Sunday, 23 May 2010

British Journal of Orthodontics Current Issue, Juvenile Idiopathic Arthritis Study

Article from the current issue of the British Journal 

Objective: To screen patients with oligoarticular and polyarticular forms of Juvenile Idiopathic Arthritis (JIA) to determine (i) the severity of their class II skeletal pattern; (ii) temporomandibular joint signs and symptoms and (iii) use of systemic corticosteroids.

Subjects and setting: Sixty-eight children with JIA aged between 9 and 16 years old who were screened at four regional treatment centres in the UK.

Method: Patients were screened clinically and radiographically for the presence of class II skeletal pattern and temporomandibular (TMJ) pain dysfunction syndrome. In addition, the JIA sub-type and history of disease activity and medication were recorded.

Main outcome measures: Class II skeletal pattern, TMJ signs and symptoms, use of systemic corticosteroids.

Results (oligo-arthitis and poly-arthitis patients):

  • 1/3 was screened with a severe to moderate Class II skeletal pattern.
  • Lower than 20% was the percentage of JIA patients with pain dysfunction symptoms, however crepitus and clicking were larger, up to 40%. Also noted that radiographically 57% of the oligo-arthitis and 70% of the poly-arthitis had erosions of the condyle visible on the X-Rays taken
  • Keep in mind that corticosteroid medication was given for a long period, especially on poly-arthitis patients.
On the conclusion there is a discussion of the benefits of functional treatment on those JIA patients, concerning only 1/3 was found with severe to moderate Class II skeletal pattern. This is a significant remark, however further studies have to be designed to answer that question.

At the orthodontic department of Aarhus a protocol for these patients is carried out, from around the age of 9-10 years, with a distraction splint functional therapy. That consists of a splint that is of increased, gradually height on the effected side, or on both. This gradual increase of height is facilitating the stretch of the soft tissue of the affected side along with the unloading of the joint on that side.

Some pictures of the technic is shown, however the following case is of a (mild) Goldenheart Syndrome patient (unilateral hemifacial microsomia, loss of hearing from affected side), that is on the late age of 14 years, and it is applied to asses the growth that is left on this case, before moving into fixed appliances and distraction osteogenessis.

Intra-oral frontal without splint, obviously the affected side is the left side of the patient.

Frontal, with the distraction splint, that is increased gradually only from the left side and has firm occlusion on the right side.

View of the splint from the right side shows the increased in height left side.

Pictures from patient treated at the Aarhus dental school, orthodontic department, by Dimitris Galaktopoulos, DDS under the supervision of PhD, Thomas Klit Pedersen.

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