Background/Purpose:

In children with juvenile idiopathic arthritis (JIA) temporomandibular joints (TMJ) are affected in up to 96% of the patients, where TMJ arthritis is frequently asymptomatic. Despite that, orofacial anomalies occur in many patients and tend to be correlated with dysfunction and excessive mechanical strain, which may complicate treatment and aggravate TMJ destruction.

To examine the prevalence and severity of relevant orofacial anomalies in patients with JIA compared to healthy children and to assess the correlation with Gadolinium (Gd) enhanced MRI.

Methods:

TMJ data of 216 consecutive JIA patients (69% female, median age 12.9 years) were compared to TMJ data of 3756 healthy children (Stahl, Grabowski et al., 2007; Hirsch et al., 2009). JIA patients were divided into group I (2–10 years) and group II (10–18 years). The following measurements were taken: occlusal relations, mandibular position, deep and open bite (group I) and TMJ noise, tenderness to palpation of the TMJ or the masticatory muscles, reduced mouth opening (group II). In a subgroup (37 consecutive JIA patients, 57% female, median age 11.1 years) Gd MRI examinations were analyzed and compared to functional measurements. Sensitivity and specificity of the functional measurements were determined.

Results:

Mandibular asymmetry was found in 35% of patients (15% right, 20% left; no correlation with sex; p = 0.76). Inhibited mandibular growth (distocclusion) was seen in 59% of patients (no correlation with sex; p= 0.57). Open bite was seen in 6.5%, deep bite in 33% of the children.

TMJ arthritis was demonstrated in 81% of the children from the MRI subgroup. Pathological TMJ sounds were present in 26% of the patients, but showed no statistical significance (p= 0.16). TMJ and masticatory muscles tenderness were present in 46.8% and 40.2%, respectively. Limitation of the interincisal opening was found in 14.4% of the patients. A positive statistical correlation was found for these functional measures (tenderness to palpation p ≤ 0.001 and limitation of interincisal opening p = 0.002), but sensitivity was low at 53% (specificity: 89%).

Conclusion:

The prevalence of orofacial abnormalities is noticeably increased in JIA patients compared to healthy children, particularly inhibition of the mandibular growth and mandibular asymmetries. Clinical findings and inflammatory state of TMJ does not reliable correlate. This mandates interdisciplinary TMJ treatment including orthodontics especially with respect to the high prevalence of TMJ dysfunction.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/orofacial-anomalies-in-children-with-confirmed-juvenile-idiopathic-arthritis/