Juvenile idiopathic arthritis and rheumatoid arthritis: bacterial diversity in temporomandibular joint synovial fluid in comparison with immunological and clinical findings.

Temporomandibular joint (TMJ) involvement in juvenile idiopathic arthritis (JIA) occurs in up to 80% of affected children. The purpose of this study was to investigate the presence of bacterial DNA in synovial fluid, and to compare this with clinical and immunological findings in children with JIA, adults with persistent JIA, and adults with rheumatoid arthritis, in order to detect whether bacteria contribute to inflammation in TMJ arthritis. Synovial fluid and skin swab samples were collected from 30 patients (54 TMJs). Bacterial detection was performed using 16S rRNA pyrosequencing. Bacterial DNA was detected in 31 TMJs (57%) in 19 patients (63%). A positive statistically significant correlation was registered between bacterial DNA detected in TMJ synovial fluid and the following factors: total protein concentration in synovial fluid, interleukin 1ß, tumour necrosis factor alpha, adrenocorticotropic hormone, and adiponectin, as well as the duration of the general medical disease. Fourteen different bacterial species were detected in synovial fluid. Bacterial DNA in TMJ synovial fluid without contamination was detected in more than 50% of the patients. Studies are needed to evaluate the consequences of this bacterial DNA in synovial fluid with regard to TMJ arthritis.

A cohort study of patients with juvenile idiopathic arthritis and arthritis of the temporomandibular joint: outcome of arthrocentesis with and without the use of steroids.

The purpose of this study was to evaluate the effects of intra-articular temporomandibular joint (TMJ) treatment in patients with juvenile idiopathic arthritis (JIA). The inclusion criteria were met by 21 patients (38 joints). Joints were randomly selected for either arthrocentesis alone (n=17) or arthrocentesis with the additional use of triamcinolone hexacetonide (n=21) using a closed single-needle system. Measurements of pain and function were performed at baseline and at follow-up after 3 and 8 months. Pain on opening and lateral excursion improved significantly after injections. Pain decreased significantly from baseline to first and second control on a visual analogue scale (VAS) for overall pain (49-18-8) and overall function (41-19-4). Significant improvement was recorded for pain on palpation of muscles and joints. There was no statistically significant difference between the treatment modalities, with or without glucocorticoid injection. Arthrocentesis in the TMJ treatment of patients with JIA may be beneficial and steroids had no additional effect. Further studies are needed to evaluate the long-term effects on the TMJ structures and on condylar growth from arthrocentesis and intra-articular steroid injections.

Long-term evaluation of swallowing function before and after sagittal split ramus osteotomy.

The aim of this study was to determine whether mandibular setback by sagittal split ramus osteotomy (SSRO) influences swallowing function. The subjects were 14 patients with skeletal class III malocclusions who underwent setback surgery by SSRO. Morphological changes were studied on cephalograms, and swallowing function was evaluated by videofluorography before the operation (T0) and at 7-10 days (T1), 3 months (T2), and 6 months (T3) after surgery. The angle between nasion, sella, and hyoid bone (HSN) and the sella-hyoid distance had increased significantly at T1. The hyoid bone returned to the preoperative position at T2. There were no significant changes in the oropharyngeal space at any time. On videofluorographic assessment, lingual movement, soft palate movement, and epiglottic movement had decreased at T1, but all patients recovered at T2. The oral transit time was significantly longer at T1 than at T0. Our results confirm that SSRO influences swallowing function. Swallowing function appears to stabilize by 3 months after surgery.

Osteoarthritis of the temporomandibular joint: an evaluation of the effects and complications of corticosteroid injection compared with injection with sodium hyaluronate.

