Clinical significance of first phase treatment for tmd finaljuyokai
The document summarizes the clinical significance of first phase treatment for temporomandibular disorder (TMD) patients. It discusses four categories of TMD symptoms, various etiologies of TMD, and the importance of establishing the physiologic rest position of the mandible using a removable neuromuscular orthosis. Data is presented showing high improvement rates across TMD symptoms including pain, with the majority of patients experiencing over 70% relief of symptoms after first phase treatment.
Short term and long-term stability of surgically assisted rapid palatal expan...Dr Sylvain Chamberland
Introduction: The purpose of this article is to present further longitudinal data for short-term and long-term
stability, following up our previous article in the surgery literature with a larger sample and 2 years of stability
data. Methods: Data from 38 patients enrolled in this prospective study were collected before treatment, at maximum
expansion, at removal of the expander 6 months later, before any second surgical phase, at the end of
orthodontic treatment, and at the 2-year follow-up, by using posteroanterior cephalograms and dental casts.
Results: With surgically assisted rapid palatal expansion (SARPE), the mean maximum expansion at the first
molar was 7.60 6 1.57 mm, and the mean relapse was 1.83 6 1.83 mm (24%). Modest relapse after completion
of treatment was not statistically significant for all teeth except for the maxillary first molar (0.99 6 1.1 mm). A
significant relationship (P-.0001) was observed between the amount of relapse after SARPE and the posttreatment
observation. At maximum, a skeletal expansion of 3.58 6 1.63 mm was obtained, and this was stable.
Conclusions: Skeletal changes with SARPE were modest but stable. Relapse in dental expansion was almost
totally attributed to lingual movement of the posterior teeth; 64% of the patients had more than 2 mm of dental
changes. Phase 2 surgery did not affect dental relapse.
Clinical significance of first phase treatment for tmd finaljuyokai
The document discusses the clinical significance of first phase treatment for temporomandibular disorder (TMD) patients. It summarizes that first phase treatment aims to eliminate or reduce patients' symptoms by stabilizing the mandible in the physiologic rest position using a removable neuromuscular orthosis. The summary analyzes data showing high improvement rates for TMD symptoms related to muscles, joints, and the autonomic nervous system following this first phase treatment approach.
This document discusses a case of tuberculosis (TB) transmission among healthcare workers in Thailand. It presents the case of a nurse with active TB who had been in contact with her roommate and other OR nurses. The document examines whether this was a result of human error or system error. It explores options for post-exposure management, including contact tracing and preventive treatment. It also discusses developing TB infection control interventions in resource-limited settings through measures like administrative controls, environmental controls, and respiratory protection.
This document provides information about new titles being published by Quintessence Publishing related to orthodontics. It lists 7 new book titles covering topics such as wire bending techniques, biomechanics principles in orthodontics, lingual orthodontics approaches, pediatric laser dentistry, Invisalign treatment, cephalometric superimposition, and facial development and transformation from an orthodontic perspective. It also provides brief descriptions of the content covered in each book.
Thank you for the case summary. The Invisalign treatment addressed the patient's chief complaint of crowding and achieved the treatment objectives. Minor refinements were made post-treatment to further improve esthetics.
This article summarizes a case series study examining the effects of cooled radiofrequency ablation of sacral lateral branches and the dorsal ramus of L5 on chronic pain from sacroiliitis. The study found improvements in pain levels, functional status, and opioid use at 3-4 month follow up for most patients. Specifically, patients experienced reductions in pain scores and improvements in function, 18 patients reported being improved or much improved, and opioid use decreased for many. This preliminary study suggests cooled radiofrequency denervation may provide clinically meaningful pain relief for chronic sacroiliitis.
The document provides an overview of the anatomy, development, and surgical anatomy of the temporomandibular joint (TMJ). It discusses the key components of the TMJ, including the mandibular condyle, articular surfaces of the temporal bone, articular disc, fibrous capsule, and ligaments. It describes the development of the TMJ from two distinct blastemas beginning in the 7th week in utero. The document highlights several unique features of the TMJ, such as its articular surface being covered by fibrocartilage instead of hyaline cartilage. It also reviews the movements, vascular supply, innervation, and age-related changes of the TMJ.
