Clinical craniofacial examination of patients with juvenile idiopathic arthritis

Stoustrup, Peter; Koos, Bernd

doi:10.1053/j.sodo.2015.02.005

Cited by 11 publications

(23 citation statements)

References 26 publications

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“…Helkimo's dysfunction index was one of the first index to be used for TMD diagnosis, but it has low reproducibility and no established validity when used in patients with JIA . Also, the validity of RDC/TMD used in several studies to assess the presence of temporomandibular disorders in JIA patients has not been established …”

Section: Discussionmentioning

confidence: 99%

“…30 Also, the validity of RDC/TMD 20 used in several studies to assess the presence of temporomandibular disorders in JIA patients 31 has not been established. 32 Arthritic inflammatory process in TMJ may cause pain, cartilage and bone tissue destruction as well as growth disturbances. After severe damage or growth disturbance, clinically detectable changes such as occlusal changes and micrognathia may occur but that is usually late in the disease process.…”

Section: Discussionmentioning

confidence: 99%

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Temporomandibular joint damage in juvenile idiopathic arthritis: Diagnostic validity of diagnostic criteria for temporomandibular disorders

Rongo

Alstergren

Ammendola

et al. 2019

J of Oral Rehabilitation

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Summary Background Diagnostic criteria reported in the expanded taxonomy for temporomandibular disorders include a standardised clinical examination and diagnosis (DC/TMD 3.B) of temporomandibular joint (TMJ) damage in patients with juvenile idiopathic arthritis (JIA); however, their validity is unknown. Objectives To assess the validity of DC/TMD 3.B for the identification of TMJ damage in JIA‐patients, using magnetic resonance imaging (MRI) as gold standard, and to investigate the relation between clinical findings and TMJ damage. Methods Fifty consecutive JIA patients (9‐16 years) were recruited. DC/TMD 3.B were compared with TMJs MRI (100 TMJs) performed maximum at 1 month from the visit. The severity of TMJ damage was scored in four grades. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), logistic regression models with odds ratio of DC/TMD 3.B and clinical findings respect to MRI were calculated. Results The DC/TMD 3.B were inadequate in the identification of TMJ damage (sensitivity = 0.15, specificity = 0.92, PPV = 0.85, NPV = 0.28, P = 0.350). Chin deviation and TMJ crepitus were associated with worse TMJ damage (P = 0.006; P = 0.034). Reduced mouth opening (OR = 3.91, P = 0.039) and chin deviation (OR = 13.7, P = 0.014) were associated with the presence of TMJ damage. Combining “pain” (history of pain, TMJ pain, pain during movements) and “function” (TMJ crepitus, reduced mouth opening, chin deviation) clinical findings, the sensitivity and the specificity were 0.88 and 0.54. Conclusion DC/TMD 3.B present a low sensitivity to diagnose TMJ damage. Chin deviation, reduced mouth opening and TMJ crepitus are associated with TMJ damage. We suggest combining “pain” and “function” findings for the evaluation of TMJ damage in JIA patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Temporomandibular joint damage in juvenile idiopathic arthritis: Diagnostic validity of diagnostic criteria for temporomandibular disorders

Rongo

Alstergren

Ammendola

et al. 2019

J of Oral Rehabilitation

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“…The assessment procedures were standardised and were based on two shortened versions of the diagnostic tools "Axis I Clinical Examination for DC/TMD" [25] and the self-assessment questionnaire Recommendations for Clinical TMJ Assessment in Patients Diagnosed With JIA" [26]. The latter was used to enhance the operational speci cation of DC/TMD due to the fact that the DC/TMD tool alone is reported to show weak validity for TMJ assessment, e.g.…”

Section: Tmd Screening and Assessmentmentioning

confidence: 99%

“…Also, younger children with JIA might suffer pain from TMJs caused by in ammation and/or destructive changes, by muscular tensions from the surrounding muscles as a component of TMD, or by a combination of the two [12]. Symptoms indicating TMJ arthritis include decreased mouth opening and/or ear ache and pain during eating, chewing, or yawning [15][16][17] (16,(25)(26)(27). In younger children, the clinical assessment of painful TMD symptoms might be biased by indirect input from their parents.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of temporomandibular disorder in children and adolescents with juvenile idiopathic arthritis – a Norwegian cross-sectional multicentre study

