Orofacial pain, jaw function, and temporomandibular disorders in women with a history of juvenile chronic arthritis or persistent juvenile chronic arthritis

doi:10.1067/moe.2001.115467

Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology

Volume 92, Issue 4, October 2001, Pages 406-414

https://doi.org/10.1067/moe.2001.115467 Get rights and content

Abstract

Objectives: We sought to study the long-term outcome of juvenile chronic arthritis (JCA) in the temporomandibular joint (TMJ). Study Design: Temporomandibular disorders, including TMJ involvement, were assessed in 42 women with pauciarticular or polyarticular JCA—on average 25.8 years from disease onset—and compared with those found in matched control subjects. Disease-related parameters associated with temporomandibular disorders were identified. Results: The TMJ was involved in 66.7% of the patients, most severely in extended pauciarticular JCA. Temporomandibular disorders were more frequent in the patients than in the control subjects, especially in those with persistent disease. The TMJ involvement was positively correlated with disease duration and negatively correlated with jaw opening and occlusal support. Duration of active JCA and history of functional pain were identified as predictors of present TMJ involvement. Conclusion: In a long-term follow-up, TMJ involvement proved frequent in the studied patients and was associated with long disease duration and previous pain on jaw opening. The findings suggest that patients with JCA should undergo orofacial evaluation on a regular basis. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001;92:406-14)

Section snippets

Patients

In 1979 and 1980, Kreiborg et al⁴ and Pedersen et al¹⁸ performed a referral-based follow-up study of 93 patients with JCA admitted to the Hornbaek Hospital of Physical Medicine, Denmark, during the period from 1965 through 1977. From this group, 65 patients were followed up in 1996 and 1997.¹⁹ To secure homogeneity and to facilitate statistical evaluation, the relatively few male subjects and the few subjects with systemic JCA were excluded from the present report. Thus, only patients with

General condition of patients with JCA

The disease and its sequelae were most severe in the extended pauciarticular and polyarticular subtype of JCA (Table I). Twenty of the 43 participants had active JCA at the time of the study (47.6%). The general VAS pain scores ranged from 0 mm to 80 mm. Most patients had complete, or only mildly affected, functional ability (Steinbrocker functional class distribution I and II), but 3 patients (7.2%) had limited functional capacity or were largely or wholly incapacitated.

Description of orofacial findings in patients with JCA

Condylar lesions on the

Discussion

The patients with JCA in the present study most likely represented those most in need of hospital care after disease onset, because the study population from the start was referral-based.¹⁹ However, even with this possible bias toward the more severe cases, the high frequency of persistent disease demonstrates that the general prognosis for pauciarticular and polyarticular JCA can be unfavorable.

The polyarticular course of the disease was associated with the most “poor” disease outcome, both in

Conclusion

The present long-term follow-up study confirms that TMJ involvement is a frequent manifestation in patients with JCA. A majority of the patients experienced increased morbidity of reduced opening and biting abilities and orofacial pain due to TMJ involvement. The severity of these symptoms and signs was associated with long JCA duration and previous pain on jaw opening. Our findings suggest that all patients with JCA should undergo regular orofacial evaluation and that optimal disease control

Acknowledgements

We thank dental nurse Mrs Ana Vilaplana for her excellent help during the study.