Clinical significance of first phase treatment for tmd finaljuyokai
The document summarizes the clinical significance of first phase treatment for temporomandibular disorder (TMD) patients. It discusses four categories of TMD symptoms, various etiologies of TMD, and the importance of establishing the physiologic rest position of the mandible using a removable neuromuscular orthosis. Data is presented showing high improvement rates across TMD symptoms including pain, with the majority of patients experiencing over 70% relief of symptoms after first phase treatment.
Short term and long-term stability of surgically assisted rapid palatal expan...Dr Sylvain Chamberland
Introduction: The purpose of this article is to present further longitudinal data for short-term and long-term
stability, following up our previous article in the surgery literature with a larger sample and 2 years of stability
data. Methods: Data from 38 patients enrolled in this prospective study were collected before treatment, at maximum
expansion, at removal of the expander 6 months later, before any second surgical phase, at the end of
orthodontic treatment, and at the 2-year follow-up, by using posteroanterior cephalograms and dental casts.
Results: With surgically assisted rapid palatal expansion (SARPE), the mean maximum expansion at the first
molar was 7.60 6 1.57 mm, and the mean relapse was 1.83 6 1.83 mm (24%). Modest relapse after completion
of treatment was not statistically significant for all teeth except for the maxillary first molar (0.99 6 1.1 mm). A
significant relationship (P-.0001) was observed between the amount of relapse after SARPE and the posttreatment
observation. At maximum, a skeletal expansion of 3.58 6 1.63 mm was obtained, and this was stable.
Conclusions: Skeletal changes with SARPE were modest but stable. Relapse in dental expansion was almost
totally attributed to lingual movement of the posterior teeth; 64% of the patients had more than 2 mm of dental
changes. Phase 2 surgery did not affect dental relapse.
Clinical significance of first phase treatment for tmd finaljuyokai
The document discusses the clinical significance of first phase treatment for temporomandibular disorder (TMD) patients. It summarizes that first phase treatment aims to eliminate or reduce patients' symptoms by stabilizing the mandible in the physiologic rest position using a removable neuromuscular orthosis. The summary analyzes data showing high improvement rates for TMD symptoms related to muscles, joints, and the autonomic nervous system following this first phase treatment approach.
This document discusses a case of tuberculosis (TB) transmission among healthcare workers in Thailand. It presents the case of a nurse with active TB who had been in contact with her roommate and other OR nurses. The document examines whether this was a result of human error or system error. It explores options for post-exposure management, including contact tracing and preventive treatment. It also discusses developing TB infection control interventions in resource-limited settings through measures like administrative controls, environmental controls, and respiratory protection.
This document provides information about new titles being published by Quintessence Publishing related to orthodontics. It lists 7 new book titles covering topics such as wire bending techniques, biomechanics principles in orthodontics, lingual orthodontics approaches, pediatric laser dentistry, Invisalign treatment, cephalometric superimposition, and facial development and transformation from an orthodontic perspective. It also provides brief descriptions of the content covered in each book.
Thank you for the case summary. The Invisalign treatment addressed the patient's chief complaint of crowding and achieved the treatment objectives. Minor refinements were made post-treatment to further improve esthetics.
This article summarizes a case series study examining the effects of cooled radiofrequency ablation of sacral lateral branches and the dorsal ramus of L5 on chronic pain from sacroiliitis. The study found improvements in pain levels, functional status, and opioid use at 3-4 month follow up for most patients. Specifically, patients experienced reductions in pain scores and improvements in function, 18 patients reported being improved or much improved, and opioid use decreased for many. This preliminary study suggests cooled radiofrequency denervation may provide clinically meaningful pain relief for chronic sacroiliitis.
The document provides an overview of the anatomy, development, and surgical anatomy of the temporomandibular joint (TMJ). It discusses the key components of the TMJ, including the mandibular condyle, articular surfaces of the temporal bone, articular disc, fibrous capsule, and ligaments. It describes the development of the TMJ from two distinct blastemas beginning in the 7th week in utero. The document highlights several unique features of the TMJ, such as its articular surface being covered by fibrocartilage instead of hyaline cartilage. It also reviews the movements, vascular supply, innervation, and age-related changes of the TMJ.
Dr Zahida Chaudnary talks with the students about what causes, and how you treat Arthritis.