The purpose of this study was to compare the efficacy and the complications of intra-articular temporomandibular joint (TMJ) injections in 40 patients with osteoarthritis of the TMJ. The subjects were randomly divided into two groups, and the patients received either two intra-articular injections with sodium hyaluronate or two intra-articular injections with corticosteroids, 14 days apart. The effect of the treatment was evaluated 14 days, 1 and 6 months after the initial injection and was based on the following measurements: pain intensity, pain localization, joint sounds, mandibular function and complications. Both groups of patients had less pain intensity at the 6-month follow-up, and there was significantly less pain intensity in the group of patients receiving sodium hyaluronate compared with corticosteroids (P = 0.001). A decrease in crepitation was seen in both groups. In the 20 subjects receiving sodium hyaluronate both the mandibular vertical opening and protrusion increased significantly (P < 0.000). Lateral movement from the affected side increased both in subjects injected with sodium hyaluronate (P = 0.024), and those injected with corticosteroids (P = 0.042). In conclusion, this study confirms that injections in the TMJ with sodium hyaluronate or corticosteroids may reduce pain and improve function in patients with osteoarthritis. The injections were more effective in patients with only TMJ pain compared with patients suffering from both TMJ and myofascial pain. Injection with sodium hyaluronate was significantly more effective in decreasing pain intensity than corticosteroids. Temporary pain after injections may be observed.

Mandibular osteotomies in patients with juvenile rheumatoid arthritic disease.

OBJECTIVE: This retrospective study evaluates the results after orthognathic surgery in a group of patients with juvenile rheumatoid arthritis. METHODS: The material comprised sixteen patients where genioplasty with or without bilateral sagittal split (BSSO) had been performed during a 10-year period between 1991 and 2000. The patients were recalled for follow-up examination and the clinical records and radiographs of the patients were analysed. RESULTS: All patients reported an improved facial esthetics. Sixty-two% reported altered neurosensory dysfunction in the inferior alveolar nerve, but no patients reported altered feelings to interfere with function. Two patients reported reduction in pain in the TMJ from a score 10 and 7 in the VAS-scale preoperatively, to 0 after the orthognathic surgery. Eight of the patients reported this to be less uncomfortable compared to other surgical procedures because of their JRA. Ninety-four% noted a positive social change after the operation. CONCLUSION: Orthognathic surgical treatment of the JRA patient improves the facial profile. The described procedures are safe and serious complications were not seen in our study.

Discectomy of the temporomandibular joint: an experimental study in monkeys.

Postoperative changes have been observed in the temporomandibular joint (TMJ) after discectomies. Animal models have often shown that interventions in the TMJ may heal uneventfully. Discectomies were performed on 14 Macaca fascicularis and macroscopic and microscopic examination performed after sacrifice of the animals. Two of the animals did not show any apparent macroscopic or microscopic changes. The remaining 12 joints showed minor to major changes. The most serious changes were seen in three joints with fibrous ankylosis and five joints showed marked destruction of the articular cartilage.

The effect of locally applied gauze drain impregnated with chlortetracycline ointment in mandibular third-molar surgery.

A prospective randomized crossover, within-patient, controlled study was performed in 26 healthy patients to test the effect of the prophylactic local use of gauze drain impregnated with chlortetracycline (Aureomycin 3%, Lederle) ointment on postoperative alveolitis formation after surgical removal of 52 bilaterally impacted mandibular third molars. The teeth were removed on two separate occasions; on one side drain was inserted in the socket, and on the other side no drain treatment was used for control. The influence on postoperative pain, swelling, and mouth opening ability was investigated. The results indicated a statistically significant reduction (P = 0.02) in the incidence of postoperative inflammatory complications, defined as postoperative alveolitis, from 35% in the no-drain group to 4% in the drain group. No statistically significant difference was found between the two treatment methods with regard to pain and mouth opening reduction. There was a significant difference between the drain and no-drain treatment with regard to swelling on the 1st postoperative day in favor of the no-drain method. It is concluded that insertion of a chlortetracycline-impregnated drain may be an effective method for reducing postoperative alveolitis formation but has no beneficial effect on pain, swelling, and mouth opening reduction after impacted mandibular third-molar surgery.

Reflex responses of the masseter muscle in patients with chronic arthritis or internal derangement of the temporomandibular joint. A comparison with symptomfree subjects.