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Evaluation of facial asymmetry in patients with juvenile idiopathic arthritis: Correlation between hard tissue and soft tissue landmarks
2018, American Journal of Orthodontics and Dentofacial Orthopedics
The aims of this study were to assess the correlation between facial hard and soft tissue asymmetry in patients with juvenile idiopathic arthritis, to identify valid soft tissue points for clinical examination, and to assess the smallest clinically detectable level of dentofacial asymmetry.
Full-face cone-beam computed tomography scans and 3-dimensional photographs were used to assess facial hard and soft tissue asymmetry in 21 patients with juvenile idiopathic arthritis. A survey was conducted to assess how asymmetry is perceived observationally based on cone-beam computed tomography scans and 3-dimensional photographs.
Significant linear correlations were seen between the hard and soft tissue landmark deviations at both the transverse and vertical positions. Among medial soft tissue points, glabella had the smallest deviation and pogonion the largest deviation from the midsagittal plane. Professionals could identify facial asymmetry based on images beyond a cutoff threshold of 2 mm for both pogonion and gonion.
Soft tissue pogonion and gonion were identified as the most appropriate landmarks to clinically predict hard tissue facial asymmetry. Facial asymmetries are most pronounced in the lower facial third in patients with juvenile idiopathic arthritis. Professionals can accurately identify asymmetry exceeding 2 mm.
No association between types of unilateral mandibular condylar abnormalities and facial asymmetry in orthopedic-treated patients with juvenile idiopathic arthritis
2018, American Journal of Orthodontics and Dentofacial Orthopedics
Dentofacial asymmetries are often observed in patients with juvenile idiopathic arthritis (JIA) and temporomandibular joint (TMJ) involvements. The aim of this split-face study was to associate types of radiologic TMJ abnormalities with the degree of dentofacial asymmetry in patients with unilateral TMJ involvements assessed with cone-beam computed tomography.
Forty-seven JIA patients and 19 nonarthritic control subjects were included in the study. Normal condylar radiologic cone-beam computed tomography appearance in at least 1 TMJ was the inclusion criterion for all patients with JIA. The contralateral TMJ was thereafter scored as either “normal,” “deformed,” or “erosive,” consistent with predefined criteria. Based on the bilateral radiologic TMJ appearances, 3 JIA groups were assigned: normal/normal, normal/deformed, and normal/erosive. The severity of the dentofacial asymmetry was compared between the JIA groups and control subjects. Dentofacial asymmetry was expressed as interside ratios and angular measurements.
Eighty-seven percent of the JIA patients were being treated or had previously received treatment with a functional orthopedic appliance at the time of the cone-beam computed tomography. Significantly greater dentofacial asymmetries were observed in the 2 groups of JIA patients with unilateral condylar abnormalities (deformation or erosion) than in the other groups. A similar degree of dentofacial asymmetry was observed in JIA patients with bilateral normal TMJs and in the nonarthritic control group.
JIA patients with unilateral condylar abnormalities (deformation or erosion) exhibited significantly more severe dentofacial asymmetries than did the JIA patients without condylar abnormalities and the control subjects. We found the same degree of dentofacial asymmetry when dividing patients with condylar abnormalities into deformation and erosion groups.
Clinical predictors of temporomandibular joint arthritis in juvenile idiopathic arthritis: A systematic literature review
2016, Seminars in Arthritis and Rheumatism
Citation Excerpt :
From a total of 345 unique citations, 21 articles complied with the inclusion and exclusion criteria were therefore included (Figure). The reasons for excluding full-text reviewed articles were studies without measureable or objective outcome variables [37–41], dual publications with the exception of meta-analyses [2,42,43], studies including insufficient imaging/x-ray modalities [4,44–47], articles mainly reporting on JIA patients older than 20 years of age [5,7,48], and the use of clinical indices where no singular outcome measures can be extrapolated from a score [49]. Due to the heterogeneity of the study designs and patient populations reported in the literature, we decided to subdivide and describe the findings in relation to the following three categories: (1) patients referred to a radiologist and/or dentist for consultation on suspicion of TMJ arthritis [20–24,29,31,33], (2) cross-sectional patient groups [15,19,25–28,30,32,35], and (3) newly diagnosed JIA patients (inception cohort) [12–14,34].
To assess the level of evidence for subjective and objective parameters in clinical orofacial examination and determine if predictors for temporomandibular joint (TMJ) involvement in juvenile idiopathic arthritis (JIA) patients exist in the current literature.
A comprehensive systematic electronic search strategy was performed in all major medical databases in June 2015. Studies were selected independently by two reviewers in accordance with a prespecified protocol and a risk of bias assessment for all included studies. Subjective examination outcome measures assessed were pain, decreased TMJ function, and TMJ sounds. The objective outcome measures assessed were maximal incisor opening, mandibular asymmetric opening, condylar translation, protrusion, myofascial pain on palpation, facial asymmetry, and micro- or retrognathism.
The electronic database search identified 345 unique citations. After application of our strict, predefined inclusion and exclusion criteria, 21 articles were included and data extracted. The study heterogeneity did not allow for meta-analyses. No singular outcome measure can be suggested as a predictor of TMJ involvement in JIA, as sensitivity and/or specificity is too low compared to contrast-enhanced magnetic resonance imaging.
The current low level of evidence and study heterogeneity do not allow us to conclude on singular clinical outcome measures. To increase study comparability, we call for a standardized terminology and evidence-based guidelines for clinical orofacial examination parameters in JIA patients.
Juvenile idiopathic arthritis and the temporomandibular joint: A comprehensive review
2016, Journal of Cranio-Maxillofacial Surgery
Juvenile idiopathic arthritis is the most common inflammatory rheumatic disease of childhood and represents a series of chronic inflammatory arthritides of unknown cause. Involvement of the temporomandibular joint has been reported in up to 87% of children with juvenile idiopathic arthritis when based on magnetic tomography imaging; it can be asymptomatic and may lead to severe long term complications. In this review a summary of the contemporary literature of imaging of the temporomandibular joint in children with juvenile idiopathic arthritis will be provided, including ultrasound which is a valuable method for guided joint injections, but does not necessarily allow detection of acute inflammation, cone beam computed tomography, which has emerged as a feasible and accurate low-dose alternative as compared to conventional computed tomography to detect destructive change, and magnetic resonance imaging which is considered the method of choice for assessing acute, inflammatory change, although the lack of normative standards remains a challenge in children.
Systemic and intra-articular anti-inflammatory therapy of temporomandibular joint arthritis in children with juvenile idiopathic arthritis
2015, Seminars in Orthodontics
Citation Excerpt :
Karhulahti et al.43 studied 121 JRA patients who were 15 years old, finding condylar flattening in 65 (55%) as well as decreased oral aperture in patients compared to healthy 15-year-old children. Important findings in several of these and other studies is that the risk of TMJ arthritis evident by radiography increases with prolonged disease duration, consistent with a cumulative effect of unopposed inflammation.44,45 This was illustrated most dramatically by Larheim and colleagues, who re-evaluated 60 of the original 103 subjects at a mean follow-up of 27 years.46
Juvenile idiopathic arthritis (JIA) is a leading cause of acquired disability and malformation in childhood. Although virtually any joint can be affected, one of the most commonly involved yet least frequently recognized joints is the temporomandibular joint (TMJ).¹ Persistent arthritis can result in pain, growth problems, cosmetic defects, and poor function, underscoring the necessity of obtaining early control of TMJ arthritis. While the therapy of JIA as a whole has benefitted enormously from the introduction of novel therapeutic agents,² it remains uncertain to what extent these therapies benefit the TMJ specifically. Thus, many practitioners use intra-articular therapy for refractory TMJ arthritis, although concerns about their long-term safety have been raised.³ Herein, we will review the data on systemic and local anti-inflammatory therapy of TMJ arthritis.
Jaw surgery for correction of dentofacial anomalies caused by JIA
2015, Seminars in Orthodontics
In a number of patients with juvenile idiopathic arthritis with involvement of the temporomandibular joint, a growth disturbance of the mandible and consequently the facial skeleton will occur. If orthopedic and orthodontic treatment cannot provide a sufficient normalization of the jaw relations and occlusion, a surgical treatment can be indicated. The aim of the surgical treatment is to relieve or prevent functional symptoms, provide an improvement of the facial morphology, and, if possible, normalize the masticatory function. A variety of surgical treatment principles can be applied to these patients, and in this article, we describe the various options and the rationale for their use. In particular, the timing of treatment is important to obtain optimal and predictable results. Conventional osteotomy techniques as well as distraction osteogenesis can be used in these treatments. It is essential to initiate early, long-term planning and involve the patient and his/her parents in the treatment options and the possible complications and relapse related to these.

