The Second Law of Thermodynamics (SLT) originated from physics but has been extrapolated to chemistry, informatics, biology, sociology and human pathology. One of the formulations of the SLT is that the entropy of an isolated system never diminishes [1]. The value of entropy is proportional to the natural logarithm of the probability of a given state of the system. The SLT defines the direction of spontaneous processes within closed systems: from a less probable to a more probable state. Heat always flows from hotter to colder areas. With time, the temperature will become equal everywhere in an isolated system, which is a permanent state with the maximal entropy.

Reversible processes do not change the system’s entropy; irreversible ones do increase its value. Without creative intervention, an isolated system would always evolve from a less probable towards a more probable state, from complicated to simple: towards equalizing of temperature and pressure, decomposition of complex structures, homogenization, mixing. Being statistical, the SLT does not exclude spontaneous fluctuations; however, across longer periods, the system would evolve towards the equilibrium [2]. The leveling of temperature goes along with structural simplification (homogenization), one of the mechanisms being the Brownian and other movements, causing diffusion and homogenization of all structures with mixing of substances. Besides, in conditions of gravitation, inhomogeneous bodies have potential energy: heavier components exert downward pressure, thus causing destruction and homogenization in the long run; the process being accelerated by “shaking” for whatever reason. Therefore, rooms in old buildings with wooden bearing structures (beams) should not be overloaded by heavy objects.

Furthermore, the thermodynamic equilibrium is characterized by discontinuation of any movement on a macro-level; only the Brownian movement would persist. Kinetic energy of all macro-movements will finally turn into the thermal energy. It can be argued that the SLT may be not universal. However, doubts about its universality arise on the level of molecules or celestial bodies. The latter may be related to the fact that the universe is not a closed system, and cannot reach a universal equilibrium. There is no way to assess the entropy for the universe [1]. Anyway, galaxies and elementary particles are of minor importance for the topic under discussion.

Entropy in the living nature and human society

Generally speaking, entropy is seen as the measure of irreversible disorganization, destruction and scattering [3]. However, repeating stereotypical structures can persist in the macro-world under conditions of high-entropy chaos; for example, borders between aggregate states or crystals. Periodic crystals may appear complex but they are continuously repeating the same structure [3]. In their reappearance, such structures are simple per mass unit. Some complicated but constantly reappearing patterns may persist at high levels of entropy. The tendency towards simplification, homogenization and endless repetition is recognizable also in anthropogenic structures. Observed from altitude, townships and fields form repeating patterns. This is visible on photographs “Earth from the Air” [4].

The concept of entropy is applicable to biology. Living organisms delay their decay into thermal equilibrium (death) by a capacity to maintain orderliness, absorbing negentropy [1], choosing suitable carriers thereof, be it food or information. Organisms are open systems in terms of matter/energy exchange but closed in terms of information [5]. Negentropy is sometimes equated with information [1]. To appreciate the need for information, one can try to sit in a closed room half a day alone without TV and reading stuff. Doing the same to a minor is regarded to be child neglect [6].

Ageing of living organisms occurs in agreement with the SLT: from a less probable towards more probable condition. It is known from paleontology that the ageing afflicts not only individual organisms but also species and ecosystems. According to the concept of biological succession, a prolonged persistence of a biocenosis may lead to degradation of its areal. Accordingly, a goal of environment protection is a scientifically based (creative) management of the natural environment in order to maintain it in a desirable condition. As we can see these days, the humankind does not fulfill this task, being unable to mitigate the main damaging factor: the human overpopulation [7]. Apparently, only developed nations are seriously concerned about environment protection.

It can be argued that evolution with development of increasingly complex animals is against the principle of the entropy increase. The key is that evolution is non-equilibrium i.e. not a final state [5]. What is prevailing today is degradation with extinction of species. New species are developed due to creative activity of humans: selection and gene engineering. The creative force is potentially negentropic; humans have some negentropic potential [3]. One can assume that also in the past biological species have been developed with participation of well-aimed creation. Here the concept of entropy agrees with the theological notion of Creatio continua, which may be realized through people and/or with their participation [8]. It is hard to imagine, how some complex structures, functioning as a whole (e.g., optical system of the eye) have developed gradually in the course of evolution. Apparently, only well-aimed creative activity can overcome the SLT and decrease the entropy. The Maxwell's sorting demon [1] is a simplistic model thereof.

Spontaneously, isolated living organisms and ecosystems evolve in accordance with the SLT: from less probable to more probable conditions [9]. The ability of organisms to temporarily lower their entropy (at a young age, in a healthy state), does not contradict to the general rule, because the end is all the same. For anabolism the living substance pays with catabolism to a larger extent [10], which is apparently true both for individual organisms and for ecosystems. The overpopulation leads to the environmental degradation, deforestation, desertification and exhaustion of non-renewable resources [7]. The human impact on the environment is an obvious example of increasing entropy within an isolated system: the terrestrial surface.

