Dental Status and Treatment Needs of Children in Foster Care.

Purpose: This study compared the dental status and treatment needs of children in foster care with other children enrolled in Florida Medicaid. Methods: The study was a retrospective dental records review of patients who were associated with a foster care agency and an age-matched group of other Medicaid recipients in 2016. Results: We abstracted the electronic dental records of 548 two- to 18-year-olds in foster care and an age-matched group of 548 Medicaid-enrolled children not in foster care. Compared with other Medicaid-enrolled children, those in foster care were more likely to have experienced dental caries overall (75.7 percent versus 58.8 percent; P<.0001), in the permanent dentition (63.6 percent versus 45.1 percent; P<.0001), and in the primary dentition (32.7 percent versus 18.8 percent; P<.0001). Children in foster care had 1.6 times greater prevalence of pulpitis, 1.4 times as many root canal treatments, 5.8 times more diagnoses of severe gingivitis, 3.5 times more diagnoses of periodontitis, and 1.3 times more treatment-planned extractions. Conclusions: Children in foster care had more dental needs, higher caries prevalence, and received more dental care than other Medicaid-enrolled children. Poor oral health status is a public health concern for children in the foster care system. (Pediatr Dent 2019;41(3):206-10) Received December 18, 2018 | Last Revision March 12, 2019 | Accepted March 14, 2019.

Juvenile dermatomyositis: is periodontal disease associated with dyslipidemia?

BACKGROUND: Association between periodontal disease and dyslipidemia was recently reported in healthy adults. However, a systematic evaluation of concomitant periodontal diseases and lipid profile was not carried out in juvenile dermatomyositis (JDM). A cross-section study was performed in 25 JDM patients and 25 healthy controls, assessing demographic data, periodontal evaluation, fasting lipoproteins and anti-lipoprotein lipase antibodies. Disease parameters, laboratorial tests and treatment were also evaluated in JDM patients. RESULTS: The mean current age was similar in patients and controls (11.5 ± 3.75 vs. 11.2 ± 2.58 years,p = 0.703). Regarding lipid profile, the median triglycerides [80(31-340) vs. 61(19-182)mg/dL,p = 0.011] and VLDL[16(6-68) vs. 13(4-36)mg/dL,p = 0.020] were significantly higher in JDM patients versus controls. Gingival vasculopathy pattern was significantly higher in the former group (60% vs. 0%,p = 0.0001), as well as the median of gingival bleeding index (GBI) [24.1(4.2-69.4) vs. 11.1(0-66.6)%,p = 0.001] and probing pocket depth (PPD) [1.7(0.6-2.4) vs.1.4(0-2.12)mm,p = 0.006]. Comparison between JDM patients with and without dyslipidemia revealed that the median of dental plaque index (PI) [100(26.7-100) vs. 59(25-100)%,p = 0.022], PPD[1.9(0.6-2.4) vs. 1.4(1.2-1.8)mm,p = 0.024] and clinical attachment level (CAL) [1.31(0.7-1.7) vs. 0.8(0.6-1.7)mm,p = 0.005] were significantly higher in patients with dyslipidemia. Further analysis between JDM patients with and without gingivitis revealed that the median of current age [12.4 (8.3-18.4) vs. 9.2 (5.5-17.5) years, p = 0.034] and disease duration [7.09 ± 3.07 vs. 3.95 ± 2.1 years, p = 0.008] were significantly higher in the former group. CONCLUSION: Our study showed that gingival inflammation seems to be related to dyslipidemia in JDM patients, suggesting underlying mechanisms for both complications.

Oral warning signs of elastic pseudoxanthoma.

The pseudoxanthoma elasticum is a multisystemic heritable disease that primarily affects the connective tissue. It has been characterized by fragmentation and calcification of elastic fibers that can lead to complications of skin and cardiovascular system and changes in retina. Involvement of the oral mucosa has been described like white patches striated especially in the mucosa of both upper and lower lips. These oral signs are potentially useful to diagnose the disease, since it is an often undiagnosed disease due to the variability in phenotypic expressions. This study reports a case of pseudoxanthoma elasticum affecting a woman who developed lesions in the oral mucosa during the disease progression. Intraoral clinical assessment revealed the presence of changes mainly in lower labial mucosa and also slightly changes in the mouth floor and the upper labial mucosa. Therefore, the acknowledgment of oral pseudoxanthoma elasticum lesions helps dental practitioners to establish an early and appropriate diagnosis of this disease. This is very important because pseudoxanthoma elasticum is a multisystem disease with morbidity and mortality, and its early diagnosis and also the establishment of a follow-up protocol for these patients could prevent systemic and oral complications.