Fischer

Skeie

Rosendahl

et al. 2020

Preprint

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Background. Children and adolescents with juvenile idiopathic arthritis (JIA) may suffer pain from temporomandibular disorder (TMD). Still, routines for the assessment of temporomandibular joint (TMJ) pain in health and dental care are lacking. The aims of this study were to examine the prevalence of TMD in children and adolescents with JIA compared to their healthy peers and to investigate potential associations between JIA and TMD. Methods. This comparative cross-sectional study is part of a longitudinal multicentre study performed during 2015–2020, including 228 children and adolescents aged 4–16 years with a diagnosis of JIA according to the ILAR criteria. This particular substudy draws on a subset of data from the first study visit, including assessments of TMD as part of a broader oral health examination. Children and adolescents with JIA were matched with healthy controls according to gender, age, and centre site. Five calibrated examiners performed the clinical oral examinations according to a standardised protocol, including shortened versions of the diagnostic criteria for TMD (DC/TMD) and the former EuroTMJoint Recommendations for Clinical TMJ Assessment in Patients Diagnosed with JIA. Symptoms were recorded and followed by a clinical examination assessing the masticatory muscles and TMJs. Results. In our cohort of 221 participants with JIA and 221 healthy controls, 88 (39.8%) participants with JIA and 25 (11.3%) healthycontrols presented with TMD based on symptoms and clinical signs. Painful TMD during the last 30 days was reported in 59 (26.7%) participants with JIA vs. 10 (5.0%) of the healthy controls (p < 0.001). Vertical unassisted jaw movement was lower in participants with JIA than in controls, with means of 46.2 mm vs. 49.0 mm, respectively (p < 0.001). Among participants with JIA, a higher proportion of those using synthetic disease-modifying antirheumatic-drugs and biologic disease-modifying antirheumatic-drugs presented with painful masticatory muscles and TMJs at palpation.Conclusion. Symptoms and clinical signs of TMD were seen in approximately half of the JIA patients compared to about one fourth of their healthy peers. Painful palpation to masticatory muscles and decreased vertical unassisted jaw movement were more frequent in participants with JIA than among healthy controls and should be part of both medical and dental routine examinations in patients with JIA.

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“…Clinical TMJ examination was performed by either a specialist in oral and maxillofacial surgery or a specialist in pediatric dentistry (PF, AR, JRB, JH) according to the DC / TMD examination and diagnostics protocol (31) and EuroTMJoint Clinical Recommendations protocol (32). The two examiners were calibrated repeatedly during the study period (33).…”

Section: Clinical Variables Tmj Examination and Assessment Of Diseamentioning

confidence: 99%

Efficacy and safety of intraarticular corticosteroid injections in adolescents with juvenile idiopathic arthritis in the temporomandibular joint: A Norwegian 2-year prospective multicenter pilot study.

Frid

Augdal

Larheim³

et al. 2020

Preprint

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Background. Intraarticular corticosteroids (IACs) have been used to treat temporomandibular joint (TMJ) arthritis. However, prospective clinical studies with magnetic resonance imaging (MRI) scoring are lacking. The aim of this study was to examine efficacy and safety of a single IAC in the TMJ in adolescents with juvenile idiopathic arthritis (JIA) in a clinical setting. Methods. In this Norwegian prospective multicenter pilot study 15 patients with JIA (mostly persistent oligo-arthritis or RF negative polyarthritis categories) and a clinically and MRI-verified diagnosis of TMJ arthritis were treated with IACs and followed for two years. Demographics, systemic medication, general disease activity and outcome measures were recorded including a pain-index score and maximal incisal opening (MIO). Inflammation and bone damage scores were assessed, using two recently published MRI scoring systems with masked radiological evaluation.Results. Among the 15 patients, 13 received a single IAC (5 bilateral), and 2 repeated IACs once unilaterally. Thus, the total number of IACs was 22. Median age was 15 years and the majority had an age not thought of as critical regarding mandibular growth retardation due to steroid injection. During the 2-year observation period systemic medication with disease modifying antirheumatic drugs (DMARDs) including biologics was initiated or adjusted in 10/15 (67%) patients. At the 2-months study visit after injection we observed a minimal improvement in MIO from median 44 (1st, 3rd quartiles; 36, 48) mm to 45 (43, 47) mm, p= 0.045 and decreased MRI mean additive inflammatory score from 4.4±1.8 standard deviations (SD) to 3.4±2.0, p= 0.040. From baseline to the 2-months follow-up pain improved in 6/11 patients but pain scores were not significantly improved. MRI-assessed damage increased in two patients with repeated IACs, and decreased in 3 patients but most of the patients were stable over the 2-year follow-up. Intra-rater repeatability of the MRI scoring system domains varied from poor to excellent.Conclusions. In this pilot study of predominately single IACs to the TMJ in combination with systemic treatment we observed improvement in MRI-assessed inflammation, mostly stable condylar bone conditions and minimal clinical improvement in adolescents with JIA and TMJ arthritis. No side effects were seen.

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Clinical craniofacial examination of patients with juvenile idiopathic arthritis

Cited by 11 publications

References 26 publications

Temporomandibular joint damage in juvenile idiopathic arthritis: Diagnostic validity of diagnostic criteria for temporomandibular disorders

Temporomandibular joint damage in juvenile idiopathic arthritis: Diagnostic validity of diagnostic criteria for temporomandibular disorders

Prevalence of temporomandibular disorder in children and adolescents with juvenile idiopathic arthritis – a Norwegian cross-sectional multicentre study

Efficacy and safety of intraarticular corticosteroid injections in adolescents with juvenile idiopathic arthritis in the temporomandibular joint: A Norwegian 2-year prospective multicenter pilot study.

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