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

Abstract

– The purpose was to determine the number and severity of lesions in the temporomandibular area and their association with occlusal status and mandibular movements, in 15‐yr‐old children afflicted with juvenile rheumatoid arthritis (JRA). The series comprised 121 JRA children, 78 girls and 43 boys, and a control group of 104 schoolchildren, 70 girls and 34 boys, taken for clinical examination. Of the JRA children, 55% had roentgenologically detectable lesions in the TMJ area. Lesions were found in 60% of the girls and in 42% of the boys, the ratio thus being 3:2. The largest group had grave lesions (48%), the second largest displayed flattening of the condyle (43%) and the smallest a flattened condyle with a minor lesion (9%). There were more bilateral lesions in the children with the severest lesions. Tendencies for Class II malocclusion, small vertical overbite and open bite were visible in the JRA children. Reduced maximal opening capacity, maximal protrusion, lateral movements of the mandible and pain in the TMJ area proved to be reliable signs predicting temporomandibular joint involvement in JRA children. Maximal mouth opening capacity was significantly restricted in the patients showing condylar lesions as compared with patients having no lesions or with controls. JRA children should be divided according to sex and the severity of the lesions. The JRA children without TMJ lesions had normal values for mandibular movements and were thus comparable to healthy children.

Frequency and Morbidity of Temporomandibular Joint Involvement in Adult Patients With a History of Juvenile Idiopathic Arthritis

“…Temporomandibular joint arthritis occurs in all subtypes of JIA, most often bilaterally [8,9,15,28]. Untreated TMJ arthritis is particularly concerning in pediatric patients because a mandibular growth center is located directly beneath the thin fibrocartilage of the condylar head, making it particularly susceptible to arthritic damage [29].…”

“…TMJ arthritis has been shown to have a significant adverse impact on physical and psychosocial well-being of children with JIA when compared to those without TMJ involvement [16]. Inflammatory arthritis of the TMJ is often asymptomatic in its early stages [2,3,[6][7][8][9][10][11][12][13], even during times when active synovitis is identified on imaging [17], rendering physical examination insufficient for diagnosis.…”

“…Juvenile idiopathic arthritis (JIA) is the most common chronic childhood rheumatic disease [1] and 25-75% of individuals with JIA have involvement of the temporomandibular joints (TMJ) [2][3][4][5][6][7][8][9][10][11][12][13]. Inflammatory TMJ arthritis can result in pain, functional limitation, occlusal instability, facial asymmetry and dentofacial deformity that may require operative correction [14,15].…”

Craniofacial growth and dento-alveolar development in juvenile idiopathic arthritis patients

“…Compensatory eruption of incisors and concomitant vertical alveolar growth may occur in the anterior part of the mandible to camouflage the mandibular growth pattern. 14 Peltomäki et al JIA patients has, however, been observed by Kreiborg et al 46 and Karhulahti et al 47 A steep occlusal plane relative to the maxillary plane in JIA patients was described by Rönning et al 31 They attributed this to the lack of vertical eruption of the maxillary molars in cases with reduced posterior facial height. They furthermore showed that the inclination of the lower incisors followed the growth pattern of the mandible.…”

Systemic and intra-articular anti-inflammatory therapy of temporomandibular joint arthritis in children with juvenile idiopathic arthritis

“…Subsequent work by this group confirmed that these radiographic abnormalities are directly related to mandibular size and asymmetrical growth. 42 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.…”