Periodontitis Response to Anti-TNF Therapy in Ankylosing Spondylitis.

BACKGROUND: Recently, it has been demonstrated that patients with ankylosing spondylitis (AS) and rheumatoid arthritis (RA) have a higher risk of periodontitis; however, the effect of anti-TNF therapy in periodontal status of patients with AS and particularly in dental attachment is not known. OBJECTIVE: To evaluate longitudinally the local periodontal effect of TNF-antagonist in AS and compare to patients with RA. METHODS: Fifteen patients with AS and 15 RA control patients were prospectively evaluated at baseline and after 6 months (6 M) of anti-TNF therapy. Periodontal assessment included: probing pocket depth (PPD), clinical attachment level (CAL), gingival bleeding index, and plaque index. Rheumatologic clinical and laboratory evaluations were the following: Bath AS Disease Activity Index, Bath AS Metrology Index, Bath AS Functional Index, C-reactive protein and erythrocyte sedimentation rate for AS and Disease Activity Score 28 joints, and C-reactive protein and erythrocyte sedimentation rate for patients with RA. RESULTS: At baseline, periodontal parameters were alike in AS and RA (P > 0.05). After 6 M of anti-TNF therapy, clinical and laboratory parameters of rheumatic diseases decreased significantly in the patients with AS and RA (P < 0.05). A significant improvement in periodontal attachment measurements were observed in the patients with AS (PPD, 2.18 vs 1.94 mm; P = 0.02; CAL, 2.29 vs.2.02 mm; P = 0.03), but not in RA (PPD, 1.92 vs 2.06 mm; P = 0.06; CAL, 2.14 vs 2.28 mm; P = 0.27). Oral hygiene and gingival inflammation remained unchanged from baseline to 6-M evaluation in AS and RA (P > 0.05). CONCLUSION: Patients with AS under anti-TNF improved periodontal attachment. The mechanism for this effect needs further studies.

Periodontal Treatment and Quality of Life of Chronic Facial Pain Patients / Tratamiento Periodontal y Calidad de Vida en Pacientes con Dolor Facial Crónico

The aim of this research is to determine the impact of periodontal treatment on the quality of life of patients with concomitant chronic headache or facial pain and periodontal disease. Thirty-eight consecutive patients with chronic periodontal disease were divided according to the presence of chronic craniofacial pain (CFP):Study Group-with CFP and Control Group-without CFP. They were evaluated with the Clinical protocol of the Orofacial Pain Clinic, the WHOQOL-bref and the McGill Pain Questionnaire. All patients received periodontal treatment. The Study Group presented worst quality of life than the Control Group. Nevertheless, the Study Group showed trend improvement in the psychological score (p=0.06) and affective descriptors at the McGill Pain Questionnaire improved (p=0.014) after periodontal treatment. There were no significant changes in quality of life from pre- to post- operatory evaluations in both groups (p>0.05). We conclued that chronic craniofacial pain sufferers presented worst score at physical and psychological domain of quality of life, however there was an improvement in their psychological state 180 days after periodontal treatment.

