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Semerci ZM, Günen Yılmaz S. Evaluation of Rheumatic Diseases Affecting the Temporomandibular Joint: A Cone Beam Computed Tomography Study and Literature Review. Diagnostics (Basel) 2023; 14:4. [PMID: 38201313 PMCID: PMC10795630 DOI: 10.3390/diagnostics14010004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/12/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024] Open
Abstract
INTRODUCTION Due to the silent manifestation of temporomandibular joint (TMJ), dentists and rheumatologists may neglect treatment for this joint. AIMS The aim of this study was to investigate the TMJ components in patients with various rheumatic diseases and to compare them with a control group based on cone beam computed tomography (CBCT) images. MATERIALS AND METHODS This study comprised an assessment of the CBCT images of 65 patients (130 temporomandibular joints) with various rheumatic diseases (mostly rheumatoid arthritis) affecting the TMJ. Moreover, 65 patients (130 temporomandibular joints) with a similar age and gender distribution were examined as the control group. Pathologies were classified into a total of 12 types for the presence of any osseous changes in the condylar head or articular fossa or for joint space narrowing. Statistical analysis of all data was performed with SPSS version 18. The conformity of continuous variables to a normal distribution was examined by the Kolmogorov-Smirnov test. The Mann-Whitney U test was used to compare the means of two independent groups. The Pearson Chi-square test, Yates correction and Fisher's exact test were used in the analysis of categorical variables. RESULTS The mean age of the patient and control groups was 50 ± 13 and 48 ± 16, respectively, and no statistically significant difference was found between the patient and control groups in terms of age distribution (p = 0.123). Condylar erosion, condylar flattening, subcondylar sclerosis, osteophytes, subcortical cysts, articular eminence resorption and articular eminence flattening rates were found to be statistically significantly higher in the patient group than in the control group (p < 0.05). CONCLUSIONS Dentomaxillofacial radiologists should examine the bony components of the TMJ in patients with rheumatic diseases, and a multidisciplinary approach involving a dental specialist and rheumatologist is required.
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Affiliation(s)
- Zeliha Merve Semerci
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Akdeniz University, Antalya 07070, Turkey;
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Hysa E, Lercara A, Cere A, Gotelli E, Gerli V, Paolino S, Pizzorni C, Sulli A, Smith V, Cutolo M. Temporomandibular disorders in immune-mediated rheumatic diseases of the adult: A systematic review. Semin Arthritis Rheum 2023; 61:152215. [PMID: 37167773 DOI: 10.1016/j.semarthrit.2023.152215] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 12/24/2022] [Accepted: 04/26/2023] [Indexed: 05/13/2023]
Abstract
OBJECTIVE To systematically review the literature concerning temporomandibular disorders (TMDs) in immune-mediated rheumatic diseases (IMRDs) of the adult. The temporomandibular joint (TMJ) outcomes used in clinical studies, the prevalence of TMDs in IMRDs and the risk factors for their development were qualitatively synthetized. METHODS A literature search on PubMed Central, Embase and Cochrane Library databases was performed for studies including TMJ outcomes in IMRDs patients compared with healthy controls, other rheumatic diseases or in the assessed IMRDs patients after follow-up and treatment. Among the IMRDs of the adult, original articles investigating TMJ involvement in inflammatory polyarthritides and/or autoimmune connective tissue diseases were considered. The quality of the studies was scored using the Newcastle-Ottawa scale (NOS). RESULTS Of the 3259 screened abstracts, 56 papers were included in the systematic review. Most of the papers (77%) investigated TMDs in rheumatoid arthritis (RA) with a prevalence of signs and symptoms varying from 8% to 70%. The risk factors for TMDs development in RA were female sex, younger age, anti-citrulline peptide autoantibodies (ACPA) positivity, higher disease activity, cervical spine involvement, cardiovascular and neuropsychiatric comorbidities. Ten papers (18%) evaluated TMDs in spondylarthritides (SpA) reporting a prevalence of symptoms and signs in 12%-80% of patients with higher TMDs prevalence in patients with radiographic spine involvement, skin psoriasis and HLADRB1×01 positivity. Among autoimmune connective tissue diseases (CTDs), systemic sclerosis (SSc) displayed the highest evidence of TMDs patient-reported outcomes (PROs) and clinical findings (20-93%), followed by systemic lupus erythematosus (SLE) in 18-85%, primary Sjogren's syndrome (24-54%) and idiopathic inflammatory myopathies (4-26%). In SSc and SLE, TMDs were more frequent in patients with higher disease activity and duration, correlating with the extent of skin fibrosis in SSc and with renal involvement in SLE. CONCLUSION TMDs in IMRDs display a significant relevance in the rheumatological clinical practice even if often misdiagnosed. This burden is epidemiologically important in terms of PROs and clinical findings which correlate with disease activity in RA, SpA, SSc and SLE. The early recognition and multidisciplinary management of TMDs is warranted and should be aimed at hindering the TMJ structural damage maximizing the quality of life of patients.
