Temporomandibular Disorders and Oral Features in Systemic Lupus Erythematosus Patients: An Observational Study of Symptoms and Signs

Abstract

Aims: Systemic Lupus Erythematosus (SLE) is a connective tissue disease characterized by a wide range of pleomorphic pictures, including mucocutaneous, renal, musculoskeletal and neurological symptoms. It involves oral tissues, with hyposalivation, tooth decay, gingivitis, angular cheilitis, ulcers and glossitis. Temporomandibular disorders represent a heterogeneous group of inflammatory or degenerative diseases of the stomatognatic system, with algic and/or dysfunctional clinical features involving temporomandibular joint (TMJ) and related masticatory muscles. The aim of this study was to investigate the prevalence of oral manifestations and temporomandibular disorders (TMD) in SLE patients (Lp) compared with a control group. Methods: Fifty-five patients (9 men and 46 women) with diagnosed Lupus were recruited in the study group. A randomly selected group of 55 patients, matched by sex and age, served as control group. The examination for TMD symptoms and signs was based on the standardized Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) through a questionnaire and clinical examination. Results: Lupus patients complained more frequently (95.8%) of oral and TMJ symptoms (dysgeusia, stomatodynia, masticatory muscle pain during function, neck and shoulder muscles pain and presence of tinnitus) but only xerostomia (χ 2 =4,1548 p=0,0415), temple headache (χ 2 =4,4542 p=0,035) and the sensation of a stuck jaw (Mid-p-test p=0,043) were significant. About signs, cheilitis (p=0,0284) oral ulcers (χ 2 =4,0104 p=0,045) and fissured tongue are significantly more frequent in study group. The salivary flow was significantly decreased in the study group respect to the control one (p<0.0001). As regard to the oral kinematics, restricted movements (RM) in protrusion and left lateral movement were significantly different between study group and controls. In particular, 85,2% of Lp showed limited protrusion versus 56,4% of controls (χ 2 = 10,91 p<0,001); 59,3% of Lp had also a limitation during left lateral movement versus 47,3% of controls (T=2,225 p=0,0282). About bruxism, only the indentations on the lateral edges of the tongue were found in Lp group (72,7%), with a significant difference respect to controls (χ 2 =7,37 p=0,007). Conclusions: While masticatory muscles have an overlapping behavior in both groups, the findings collected show a more severe TMJ kinematic impairment in Lp than in controls, with protrusion and left lateral movements significantly different. In addition, a remarkable reduction of salivary flow has been detected in Lp compared to controls. In conclusion, this autoimmune disease seems to play a role in oral manifestations and TMJ disorders, causing an increase in orofacial pain and an altered chewing function.

Cellular Response against Oxidative Stress, a Novel Insight into Lupus Nephritis Pathogenesis

“…Skin lesions are frequent, such as symmetric malar erythema, photo sensibility, hyperkeratosis, ecchymosis, oral or mucosal ulcerations, alopecia. Proteinuria or nephrotic syndrome, changes in urinary sediment, increase in serum creatinine and arterial hypertension are clinical manifestations of lupus nephritis [ 1 , 2 ]. SLE—Autoimmune prototype disease—is characterized by abnormal responses of T and B immune cells with excessive synthesis of autoantibodies and immune circulant complexes [ 3 ] associated with nonimmune factors [ 4 , 5 ].…”

Thermal condition of muscle area around the temporomandibular joint in patient with systemic lupus erythematosus using infrared thermography application: A case report

“…In addition, the patient also had rheumatoid arthritis, therefore often experienced pain in the joints that existed throughout the body, including the TMJ. [ 13 14 ]As in the study of Aliko et al [ 6 ] showed the highest frequency of pain and joint sound found in patients with rheumatoid arthritis as much as 65% compared with the control group. [ 15 ]…”

Effects of Contact Sports on Temporomandibular Disorders: An Observational Study

“…Among adults, the prevalence of TMD ranges from 1% to 75% for objective signs and 5% to 33% for subjective symptoms [ 4 ]. TMD’s etiology is multifactorial and often influenced by age, gender, hormonal imbalances, traumatic injuries, stress and other systemic diseases [ 3 , 5 , 6 , 7 ]. Age plays an etiological role in TMD: the prevalence of TMD is usually more common in young adults and the range from 20 to 40 years of age coincides with the peak of the incidence of TMD, as reported by previous studies [ 3 , 4 , 5 , 6 , 8 ].…”