Check out the slideshow by itself here.
Want an audio version? Subscribe to our Podcast on iTunes!
Want to join us for the live discussion? Check out our Social Media in the noon hour every Monday as we sit down on Google Hangout OnAir! Follow us on Twitter, Facebook, or Google+ to get updated with the link when we start!
12.01.08(a): Rheumatoid Arthritis/Pathogenesis and Clinical Presentation of J...Open.Michigan
Rheumatoid arthritis is caused by a complex interplay of genetic and environmental factors. Genetic susceptibility involves genes related to cellular immune responses, including HLA-DR4 alleles. Environmental triggers may include infection or smoking. The disease involves a dysregulated immune response in the synovium, with synoviocyte transformation and interaction with macrophages, T cells, and cytokines leading to inflammation and joint destruction. Autoantibodies such as rheumatoid factor and anti-CCP antibodies are involved in pathogenesis but their exact roles are still being elucidated.
Objective: To understand the pathophysiology of the arthrosis that lead to condylar resorption. To understand systemic, local and occlusal factors that may lead to condylar resorption. To know the diagnostic test that are recommended. To know how to adapt the treatment plan (surgical or non surgical) to patients with condylar resorption.
Temporomandibular joint disorder (TMD), or TMJ syndrome, is an umbrella term covering acute or chronic inflammation of the temporomandibular joint, which connects the mandible to the skull. The disorder and resultant dysfunction can result in significant pain and impairment. Because the disorder transcends the boundaries between several health-care disciplines — in particular, dentistry, neurology, physical therapy, and psychology — there are a variety of treatment approaches.
The temporomandibular joint (TMJ) permits the mandible to move through gliding and hinge movements. It consists of the mandibular condyle, mandibular fossa, articular disc, and articular capsule. The condyle articulates with the fossa and articular eminence, while the articular disc separates the joint into upper and lower compartments. The joint capsule surrounds the joint and is lined with a synovial membrane that produces lubricating synovial fluid. Accessory ligaments and the lateral temporomandibular ligament provide stability to the joint. The TMJ undergoes age-related changes including flattening of the condyle and thinning of the
Rheumatoid arthritis is a chronic disease that damages joints, causing inflammation and stiffness. It affects approximately 1% of the world's population, mostly women. While the exact cause is unknown, it is an autoimmune disorder where the immune system attacks the body's own tissues. Symptoms include fatigue, lack of appetite, fever, and joint pain. It is diagnosed through blood tests and x-rays. Treatment involves medications like NSAIDs, DMARDs, and corticosteroids to reduce inflammation and manage symptoms.
The temporomandibular joint (TMJ) connects the jaw to the skull. TMJ disorders are commonly caused by muscular problems or issues with the TMJ elements. Diagnosis involves x-rays or CT/MRI scans of the joint. Conservative treatments include rest, warm compresses, splints, gentle exercises, and injections. More invasive procedures include washing out the joint or cortisone injections. Surgery is a last resort to replace the jaw joints.
This document provides an overview of internal derangements of the temporomandibular joint (TMJ). It defines internal derangement as an abnormal relationship between the articular disc and condyle. The most common type is anterior disc displacement, which can be with or without reduction. Causes include trauma, functional overloading, joint laxity, and muscle spasms. Symptoms vary depending on the type but may include clicking, limited opening, and pain. Diagnosis involves clinical exams and MRI imaging. Treatment ranges from splint therapy to arthrocentesis or arthroscopy for lavage and relief of adhesions. Arthrocentesis is shown to improve opening and reduce pain by removing inflammatory factors from the
The document discusses temporomandibular joint (TMJ) disorders, including TMJ dysfunction syndrome (TMD) and myofacial pain dysfunction syndrome (MPDS). It covers the anatomy of the TMJ, functional movements, classification of disorders, signs and symptoms, examination techniques, treatment options including reversible therapies like splint therapy and irreversible surgical treatment, and prevention strategies.
Temporomandibular joint and muscle disorders (TMJ) cause jaw pain and dysfunction. There are three main types: myofascial pain involving jaw muscles, internal derangement involving a displaced disc or joint injury, and arthritis. Causes include trauma, teeth grinding, hormones, genetics, and stress. Treatment involves heat/ice, soft diet, jaw exercises, relaxation techniques, and over-the-counter anti-inflammatory drugs. More severe cases may require physical therapy, splints, injections, or surgery like arthrocentesis, arthroscopy, or disc removal.
