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de Sonnaville WFC, Speksnijder CM, Zuithoff NPA, Ter Horst SAJ, Nap FJ, Wulffraat NM, Steenks MH, Rosenberg AJWP. The reliability and validity of the juvenile idiopathic arthritis magnetic resonance scoring system for temporomandibular joints. J Craniomaxillofac Surg 2024; 52:906-913. [PMID: 38997869 DOI: 10.1016/j.jcms.2024.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 02/04/2024] [Accepted: 04/27/2024] [Indexed: 07/14/2024] Open
Abstract
In children with juvenile idiopathic arthritis (JIA), the temporomandibular joint (TMJ) can be involved. To prevent TMJ damage due to inflammation, early recognition is important, for which contrast-enhanced magnetic resonance imaging (MRI) is the gold standard. In this study, the interobserver reliability and construct validity of the Juvenile Idiopathic Arthritis Magnetic Resonance Scoring System for Temporomandibular Joints (JAMRIS-TMJ) was assessed. Two radiologists independently examined 38 MRIs using the JAMRIS-TMJ scoring system. Inter-observer reliability was assessed by Cohen's (weighted) kappa (κ), 95% confidence intervals (CIs) and absolute agreement (%). Construct validity was assessed by correlation between the JAMRIS-TMJ items and TMJ involvement, active maximum interincisal mouth opening (AMIO), and anterior maximum voluntary bite force (AMVBF). The interobserver reliability for the JAMRIS-TMJ items varied from poor to good (κ = 0.18-0.61). Joint enhancement had the highest reliability (κ = 0.61). Correlations were found between TMJ involvement, AMIO, and the JAMRIS-TMJ items, although variation between radiologists and TMJ side existed. No correlation was found between AMVBF and the JAMRIS-TMJ items for both radiologists. The strongest correlations were found between most of the JAMRIS-TMJ items and AMIO. Our findings support the utility of AMIO as a clinical measure of TMJ status in children with JIA.
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Affiliation(s)
- Willemijn F C de Sonnaville
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
| | - Caroline M Speksnijder
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Nicolaas P A Zuithoff
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Simone A J Ter Horst
- Department of Radiology, University Medical Center Utrecht and Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - Frank J Nap
- Department of Radiology, University Medical Center Utrecht and Wilhelmina Children's Hospital, Utrecht, the Netherlands; Department of Radiology, Central Military Hospital (CMH) Utrecht and University Medical Center Utrecht, Utrecht, the Netherlands
| | - Nico M Wulffraat
- Department of Pediatric Rheumatology and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; European Reference Network RITA, the Netherlands
| | - Michel H Steenks
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Antoine J W P Rosenberg
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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de Sonnaville WFC, Speksnijder CM, Zuithoff NPA, Heijstek MW, Wulffraat NM, Steenks MH, Rosenberg AJWP. Clinically Established Temporomandibular Involvement in Adults With Juvenile Idiopathic Arthritis. J Rheumatol 2023; 50:1462-1470. [PMID: 37399466 DOI: 10.3899/jrheum.2023-0204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVE To study clinical variables defining temporomandibular function in adults with juvenile idiopathic arthritis (JIA) and healthy controls. METHODS In this cross-sectional study, the temporomandibular joint (TMJ) screening protocol, mandibular range of motion (MROM), and anterior maximum voluntary bite force (AMVBF) were compared between adults with JIA and healthy controls. Unadjusted and adjusted models with corrections for sex and disease duration were constructed for active maximum interincisal mouth opening (AMIO) and AMVBF. RESULTS A total of 100 adults with JIA and 59 healthy adults were included in this study. In adults with JIA, 56% had clinically established TMJ involvement. AMIO was the MROM variable most reduced by TMJ involvement; AMIO was 8.8 mm (95% CI -11.40 to -6.12; P < 0.001) less in adults with JIA with TMJ involvement compared to JIA without TMJ involvement. No differences of AMIO were found between healthy adults and adults with JIA without TMJ involvement (-2.52, 95% CI -5.13 to 0.10; P = 0.06). Male sex was associated with a higher AMIO, and disease duration was associated with a decreased AMIO. Collinearity between the subtype prebiologic era and disease duration was found. AMVBF did not differ between adults with JIA and healthy adults. CONCLUSION The high prevalence of clinically established TMJ involvement in adults with JIA indicates the need for awareness of TMJ problems in adults with JIA. TMJ involvement negatively influenced AMIO and should therefore be part of the TMJ screening in adults with JIA. AMVBF seems to have less utility for TMJ screening in adult populations.