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Affiliation(s)
- Elvis Hysa
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, University of Genova, IRCCS San Martino Polyclinic Hospital Viale Benedetto XV, No 6, Genova 16132, Italy
| | - Adriano Lercara
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, University of Genova, IRCCS San Martino Polyclinic Hospital Viale Benedetto XV, No 6, Genova 16132, Italy
| | - Andrea Cere
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, University of Genova, IRCCS San Martino Polyclinic Hospital Viale Benedetto XV, No 6, Genova 16132, Italy
| | - Emanuele Gotelli
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, University of Genova, IRCCS San Martino Polyclinic Hospital Viale Benedetto XV, No 6, Genova 16132, Italy
| | - Veronica Gerli
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, University of Genova, IRCCS San Martino Polyclinic Hospital Viale Benedetto XV, No 6, Genova 16132, Italy
| | - Sabrina Paolino
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, University of Genova, IRCCS San Martino Polyclinic Hospital Viale Benedetto XV, No 6, Genova 16132, Italy
| | - Carmen Pizzorni
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, University of Genova, IRCCS San Martino Polyclinic Hospital Viale Benedetto XV, No 6, Genova 16132, Italy
| | - Alberto Sulli
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, University of Genova, IRCCS San Martino Polyclinic Hospital Viale Benedetto XV, No 6, Genova 16132, Italy
| | - Vanessa Smith
- Department of Internal Medicine, Department of Rheumatology, Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Center (IRC), Ghent University Hospital, Corneel Heymanslaan 10, Ghent 9000, Belgium
| | - Maurizio Cutolo
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, University of Genova, IRCCS San Martino Polyclinic Hospital Viale Benedetto XV, No 6, Genova 16132, Italy.
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Piancino MG, Rotolo R, Cannavale R, Cuomo G, Masini F, Dalmasso P, D'Apuzzo F, Perillo L, Nucci L. Cranial structure and condylar asymmetry of adult patients with rheumatoid arthritis. BMC Oral Health 2023; 23:269. [PMID: 37161398 PMCID: PMC10170686 DOI: 10.1186/s12903-023-03001-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 04/29/2023] [Indexed: 05/11/2023] Open
Abstract
OBJECTIVE The aim of this prospective cross sectional study was to evaluate the cranial structure and condylar asymmetry of adult patients with rheumatoid arthritis (RA) diagnosed after 25 years of age compared to a healthy adult control group. METHODS Eighteen adult patients (57.4 ± 11.4 years) with RA were compared with a control group. Cephalometric analysis and the Habets method for the calculation of the condylar asymmetry were used. The main cephalometric data investigated were focused on the diagnosis of hyperdivergent cranial structure (NSL/ML, NL/ML), backwards rotation of the mandible (Fh/ML), short vertical ramus (Ar:Go), steep mandibular plane (ML/Oc). RESULTS The cephalometric data considered were not significantly different in the RA vs controls except for the steepness of the occlusal plane (NL/Oc), which was steeper in the patients group (P < 0.02) and the ramus of the mandible which was greater in patients. The asymmetry of the condyles was significant (P < 0.003) and different from the control group, but that of the ramus was not. CONCLUSIONS In this study, RA patients diagnosed after 25 years of age did not show a different pattern of growth with respect to the control group. As expected, the condyles showed a difference being asymmetrical in RA patients due to the high turnover of this joint reacting to severe systemic inflammation in conditions of continuous functional work, load and forces. This study follows a previous study with the same research plan conducted on young JIA patients who showed a different pattern of growth of the skull leading to a severe hyperdivergent cranial structure with backward rotation of the mandible; this is mainly due to the insufficient growth of the condylar site exposed to the inflammatory process during development. Unlike JIA patients, this study showed that RA patients follow an individual growth pattern not affected by inflammation, even if they show joint asymmetry.
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Affiliation(s)
- Maria Grazia Piancino
- Department of Surgical Sciences-Orthodontic Division, Italian Research Center, University of Turin, Turin, Italy
| | - Rossana Rotolo
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of the Study of Campania Luigi Vanvitelli, Naples, Italy
| | - Rosangela Cannavale
- Department of Surgical Sciences-Orthodontic Division, Italian Research Center, University of Turin, Turin, Italy.