This document provides an overview of the temporomandibular joint (TMJ). It begins by defining the TMJ as the joint connecting the mandible to the skull and regulating mandibular movement. It then describes the different types of joints in the body before focusing on the specifics of the TMJ. Key points include that the TMJ is a complex synovial joint that allows for both hinging and gliding movements. An articular disc separates the condyle of the mandible and fossa of the temporal bone. The document outlines the development, structures, innervation, vascularization and biomechanics of the TMJ.
This document discusses juvenile arthritis (JIA), the most common cause of chronic arthritis in childhood. It describes different classification systems for JIA, including the current ILAR classification which divides JIA into 7 subtypes based on symptoms. The subtypes include systemic, oligoarticular, and different types of polyarticular JIA. It also discusses investigations, treatment options including medications and physical therapy, as well as complications and prognosis for each JIA subtype.
Megkérdőjelezhető eljárások a gyermekgyógyászati gyakorlatbanElod Koncsag-Szasz
Megkérdőjelezhető eljárások a gyermekgyógyászati gyakorlatban: antibiotikumok alkalmazása előtti bőrteszt, BCG hegnegativitás követése. Előadás az Erdélyi Múzeum Egyesület XXIII. Tudományos Ülésszakán
Dr. Padmesh, a pediatrician, gave a presentation on International Day Against Drug Abuse. He discussed that drugs are chemical substances that affect the body's normal functioning. People often take drugs due to peer pressure, trying to escape problems, curiosity, or just wanting to feel good. However, drug use can have serious side effects and influence a person's health, education, relationships, career, and happiness. The presentation emphasized saying no to drugs and avoiding addiction.
Classifications of etio pathogenesis of uveitis, anterior uveitis- dr.k.srik...ophthalmgmcri
The document discusses the classification, etiology, pathogenesis, and management of uveitis. Uveitis is categorized based on the location of inflammation within the uvea (anterior, intermediate, posterior, or panuveitis). Treatment involves topical, periocular, or systemic corticosteroids with the addition of immunomodulatory medications for more severe cases.
Clinical significance of first phase treatment for tmd finaljuyokai
The document discusses the clinical significance of first phase treatment for temporomandibular disorder (TMD) patients. It summarizes that first phase treatment aims to eliminate or reduce patients' symptoms by stabilizing the mandible in the physiologic rest position using a removable neuromuscular orthosis. The summary analyzes data showing high improvement rates for TMD symptoms related to muscles, joints, and the autonomic nervous system following this first phase treatment approach.
Dr Zahida Chaudnary talks with the students about what causes, and how you treat Arthritis.
Check out the slideshow by itself here.
Want an audio version? Subscribe to our Podcast on iTunes!
Want to join us for the live discussion? Check out our Social Media in the noon hour every Monday as we sit down on Google Hangout OnAir! Follow us on Twitter, Facebook, or Google+ to get updated with the link when we start!
12.01.08(a): Rheumatoid Arthritis/Pathogenesis and Clinical Presentation of J...Open.Michigan
Rheumatoid arthritis is caused by a complex interplay of genetic and environmental factors. Genetic susceptibility involves genes related to cellular immune responses, including HLA-DR4 alleles. Environmental triggers may include infection or smoking. The disease involves a dysregulated immune response in the synovium, with synoviocyte transformation and interaction with macrophages, T cells, and cytokines leading to inflammation and joint destruction. Autoantibodies such as rheumatoid factor and anti-CCP antibodies are involved in pathogenesis but their exact roles are still being elucidated.
Objective: To understand the pathophysiology of the arthrosis that lead to condylar resorption. To understand systemic, local and occlusal factors that may lead to condylar resorption. To know the diagnostic test that are recommended. To know how to adapt the treatment plan (surgical or non surgical) to patients with condylar resorption.
