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

Abstract

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.

Management of Orofacial Manifestations of Juvenile Idiopathic Arthritis: Interdisciplinary Consensus‐Based Recommendations

“…Occasionally, TMJ arthritis is the only manifestation of JIA (8). Early TMJ arthritis may be asymptomatic, but many patients experience orofacial symptoms, orofacial dysfunction, and a decrease in quality of life as the disease progresses (1)(2)(3)5,6,(9)(10)(11)(12). In skeletally immature patients, TMJ arthritis can interfere with facial growth and development, resulting in dentofacial deformity (13,14).…”

Growth curves for mandibular range of motion and maximum voluntary bite force in healthy children

“…Several studies show the value of bite force measurements in the assessment of mandibular function [5,[13][14][15][16]. Values of range of motion and bite force and their change over time in healthy young children and adolescents might be helpful in the recognition of potential temporomandibular sequelae due to medical and dental conditions [16][17][18][19][20][21][22]. In order to appraise these outcome measures in clinical patients, data from nonpatient groups of children and adolescents are mandatory.…”

Vitamin D, oral health, and disease characteristics in juvenile idiopathic arthritis: a multicenter cross-sectional study

“…Arthritis of the temporomandibular joint (TMJ) is common, and it may lead to oral and dentofacial deformities such as abnormal skeletal growth of the jaws with facial asymmetry or mandibular retrognathia, and malocclusion [4,5]. Common orofacial symptoms are temporomandibular dysfunction, with painful and restricted jaw movements due to myalgia or arthralgia [5,6].…”