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Conservative Treatment with Occlusal Appliance for Temporomandibular Disorder Patients with Rheumatoid Arthritis

  • Kim, Young-Ae ;
  • Kim, Kyung-Hee ;
  • Ok, Soo-Min ;
  • Ahn, Yong-Woo ;
  • Jeong, Sung-Hee
  • Received : 2016.11.21
  • Accepted : 2016.12.10
  • Published : 2016.12.30

Abstract

Purpose: This study is designed to analyse etiology and bone pattern at the first visit using cone-beam computed tomography (CBCT) and to evaluate the treatment outcome of conservative treatment in temporomandibular disorder (TMD) patients with rheumatoid arthritis (RA). Methods: One hundred condyles in 50 subjects with RA were chosen among the patients who presented to the Department of Oral Medicine of Pusan National University Dental Hospital, diagnosed as TMD. Condylar bone changes were classified by normal, erosive bony change, proliferative bony change and combined group (erosive bony change+proliferative bony change). They were treated conservatively with physical therapy, medication, behavioral therapy and/or occlusal stabilizing splint therapy. After 3 months on average, patients were re-evaluated with regards to subjective symptoms and the clinical findings were investigated. Results: TMD patients with RA have behavioral contributing factors such as parafunctional habit. The results that analyse bone pattern at the first visit using CBCT proliferative bony changes group (32.6%) were more common than erosive bony changes group (15.2%). In comparison between unilateral and bilateral bony change in temporomandibular joint, the ratio showed no significant differences. After 3 months of conservative treatments, pain, noise, limitation of motion (LOM) were markedly improved regardless of occlusal splint therapy. However only LOM was significantly improved through occlusal splint therapy during 3 months. Conclusions: TMD patients with RA had similar behavioral contributing factors and characteristics of CBCT images shown in general TMD patients and also similar response to conservative treatment so it is difficult to differentiate. Therefore when TMD patients show symptoms corresponding to clinical diagnostic criteria of RA at the first visit, serological testing should be conducted and through this, early diagnosis and treatment of RA should be initiated.

Keywords

Arthritis, rheumatoid;Cone-beam computed tomography;Conservative treatment;Temporomandibular joint disorders