Temporomandibular joint disorder (TMD), or TMJ syndrome, is an umbrella term covering acute or chronic inflammation of the temporomandibular joint, which connects the mandible to the skull. The disorder and resultant dysfunction can result in significant pain and impairment. Because the disorder transcends the boundaries between several health-care disciplines — in particular, dentistry, neurology, physical therapy, and psychology — there are a variety of treatment approaches.
The temporomandibular joint (TMJ) permits the mandible to move through gliding and hinge movements. It consists of the mandibular condyle, mandibular fossa, articular disc, and articular capsule. The condyle articulates with the fossa and articular eminence, while the articular disc separates the joint into upper and lower compartments. The joint capsule surrounds the joint and is lined with a synovial membrane that produces lubricating synovial fluid. Accessory ligaments and the lateral temporomandibular ligament provide stability to the joint. The TMJ undergoes age-related changes including flattening of the condyle and thinning of the
Rheumatoid arthritis is a chronic disease that damages joints, causing inflammation and stiffness. It affects approximately 1% of the world's population, mostly women. While the exact cause is unknown, it is an autoimmune disorder where the immune system attacks the body's own tissues. Symptoms include fatigue, lack of appetite, fever, and joint pain. It is diagnosed through blood tests and x-rays. Treatment involves medications like NSAIDs, DMARDs, and corticosteroids to reduce inflammation and manage symptoms.
The temporomandibular joint (TMJ) connects the jaw to the skull. TMJ disorders are commonly caused by muscular problems or issues with the TMJ elements. Diagnosis involves x-rays or CT/MRI scans of the joint. Conservative treatments include rest, warm compresses, splints, gentle exercises, and injections. More invasive procedures include washing out the joint or cortisone injections. Surgery is a last resort to replace the jaw joints.
This document provides an overview of internal derangements of the temporomandibular joint (TMJ). It defines internal derangement as an abnormal relationship between the articular disc and condyle. The most common type is anterior disc displacement, which can be with or without reduction. Causes include trauma, functional overloading, joint laxity, and muscle spasms. Symptoms vary depending on the type but may include clicking, limited opening, and pain. Diagnosis involves clinical exams and MRI imaging. Treatment ranges from splint therapy to arthrocentesis or arthroscopy for lavage and relief of adhesions. Arthrocentesis is shown to improve opening and reduce pain by removing inflammatory factors from the
The document discusses temporomandibular joint (TMJ) disorders, including TMJ dysfunction syndrome (TMD) and myofacial pain dysfunction syndrome (MPDS). It covers the anatomy of the TMJ, functional movements, classification of disorders, signs and symptoms, examination techniques, treatment options including reversible therapies like splint therapy and irreversible surgical treatment, and prevention strategies.
Temporomandibular joint and muscle disorders (TMJ) cause jaw pain and dysfunction. There are three main types: myofascial pain involving jaw muscles, internal derangement involving a displaced disc or joint injury, and arthritis. Causes include trauma, teeth grinding, hormones, genetics, and stress. Treatment involves heat/ice, soft diet, jaw exercises, relaxation techniques, and over-the-counter anti-inflammatory drugs. More severe cases may require physical therapy, splints, injections, or surgery like arthrocentesis, arthroscopy, or disc removal.
This document provides an overview of the temporomandibular joint (TMJ). It begins by defining the TMJ as the joint connecting the mandible to the skull and regulating mandibular movement. It then describes the different types of joints in the body before focusing on the specifics of the TMJ. Key points include that the TMJ is a complex synovial joint that allows for both hinging and gliding movements. An articular disc separates the condyle of the mandible and fossa of the temporal bone. The document outlines the development, structures, innervation, vascularization and biomechanics of the TMJ.
This document discusses juvenile arthritis (JIA), the most common cause of chronic arthritis in childhood. It describes different classification systems for JIA, including the current ILAR classification which divides JIA into 7 subtypes based on symptoms. The subtypes include systemic, oligoarticular, and different types of polyarticular JIA. It also discusses investigations, treatment options including medications and physical therapy, as well as complications and prognosis for each JIA subtype.
