Abstract
BackgroundChildren and adolescents with juvenile idiopathic arthritis (JIA) may suffer from temporomandibular disorder (TMD). Due to this, imaging diagnosis is crucial in JIA with non-symptomatic TM joint (TMJ) involvement. The aim of the study was to examine the association between clinical TMD signs/symptoms and cone-beam computed tomography (CBCT) findings of TMJ structural deformities in children and adolescents with JIA.MethodsThis cross-sectional study is part of a longitudinal prospective multi-centre study performed from 2015–2020, including 228 children and adolescents aged 4–16 years diagnosed with JIA, according to the International League of Associations for Rheumatology (ILAR). For this sub-study, we included the Bergen cohort of 72 patients (32 female, median age 13.1 years, median duration of JIA 4.5 years). Clinical TMD signs/symptoms were registered as pain on palpation, pain on jaw movement, and combined pain of those two. The severity of TMJ deformity was classified as sound (no deformity), mild, or moderate/severe according to the radiographic findings of CBCT.ResultsOf 72 patients, 21 (29.2%) had pain on palpation at and around the lateral pole, while 41 (56.9%) had TMJ pain upon jaw movement and 26 (36.1%) had pain from both. Of 141 TMJs, 18.4% had mild and 14.2% had moderate/severe structural deformities visible on CBCT. CBCT findings were not significantly associated with either the pain on palpation or the pain on jaw movement. A significant difference was found between structural deformities in CBCT and the combined pain outcome (pain at both palpation and movement) for both TMJs for the persistent oligoarticular subtype (p = 0.031).ConclusionsThere was no association between painful TMD and CBCT imaging features of the TMJ in patients with JIA, but the oligoarticular subtype of JIA, there was a significant difference associated with TMJ pain and structural CBCT deformities.
Highlights
Children and adolescents with juvenile idiopathic arthritis (JIA) may suffer from temporomandibular disorder (TMD)
An even higher TMD figure of 83% was reported in a cohort of Brazilian adolescents with JIA [16], while a Danish study revealed that 38–53% of patients with JIA experienced orofacial symptoms and dysfunction due to TM joint (TMJ) arthritis and/or muscular tensions [17]
Clinical TMD examinations were performed by using a shortened version of the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) Axis I [23] and the self-assessment questionnaire recommended by Temporomandibular Joint Juvenile Arthritis group (TMJaw) for clinical TMJ assessment in patients diagnosed with JIA [24]
Summary
Children and adolescents with juvenile idiopathic arthritis (JIA) may suffer from temporomandibular disorder (TMD). The aim of the study was to examine the association between clinical TMD signs/symptoms and cone-beam computed tomography (CBCT) findings of TMJ structural deformities in children and adolescents with JIA. In a retrospective study by Cho and colleagues including 282 children and adolescents aged 10 – 18 years, the authors found an association between TMJ condylar deformities and TMJ symptoms or reduced mouth opening capacity [21]. Another CBCT-based study showed that children and adolescents (10–19 years) with TMD had more erosive cortical bone changes than same-aged pre-orthodontic controls with malocclusion [22], and the same study highlighted that pre-orthodontic participant with malocclusion presented solid radiographic signs. Clinical symptoms may serve as predictors for justified CBCT examination
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