References

  1. Harris ED. Clinical features of rheumatoid arthritis. In: Harris ED, Budd RC, Firestein GS, et al. eds. Kelly's textbook of rheumatology. 7th ed. Philadelphia (PA): W.B. Saunders; 2005. pp. 1043-1078.
  2. Alamanos Y, Drosos AA. Epidemiology of adult rheumatoid arthritis. Autoimmun Rev 2005;4:130-136. https://doi.org/10.1016/j.autrev.2004.09.002
  3. Riise T, Jacobsen BK, Gran JT. Incidence and prevalence of rheumatoid arthritis in the county of Troms, northern Norway. J Rheumatol 2001;27:1386-1389.
  4. Gabriel SE, Crowson CS, O'Fallon WM. The epidemiology of rheumatoid arthritis in Rochester, Minnesota, 1955-1985. Arthritis Rheum 1999;42:415-420. https://doi.org/10.1002/1529-0131(199904)42:3<415::AID-ANR4>3.0.CO;2-Z
  5. Aho K, Kaipiainen-Seppanen O, Heliovaara M, Klaukka T. Epidemiology of rheumatoid arthritis in Finland. Semin Arthritis Rheum 1998;27:325-334. https://doi.org/10.1016/S0049-0172(98)80053-X
  6. van der Woude D, Houwing-Duistermaat JJ, Toes RE, et al. Quantitative heritability of anti-citrullinated protein antibody-positive and anti-citrullinated protein antibody-negative rheumatoid arthritis. Arthritis Rheum 2009;60:916-923. https://doi.org/10.1002/art.24385
  7. Liao KP, Alfredsson L, Karlson EW. Environmental influences on risk for rheumatoid arthritis. Curr Opin Rheumatol 2009;21:279-283. https://doi.org/10.1097/BOR.0b013e32832a2e16
  8. Kononen M, Wenneberg B, Kallenberg A. Craniomandibular disorders in rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. A clinical study. Acta Odontol Scand 1992;50:281-287. https://doi.org/10.3109/00016359209012774
  9. Aliko A, Ciancaglini R, Alushi A, Tafaj A, Ruci D. Temporomandibular joint involvement in rheumatoid arthritis, systemic lupus erythematosus and systemic sclerosis. Int J Oral Maxillofac Surg 2011;40:704-709. https://doi.org/10.1016/j.ijom.2011.02.026
  10. Bessa-Nogueira RV, Vasconcelos BC, Duarte AP, Goes PS, Bezerra TP. Targeted assessment of the temporomandibular joint in patients with rheumatoid arthritis. J Oral Maxillofac Surg 2008;66:1804-1811. https://doi.org/10.1016/j.joms.2007.08.037
  11. Atsu SS, Ayhan-Ardic F. Temporomandibular disorders seen in rheumatology practices: a review. Rheumatol Int 2006;26:781-787. https://doi.org/10.1007/s00296-006-0110-y
  12. Goupille P, Fouquet B, Cotty P, Goga D, Valat JP. Direct coronal computed tomography of the temporomandibular joint in patients with rheumatoid arthritis. Br J Radiol 1992;65:955-960. https://doi.org/10.1259/0007-1285-65-779-955
  13. Kretapirom K, Okochi K, Nakamura S, et al. MRI characteristics of rheumatoid arthritis in the temporomandibular joint. Dentomaxillofac Radiol 2013;42:31627230. https://doi.org/10.1259/dmfr/31627230
  14. Krishnamoorthy B, Mamatha N, Kumar VA. TMJ imaging by CBCT: current scenario. Ann Maxillofac Surg 2013;3:80-83. https://doi.org/10.4103/2231-0746.110069
  15. Honey OB, Scarfe WC, Hilgers MJ, et al. Accuracy of cone-beam computed tomography imaging of the temporomandibular joint: comparisons with panoramic radiology and linear tomography. Am J Orthod Dentofacial Orthop 2007;132:429-438. https://doi.org/10.1016/j.ajodo.2005.10.032
  16. Alkhader M, Ohbayashi N, Tetsumura A, et al. Diagnostic performance of magnetic resonance imaging for detecting osseous abnormalities of the temporomandibular joint and its correlation with cone beam computed tomography. Dentomaxillof Radiol 2010;39:270-276. https://doi.org/10.1259/dmfr/25151578
  17. Laskin DM, Greene CS, Hylander WL. Temporomandibular disorders: an evidence-based approach to diagnosis and treatment. 3rd ed. Chicago: Quintessence Pub.; 2006. pp. 222-223.
  18. Zhao YP, Zhang ZY, Wu YT, Zhang WL, Ma XC. Investigation of the clinical and radiographic features of osteoarthrosis of the temporomandibular joints in adolescents and young adults. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;111:e27-e34.
  19. Scott DL, Wolfe F, Huizinga TW. Rheumatoid arthritis. Lancet 2010;376:1094-1108. https://doi.org/10.1016/S0140-6736(10)60826-4