| | - Giovanna Cuomo
- Department of Precision Medicine, University of the Study of Campania Luigi Vanvitelli, Naples, Italy
| | - Francesco Masini
- Department of Medical and Surgical Sciences, University of the Study of Campania Luigi Vanvitelli, Naples, Italy
| | - Paola Dalmasso
- Department of Public Health and Paediatrics, University of Turin, Turin, Italy
| | - Fabrizia D'Apuzzo
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of the Study of Campania Luigi Vanvitelli, Naples, Italy
| | - Letizia Perillo
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of the Study of Campania Luigi Vanvitelli, Naples, Italy
| | - Ludovica Nucci
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of the Study of Campania Luigi Vanvitelli, Naples, Italy
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Three-dimensional relationships between condylar volume and dentoskeletal characteristics in Class II hyperdivergent female adults. BMC Oral Health 2023; 23:148. [PMID: 36915097 PMCID: PMC10012536 DOI: 10.1186/s12903-023-02838-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 02/24/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND This study aimed to determine the differences among various volumes of condylar osseous patterns and the corresponding dentoskeletal characteristics based on the risk of temporomandibular disorder. METHODS Craniofacial spiral computed tomography data of 60 Class II hyperdivergent female adults were divided into normal, resorptive, flattened, and osteophyte groups based on condylar osseous forms. The condylar volumes of each group were compared, and their correlations with the dentoskeletal characteristics were assessed in three dimensions. Pairwise least significant difference tests were used to examine individual pairwise differences between groups, and one-way analysis of variance was used to measure differences among multiple groups. Pearson correlation and Spearman rank correlation analyses were used to determine the correlation between condylar volume and dentofacial characteristics. Statistical significance was established at p < 0.05. RESULTS The condylar volume in the normal group was significantly greater than that in the changed groups, with no significant differences between the subgroups. The decrease in condylar volume was associated with a retruded and clockwise-rotated mandible with shorter rami. Condylar volume was negatively correlated with overjet, the alveolar height of the lower anterior and posterior teeth, sagittal inclinations of the lower teeth, intermolar width of the mandibular first molars, and width between the corresponding alveolar crests. CONCLUSION Multiple three-dimensional dentoskeletal characteristics of Class II hyperdivergent female adults are correlated with condylar bony changes, regardless of the form. These results could be helpful in indicating potential pathological changes in the temporomandibular joint and in making proper treatment plans for these patients.
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Gharavi SM, Qiao Y, Faghihimehr A, Vossen J. Imaging of the Temporomandibular Joint. Diagnostics (Basel) 2022; 12:diagnostics12041006. [PMID: 35454054 PMCID: PMC9031630 DOI: 10.3390/diagnostics12041006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/01/2022] [Accepted: 04/14/2022] [Indexed: 12/14/2022] Open
Abstract
Temporomandibular disorder (TMD) is a common musculoskeletal condition that causes pain and disability for patients and imposes a high financial burden on the healthcare system. The most common cause of TMD is internal derangement, mainly secondary to articular disc displacement. Multiple other pathologies such as inflammatory arthritis, infection, and neoplasm can mimic internal derangement. MRI is the modality of choice for evaluation of the TMJ. Radiologists need to be familiar with the normal anatomy and function of the TMJ and MR imaging of the internal derangement and other less common pathologies of the TMJ.
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Mustafa MA, AL-Attas BA, Badr FF, Jadu FM, Wali SO, Bawazir YM. Prevalence and Severity of Temporomandibular Disorders in Rheumatoid Arthritis Patients. Cureus 2022; 14:e21276. [PMID: 35070578 PMCID: PMC8761059 DOI: 10.7759/cureus.21276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction The temporomandibular joint (TMJ) is an important joint that plays major functions, including dental occlusion, mastication, and facial expressions. Different diseases can affect the TMJ, including chronic inflammatory arthritis. Rheumatoid arthritis (RA) is the most common inflammatory arthritis worldwide associated with TMJ dysfunction. In this study, we assess the prevalence of TMJ among RA patients based on the Fonseca Anamnestic Index. Methods Eighty-one patients with rheumatoid arthritis were interviewed by a trained physician to fulfill the Fonseca Anamnestic Index questionnaire. All participants underwent a medical file review to collect their sociodemographic data, RA duration, co-existing comorbidities, and different lab results. Result According to the Fonseca score, 29.6% had no temporomandibular disorder (TMD) among RA patients, while 39.5% had mild TMD. Only 6% had severe TMD. The female sex and increased body weight were associated with TMJ disease. Conclusion The majority of rheumatoid arthritis patients (70%) suffer from some degree of temporomandibular joint disorder.