El objetivo fue determinar el impacto del tratamiento periodontal sobre la calidad de vida de los pacientes con cefalea crónica concomitante o dolor facial y enfermedad periodontal. Treinta y ocho pacientes consecutivos con enfermedad periodontal crónica fueron divididos de acuerdo a la presencia de dolor craneofacial crónico (CFC); grupo de estudio con CFC y el grupo control, sin CFC. Fueron evaluados con el protocolo clínico de la Clínica del Dolor Orofacial, el WHOQOL-bref y el cuestionario de dolor McGill. Todos los pacientes recibieron tratamiento periodontal. El grupo estudio presentó peor calidad de vida que el grupo control. No obstante, el Grupo de estudio mostró una tendencia de mejoría en la puntuación psicológica (p=0,06 ) y los descriptores afectivos en el cuestionario de dolor de McGill tambien mejoraron (p=0,014 ) después del tratamiento periodontal. No hubo cambios significativos en la calidad de vida de las evaluaciones pre y postoperatorias en ambos grupos (p>0,05). Concluimos que los pacientes de dolor crónico craneofaciales presentaron peor puntuación en el dominio físico y psicológico de la calidad de vida, sin embargo, hubo una mejoría en su estado psicológico 180 días después del tratamiento periodontal.

Periodontitis and Metabolic Control: A Preliminary Study / Periodontitis y Control Metabólico: Estudio Preliminar

The aim of this study was to evaluate the periodontal condition and the metabolic control of patients with diabetes mellitus type 2. Patients with diabetes mellitus type 2 were evaluated pre- and post (30 days) treatment of the periodontitis through the following exams: glycemia, glycosylated hemoglobin, plaque index, gingival bleeding index and periodontal pocket depth index. Periodontal treatment consisted of: Scaling, root planning and plaque control, associated with systemic antibiotic therapy with amoxicillin. Seventeen patients (12 women and 5 men; mean age = 55.94 years) were included. The chief complaints were: gingival bleeding (n=13); gingival pain (n=8), tooth mobility (n=3), gingival swelling (n=2) and halitosis (n=2). The mean time of these complaints ranged from 2 months to 20 years. None of them had ever received guidance on oral hygiene or dental assessment. There was a reduction in the following indexes (30 days after the periodontal treatment): plaque, from 41.79±24% to 12.26±13%) (p0.0005), gingival bleeding from 51.58±25%) to 15.77±15% (p0.0005), periodontal pocket depth from 0.98±0.91 mm to 1.76±0.63 mm) (p0.0005). In 15 patients there was a reduction in the glycosylated hemoglobin (10.85±3.03% to 8.72±1.68%) (p0.0005). This preliminary study shows that patients of this sample had chronic and severe periodontal disease; there was a reduction in the glycosylated hemoglobin levels, but not of glycemia, 30 days after periodontal treatment. Long-standing studies are necessary; however patients with diabetes mellitus need control of chronic infections, including periodontal disease.

El objetivo fue evaluar la condición periodontal y el control metabólico de pacientes con diabetes mellitus tipo 2. En los pacientes con diabetes mellitus tipo 2 se evaluaron previo y posterior (30 días) al tratamiento de la periodontitis los siguientes exámenes: glucemia, hemoglobina glicosilada, índice de placa bacteriana, índice de sangrado gingival e índice de profundidad de la bolsa periodontal. El tratamiento periodontal consistió en: curetage, alisado radicular y control de placa, asociado a la terapia sistémica antibiótica con amoxicilina. Se evaluaron 17 pacientes (12 mujeres y 5 hombres, con una edad media de 55,94 años). Las principales complicaciones fueron: sangrado gingival (n= 13), dolor gingival (n= 8), movilidad dental (n= 3), edema gingival (n= 2) y halitosis (n= 2). El tiempo medio de estas complicaciones varió entre 2 meses y 20 años. Ninguno de ellos reconoció haber recibido orientación sobre higiene oral o evaluación dental. Hubo una reducción (30 días después del tratamiento periodontal) en los siguientes índices: placa, de 41,79±24% a 12,26±13%) (p0,0005); sangrado gingival, de 51,58±25%) a 15,77±15% (p0,0005), profundidad de la bolsa periodontal, de 0,98±0,91 mm a 1,76±0,63 mm) (p0,0005). En 15 pacientes se observó una reducción en la hemoglobina glucosilada (10,85±3,03% a 8,72±1,68%) (p0,0005). Observamos que los pacientes de esta muestra tenían enfermedad periodontal crónica y severa; que hubo una reducción en los niveles de hemoglobina glucosilada, pero no de la glucemia, 30 días después del tratamiento periodontal. Estudios longitudinales son necesarias, sin embargo los pacientes con diabetes mellitus requieren control de las infecciones crónicas, como la enfermedad periodontal.

