Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, PO Box 85500, The Netherlands.
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
Pediatr Rheumatol Online J. 2021 Jul 3;19(1):106. doi: 10.1186/s12969-021-00583-5.
Recognition of temporomandibular joint (TMJ) involvement in children with juvenile idiopathic arthritis (JIA) has gained increasing attention in the past decade. The clinical assessment of mandibular range of motion characteristics is part of the recommended variables to detect TMJ involvement in children with JIA. The aim of this study was to explore explanatory variables for mandibular range of motion outcomes in children with JIA, with and without clinically established TMJ involvement, and in healthy children.
This cross-sectional study included children with JIA and healthy children of age 6-18 years. Mandibular range of motion variables included active and passive maximum interincisal opening (AMIO and PMIO), protrusion, laterotrusion, dental midline shift in AMIO and in protrusion. Additionally, the TMJ screening protocol and palpation pain were assessed. Adjusted linear regression analyses of AMIO, PMIO, protrusion, and laterotrusion were performed to evaluate the explanatory factors. Two adjusted models were constructed: model 1 to compare children with JIA and healthy children, and model 2 to compare children with JIA with and without TMJ involvement.
A total of 298 children with JIA and 169 healthy children were included. Length was an explanatory variable for the mandibular range of motion excursions. Each centimeter increase in length increased AMIO (0.14 mm), PMIO (0.14 mm), and protrusion (0.02 mm). Male gender increased AMIO by 1.35 mm. Having JIA negatively influenced AMIO (3.57 mm), PMIO (3.71 mm), and protrusion (1.03 mm) compared with healthy children, while the discrepancy between left and right laterotrusion raised 0.68 mm. Children with JIA and TMJ involvement had a 8.27 mm lower AMIO, 7.68 mm lower PMIO and 0.96 mm higher discrepancy in left and right laterotrusion compared to healthy children.
All mandibular range of motion items were restricted in children with JIA compared with healthy children. In children with JIA and TMJ involvement, AMIO, PMIO and the discrepancy between left and right laterotrusion were impaired more severely. The limitation in protrusion and laterotrusion was hardly clinically relevant. Overall, AMIO is the mandibular range of motion variable with the highest restriction (in millimeters) in children with JIA and clinically established TMJ involvement compared to healthy children.
在过去十年中，人们越来越关注儿童颞下颌关节（TMJ）受累的问题。下颌运动范围特征的临床评估是检测儿童青少年特发性关节炎（JIA）患者 TMJ 受累的推荐变量之一。本研究旨在探讨 JIA 患儿和健康儿童中，有和无临床确定的 TMJ 受累时，下颌运动范围结果的解释变量。
这是一项横断面研究，纳入了 6-18 岁的 JIA 患儿和健康儿童。下颌运动范围变量包括主动和被动最大开口度（AMIO 和 PMIO）、前伸、侧方运动、AMIO 和前伸时的牙中线偏移。此外，还评估了 TMJ 筛查方案和触诊疼痛。对 AMIO、PMIO、前伸和侧方运动进行了调整后的线性回归分析，以评估解释因素。构建了两个调整后的模型：模型 1 用于比较 JIA 患儿和健康儿童，模型 2 用于比较有和无 TMJ 受累的 JIA 患儿。
共纳入 298 名 JIA 患儿和 169 名健康儿童。长度是下颌运动范围的解释变量。每增加 1 厘米长度，AMIO（0.14mm）、PMIO（0.14mm）和前伸（0.02mm）增加。男性增加 AMIO 1.35mm。与健康儿童相比，JIA 患儿的 AMIO（3.57mm）、PMIO（3.71mm）和前伸（1.03mm）减少，而左侧和右侧侧方运动的差异增加了 0.68mm。与健康儿童相比，JIA 患儿伴 TMJ 受累时 AMIO 减少 8.27mm，PMIO 减少 7.68mm，左侧和右侧侧方运动的差异增加 0.96mm。
与健康儿童相比，JIA 患儿的所有下颌运动范围项目均受到限制。在 JIA 患儿伴 TMJ 受累的情况下，AMIO、PMIO 和左侧与右侧侧方运动的差异更严重受损。前伸和侧方运动的限制在临床上几乎没有意义。总体而言，与健康儿童相比，AMIO 是 JIA 患儿和临床确定的 TMJ 受累者中限制最严重的（以毫米计）下颌运动范围变量。
