[Temporomandibular joint disorders in juvenile idiopathic arthritis and their treatments].

INTRODUCTION

Juvenile idiopathic arthritis (JIA) is a chronic inflammatory disease with unknown cause, affecting one child out of 2,000. In more than a third of cases, the temporomandibular joints (TMJs) are involved. TMJ arthritis may cause significant functional disorders such as pain, reduced mouth opening, and malocclusion, as well as permanent aesthetic issues involving facial deformity. The purpose of this article is to describe the diagnosis and treatment of these children.

MATERIALS AND METHOD: Based on a literature analysis of TMJ involvement in JIA and our own personal experience, we present the data obtained and the questions that remain.

RESULTS

Diagnosis of TMJ arthritis in JIA relies on clinical examination and MRI with injection. It is often made too late, when sequelae are already permanent, due to the asymptomatic nature of TMJ arthritis in many children and because deformities appear long after destructive lesions of one or both joints. Screening for TMJ inflammation in JIA should be routine. MRI with injection has been chosen as the best screening tool, but false positives are numerous. How to improve TMJ arthritis screening in JIA remains an unanswered question. Treatments of active TMJ arthritis are varied, including orthodontic procedures, maxillofacial surgery, and systemic therapies, but there is currently no unified strategy, and the use of intra-articular corticosteroid injections in children is increasingly being challenged.

DISCUSSION: Many aspects of the management of TMJ arthritis remain a matter of debate, from the early detection of inflammatory involvement of the TMJs, which may place the orthodontist on the front line, to the role of orthodontic and systemic treatments, as well as that of maxillofacial surgery.

CONCLUSION

These unanswered questions could be addressed via a French multidisciplinary network involving orthodontists, maxillofacial surgeons, radiologists and pediatric rheumatologists.