Incidence of Orofacial Manifestations of Juvenile Idiopathic Arthritis From Diagnosis to Adult Care Transition: A Population-Based Cohort Study.

OBJECTIVE: To estimate the cumulative incidences of orofacial conditions related to temporomandibular joint (TMJ) juvenile idiopathic arthritis (JIA) between diagnosis in childhood to transition into adult care, and to identify features in JIA associated with TMJ involvement. METHODS: A population-based cohort analysis was conducted of patients with JIA involving longitudinal data on orofacial health from 2000 to 2018. Regardless of TMJ status, the patients were referred to the Regional Specialist Craniofacial Clinic of Western Denmark for routine orofacial examinations. Data collection included information about disease-specific background characteristics, TMJ involvement, JIA-induced dentofacial deformity, and orofacial symptoms and dysfunction. RESULTS: A total of 613 patients were followed up with a mean clinical TMJ observation time of 4.0 years. From JIA onset to transition into adult care, the cumulative incidence of patients with JIA involvement of the TMJ was 30.1%. Furthermore, 20.6% of the cohort had developed arthritis-induced dentofacial deformity. A substantial proportion of the cohort experienced several events with orofacial symptoms (23.5%) and dentofacial dysfunction (52%). Young age at diagnosis (<9 years), female gender, and antinuclear antibody positivity were significantly associated with TMJ involvement. CONCLUSION: Orofacial signs and symptoms were frequent findings in children and adolescents with JIA. TMJ involvement was seen in 30.1% of the cohort; and 20.6% of the total cohort developed JIA-related dentofacial deformity before transition into adult care. This is the first population-based study in the era of available biologic treatments to document these frequent orofacial complications in children with JIA.

Impact of Aligners and Fixed Appliances on Oral Health during Orthodontic Treatment: A Systematic Review and Meta-Analysis.

PURPOSE: To identify and assess differences in oral hygiene parameters in patients undergoing orthodontic treatment with clear aligners compared to fixed appliances. MATERIALS AND METHODS: Published and unpublished literature was searched in seven databases until May 31st 2021. Representative keywords included 'orthodontic aligner', 'fixed appliance', 'oral hygiene', 'plaque index', 'caries'. Study selection, data extraction, risk of bias and certainty of evidence assessment were undertaken independently by three reviewers. Random effects meta-analyses with respective confidence intervals (95% CI) were conducted, where applicable. RESULTS: A total of 882 unique records were screened, with a final number of 21 articles being eligible for qualitative synthesis, while 4 of those contributed to meta-analyses. Risk of bias was rated within the range of low to high or serious overall, while certainty of evidence was low to very low according to GRADE. For periodontal parameters, adults undergoing aligner orthodontic treatment presented summary plaque scores 0.58 lower than those treated with fixed appliances, within the first 6 to 12 weeks (4 studies: mean difference: -0.58; 95%CI: -0.82, -0.34; p < 0.001; I2 squared: 71.3%), while no evidence of difference was recorded for inflammation indices. Microbiologic parameters such as presence of S. mutans and lactobacilli were more pronounced in patients with fixed appliances for the first 3 to 6 months (synthesised data from 2 studies). CONCLUSIONS: In the short-term after initiation of orthodontic treatment, patients treated with aligners and no additional attachments/adjuncts presented potentially higher levels of oral health overall. However, the evidence is supported by low to very low certainty.