|0 – Absence of need for care|
Complete Status Intervention Index