Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology
Oral MedicineClinical and radiographic findings of the temporomandibular joint in patients with various rheumatic diseases. A case-control study
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Patients
We studied 80 patients with rheumatic disease (24 with RA, 16 with MCTD, 19 with AS, and 21 with SPA) and 80 matched controls (Table I).
All subjects had given written informed consent to their participation in the study, and the Ethics Committee of Helsinki University Central Hospital had approved the study protocol.
Some patients met current classification criteria for RA,6 MCTD,7 and AS.8 Others, with seronegative oligoarthritis or spondylitis not meeting the diagnostic criteria for AS, were
Subjective symptoms and clinical findings
Subjective TMJ symptoms and clinical findings are shown in Table II, Table III, Table IV. The number of patients with rheumatic disease exhibiting severe TMJ symptoms was significantly higher than the number of control subjects exhibiting such symptoms (P < .001). The AS patients reported TMJ symptoms most often (7/19, 37%). TMJ clicking and crepitation were reported by the patients with rheumatic disease significantly more often than by the control subjects (P = .002 and P < .001, respectively).
Discussion
The term TMJ disorders is used collectively to describe congenital and acquired abnormalities affecting the TMJ. The commonest clinical symptoms are pain in the TMJ area, TMJ clicking and locking, and limitation of opening of the mouth. The symptoms are usually aggravated by function, wide opening for prolonged periods (eg, during dental treatment), and chewing food that is hard or requires much mastication.15 In the study reported here we used routine methods and examination protocols relating
Conclusion
We found a high prevalence of TMJ erosion in all of the groups of patients with rheumatic disease studied, even in the group of MCTD patients. We also found a significant correlation between the radiographic evidence of TMJ erosion and condylar movement, stiffness of the masticatory muscles on palpation, and erosion in all of the patient groups. Accordingly, reduced maximal opening of the mouth, tenderness of the masticatory muscles, and reduced maximal laterotrusion are symptoms that indicate
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2023, Archives of Oral BiologyCitation Excerpt :In that regard, since the articular disc displacement seems to play the main role in the arthritic involvement of the TMJ in AS individuals, as in the process of TMJ osteoarthritis, the movement of the condyle directly with the articular fossa would provoke its destructive process (Okeson, 2020). The direct relationship between condyle and fossa, with no disc interposition, would also explain the association of crepitus noise, observed in the clinical examination, with bone changes, as the erosion of joint surfaces, observed in the radiographic exams of AS individuals (Helenius et al., 2005). Although case report studies were not included in this review, it is worth mentioning the presence of different reports of TMJ ankylosis in AS individuals (de Andrade Freitas Oliveira et al., 2013; de Oliveira-Neto et al., 2014; Goswami et al., 2021; Gupta et al., 2016; Li et al., 2013).
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2020, Egyptian RheumatologistCitation Excerpt :TMJ clicking, crepitation and soft tissue swelling over the joint were documented. Crepitus was registrated as: no crepitus = 0, palpable = 1, audible = 2 [24]. Functional assessment of the TMJ was performed according to the Fonseca’s questionnaire [25].
Supported by grants from the Helsinki University Central Hospital, Finnish Dental Foundation, Finnish Women's Dental Foundation, and the Orion Research Foundation.