Doença periodontal em doenças reumáticas pediátricas / Periodontal disease in pediatric rheumatic diseases

Gengivite e periodontite são doenças periodontais imunoinflamatórias caracterizadas por infecções localizadas crônicas geralmente associadas a uma inflamação insidiosa. Essa revisão narrativa discute doenças periodontais e mecanismos que influenciam a resposta imune e a autoimunidade na área das doenças reumáticas pediátricas (DRP), particularmente a artrite idiopática juvenil (AIJ), lúpus eritematoso sistêmico juvenil (LESJ) e dermatomiosite juvenil (DMJ). Foi notada maior frequência de gengivite nessas doenças em comparação com controles sadios, enquanto casos de periodontite foram achados raros. Em pacientes com AIJ, a gengivite e a periodontite estavam relacionadas a fatores mecânicos, artrite crônica com incapacitação funcional, desregulação da resposta imunoinflamatória, dieta e medicamentos, principalmente corticosteroides e ciclosporina. Em pacientes com LESJ, a gengivite estava associada a períodos mais longos da doença, doses elevadas de corticosteroides, hiperativação dos linfócitos B e elevação da imunoglobulina G. São escassos os dados sobre doenças periodontais na população com DMJ; nos pacientes ativos, foi observado um padrão gengival singular, caracterizado por eritema gengival, dilatação dos capilares e formação arbustiforme. Em conclusão, gengivite foi a doença periodontal mais comum em pacientes com DRP. A associação observada com a atividade da doença reforça a necessidade de futuros estudos, com o intuito de determinar se a resolução dessa complicação irá influenciar o curso ou a gravidade da doença.

Gingivitis and periodontitis are immunoinflammatory periodontal diseases characterized by chronic localized infections usually associated with insidious inflammation. This narrative review discusses periodontal diseases and mechanisms influencing the immune response and autoimmunity in pediatric rheumatic diseases (PRD), particularly juvenile idiopathic arthritis (JIA), childhood-onset systemic lupus erythematosus (C-SLE) and juvenile dermatomyositis (JDM). Gingivitis was more frequently observed in these diseases compared to health controls, whereas periodontitis was a rare finding. In JIA patients, gingivitis and periodontitis were related to mechanical factors, chronic arthritis with functional disability, dysregulation of the immunoinflammatory response, diet and drugs, mainly corticosteroids and cyclosporine. In C-SLE, gingivitis was associated with longer disease period, high doses of corticosteroids, B-cell hyperactivation and immunoglobulin G elevation. There are scarce data on periodontal diseases in JDM population, and a unique gingival pattern, characterized by gingival erythema, capillary dilation and bush-loop formation, was observed in active patients. In conclusion, gingivitis was the most common periodontal disease in PRD. The observed association with disease activity reinforces the need for future studies to determine if resolution of this complication will influence disease course or severity.

[Periodontal disease in pediatric rheumatic diseases]. / Doença periodontal em doenças reumáticas pediátricas.

Gingivitis and periodontitis are immunoinflammatory periodontal diseases characterized by chronic localized infections usually associated with insidious inflammation This narrative review discusses periodontal diseases and mechanisms influencing the immune response and autoimmunity in pediatric rheumatic diseases (PRD), particularly juvenile idiopathic arthritis (JIA), childhood-onset systemic lupus erythematosus (C-SLE) and juvenile dermatomyositis (JDM). Gingivitis was more frequently observed in these diseases compared to health controls, whereas periodontitis was a rare finding. In JIA patients, gingivitis and periodontitis were related to mechanical factors, chronic arthritis with functional disability, dysregulation of the immunoinflammatory response, diet and drugs, mainly corticosteroids and cyclosporine. In C-SLE, gingivitis was associated with longer disease period, high doses of corticosteroids, B-cell hyperactivation and immunoglobulin G elevation. There are scarce data on periodontal diseases in JDM population, and a unique gingival pattern, characterized by gingival erythema, capillary dilation and bush-loop formation, was observed in active patients. In conclusion, gingivitis was the most common periodontal disease in PRD. The observed association with disease activity reinforces the need for future studies to determine if resolution of this complication will influence disease course or severity.