Averaged reflex responses in the masseter muscle to transverse taps delivered to the upper central incisor were studied in 13 patients with chronic arthritic temporomandibular joint (TMJ) disease (arthritis group) and 28 patients having internal TMJ derangement (derangement group). The diagnostic assessment of TMJ disease was based on a combination of imaging methods. Fourteen symptomfree subjects served as a control for the electromyographic observations. The tapping force was increased in steps from 0.25 to 6 N. The pattern of the reflex response consisted of various inhibitory and excitatory waves, which were found to change with increasing tapping force. The first inhibitory wave (I-1) increased in duration with increasing tapping force in all subjects. At certain tapping forces, I-1 was of significantly lower amplitude and longer duration in the arthritis group than in the control group, but latency and threshold did not differ. The excitatory wave seemed to have longer latency and higher amplitude in the arthritis group than in the control subjects at some tapping forces. In summary we conclude that the pattern of the reflex response seemed to be similar in patients with different TMJ disorders and in symptomfree subjects. Only the level of inhibition, duration of I-1 and higher excitatory response, might separate the patients with arthritic TMJ disease and internal TMJ derangement from symptomfree subjects, but no specific differences between the groups could be found.

Reproducibility of postoperative courses after surgical removal of symmetrically impacted wisdom teeth.

The acute postoperative courses after bilateral ¿identical¿ surgical removals of symmetrically impacted third molars on two separate occasions were investigated in a study containing two separate trials. Both trials were conducted as open interpatient crossover trials. Codeine phosphate (50 mg), with assumed analgesic effect but with no known clinical antiinflammatory effect, was given 4 times daily for 3 days starting 2 h after surgery in one trial using 20 patients (mean age 22.7 years, 12 females/8 males) and starting 3 h after surgery in the other trial using 20 patients (mean age 23.0 years, 11 females/9 males). Identical surgical procedures were carried out by the same surgeon in the same patient. The study shows the mean postoperative time courses of pain intensity, sum pain intensity, and swelling to be similar after bilateral operations. Pain intensity difference scores as measures of analgesia suggested the influence of carryover effects with respect to the second operation, irrespective of drug starting time. Mouth opening ability was not similar on each occasion after bilateral surgery. It can be concluded that the carryover design in bilateral surgery is valid and useful with respect to testing drug effects on swelling. The bilateral third molar model also offers the ability to test clinically relevant multiple dose regimens in phase 3 trials. It should, however, be recognized that the bilateral third molar model is highly dependent on the skill of the surgeon and may thus be more difficult to complete than parallel group trials.

Synovectomy and diskectomy of the temporomandibular joint in patients with chronic arthritic disease compared with diskectomies in patients with internal derangement. A 3-year follow-up study.

Twenty-five temporomandibular joints (TMJs) in 15 patients with chronic arthritic disease were treated with synovectomy and diskectomy. Twenty patients with internal derangement of 27 TMJs treated with diskectomy served as a control group. A response in pain relief was seen in 73% of the patients with chronic arthritic disease and in 80% of the patients with internal derangement 3 yr postoperatively. In both groups of patients a significant increase in mouth opening capacity and lateral movement of the mandible was seen postoperatively, with no significant difference in the improvement between the two groups. Four patients with chronic arthritic disease were reoperated within the 3-yr observation period. This study indicates that synovectomy and diskectomy of the TMJ may reduce pain and improve mandibular function in patients with severe chronic arthritic TMJ disease.

Histopathologic changes of the temporomandibular joint disk in patients with chronic arthritic disease. A comparison with internal derangement.

Histopathologic examination was performed of the disk and the posterior attachment extirpated from 17 temporomandibular joints from 15 patients with chronic arthritic disease. Seven patients had rheumatoid arthritis (including two with juvenile type), five had ankylosing spondylitis, and three had psoriatic arthropathy, which affected more joints than the temporomandibular joint. Specimens removed from 16 temporomandibular joints from 15 patients with internal derangement were used for histopathologic comparison. In both groups of patients, inflammatory changes were observed, but no specific histopathologic signs could distinguish the groups. Patients with chronic arthritic disease seemed to have more pronounced changes of vascular proliferation, perivascular cellular infiltrate, inflammatory cells, and fibrosis throughout the soft tissues. Destruction of the disk was another finding evident in patients with chronic arthritic temporomandibular joint disease; there was no visible disk structure in 8 of these 17 joints, compared with 1 of the 16 joints in the internal derangement group.

