Temporomandibular joint dysfunction and disorders in the development of the mandible in patients with juvenile idiopathic arthritis-preliminary study

Abstract

Background. The temporomandibular joint (TM J) may be affected unilaterally or bilaterally in the course of juvenile idiopathic arthritis (JIA). Permanent complications involve joint damage or stiffness and disorders in the development of the mandible, such as micrognathia, posterior rotation of the mandible, crowding and protrusion of the front teeth and malocclusion. Objectives. The aim of the study was the clinical and radiological assessment of TMJ dysfunctions and disorders in the development of the mandible in patients suffering from JIA, depending on the duration of the disease. Material and Methods. The research involved 46 patients with JIA, recognized according to the criteria established by the International League of Associations for Rheumatology (ILAR). Among the patients, 20 suffered from polyarticular JIA and 26 from pauciarticular JIA. The clinical assessment included determination of the facial profile according to Ricketts, intraoral assessment according to Angle's classification and canine class. There were 15 patients (9 with polyarticular and 6 with pauciarticular JIA) qualified for radiological examination. The location of the mandible was determined with the use of a lateral cephalometric image on the basis of a compilation of various analyses. Results. Out of the 46 patients, 15 individuals (32.6%) displayed clinical features of TMJ dysfunction (pain, clicking, crepitus). Of these, 6 patients (40.0%) reported disorders in mandibular development typical of JIA in the form of retrognathia and posterior rotation of the mandible. According to the grading system developed by Rohlin and Petersson, articular surface damage was considerably higher in the patients with a longer history of the disease (p < 0.01) and positively correlated with the deficit in mandible growth (r=0.66, p < 0.008). Conclusions. Early detection of temporomandibular joint damage, even in the case of juvenile idiopathic arthritis with a low level of inflammation, may prevent permanent and significant facial deformities when combined with orthodontic treatment of disorders in the development of the mandible