Persistent periodontal disease hampers anti-tumor necrosis factor treatment response in rheumatoid arthritis.

OBJECTIVE: This study aimed to evaluate prospectively the influence and the evolution of periodontal disease (PD) in rheumatoid arthritis (RA) patients submitted to anti-tumor necrosis factor (TNF) therapy. METHODS: Eighteen patients with RA (according to the American College of Rheumatology criteria) were assessed for PD before (BL) and after 6 months (6M) of anti-TNF treatment: 15 infliximab, 2 adalimumab, and 1 etanercept. Periodontal assessment included plaque and gingival bleeding indices, probing pocket depth, cementoenamel junction, and clinical attachment level. Rheumatologic evaluation was performed blinded to the dentist's assessment: demographic data, clinical manifestations, and disease activity (Disease Activity Score using 28 joints [DAS28], erythrocyte sedimentation rate [ESR], and C-reactive protein [CRP]). RESULTS: The median age and disease duration of patients with RA were 50 years (25-71 y) and 94% were female. Periodontal disease was diagnosed in 8 patients (44.4%). Comparing BL to 6M, periodontal parameters in the entire group remained stable (P > 0.05) throughout the study (plaque and gingival bleeding indices, probing pocket depth, cementoenamel junction, and clinical attachment level), whereas an improvement in most analyzed RA parameters was observed in the same period: DAS28 (5.5 vs. 3.9, P = 0.02), ESR (21 vs. 12.5 mm/first hour, P = 0.07), and CRP (7.8 vs. 2.8 mg/dL, P = 0.25). Further analysis revealed that this improvement was restricted to the group of patients without PD (DAS28 [5.5 vs. 3.6, P = 0.04], ESR [23.0 vs. 11.5 mm/first hour, P = 0.008], and CRP [7.4 vs. 2.1, P = 0.01]). In contrast, patients with PD had lack of response, with no significant differences in disease activity parameters between BL and 6M: DAS28 (5.2 vs. 4.4, P = 0.11), ESR (17.0 vs. 21.0, P = 0.56), and CRP (9.0 vs. 8.8, P = 0.55). CONCLUSIONS: This study supports the notion that PD may affect TNF blocker efficacy in patients with RA. The possibility that a sustained gingival inflammatory state may hamper treatment response in this disease has high clinical interest because this is a treatable condition.

Avaliação da abertura bucal em pacientessubmetidos à radioterapia de cabeça e pescoço / Evaluation of mouth opening in patients undergoing head and neck radiotherapy

A radioterapia de cabeça e pescoço quando direcionada à articulaçãotemporomandibular e músculos da mastigação, pode provocar sequelas como redução daamplitude de abertura bucal e trismo, que, muitas vezes, pode ser irreversível.Objetivo: comparar a amplitude de abertura bucal, antes e após a radioterapia da regiãode cabeça e pescoço.Metodologia: foram selecionados 30 pacientes com diagnóstico de tumores malignos decabeça e pescoço para serem submetidos à mensuração da abertura bucal 30 dias antes daradioterapia, e 90 dias após. Também foram observadas as características gerais comotipo histológico do tumor e dose de radioterapia.Resultados: a idade média da amostra foi de 58 anos, sendo que 80,76% eram do sexomasculino e 19,24% do feminino. Na primeira avaliação encontrou‐se limitação deabertura bucal (35,08±8,74), e 90 dias após a radioterapia houve aumento da limitação deabertura bucal (31,5±10,42), porém, sem mostrar significância estatística (p≤0,061).Conclusão: não houve agravamento da limitação de abertura bucal após três meses deradioterapia...

When temporomandibular joint and muscles of mastication are in the fieldof radiation, trismus and restriction of mouth opening are common and often irreversiblesequelae.Aim: compare mouth opening before and after head and neck radiotherapy.Methodology: thirty patients with head and neck malignant tumors were chosen to havetheir mouth opening measured 30 days before and 90 days after radiotherapy. Generalcharacteristics as histological type of the tumor and radiotherapy dose were alsoevaluated.Results: the mean age of the sample was 58 years, 21 subjects (80.76%) were male, and 5(19.24%) were female. At the first evaluation, we found mouth opening restriction(35.08±8.74) and ninety days after radiotherapy the mouth opening increased (31.5±10.42),but without statistical significance (p≤0.061).Conclusion: the mouth opening did not worse after 3 months of radiotherapy...

