Comprehensive Assessment of Orofacial Health and Disease Related Parameters in Adolescents with Juvenile Idiopathic Arthritis-A Cross-Sectional Study

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

Involvement of the temporomandibular joint (TMJ) is common in juvenile idiopathic arthritis (JIA). TMJ arthritis can lead to orofacial symptoms, orofacial dysfunction, and dentofacial deformity with negative impact on quality of life. Management involves interdisciplinary collaboration. No current recommendations exist to guide clinical management. We undertook this study to develop consensus-based interdisciplinary recommendations for management of orofacial manifestations of JIA, and to create a future research agenda related to management of TMJ arthritis in children with JIA. Recommendations were developed using online surveying of relevant stakeholders, systematic literature review, evidence-informed generation of recommendations during 2 consensus meetings, and Delphi study iterations involving external experts. The process included disciplines involved in the care of orofacial manifestations of JIA: pediatric rheumatology, radiology, orthodontics, oral and maxillofacial surgery, orofacial pain specialists, and pediatric dentistry. Recommendations were accepted if agreement was >80% during a final Delphi study. Three overarching management principles and 12 recommendations for interdisciplinary management of orofacial manifestations of JIA were outlined. The 12 recommendations pertained to diagnosis (n = 4), treatment of TMJ arthritis (active TMJ inflammation) (n = 2), treatment of TMJ dysfunction and symptoms (n = 3), treatment of arthritis-related dentofacial deformity (n = 2), and other aspects related to JIA (n = 1). Additionally, a future interdisciplinary research agenda was developed. These are the first interdisciplinary recommendations to guide clinical management of TMJ JIA. The 3 overarching principles and 12 recommendations fill an important gap in current clinical practice. They emphasize the importance of an interdisciplinary approach to diagnosis and management of orofacial manifestations of JIA.

Dental caries in children and adolescents with juvenile idiopathic arthritis and controls: a multilevel analysis

Background

Optimal utilization of dental caries data is crucial in epidemiological research of individuals with juvenile idiopathic arthritis (JIA). The aims were to: explore whether caries is more prevalent among children and adolescents with JIA compared to controls; examine presence of caries according to JIA group, socio-behavioral and intraoral characteristics, and the extent to which surface-specific caries varies between and within individuals; assess whether surface-specific caries varies according to JIA group and dentition; and investigate whether disease-specific clinical features of JIA are associated with presence of caries.

Methods

In this comparative cross-sectional study, calibrated dentists examined index teeth (primary 2. molars, 1. permanent molars) of 4–16-year-olds with JIA (n = 219) and matched controls (n = 224), using a detailed caries diagnosis system (including enamel caries). JIA-specific characteristics were assessed by pediatric rheumatologists and socio-behavioral information collected by questionnaires. Multilevel mixed-effect logistic regressions reporting odds ratios (OR) with 95% confidence interval (CI) were applied (caries at surface level as outcome variable). Potential confounders were adjusted for, and the effect of dependency of surface-specific caries data was estimated by calculating intra-class correlation coefficients (ICC).

Results

At individual level, no significant difference in caries prevalence was found between individuals with JIA and controls, regardless of inclusion of enamel caries. Proportion of enamel lesions exceeded dentine lesions. JIA was not associated with presence of caries, but in both groups, low maternal educational level was associated with presence of caries (OR: 2.07, 95% CI: 1.24–3.46). Occlusal and mesial surfaces, compared to buccal surfaces, had generally higher OR according to presence of caries than distal and lingual surfaces (ICC = 0.56). Surface-specific caries in the permanent dentition differed significantly according to group affiliation. Some JIA disease-specific variables were suggested to associate with presence of caries.

Conclusions

No overall difference in caries prevalence between individuals with JIA and controls was observed, but for both groups, low maternal educational level and tooth surface associated with presence of caries. Associations between JIA disease-specific variables and presence of caries cannot be excluded. Due to predominance of enamel lesions, the potential of preventative dental strategies is considerable.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-021-01758-y.