Degenerative changes in the temporomandibular joint after diagnostic arthroscopy. An experimental study in goats.

Arthroscopic procedures for diagnosis and treatment of temporomandibular joint (TMJ) diseases are widely used. Few adverse effects of the procedures have been reported. In this in vivo study, diagnostic arthroscopy was performed in the left TMJ of seven castrated male goats, the right TMJ serving as a control. The goats were killed 1, 2, and 3 months after the arthroscopy. Macroscopic and microscopic examination revealed no apparent pathologic changes in two animals, minor changes in two, and severe degenerative changes in three. This study indicates that arthroscopic intervention in the TMJ may cause irreversible changes in the articular tissues.

The effect of soft-laser application on postoperative pain and swelling. A double-blind, crossover study.

The effect of soft-laser application on postoperative pain and swelling was evaluated in a double-blind, crossover study. Twenty-five healthy adults with bilateral identically impacted lower third molars were selected for this study. The teeth were removed in two separate operations. Laser treatment was tested in comparison with placebo laser, with a 40-mW, 830-nm Biophoton laser (Roenvig Dental, Denmark). All surgical procedures and measurements were done by the same surgeon. The following features were statistically analyzed: swelling, trismus, and subjective registration of pain on a visual analog scale. No statistically significant differences were observed in comparison of the experimental side with the placebo side. It may be concluded that soft-laser treatment has no beneficial effect on swelling, trismus, and pain after third molar surgery.

Masseter muscle reflex evoked by tapping on osseointegrated Frialit implants.

Comparison was made of the masseter muscle reflexes evoked by tapping on osseointegrated single-tooth aluminum oxide implants, and on natural teeth in nine patients. Tapping on eight out of nine patients evoked an inhibitory masseter muscle reflex, whereas tapping on all of the natural teeth evoked an inhibitory reflex. The threshold for this reflex was clearly elevated in implants compared to natural teeth. The pathway for the impulses responsible for this reflex and the clinical implications of the elevated threshold are discussed.

Surgical treatment of temporomandibular joints in patients with chronic arthritic disease: preoperative findings and one-year follow-up.

Twenty-nine temporomandibular joints (TMJs) in 19 patients with chronic arthritic disease were surgically treated. Nine patients had rheumatoid arthritis (including two with juvenile type), six had ankylosing spondylitis and four had psoriatic arthropathy. Using a preauricular approach, diskectomies with synovectomies were performed in 23 joints (14 patients) with chronic arthritic abnormalities. Diskectomies without synovectomies were performed in six joints (five patients), which proved to have internal derangements unrelated to their chronic arthritic disease. Joints with chronic arthritis showed considerable variation in inflammatory reactions, but were characterized by increased vascularization, synovial proliferation to the articulating surfaces and mostly pannus formation and bone resorption. A response in pain relief was seen in 85% of the patients three months postoperatively and in 79% of the patients 12 months postoperatively, indicating that diskectomy with synovectomy may be favorable in patients with severe TMJ problems due to involvement of chronic arthritic disease.

Imaging temporomandibular joint abnormalities in patients with rheumatic disease. Comparison with surgical observations.