Gingival capillary changes and oral motor weakness in juvenile dermatomyositis.

OBJECTIVE: We assessed the orofacial involvement in JDM, and evaluated the possible association of gingival and mandibular mobility alterations with demographic data, periodontal indices, clinical features, muscle enzyme levels, JDM scores and treatment. METHODS: Twenty-six JDM patients were studied and compared with 22 healthy controls. Orofacial evaluation included clinical features, dental and periodontal assessment, mandibular function and salivary flow. RESULTS: The mean current age was similar in patients with JDM and controls (P > 0.05). A unique gingival alteration characterized by erythema, capillary dilation and bush-loop formation was observed only in JDM patients (61 vs 0%, P = 0.0001). The frequencies of altered mandibular mobility and reduced mouth opening were significantly higher in patients with JDM vs controls (50 vs 14%, P = 0.013; 31 vs 0%, P = 0.005). Comparison of the patients with and without gingival alteration showed that the former had lower values of median of cementoenamel junction (-0.26 vs -0.06 mm, P = 0.013) and higher gingival bleeding index (27.7 vs 14%, P = 0.046). This pattern of gingival alteration was not associated with periodontal disease [plaque index (P =0.332) and dental attachment loss (P = 0.482)]. The medians for skin DAS and current dose of MTX were higher in JDM with gingival alteration (2.5 vs 0.5, P = 0.029; 28.7 vs 15, P = 0.012). A significant association of lower median manual muscle testing with a reduced ability to open the mouth was observed in patients with JDM than those without this alteration (79 vs 80, P = 0.002). CONCLUSIONS: The unique gingival pattern associated with cutaneous disease activity, distinct from periodontal disease, suggests that gingiva is a possible target tissue for JDM. In addition, muscle weakness may be a relevant factor for mandibular mobility.

Prevalência de cárie em pacientes autistas / Caries prevalence in autistic patients

Os autistas, no tocante aos aspectos odontológicos, são pacientes de difícil abordagem e características definidas descritas na literatura, como altos índices de placa e má condição periodontal. O objetivo deste estudo foi avaliar a prevalência de cárie nestes pacientes. Foram avaliados 17 pacientes autistas com idade entre 9 e 26 anos (média=15,9 anos), quanto ao índice de cárie (CPO-D) e os resultados obtidos comparados a um grupo controle composto por 17 pacientes com atrasos cognitivos. Para análise dos resultados, foram utilizados testes não paramétricos (Qui-quadrado-X2 e Mann-Whitney). Os resultados mostraram associação significante para o número de pacientes livres de cárie do grupo estudo (p=0,00723) e diferença significantemente maior para o índice de cárie do grupo controle (p=0,0001). Os pacientes autistas, mesmo frente às dificuldades na realização de higiene oral e tratamento odontológico, apresentam baixo índice de cáries. É de fundamental importância melhorar as condições bucais nesses pacientes, quer pela aplicação da Odontologia Preventiva, ou por análises de susceptibilidade a doenças bucais, reduzindo o número de intervenções odontológicas e eliminando fatores potenciais de dor e agitação, melhorando a qualidade de vida.

Dental and facial characteristics of patients with juvenile idiopathic arthritis.