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Şirin G, Amuk M. Radiographic changes in the temporomandibular joint related to medication in rheumatic diseases. Dentomaxillofac Radiol 2021; 50:20200557. [PMID: 33684330 DOI: 10.1259/dmfr.20200557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The purpose of this study was to assess radiographical changes on temporomandibular joint (TMJ) in relation the autoimmune rheumatic diseases and the medicines that treat this diseases with cone beam computed tomography(CBCT). METHODS 65 people with rheumatoid diseases were included in the study and divided into five subgroups according to drugs they used. Condyle height (CH), anteroposterior dimension (APD), mesiolateral dimension (MLD) and superior joint space (SJS) were measured in order to evaluate mandibular condyle dimensions. Further, were evaluated in terms of osteoarthritic changes such as erosion, flattening, osteophyte and subchondral cyst in the mandibular condyle. TMJ measurements were compared between study-control groups and subgroups by using Student's t-test, Mann-Whitney-U test, one-way analysis of variance (ANOVA) and Kruskal-Wallis test. The association between osteoarthritic features, rheumatoid status was tested by using χ2 test. Observers were blinded to all groups. Cohen κ values (0853-0945) and Spearman's correlation coefficient (0.959-0.997) indicated high interexaminer reliability. RESULTS Condylar dimentions were significantly lower in CH and SJS in rheumatic diseases group (p < 0.001), however APD (p = 0,681) and MLD (p = 0,757) was not different significantly. Osteoarthritic changes such as erosion (p < 0.001), flattening (p = 0.005), osteophyte (p = 0.001) and subchondral cyst (p = 0.001) were significantly higher in the patient group. None of the parameters were different significantly according to subgroups determined according to drugs used(p > 0.05). CONCLUSIONS Degenerative changes may cause decrease in condyle size and changes in condyle position. It is a process that can continue despite the use of antirheumatic or immunosuppressive drugs. All of these can become the source of possible TMJ problems.
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Affiliation(s)
- Gamze Şirin
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Erciyes University, Kayseri, Turkey
| | - Mehmet Amuk
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Erciyes University, Kayseri, Turkey
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Türkmenoğlu A, Yüksel HT, Karahan AY. Evaluation of mandibular condyle trabecular structure in patients with rheumatoid arthritis using fractal analysis. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 133:229-237. [PMID: 34526250 DOI: 10.1016/j.oooo.2021.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 08/07/2021] [Accepted: 08/14/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVES The aim of this study was to compare the fractal dimension (FD) of trabecular structure of the mandibular condyles in patients with rheumatoid arthritis (RA) to patients without RA. Correlations between condylar FD and bone mineral density T-scores in the femoral neck and lumbar spine were also examined. STUDY DESIGN The RA study group patients were divided into 3 categories (33 normal, 33 osteopenic, and 34 osteoporotic) according to T-scores. The control group without RA was sex- and age-matched with the study group. FD was calculated from panoramic radiographs and compared between the study and control groups. The relationships between FD values and femoral neck and L1-L4 lumbar spine T-scores were investigated for study and control groups. Significance was established at P < .05. RESULTS The mean FD values of the entire study group and of each category in the study group were significantly lower than those of the control group (P < .001). There were no significant differences in FD values among the 3 RA categories (P > .05). No significant correlations appeared between FD and femoral neck or lumbar spine T-scores (P ≥ .063). CONCLUSIONS Fractal analysis of the condyles on panoramic radiographs can distinguish RA from healthy condyles, even if the patients with RA have normal bone mineral density T-scores.
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Affiliation(s)
- Ayşegül Türkmenoğlu
- Lecturer, Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Usak University, Uşak, Turkey.
| | - Halil Tolga Yüksel
- Assistant Professor, Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Usak University, Uşak, Turkey
| | - Ali Yavuz Karahan
- Associate Professor, Department of Physical Medicine and Rehabilitation, Training and Research Hospital, Faculty of Medicine, Usak University, Uşak, Turkey
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Covert L, Mater HV, Hechler BL. Comprehensive Management of Rheumatic Diseases Affecting the Temporomandibular Joint. Diagnostics (Basel) 2021; 11:diagnostics11030409. [PMID: 33673675 PMCID: PMC7997293 DOI: 10.3390/diagnostics11030409] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 11/18/2022] Open
Abstract
The temporomandibular joint (TMJ) is a synovial joint and thus is vulnerable to the afflictions that may affect other joints in the fields of rheumatology and orthopedics. Too often temporomandibular complaints are seen strictly as dental or orofacial concerns. Similarly, patients with known rheumatic disease may not have their TMJs included in routine screening and monitoring protocols. The purpose of this review is to highlight the rheumatic conditions likely to affect the TMJ and outline medical and surgical management in these patients with a focus on the need for continued patient reassessment and monitoring.
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Affiliation(s)
- Lauren Covert
- Department of Pediatrics, Division of Rheumatology, Duke University Hospitals, Durham, NC 27710, USA; (L.C.); (H.V.M.)
| | - Heather Van Mater
- Department of Pediatrics, Division of Rheumatology, Duke University Hospitals, Durham, NC 27710, USA; (L.C.); (H.V.M.)
| | - Benjamin L. Hechler
- Department of Surgery, Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Hospitals, Durham, NC 27710, USA
- Department of Head and Neck Surgery and Communication Sciences, Duke University Hospitals, Durham, NC 27710, USA
- Correspondence:
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