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Shelly Abramowicz DMD, MPH
Statement of the Problem: Pediatric rheumatologists dictate systemic treatment for children with Juvenile Idiopathic Arthritis (JIA). When the temporomandibular joint (TMJ) is involved, the rheumatologist requests an opinion from the oral and maxillofacial surgeon (OMS). Currently, there is not a standardized method of diagnosis and treatment of TMJ involvement in children with JIA by OMS. The purpose of this investigation is to assess the current clinical practices by OMS in US regarding diagnosis and treatment of TMJ involvement in JIA.
Materials and Methods: The investigators implemented a cross-sectional survey of academic OMSs in the United States via electronic survey. The predictor variables were demographics (age, gender, number of years in practice and diplomat status of provider). The primary outcome measures were patient volume and management practices (data regarding commonly performed procedures, medication usage, average requested follow up intervals). Descriptive statistics were calculated.
Results: The study respondents were composed of 50 subjects with the majority male (89.4%), 51 to 60 years old (40.8%) in full time academics (82%) with over 20 years of experience (52%) and seeing 1 to 5 patients per month with JIA (48.8%). The majority of patients were 11 to 15 years of age (60%) on one to two systemic medications (80.6%). The TMJ evaluation included history, clinical exam, imaging (100%) and laboratory testing (86.7%). The most commonly utilized imaging were panoramic radiographs (69.4%) and MRI (56.8%). The decision to utilize intra-articular medication was most often based on history and symptoms (94.6%) with triamcinolone utilized by 93.9% of respondents. Once in remission, patients are followed on a 6 month (31.3%) and one year (34.4%) intervals. Surgeons reported that a skeletally mature teenager with facial asymmetry and mandibular hypoplasia, with inactive disease, would most likely undergo orthognathic surgery (79.4%), a combination of TMJ replacement and orthognathic surgery (58.8%) or TMJ replacement alone (35.3%).
Conclusions: JIA patients with TMJ involvement are commonly treatment by full time academic OMS seeing on average, one to five patients with JIA per month. There are specific practice patterns and treatment trends of children with JIA and TMJ involvement.