Megkérdőjelezhető eljárások a gyermekgyógyászati gyakorlatbanElod Koncsag-Szasz
Megkérdőjelezhető eljárások a gyermekgyógyászati gyakorlatban: antibiotikumok alkalmazása előtti bőrteszt, BCG hegnegativitás követése. Előadás az Erdélyi Múzeum Egyesület XXIII. Tudományos Ülésszakán
Dr. Padmesh, a pediatrician, gave a presentation on International Day Against Drug Abuse. He discussed that drugs are chemical substances that affect the body's normal functioning. People often take drugs due to peer pressure, trying to escape problems, curiosity, or just wanting to feel good. However, drug use can have serious side effects and influence a person's health, education, relationships, career, and happiness. The presentation emphasized saying no to drugs and avoiding addiction.
Classifications of etio pathogenesis of uveitis, anterior uveitis- dr.k.srik...ophthalmgmcri
The document discusses the classification, etiology, pathogenesis, and management of uveitis. Uveitis is categorized based on the location of inflammation within the uvea (anterior, intermediate, posterior, or panuveitis). Treatment involves topical, periocular, or systemic corticosteroids with the addition of immunomodulatory medications for more severe cases.
Clinical significance of first phase treatment for tmd finaljuyokai
The document discusses the clinical significance of first phase treatment for temporomandibular disorder (TMD) patients. It summarizes that first phase treatment aims to eliminate or reduce patients' symptoms by stabilizing the mandible in the physiologic rest position using a removable neuromuscular orthosis. The summary analyzes data showing high improvement rates for TMD symptoms related to muscles, joints, and the autonomic nervous system following this first phase treatment approach.
Purpose: To assess the amount of dental and skeletal expansion and stability after surgically assisted
rapid maxillary expansion (SARPE).
Patients and Methods: Data from 20 patients enrolled in this prospective study were collected before
treatment, at maximum expansion, at the removal of the expander 6 months later, before any second
surgical phase, and at the end of orthodontic treatment, using posteroanterior cephalograms and dental
casts.
Results: With SARPE, the mean maximum expansion at the first molar was 7.48 1.39 mm, and the
mean relapse during postsurgical orthodontics was 2.22 1.39 mm (30%). At maximum, a 3.49 1.37
mm skeletal expansion was obtained, and this expansion was stable, such that the average net expansion
was 67% skeletal.
Conclusion: Clinicians should anticipate a loss of about one third of the transverse dental expansion
obtained with SARPE, although the skeletal expansion is quite stable. The amount of postsurgical relapse
with SARPE appears quite similar to the changes in dental-arch dimensions after nonsurgical rapid palatal
expansion, and also quite similar to dental-arch changes after segmental maxillary osteotomy for
expansion.
This document discusses new developments in osteoporosis treatment. It summarizes recent data from clinical trials comparing bone forming agents like teriparatide and romosozumab to anti-resorptive treatments for fracture prevention. The data shows bone forming agents are more effective at reducing vertebral fractures compared to anti-resorptives. Romosozumab and teriparatide also reduce non-vertebral and hip fractures. Sequential treatment with a bone forming agent followed by an anti-resorptive maintains gains in bone mineral density and strength. Drug holidays after anti-resorptive treatment result in loss of bone mineral density.
This study evaluated external root resorption (ERR) in root-filled teeth (RFT) and vital pulp teeth (VPT) after orthodontic treatment. The study assessed 69 patients who underwent either non-extraction or extraction orthodontic treatment. Pre- and post-treatment panoramic radiographs were used to measure root and crown lengths and areas to determine the amount of ERR. The results found that ERR was significantly higher in VPT compared to RFT. Additionally, the amount of ERR increased with longer treatment duration. However, the modality of treatment (extraction vs. non-extraction) did not significantly affect the amount of ERR in RFT. The study concluded that RFT are more resistant to ERR
Differential diagnosis and management of gummy smileAbhilasha Goyal
This document discusses the diagnosis and management of gummy smiles. It defines a gummy smile as excessive gingival display when smiling. There are multiple potential etiologies including altered passive eruption, a short upper lip, hyperactive upper lip, vertical maxillary excess, and loss of tooth torque. A thorough facial and intraoral examination is required to differentiate between these causes to guide treatment. Management depends on the specific diagnosis but may include gingivectomy, lip repositioning, orthodontics, orthognathic surgery, or Botox injections. An interdisciplinary approach is often needed to achieve stable correction of gummy smiles.