Clinical and Instrumental TMJ Evaluation in Children and Adolescents with Juvenile Idiopathic Arthritis: A Case—Control Study

To investigate temporomandibular joint (TMJ) involvement signs such as muscle pain, the ratio of masseter and temporal muscle activity, mouth opening width and jaw deviation during mouth opening in children and adolescents with juvenile idiopathic arthritis (JIA), a group of 32 subjects with JIA and a control group of 32 healthy subjects were evaluated. Data were collected clinically by muscle palpation (masseters, anterior temporalis and sternocleidomastoids) and instrumental analysis (electromyography and kinesiography). Higher pain was registered in the masseter and sternocleidomastoid muscles on both sides and in the right anterior temporalis in the JIA group compared to the control group (p < 0.05). Electromyography showed no statistically significant difference in the frequency of the pathological ratio of masseter and temporal muscle activity (MM/TA < 1) both in the JIA group and in the control group. Kinesiography showed a statistically significant difference in mouth opening width and jaw deviation during mouth opening between the groups (p < 0.05): JIA subjects showed lower mouth opening values and wider deviation on mouth opening; 29 out of 32 JIA subjects showed jaw deviation towards the right side. JIA affects the TMJ, causing myalgia in the head and neck muscles, a reduction in mouth opening width and an increase in jaw deviation during mouth opening.

Analysis of the condition of solid tissues of teeth and the level of dental care provided to children with rheumatic diseases

Relevance. Rheumatic diseases strongly influence the condition of the oral cavity, salivary glands and the temporomandibular joint, that, along with poor oral hygiene in children and active growth, increases the risk of oral disease development. The growing number of rheumatic diseases in children requires evaluation of the oral cavity condition and assessment of the provided dental services; enhancement of the professional oral care in children with rheumatic diseases through the comprehensive evaluation of the quality of the performed dental procedures and development of caries prevention measures based on the analysis of the epidemiological survey results.Materials and methods. 316 children with rheumatic pathology aged 1 to 18 years were examined. The children were divided into three age groups: group I – 1-5 years, group II – 6-12 years, group III – 13-17 years. The Oral hygiene and past dental experience questionnaire was developed for each group. Hard dental tissue condition and caries intensity level (df – in group I, df+DMF – in group II, DMF – in group III) were assessed, the oral hygiene index was calculated by the child age. On dental examination, past caries treatment and its complications were considered, the level of dental care (LDC) according to Leus was assessed.Results. The received data on caries intensity in all age groups and all medical conditions were analyzed. The values corresponded to the high and very high intensity (4.2 to 13); the values were 1.89 – 3 times higher than the values received during the epidemiological survey in children of the same age groups in Russia. Multiple primary and secondary (as a complication after the previous dental treatment) caries, associated with poor oral hygiene, was detected. The data revealed that the dental care level in children with rheumatic diseases was ‘poor’ and ‘insufficient’ The interview of the children and their parents showed that 91% of children had never had preventive treatment and 89% of children visited the dentist less than twice a year. The examination revealed that secondary caries, that had developed in 50% of children after the treatment of caries and its complications, and bad fillings, that had to be replaced.Conclusions. Thus, indirect influence of the main disease on the hard dental tissues in children was revealed – motivation for dental treatment and good oral hygiene was decreased for the lack of knowledge. The analysis of dental treatment quality in such children was insufficient. Only emergency dental visits as well as inappropriate materials and methods used for the treatment of caries and its complications result in secondary caries. So, customized treatment approach and prevention programs should be developed and introduced for the oral care in children with rheumatic diseases according to the main disease course, administered background therapy and the level of dental health education.

A Study of Enamel Defects and Dental Caries of Permanent Dentition in School Children with Intellectual Disability

Data concerning the prevalence of developmental enamel defects and their association with dental caries in individuals with intellectual disability are scarce. This paper aims to evaluate the prevalence and distribution of developmental enamel defects and dental caries in the permanent dentition of special-care school children from Poznan (Poland). Out of 1091 students attending all special-care schools in the city, the study covered 268 subjects with intellectual disability (mild, moderate, severe, and profound) with permanent dentition, aged 10-20. One calibrated dentist performed dental examinations. The Statistica Software v10 was used for statistical analysis, assuming the level of statistical significance p ≤ 0.05. Among the subjects of the study, 19.40% presented developmental enamel defects. The number of teeth with changes ranged from 1 to 28, with maxillary incisors most frequently affected. Students without developmental enamel defects had more teeth observed with active caries compared to those with such changes (10.92% vs. 7.82%, p < 0.01). The highest number of students with developmental defects of enamel was observed in the group of individuals with mild intellectual disabilities. The present study revealed that in special-care students from Poznan, enamel defects and dental caries were frequently observed. However, individuals with developmental enamel defects did not show higher dental caries indices.