The value of entropy is defined not only by the structural complexity but also by the usefulness because preservation of a useful system is less probable than that of a useless one. Deviation from usefulness elevates probability and, accordingly, the entropy. A dump of broken computers remains structurally complex but useless; therefore, its entropy is higher than that of a functional computing center. Analogously to usefulness, the concept of entropy is applicable to ethical concepts of the good and evil. Despite diversity of understanding of these terms, the good must satisfy more requirements than the evil. The latter includes more choices: crime, corruption, immoral behavior, scientific and professional misconduct [8,11]. In a sense, the ethical concept of the good, similarly to usefulness and benevolent creativity, is the opposite of evil, decay, corruption and chaos.

An important example of entropy elevation in society is corruption, which can be compared with malignization in general pathology. Similarly to a cancer cell, a corrupt functionary ceases to perform socially useful work, caring instead about his own nutrition and procreation. The same is true for falsifiers in science, the medical research in particular [11]. Dishonest scientists transform the research from entropy-lowering creativity to a tool for satisfying their private needs. Among other indicators of the entropy elevation in society are demagogy and economical irrationality [3].

The SLT ceases to be universal when a benevolent creative effort intervenes. An engineer or programmer decreases the entropy, creating useful systems, which are then materialized. It can be argued that results of human activities may lower entropy only locally and temporarily, against the background of degradation on a larger scale. It is hard to refute such claims. The global environmental degradation thanks to the overpopulation and human activities is obvious. From a height, cities and villages resemble histological pattern of cancer metastases, which is visible on photographs “Earth from the Air” [4]. Reconstruction of historic city centers contributes to the same process [12].

The global overpopulation is an essential factor increasing the entropy both in society and the environment. As a result of the mass migration to developed countries, the healthcare system is overloaded. The availability of high-quality medical care is decreasing. Constructive behavioral stereotypes are breaking down; aggression and auto-aggression are on the rise. Similarly, animal behavior in overcrowded populations is disrupted and simplified: they start devouring each other and their offspring. Applied to human society, these phenomena can be characterized as a loss of morality and shame, disrespect for laws and regulations.

History is full of examples of how civilizations (low-entropy state) collapsed under the pressure of barbarism (high-entropy state). Revolutions and riots are accompanied by structural disorganization, simplification, and a decrease in the life expectancy. Conversely, expansion of more developed and civilized nations was accompanied by entropy lowering, one of the objective indicators being an increase in the average life expectancy. Under conditions of globalization, humanity can turn into a single system, which would evolve in the direction of simplification, degradation and destruction. Only benevolent creative activity, emanating from the most developed parts of the world, can prevent a global increase in the entropy. Such a development would be in the interests of the whole humankind, except for corrupt elites of some countries. In the context of globalization, it is necessary to spread the moral norms adopted in the most developed parts of the world.

Entropy in human pathology with special reference to oral and dental conditions

The concept of entropy is applicable to the human pathology [9]. Simplistically, all pathological conditions can be subdivided to those with elevated and decreased entropy. In the first group are those with increased complexity: due to added extrinsic structures (infection, infestation) or a local change (tumor or another lesion). The above is in line with the subdivision of diseases into additive (e.g. parasitic infestation) and coherent or linearly progressive ones [13]. The second group includes generalized or systemic conditions with prevailing atrophy, degeneration, accumulation of mutations etc. [3]. Diseases from the first group may become generalized with an entropy increase, e.g., metastasizing cancer. Conditions of the first group can be treated by entropy-elevating measures (antibiotics, surgical excision); those of the second group must be managed by maintenance and inhibiting degeneration. The therapy of the latter type would be more efficient if creatively adjusted and individualized down to the molecular level: genetic engineering, conjugation of drugs with antibodies etc.

Destruction of teeth due to caries and/or accelerated restoration cycle, progressive periodontitis and gingival recession (GR) is a visible example of the entropy elevation (Fig. 1a-c) [14,15]. In Russia, iatrogenic damage as a result of the accelerated restoration cycle, so-called tooth death spiral [16], has been habitually ascribed to caries: teeth after repeated restorations were described as having “caries below the level of gingival margin” [17], if even the patient had not noticed any tooth decay for decades after restoration failures or fractures. If a patient does not notice any spontaneous decay, it can be considered as an argument in favor of less extensive preparation. Patients should be involved in treatment decisions in a meaningful way, with due consideration given to their needs and desires [18].

