Modified Diet Use in Adults with Temporomandibular Disorders related to Rheumatoid Arthritis: A Systematic Review

Abstract

Objective: Individuals presenting with rheumatoid arthritis (RA) frequently experience temporomandibular disorders (TMDs), which can result in limited ranges of mandibular motion, pain and fatigue on jaw function, and impaired mastication. As such, individuals with RA-related TMDs may consume a texture-modified diet in order to reduce the exacerbation of jaw pain and dysfunction, and to increase the ease of oral intake. These softer food options may not contain the recommended nutrients, vitamins, and minerals, and therefore, may not be nutritionally optimal. As unintentional body composition and weight changes are common in individuals with RA, there may be elevated risks of obesity or malnutrition in this patient subgroup. However, minimal researcth has been conducted to investigate the use of modified diets in this cohort, and therefore, the true level of risk to these patients cannot not be adequately determined. The aim of this study was to determine the prevalence of diet modifications in adults presenting with RA affecting the TMJ. Methods: All available evidence presenting data on adults with RA who consume modified diets was systematically reviewed. A range of electronic databases were searched, including: EMBASE, PubMed, CINAHL, Web of Science, Elsevier Scopus, Science Direct, AMED, The Cochrane Database of Systematic Reviews, and ProQuest Dissertations and Theses A & I. Supplementary Google Scholar, reference list, and grey literature searches were also conducted. Independent reviewers assessed study eligibility, and methodological quality was rated using the Down’s and Black assessment. Results: One study was eligible for inclusion, and half (50.82%; CI: 37.7–63.86) of individuals with RA in this study consumed a modified diet. This study was rated to be of moderate quality. The primary limitation of this review was the lack of studies on this topic which were available for inclusion. Conclusions: Although from clinical practice, it is recognised that adults with TMD related to RA do modify their diets to cope with the functional impairment of TMD, this review confirms that minimal research has been conducted regarding the use of texture modified diets by this population. This is despite concerns regarding unintentional weight changes in this patient group. Further research investigating this area is warranted in order to improve patient outcomes and experience of care.

Prevalence of temporomandibular disorders (TMD) in obesity patients: A systematic review and meta‐analysis

“…Weight gain and adipocyte hypertrophy cause compression of the blood arteries in the white adipose tissue, even though not all mechanisms are understood. 28 This scenario would set off a cascade of inflammatory reactions and the process of angiogenesis, which results in the development of new blood vessels.…”

“…Inflammatory cytokines and markers are elevated in obese people, and their white adipose tissue has infiltrating macrophages, which is thought to be a sign of persistent low‐grade inflammation. Weight gain and adipocyte hypertrophy cause compression of the blood arteries in the white adipose tissue, even though not all mechanisms are understood 28 . This scenario would set off a cascade of inflammatory reactions and the process of angiogenesis, which results in the development of new blood vessels.…”

Preclinical models of deep craniofacial nociception and temporomandibular disorder pain

“…TMD patients complain a long-persistency of pain, whereas CFA-evoked increases in deep craniofacial nociception are returned to control levels within 4 weeks [ 103 , 140 ]. On the other hand, CFA model could mimic the arthritis type of TMD, since CFA-evoked TMJ inflammation displays time dependent changes in structures of the TMJ and nociception [ 120 , 131 ] and individuals presenting with RA often experience TMD pain [ 141 ].…”

Fly Me to the Immune: Immunonutrition in Rheumatic Diseases

“…35 In fact, subclinical inflammation is propagated long before the first signs or symptoms of RDs are apparent. 36 As for the final “ I ”, namely I njury , musculoskeletal conditions are apparent in all patients with RDs, 37 – 39 accompanied by pain, underlying connective tissue disease and the consequent reduction in the function and range of motion in one or more parts of the musculoskeletal system. 40 , 41 Furthermore, in RDs, all “ I s ” are linked in a perpetual vicious circle of continuity, with each domain interacting and feeding the rest.…”