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Affiliation(s)
- Willemijn F C de Sonnaville
- W.F.C. de Sonnaville, MD, C.M. Speksnijder, PT, MSc, PhD, M.H. Steenks, DDS, PhD, A.J.W.P. Rosenberg, DMD, MD, Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University;
| | - Caroline M Speksnijder
- W.F.C. de Sonnaville, MD, C.M. Speksnijder, PT, MSc, PhD, M.H. Steenks, DDS, PhD, A.J.W.P. Rosenberg, DMD, MD, Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University
| | - Nicolaas P A Zuithoff
- N.P.A. Zuithoff, MSc, PhD, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht
| | - Marloes W Heijstek
- M.W. Heijstek, MD, PhD, Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht
| | - Nico M Wulffraat
- N.M. Wulffraat, MD, PhD, Department of Pediatric Rheumatology and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, and European Reference Network (RITA), Utrecht, the Netherlands
| | - Michel H Steenks
- W.F.C. de Sonnaville, MD, C.M. Speksnijder, PT, MSc, PhD, M.H. Steenks, DDS, PhD, A.J.W.P. Rosenberg, DMD, MD, Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University
| | - Antoine J W P Rosenberg
- W.F.C. de Sonnaville, MD, C.M. Speksnijder, PT, MSc, PhD, M.H. Steenks, DDS, PhD, A.J.W.P. Rosenberg, DMD, MD, Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University
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Verkouteren DRC, de Sonnaville WFC, Zuithoff NPA, Wulffraat NM, Steenks MH, Rosenberg AJWP. Growth curves for mandibular range of motion and maximum voluntary bite force in healthy children. Eur J Oral Sci 2022; 130:e12869. [PMID: 35482417 PMCID: PMC9321901 DOI: 10.1111/eos.12869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 04/02/2022] [Indexed: 11/30/2022]
Abstract
Mandibular range of motion and bite force are indispensable variables for the evaluation of mandibular function. There are a variety of medical and dental conditions that can negatively affect mandibular function. Values for mandibular range of motion (i.e., active and passive maximum interincisal mouth opening, protrusion, and laterotrusion) and anterior maximum voluntary bite force (AMVBF) in healthy children and adolescents can help in recognizing temporomandibular dysfunction. In this longitudinal study, 169 healthy children aged 6-18 years were included. They were examined at four time points over 1 year. Mixed model analysis was performed to produce growth curves of mandibular range of motion and AMVBF. Average active maximum interincisal mouth opening was significantly higher in boys with 50.0 mm compared to 47.8 mm in girls. Boys also had a significantly higher AMVBF than girls with an average of 169.0 N versus 140.0 N, respectively. Growth curves of active and passive maximum interincisal mouth opening showed an increase with age, albeit levelling off through puberty. The growth curves of AMVBF in girls reach a plateau phase at ages 12-14 years, after which the curve descends; in boys, the AMVBF tended to increase up to 18 years of age, although a slow-down after 14 years of age was noted.
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Affiliation(s)
- Daan R C Verkouteren
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Willemijn F C de Sonnaville
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Nicolaas P A Zuithoff
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Nico M Wulffraat
- Department of Pediatric Rheumatology and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Michel H Steenks
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Antoine J W P Rosenberg
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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de Sonnaville WFC, Speksnijder CM, Zuithoff NPA, Verkouteren DRC, Wulffraat NW, Steenks MH, Rosenberg AJWP. Maximum bite force in children with juvenile idiopathic arthritis with and without clinical established temporomandibular joint involvement and in healthy children: a cross-sectional study. J Oral Rehabil 2021; 48:774-784. [PMID: 33780558 PMCID: PMC8251949 DOI: 10.1111/joor.13172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/27/2021] [Indexed: 12/14/2022]
Abstract
Background In children with juvenile idiopathic arthritis (JIA), the temporomandibular joint (TMJ) can be involved, resulting in dysfunction of the masticatory system. Bite force is one of the variables that reflects the function of the masticatory system. The aim of this study was to compare maximum bite force in children with JIA, with and without TMJ involvement and with healthy children. Methods Children with JIA and healthy children between the ages 6 and 18 were included in this cross‐sectional study. The clinical examination consisted of measuring the anterior maximum voluntary bite force (AMVBF), assessment of the TMJ screening protocol items and TMJ, masseter and temporal muscle palpation pain. Unadjusted linear regression analyses were performed to evaluate the explanatory factors for AMVBF. Two adjusted models were constructed with corrections for age and gender differences: model 1 to compare children with JIA and healthy children and model 2 to compare children with JIA with and without TMJ involvement. Results In this cross‐sectional study, 298 children with JIA and 169 healthy children participated. AMVBF was 24 Newton (N) lower in children with JIA, when compared with healthy children (95%CI: −35.5–−12.4, p = .000). When children with JIA also had clinically established TMJ involvement, AMVBF was reduced 42 N (component JIA:−16.78, 95% CI −28.96–−4.59, p = .007 and component TMJ involvement:−25.36, 95% CI −40.08–−10.63, p = .001). Age and male gender increased AMVBF. Conclusion Children with JIA had a reduction in the AMVBF compared with healthy children. In children with JIA and clinically established TMJ involvement, AMVBF was more reduced.
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Affiliation(s)
- Willemijn F C de Sonnaville
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Caroline M Speksnijder
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Nicolaas P A Zuithoff
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Daan R C Verkouteren
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Nico W Wulffraat
- Department of Pediatric Rheumatology and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Michel H Steenks
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Antoine J W P Rosenberg
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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