From the viewpoint of general pathology, being an atrophic condition, GR can advance due to repeated injury e.g. scaling, root planing or excessive tooth brushing. The latter not only contributes to GR, but also can damage enamel [19-21]. The treatment of GR should be seen within the framework of minimally invasive periodontal therapy [15,22,23]. As in atrophy in general and in age-related atrophy in particular, the prevailing approach must be preservation and avoidance, as far as reasonably possible, of traumatizing manipulations such as excessive brushing, socket curettage at exodontia, and gentle handling of tissues in periodontal surgery. In the context of the topic under discussion, such treatment would inhibit the entropy increase.

Fig 1: The Same Patient in 2013 (A,B) and 2025 (C,D), 69 Years Old at Present. Periodontitis and Marked GR. Predominantly Iatrogenic Tooth Defects, Remaining Unchanged for Decades without Treatment. Tooth Extractions with Excessive Socket Curettage Led to Root Denudation of Neighboring Teeth and Subsequent Exodontias. The Entropy is Increasing with Time.

Entering the tooth restorative cycle should be avoided as long as reasonably possible. An economical re-routing of dental practices is needed, so that they survive using preventive and minimally invasive methods more extensively. Improvements in educational and ethical standards of healthcare providers at all levels are needed. The principle of informed consent must be rigorously observed. For this scenario to be realized, the first step that needs to be taken includes the exchange of experience through the implementation of temporary programs for Russian dentists to go abroad and authorized foreign advisers to come to Russia.

The warmongering must be stopped to facilitate international cooperation. The change of political leadership in Russia would be favorable in this connection [7]. If the world is indeed becoming multipolar [24], armed conflicts would become permanent, guaranteeing all kinds of destruction and degradation i.e. entropy increase. It seems to be inevitable that the global population will become reduced during the present century. How this happens may be to some extent within our control. It will not remain so indefinitely [7]. To avoid major disasters, not the multipolarity but order and governance by the most developed nations are urgently needed. The higher the moral level of a society, the more efficiently can the entropy increase be counteracted. Among indicators of the moral level are the life expectancy, efficiency and honesty of medical research. A majority of reviewers would probably agree that reliable medical science originates predominantly from Europe and America; the Food and Drug Administration (FDA) being one of the last strongholds of evidence-based medicine. Note that reliable information is available for the rest of the world gratis through the PubMed and other free databases. Hardly anybody gives thanks. It should not be left without comment, when the celebrated editions such as the Histopathology of the Skin by Walter F. Lever and Gundula Schaumburg-Lever, the classical Robbins’ Pathologic Basis of Disease, Handbuch der Speziellen Pathologischen Anatomie und Histologie by Henke and Lubarsch, and Carranza’s Clinical Periodontology are rewritten without proper references, mistranslated, and distorted by additions. We can hardly imagine what immense work and immaculate integrity stands behind these great and truthful books. Numerous examples are illustrated and referenced in the monograph [11]. Today’s and tomorrow’s plagiarists should be aware that they may be identified and exposed; otherwise the misconduct would spread over the globe and persist endlessly, contributing to the entropy elevation. This is one of the reasons why the leadership must be concentrated in most developed parts of the world. Short-sighted decisions in the past, such as unleashing of world wars or support of the Stalinist dictatorship, imply that developed nations have gathered valuable experience, which may be lacking elsewhere. The only thinkable justification of certain Russian moves is the changeable and unpredictable policy of some democracies.

In the meantime, Vladimir Putin and Xi Jinping continue the cause of Stalin and Mao. Both acknowledge that borrowing (read purloining) know-how is a vehicle of their progress. In regard to China, this process was named “anti-Western westernization” [25]. Among others, this pertains to the healthcare and medical research [11,26]. Reportedly, over 80% of clinical trial data submitted to support new drug registrations in China have been fraudulent [27]. It will take some time before disadvantages of unburied Maoism [28] and totalitarianism will become evident once again. The war in Europe agrees with China’s interests, as it was through the 20th century. It seems that Putin is ready to cooperate and share power with people of non-Russian ethnicity and citizenship, just to preserve the privileges of the Nomenklatura [29]; while the Ukraine war is used for distraction. Crises are often used by oligarchy to distract from internal problems, from shortages of the healthcare in the first place [26]. In fact, Putin acts in Ukraine and on the international arena in the interests of certain non-European agent(s). Wars within Europe implicate bravery of soldiers and irresponsibility of some leaders. Winners of such wars are those who stay outside. The westward animosity is framed as a defensive response to the “centuries of Western hostilities towards Russia” [30]. The Tatar-Mongol Yoke (1237-1480), the most efficient “hostility towards Russia”, has not been mentioned, although it is a real perspective in view of demographic and economic developments.

In conclusion, the SLT can be counteracted by creativity combined with conscientiousness; which might amount to the Creatio continua with human participation. Creativity without guidance can be destructive: modern weapons efficiently elevate the entropy. Only a combination of creative efforts with good intentions would prevent further entropy increase worldwide.

Declaration

No conflict of interest.

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