Carvalho Renata Teixeira de, Braga Flávia Silva Farah Ferreira, Brito Fernanda, Capelli Junior Jonas, Figueredo Carlos Marcelo, Sztajnbok Flávio Roberto
Universidade Veiga de Almeida, Rio de Janeiro, RJ, Brazil.
Rev Bras Reumatol. 2012 Dec;52(6):907-11.
Patients with juvenile idiopathic arthritis (JIA) can have alterations in bone metabolism and skeletal growth, as well as damage to the temporomandibular joint (TMJ), which can generate extra and/or intraoral alterations, resulting in craniofacial disorders. Our goal is to carry out a review of the literature on orofacial alterations in patients with JIA. Among the orofacial disorders in patients with JIA, alterations in mandibular growth, caused by dysfunctions in the TMJ region, seem highly prevalent in these patients. The most often found alterations are: retrognathia, micrognathia, anterior open bite, dental crowding, facial asymmetry and mouth opening limitation. Thus, the rheumatologist becomes a key agent in the early detection of these disorders, helping with patient referral to a dentist. The diagnosis, in turn, should be performed by the orthodontist, using clinical examination and imaging methods, allowing early treatment and a favorable prognosis. TMJ disorders should be treated by a multidisciplinary team, including pharmacological treatment for pain control and dental care through functional appliance and/or orthodontic therapy, physical therapy and sometimes, speech therapy. We conclude that among the orofacial disorders in patients with JIA, alterations in mandibular growth generated by dysfunctions in the TMJ region seem highly prevalent. Such dysfunctions can cause mainly open bite, mandibular retrusion, micrognathia, dental crowding and facial asymmetry. The rheumatologist can detect these alterations at an early stage, with immediate patient referral to a team that should preferably be a multidisciplinary one, consisting of an orthodontist, physical therapist and speech therapist, to reduce future occlusal and mandibular growth complications.
青少年特发性关节炎（JIA）患者可能会出现骨代谢和骨骼生长改变，以及颞下颌关节（TMJ）损伤，这会导致口腔内外改变，进而引发颅面疾病。我们的目标是对有关JIA患者口面部改变的文献进行综述。在JIA患者的口面部疾病中，由TMJ区域功能障碍引起的下颌生长改变在这些患者中似乎非常普遍。最常发现的改变有：下颌后缩、小下颌、前牙开颌、牙列拥挤、面部不对称和张口受限。因此，风湿病学家成为早期发现这些疾病的关键人物，协助将患者转诊至牙医处。反过来，诊断应由正畸医生进行，采用临床检查和影像学方法进行，以便早期治疗并获得良好预后。TMJ疾病应由多学科团队进行治疗，包括通过药物治疗控制疼痛，通过功能性矫治器和/或正畸治疗进行牙齿护理、物理治疗，有时还包括言语治疗。我们得出结论，在JIA患者的口面部疾病中，TMJ区域功能障碍导致的下颌生长改变似乎非常普遍。此类功能障碍主要可导致开颌、下颌后缩、小下颌、牙列拥挤和面部不对称。风湿病学家可在早期发现这些改变，并立即将患者转诊至一个最好是多学科的团队，该团队由正畸医生、物理治疗师和言语治疗师组成，以减少未来的咬合和下颌生长并发症。
