Gaetano Isola

Occlusal and MRI characterizations in systemic sclerosis patients: A prospective study from Southern Italian cohort

OBJECTIVES The aim of the present study was to assess the prevalence of temporomandibular joint (TMJ) symptoms, clinical and magnetic resonance imaging (MRI) findings in a cohort of Southern Italian patients with SSc. METHODS Twenty-seven patients with SSc (12 diffuse, 15 limited, mean age 53.9, SD±1.2) and 28 healthy subjects (mean age 54.8, SD±4.2) were enrolled in this observational cohort study. In all patients, clinical examination for assessing the presence of TMJ sounds, pain in the TMJ area, tenderness of masticatory muscles, limited mouth opening, pain assessment, MRI scan and Anamnestic and Dysfunctional Index were performed. RESULTS The test groups reported more clinical and MRI findings of TMJ symptoms and dysfunction than control group. The frequency distributions of symptoms were significantly different (P<0.05), in the test groups for TMJ sounds, pain during mandibular movement and difficulty in the maximum mouth opening. There was also a significant decrease (P<0.001), in the test groups, in the mean of leftward, rightward laterotrusion and protrusion. Correlation analysis allowed to affirm that maximum opening leftward laterotrusion, protrusion and click were significantly correlated to Modified Rodnan Skin Score. The mean duration of disease was significantly correlated, ever in total SSc group, only for the maximum mouth opening value. CONCLUSION This study demonstrates that TMJ involvement is common in SSc patients and is correlated with a length and involvement of disease and supports the notion that TMJ examination should be encouraged in the rheumatology setting and clinicians should provide a right pain management and patient support.

The effect of a functional appliance in the management of temporomandibular joint disorders in patients with juvenile idiopathic arthritis.

BACKGROUND Patients affected by juvenile idiopathic arthritis (JIA) may have several craniofacial growth disturbances and involvements at the temporomandibular joint (TMJ). The objectives of the present study were to evaluate the clinical effectiveness of functional therapy used to reduce asymmetry of mandibular growth and TMJ disorder in patients with JIA. METHODS By a retrospective longitudinal design, a cohort of 54 patients with JIA (mean age, 13.2±3.7 years; range, 5-17.7 years) and with TMJ involvements was enrolled in the study. Each patient, following the collection of clinical parameters, was treated for 24 months with a functional appliance individually customized by acrylic resin and resilient stainless steel with posterior and anterior metallic bite planes preventing the teeth from intercuspal contact. To evaluate differences before (T0) and after therapy (T1) of the clinical TMJ parameters, the statistical analysis by the χ2 Test was performed. RESULTS All the patients completed successfully the study. In patients with JIA, the use of a functional appliance determined a statistically significant difference of the pain during jaw movement, maximal mouth opening, TMJ sounds and crepitations (P<0.001) and TMJ click, significantly reduced at T1 (P<0.05). CONCLUSIONS The use of an orthodontic functional appliance determined a significant improvement, at 24 months, in many TMJ signs and symptoms in patients affected by JIA and with TMJ disorders. This study suggests that children and adolescents with JIA which presented either unilateral or bilateral moderate to severe TMJ involvement, if not treated, should be develop severe disturbances during growing.

Toward a multidisciplinary approach of systemic sclerosis

We read with great interest and enthusiasm the study by Baron et al, published recently in Arthritis Care & Research (1). The authors demonstrated that the severity of global disease during systemic sclerosis (SSc) is associated with periodontal disease (2), mandibular erosion, and tooth loss. The pathophysiology of SSc remains only partially understood, but several modifiable factors exist; among these, orofacial involvement may play a specific role that can lead to an increased liability to dental caries, periodontitis, and chewing disorder (3). SSc is characterized by symmetric and erosive synovitis that may result in joint irregularity and disability. Temporomandibular joint (TMJ) arthritis is a frequent finding in patients with SSc, and if not diagnosed early, can lead to facial dysmorphism and lifetime disability and pain (4). We recently reported a detectable prevalence of symptoms and signs of dysfunction at TMJs and self-reported symptoms in SSc (limited and diffuse) patients compared to healthy subjects (5). In our sample, the Modified Rodnan Skin Score was correlated with the worsening of maximum mouth opening and TMJ dysfunction in SSc patients. In addition to our results, emerging evidence indicates that the involvement of the orofacial region during SSc is usually associated with an impaired quality of life, emphasizing the need for a specific treatment related to this kind of disability (6). For these reasons a specific disease-related questionnaire quantifying mouth disability in SSc was developed (7). Considering the fact that 80% of SSc patients can show a wide array of oral manifestations (8), we believe that the dentist could play an important role and should be involved in a multidisciplinary diagnostic process aimed at preserving oral health during the treatment of this disease and providing correct oral pain management and clinical support for patients affected by SSc. The orofacial involvement in SSc is often underdiagnosed. Therefore, the findings by Baron et al (1) open avenues for further research and provide recent evidence on how the health of the mouth can be important in the quality of life in SSc, as are appropriate preventive measures to prevent future complications.

FRI0447 Temporomandibular Joint and Chewing Features in Systemic Sclerosis Patients: A Clinical and Magnetic Resonance Imaging Analysis

Background The pathogenesis of Systemic Sclerosis (SSc) remains unknown, but increasing evidence suggests that activation of lesional fibroblasts contributes to the fibrotic process. SSc is characterized by symmetric, erosive synovitis, which may result in joint irregularity and disability. Objectives The purpose of this clinical study was to assess the prevalence and characteristics of Temporomandibular joint (TMJ) symptoms, clinical and Magnetic Resonance Imaging (MRI) findings in a cohort of patients with SSc. Methods 27 patients with SSc (12 Diffuse, 15 Limited, mean age 53.9, SD ±1.2) and 28 healthy subjects (mean age 54.8, SD ±4.2) were enrolled in this cohort study. Oro-facial clinical examination for assessing the presence of TMJ sounds, pain in the TMJ area, tenderness of masticatory muscles, limited mouth opening, pain assessment, MRI scan and Anamnestic and Dysfunctional Index were achieved in all of patients. Results The test groups presented more clinical and MRI TMJ symptoms and dysfunction than Control group. The distributions of symptoms were significantly different (P<0.05), in the Test groups for TMJ sounds, pain during mandibular movement and difficulty in the maximum mouth opening. There was also a significant decrease (P<0.001), in the Test groups, in the mean of leftward, rightward laterotrusion and protrusion. Correlation analysis showed that maximum opening leftward laterotrusion, protrusion and click were significantly correlated to Modified Rodnan Skin Score. The mean duration of disease was significantly correlated, ever in Total SSc group, only for the maximum mouth opening value. Conclusions This study proves that TMJ dysfunction is a common feature in SSc patients and it is correlated with a extent and involvement of disease and supports the notion that TMJ examination should be encouraged in rheumatology and clinicians should provide a patient support and a right pain management. References Jelaska A, Arakawa M, Broketa G, Korn JH. Heterogeneity of collagen synthesis in normal and systemic sclerosis skin fibroblasts: increased proportion of high collagen–producing cells in systemic sclerosis fibroblasts. Arthritis Rheum 1996;39:1338–46. Schieir O, Thombs BD, Hudson M, Boivin JF, Steele R, Bernatsky S, et al. Canadian Scleroderma Research Group. Prevalence, severity, and clinical correlates of pain in patients with systemic sclerosis. Arthritis Care Res (Hoboken). 2010;62:409-17. Disclosure of Interest None declared