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^*: Supported by The Danish Rheumatism Association, The Danish Hospital Foundation for Medical Research, the Region of Copenhagen, The Faroe Islands and Greenland, The Gangsted Foundation, and The Rosalie Petersen Foundation.

^**: Reprint requests: Merete Bakke, DDS, PhD, Dr Odont, Department of Oral Function and Physiology, School of Dentistry, University of Copenhagen, 20 Nørre Allé, DK-2200 Copenhagen, Denmark, [email protected]

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Oral MedicineOrofacial pain, jaw function, and temporomandibular disorders in women with a history of juvenile chronic arthritis or persistent juvenile chronic arthritis*,**

Abstract

Section snippets

Patients

General condition of patients with JCA

Description of orofacial findings in patients with JCA

Discussion

Conclusion

Acknowledgements

Oral Surg Oral Med Oral Pathol

J Clin Epidemiol

Heberden Oration, 1977. Chronic arthritis in childhood

Ann Rheum Dis

Juvenile (rheumatoid) arthritis

Epidemiology of juvenile chronic arthritis in South-western Sweden: A 5-year prospective population study

Pediatrics

Juvenile chronic arthritis. A clinical and radiographic study of the chewing apparatus

Tandlaegernes Tidsskr

Craniomandibular function in juvenile chronic arthritis. A clinical and radiographic study

Swed Dent J

Mandibular condyle lesions related to age at onset and subtypes of juvenile rheumatoid arthritis in 15-year-old children

Scand J Dent Res

Lesions of the mandibular condyle in juvenile chronic arthritis

Br J Orthod

Bite force and temporomandibular disorder in juvenile chronic arthritis

J Oral Rehabil

The temporomandibular joint in juvenile rheumatoid arthritis. Radiographic changes related to clinical and laboratory parameters in 100 children

Scand J Rheumatol

Normal and abnormal growth of the mandible. A synthesis of longitudinal cephalometric implant studies over a period of 25 years

Eur J Orthod

Craniofacial growth in juvenile chronic arthritis

Acta Odontol Scand

Mandibular dysfunction in patients with juvenile rheumatoid arthritis

J Craniomandib Disord

Mandibular condyle lesions, jaw movements, and occlusal status in 15-year-old children with juvenile rheumatoid arthritis

Scand J Dent Res

Facial growth and oral function in a case of juvenile rheumatoid arthritis during an 8-year period

Eur J Orthod

Characteristics of masticatory movements and velocity in children with juvenile chronic arthritis

J Orofacial Pain

Mandibular growth, temporomandibular joint changes and dental occlusion in juvenile rheumatoid arthritis. A 17-year follow-up study

Scand J Rheumatol

Risk factors in juvenile chronic arthritis for developing temporomandibular disorders [abstract 3530]

J Dent Res

Oral Medicine
Orofacial pain, jaw function, and temporomandibular disorders in women with a history of juvenile chronic arthritis or persistent juvenile chronic arthritis*,**