Arthritis and Dental Health

Arthritis is the most common joint inflammatory disorder with varied aetiology affecting the human population. However, its presence in the maxillofacial region is not widely accepted. Dental arthritis or T.M.J (Temporomandibular) arthritis affects 1% to 84% of the population. Arthritis is a highly debilitating disease as it limits the mobility and well-being of an individual.

Signs and Symptoms: The most significant presenting symptoms of the temporomandibular joint arthritis are:

• Pain/ Discomfort
• Loss of Joint function
• Mandibular dysfunction/ disorderly movement of the jaw
• Facial asymmetry due to impaired development or obliteration of height of the condylar region

Diagnosis:

Arthritis detection based on symptoms is not definitive due to the shared symptoms irrespective of the type of arthritis, be it OSTEOARTHRITIS or RHEUMATOID ARTHRITIS. Arthritis symptoms also overlap with symptoms of other TMJ disorders.

Arthritis is classified as Low Inflammatory arthritis and High Inflammatory arthritis. Low inflammatory disease is associated with degenerative changes and anatomical variations due to effects occurring post-trauma. This includes osteoarthritis and trauma-related arthritis. High inflammatory arthritis is associated with systemic disorders. It includes Rheumatoid arthritis and arthritis due to metabolic diseases, namely Gout, Pseudogout, and Psoriatic arthritis.

Differential diagnosis is concluded by comprehensive history and clinical examination. A history of trauma and discomfort on one side/joint is indicative of osteoarthritis, however, bilateral joint pain coupled with fever indicates rheumatoid arthritis.

A definitive diagnosis is mandatory for precise treatment. Blood investigations for R.F. (rheumatic factor) CRP (C -reactive proteins), etc are done to detect rheumatic factors if the TMJ is the first joint to be affected.

Radiographic evaluation by X-RAY, MRI, and scans reveal trauma to disc and condylar head for osteoarthritis. Obliteration of interarticular space and cystic formations in the condyle indicate Rheumatoid.

Rheumatoid Arthritis often leads to facial deformity due to loss of condylar height. This results in bilateral or unilateral impaired development of the jaw, resulting in a retrognathic mandible.

Juvenile idiopathic arthritis affects children from birth and results in facial feature disfigurement.

Management: Arthritis is a highly manageable disease.

Lifestyle:

• Alterations in food habits

Early diagnosis is a remedy in itself. Patients are advised to consume soft food items and avoid hard, nutty, and crisp food items

• De-stress; to stop grinding and clenching teeth.
• To avoid inadvertent, irrelevant, and irregular contact of teeth.
• Jaw exercises

Muscle-strengthening exercises help in relieving joint pain.

Pharmacological:

• NSAIDs, for pain relief.
• Treatment of rheumatism.
• Laser Photo biomodulation.

Surgical:

• Arthrocentesis
• Arthroscopy
• Joint replacement therapy.

Dental Complications Due To Rheumatoid Arthritis

Sjogren’s Syndrome:

Sjogren’s Syndrome is a disorder that occurs in conjunction with autoimmune connective tissue disease such as rheumatoid arthritis. This disorder is characterized by a decrease in the amount of moisture in your eyes and mouth. While many patients experience dry eyes, dry mouth, fatigue and joint pain, Sjogren’s Syndrome can also cause dysfunction of organs such as the kidneys, gastrointestinal system, blood vessels, lungs, liver, pancreas, and the central nervous system. To reach a diagnosis, dentists can perform a salivary flow test to measure the amount of saliva produced or a salivary gland biopsy. This dry mouth leads to gingival inflammation and an increase in dental caries. These patients are advised to practice adequate dental hygiene.

TMJ Disorders: The temporomandibular joint connects the jaw to the skull. Due to inflammation from rheumatoid arthritis, it can become painful to move your jaw.

Symptoms of TMJ include:

• Pain or tenderness in your face, jaw joint area, neck and shoulders, and in or around the ear
• Problems when you try to open your mouth wide, these patients are advised not to do so.
• Jaws that get “stuck” or “lock” in the open- or closed-mouth position
• Clicking, popping, or grating sounds in the jaw joint while opening and closing the mouth.

Conclusion: Arthritis of the jaw includes a vast group of patients who require a definitive diagnosis before any treatment is initiated. Arthritis irrespective of its origin has overlapping symptoms and thus requires comprehensive study. Dental arthritis can be well managed throughout one’s life if precautions and management techniques are followed religiously. Facial deformities cause not only physical but mental anguish as well, thus, they need to be treated holistically.

About the Author: Dr. Shweta Mathur Lall is a practicing dentist by profession and a writer at heart. She is a senior consultant at the Apollo Hospital and has a private practice based in New Delhi. She graduated in dentistry from Lucknow and pursued a specialization in the use of lasers in dental practice from University College London, UK.