The temporomandibular joint in juvenile rheumatoid arthritis: Part II. Relationship between computed tomographic and clinical findings.

A study was undertaken to examine the relationship between the clinical signs and symptoms of temporomandibular joint (TMJ) disorder and computed tomographic (CT) evidence of destruction of these joints in children afflicted with juvenile rheumatoid arthritis (JRA). A thorough clinical examination including determination of the craniomandibular index (CMI) was performed on each of 37 consecutive JRA patients (6-17 years old), who had also received comprehensive evaluations of TMJ morphology by axial CT (see Part I, Pediatr Dent, 17:46-53, 1995). Measures of facial asymmetry (photographic) and mandibular size (cephalometric) also were collected. Published norms for mandibular dimensions and for prevalences of symptoms and signs of TMJ disorders served as control data. Various ANOVA and nonparametric statistical models were used for analysis. Average maximal opening was significantly less in the JRA subjects compared with the controls, and more than 50% of the JRA children manifested chin deviations or vertical disparities between mandibular angle regions, indicating compromised mandibular function and form. With the exception of facial asymmetry, however, none of the clinical signs or symptoms of TMJ dysfunction were remarkable predictors of bony destruction of the TMJ. Subjects with definitive evidence (CT) of TMJ destruction (62%) could not be identified reliably by any of the clinical measures used here. These findings indicate that clinical examination alone is inadequate for detecting condylar degeneration in the TMJ of children with JRA.