The preoperative examination findings in the soft tissue and bone of 22 temporomandibular joints of 15 patients with rheumatic disease were compared with the diagnosis after TMJ surgery. Agreement was found in 15 joints with rheumatic involvement and in 4 with internal derangement. In 5 (with unsuccessful arthrotomography) of the 15 rheumatic joints, magnetic resonance imaging showed destruction of disks with soft-tissue replacement, corresponding to fibrous tissue/ankylosis observed at surgery. Bony fusions in 2 of these joints were depicted with computed tomography. In the remaining 10 joints, arthrotomography showed irregularly outlined small compartments corresponding to synovial proliferations observed during surgery. Similar arthrotomographic interpretation, however, was made in 2 of 3 temporomandibular joints with imaging-surgery disagreement; surgery showed fibrous adhesions. In the third joint with unsuccessful arthrotomography, magnetic resonance imaging showed internal derangement but no synovial proliferations that were surgically observed. As experienced with other joints, synovial proliferations (or fibrous adhesions) could not be depicted with magnetic resonance imaging. Thus, differentiation between internal derangement with and without rheumatic involvement could be impossible with both arthrotomography and unenhanced magnetic resonance imaging.

Light and transmission-electron microscopy study of enamel organ cells in germectomized human third mandibular molars.

Using nine serially sectioned germectomized mandibular third molars it was possible to examine light microscopical (LM) and transmission-electron microscopical (TEM) features of maturing human enamel organ cells. The degree of enamel mineralization was estimated by quantitative imbibition studies in polarized light. It was possible to distinguish between three progressive stages of enamel mineralization. The most advanced stage was characterized by external enamel porosity. In the least advanced stages the enamel porosity appeared more extensive beneath a less porous surface layer. Ruffle- and smooth-ended ameloblasts were identified corresponding to the maturing enamel. Smooth-ended ameloblasts were the most frequently observed. However, no preferences for one of the two cell types could be observed in relation to the different stages of enamel mineralization. The maturing human enamel organ cells broadly revealed the same characteristics with respect to morphology features, intracellular organization, and junctional complexes as described in the maturation zone of the rat incisor enamel organ. Our findings therefore add to the view that the basic pattern of amelogenesis is identical in human and rat incisor enamel.

Force-related changes in the masseter muscle reflex response to tooth-taps in man.

In 14 subjects with no disorder of the masticatory apparatus, excitatory and inhibitory reflex responses in the masseter muscles were derived by standardized mechanical stimulation of the upper central incisor. A series of eight taps was delivered during isometric contraction at 40% of maximum EMG activity, with tapping forces ranging from 0.25-9 N. The mean post-stimulus masseteric EMG complex (PSEC) consisted of up to three inhibitory (I-1, I-2 and I-3) and three excitatory phases. The first inhibitory wave increased in duration with increasing tapping force, and the second and third inhibitory waves occurred at higher thresholds than the first inhibitory wave.

[Laser therapy in dental practice. What is laser?]. / Laserterapi i odontologisk praksis. Laser - hva er det?

This article briefly discusses laser theory and medical use of different types of laser, laserphysics and laser properties. The indications for lasertherapy as claimed from laser-producers, are numerous. However, we recommend that the effect of treatment with low level laser therapy has to be more documented before general use in a dental practice.

Arthrographic findings in the temporomandibular joint in patients with rheumatic disease.

Hypocycloidal multisection tomography and lower-space arthrotomography with videofluoroscopy were performed on 20 symptomatic temporomandibular joints (TMJs) of 17 patients. All patients (16 women, one man, aged 17 to 38 years) had definite or suspected rheumatoid arthritis (adult or juvenile type), ankylosing spondylitis, or psoriatic arthropathy. Bone abnormalities were found in 14 TMJs, primarily cortical erosion (11 joints), but also condylar flattening (three joints). Irregularity in outline of the contrast material, bone contour-contrast material gaps, evidence of adherent discs and/or small joint compartments indicated synovial hyperplasia/pannus formation in 15 joints. Six of these (four with normal disc position) showed perforation between the joint compartments. In those with normal disc position the perforation seemed to occur in the central portion. Ten of the 15 joints had normal disc position; the remaining five had anterior disc displacement without reduction. One joint showed only disc displacement. Most joints with bone abnormalities (12 of 14) showed arthrographic signs of rheumatic involvement. Such signs were also observed in two of the six joints with no bone abnormalities, indicating the value of arthrography in the early diagnosis of patients with rheumatic disease and TMJ problems.