  20. Gylys-Morin VM, Graham TB, Blebea JS, et al. Knee in early juvenile rheumatoid arthritis: MR imaging findings. Radiology 2001;220:696-706. https://doi.org/10.1148/radiol.2203000461
  21. Sugimoto H, Takeda A, Hyodoh K. Early-stage rheumatoid arthritis: prospective study of the effectiveness of MR imaging for diagnosis. Radiology 2000;216:569-575. https://doi.org/10.1148/radiology.216.2.r00au20569
  22. Laskin DM, Greene CS, Hylander WL. Temporomandibular disorders: an evidence-based approach to diagnosis and treatment facial pain. Chicago: Quintessence Pub.; 2006. pp. 105-106, 165-166.
  23. Solberg WK. Temporomandibular disorders. London: Taylor & Francis; 1986. pp. 56.
  24. Alstergren P, Kopp S. Insufficient endogenous control of tumor necrosis factor-alpha contributes to temporomandibular joint pain and tissue destruction in rheumatoid arthritis. J Rheumatol 2006;33:1734-1739.
  25. Nilner M. Prevalence of functional disturbances and diseases of the stomatognathic system in 15-18 year olds. Swed Dent J 1981;5:189-197.
  26. Franks AS. Temporomandibular joint in adult rheumatoid arthritis. A comparative evaluation of 100 cases. Ann Rheum Dis 1969;28:139-145. https://doi.org/10.1136/ard.28.2.139
  27. Marbach JJ, Raphael KG, Dohrenwend BP, Lennon MC. The validity of tooth grinding measures: etiology of pain dysfunction syndrome revisited. J Am Dent Assoc 1990;120:327-333. https://doi.org/10.14219/jada.archive.1990.0051
  28. Larheim TA, Storhaug K, Tveito L. Temporomandibular joint involvement and dental occlusion in a group of adults with rheumatoid arthritis. Acta Odontol Scand 1983;41:301-309. https://doi.org/10.3109/00016358309162339
  29. Syrjanen SM. The temporomandibular joint in rheumatoid arthritis. Acta Radiol Diagn (Stockh) 1985;26:235-243. https://doi.org/10.1177/028418518502600302
  30. Larheim TA, Tveito L, Dale K, Ruud AF. Temporomandibular joint abnormalities in rheumatoid arthritis: comparison of different radiographic methods. Acta Radiol Diagn (Stockh) 1981;22:703-707. https://doi.org/10.1177/028418518102200615
  31. Gynther GW, Tronje G, Holmlund AB. Radiographic changes in the temporomandibular joint in patients with generalized osteoarthritis and rheumatoid arthritis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996;81:613-618. https://doi.org/10.1016/S1079-2104(96)80058-8
  32. Ardic F, Gokharman D, Atsu S, Guner S, Yilmaz M, Yorgancioglu R. The comprehensive evaluation of temporomandibular disorders seen in rheumatoid arthritis. Aust Dent J 2006;51:23-28. https://doi.org/10.1111/j.1834-7819.2006.tb00396.x
  33. Lin YC, Hsu ML, Yang JS, Liang TH, Chou SL, Lin HY. Temporomandibular joint disorders in patients with rheumatoid arthritis. J Chin Med Assoc 2007;70:527-534. https://doi.org/10.1016/S1726-4901(08)70055-8
  34. Uchiyama Y, Murakami S, Furukawa S. Temporomandibular joints in patients with rheumatoid arthritis using magnetic resonance imaging. Clin Rheumatol 2013;32:1613-1618. https://doi.org/10.1007/s10067-013-2323-2
  35. Carraro JJ, Caffesse RG. Effect of occlusal splints on TMJ symptomatology. J Prosthet Dent 1978;40:563-566. https://doi.org/10.1016/0022-3913(78)90094-X
  36. Cohen SR. Follow-up evaluation of 105 patients with myofascial pain-dysfunction syndrome. J Am Dent Assoc 1978;97:825-828. https://doi.org/10.14219/jada.archive.1978.0387
  37. Wessberg GA, Carroll WL, Dinham R, Wolford LM. Transcutaneous electrical stimulation as an adjunct in the management of myofascial pain-dysfunction syndrome. J Prosthet Dent 1981;45:307-314. https://doi.org/10.1016/0022-3913(81)90396-6
  38. Ko MY, Kim JH, Heo JY, Ok SM, Jeong SH, Ahn YW. Study on temporomandibular disorder patients with conservative treatment. Korean J Oral Med 2013;38:77-86.
  39. Kyburz D, Finckh A. The importance of early treatment for the prognosis of rheumatoid arthritis. Swiss Med Wkly 2013;143: w13865.

Acknowledgement

Supported by : Pusan National University