OBJECTIVE: It has been shown that the temporomandibular joint is frequently affected by juvenile idiopathic arthritis, and this degenerative disease, which may occur during facial growth, results in severe mandibular dysfunction. However, there are no studies that correlate oral health (tooth decay and gingival diseases) and temporomandibular joint dysfunction in patients with juvenile idiopathic arthritis. The aim of this study is to evaluate the oral and facial characteristics of the patients with juvenile idiopathic arthritis treated in a large teaching hospital. METHOD: Thirty-six patients with juvenile idiopathic arthritis (26 female and 10 male) underwent a systematic clinical evaluation of their dental, oral, and facial structures (DMFT index, plaque and gingival bleeding index, dental relationship, facial profile, and Helkimo's index). The control group was composed of 13 healthy children. RESULTS: The mean age of the patients with juvenile idiopathic arthritis was 10.8 years; convex facial profile was present in 12 juvenile idiopathic arthritis patients, and class II molar relation was present in 12 (P =.032). The indexes of plaque and gingival bleeding were significant in juvenile idiopathic arthritis patients with a higher number of superior limbs joints involved (P =.055). Anterior open bite (5) and temporomandibular joint noise (8) were present in the juvenile idiopathic arthritis group. Of the group in this sample, 94% (P =.017) had temporomandibular joint dysfunction, 80% had decreased mandibular opening (P = 0.0002), and mandibular mobility was severely impaired in 33% (P =.015). CONCLUSION: This study confirms that patients with juvenile idiopathic arthritis a) have a high incidence of mandibular dysfunction that can be attributed to the direct effect of the disease in the temporomandibular joint and b) have a higher incidence of gingival disease that can be considered a secondary effect of juvenile idiopathic arthritis on oral health.

Dental and facial characteristics of patients with juvenile idiopathic arthritis

OBJETIVO: A articulação temporomandibular é freqüentemente afetada pela artrite idiopática juvenil, e esta doença degenerativa, durante o crescimento facial, resulta em disfunção mandibular grave. No entanto, não há estudos que avaliam conjuntamente alterações na saúde oral (cáries e doenças gengivais) e na articulação temporomandibular decorrentes da artrite idiopática juvenil. O objetivo deste estudo é avaliar a condição dentária e a função mandibular de pacientes com artrite idiopática juvenil tratados em um hospital escola. MÉTODO: Trinta e seis pacientes com artrite idiopática juvenil (26 meninas e 10 meninos) foram submetidos a uma avaliação clínica sistemática de suas estruturas dentárias, orais e faciais (índice CPO-D, índice de placa e sangramento gengival, relação dentária, perfil facial e índice de Helkimo para articulação temporomandibular). O grupo controle foi composto por 13 crianças saudáveis. RESULTADOS: A média de idade dos pacientes com diagnóstico de artrite idiopática juvenil foi 10,8 anos; o perfil facial convexo foi encontrado em 12 pacientes com artrite idiopática juvenil e relação molar classe II esteve presente em 12 deles (p=0,032). Os índices de placa e sangramento gengival foram significantes em pacientes com artrite idiopática juvenil que apresentavam maior número de articulações dos membros superiores comprometidas (p=0,055). Mordida aberta anterior (cinco) e ruídos articulares (oito) foram encontradas no grupo com artrite idiopática juvenil . Este grupo apresentou 94% dos pacientes com disfunção da articulação temporomandibular (p=0,017), além de amplitude mandibular diminuída (p=0,0002) e mobilidade mandibular gravemente comprometida em 33% (p=0,015). CONCLUSÃO: Este estudo confirma que pacientes com artrite idiopática juvenil: a) têm alto índice de disfunção mandibular, que pode ser atribuído ao efeito direto da doença sobre a articulação temporomandibular e b) maior índice de doença gengival, que pode ser considerado como efeito indireto da artrite idiopática juvenil na saúde oral.

Características morfológicas e funcional do sistema estomatognático em pacientes portadores de artrite reumatóide juvenil / Functinal morphologic characteristics of the stomatognathic system in patients carriers of arthritis juvenile rheumatoid

As alterações faciais são comuns em pacientes portadores de artrite reumatóide juvenil (ARJ) e decorrem do comprometimento do sistema estomatognático, principalmente devido a inibição do crescimento da mandíbula através da articulação temporomandibular (ATM). Outros aspectos odontológicos relacionados a esta doença também devem ser considerados durante a avaliação do destes pacientes e no estabelecimento de um plano de tratamento. É importante o conhecimento destas características por Médicos e Cirurgiões-Dentistas, prevenindo maiores problemas referentes a articulação temporomandibular, crescimento facial, dentes e periodonto. Estes aspectos foram avalidos através do relato de um caso clínico comparado na literatura revisada