A talk by Pratik Pandharipande at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All of the conference content can be found here: https://scanfoam.org/ssai2017/
Developed in collaboration between scanFOAM, SSAI and SFAI.
analysi of records.pptx a topic of orthodonticsKhanMustafa3
The document provides an overview of methods for analyzing dental records, including cast analysis and radiographic analysis. It describes evaluating symmetry, arch form, alignment, dental relationships, and space analysis using dental casts. Radiographic analysis includes assessing teeth, bone, and relationships using techniques like panoramic radiographs, lateral cephalograms, and CBCT. Lateral cephalograms allow evaluation of skeletal, dental, and soft tissue measurements and relationships to assess growth, treatment needs, and outcomes.
This document presents the case of a 32-year-old female patient seeking treatment to align her lower teeth and hide her upper gum during smiling. Her clinical examination revealed gummy smile, crowding on the lower arch, and asymmetry of the gingival margins when smiling. The treatment plan is to relieve crowding, correct midline shifts, achieve normal overjet and overbite, intrude the upper posterior teeth to reduce gummy smile, and perform gingival reshaping. Appliances to be used include low bracket placement, extraction of teeth #18 and #28, TPA, lingual arch, and mini-screw anchorage.
This document summarizes a presentation on serial extraction revisited after 30 years. It discusses tooth size-arch length discrepancy (TSALD) as a common problem in orthodontics. Studies have found that extracting premolars in the mixed dentition leads to better long-term stability and minimal crowding compared to other approaches like arch expansion. The document outlines the speaker's approach to diagnosis and extraction sequencing for TSALD cases in the mixed dentition. Serial extraction is followed by full fixed appliance treatment and retention. Studies of patients 30 years post-treatment found minimal irregularity and good stability and facial profiles when this approach is used.
This document discusses osteoporosis management and the efficacy and safety of bisphosphonates. It begins with an overview of the burden of osteoporosis, noting that over 2.5 million people in Indonesia have osteoporosis and over 88 million have osteopenia. It then reviews screening and treatment guidelines before focusing on bisphosphonates. The document discusses the efficacy of various bisphosphonates at reducing fractures based on clinical trials. It also reviews controversial issues associated with long-term bisphosphonate use such as osteonecrosis of the jaw, atypical fractures, atrial fibrillation, and esophageal cancer. It concludes by noting that annual zoledronic acid injections can significantly reduce hip,
This document discusses apical periodontitis, including its definition, causes, prognosis, and epidemiology. Some key points:
- Apical periodontitis is an inflammatory response to infection of the root canal system, which can include both acute and chronic phases.
- The prognosis of endodontic treatment depends on preventing apical periodontitis by eliminating root canal infection.
- Epidemiological studies show the prevalence of apical periodontitis varies widely between populations, from 20-80% depending on factors like access to dental care.
- Reasons for tooth extraction often include apical periodontitis and failed endodontic treatment, though historically it has not been well recognized as a disease. Progn
This document presents a case report for a 35-year-old female patient who presented with a gap between her central and lateral incisors. On examination, the patient was found to have spacing between several of her maxillary anterior teeth. The diagnosis was determined to be a midline diastema caused by tooth and arch size discrepancy. The proposed treatment plan was to close the gaps using direct composite restoration with enamel and dentine shades. The restorations were placed after quadrant isolation and shade selection. Upon completion, the midline gap and some lateral spacing were corrected, though the incisors appeared more prominent than before and the normal tooth shape was not fully achieved.
Aao 109th annual_session_boston_2009_closer look at the stability of sarpe 20...Dr Sylvain Chamberland
Clinical prospective study on the stability of SARPE including short term data at debonding and long term data at 2 years out of orthodontic treatment.
- A 12-year-old boy presented with pain and swelling in his left tibia for one month with a history of intermittent fever. Differential diagnoses included osteomyelitis, osteoid osteoma, Ewing's sarcoma, and osteosarcoma.
- Ewing's sarcoma most commonly affects children and young adults between 5-25 years old and presents with pain, swelling, and sometimes pathological fractures. Definitive diagnosis is based on histology, immunohistochemistry, and detection of specific gene fusions.
- Treatment involves chemotherapy with VACA/IE cycles alternating every 2-3 weeks for 17 cycles along with possible surgery and/or radiation therapy based on response and margins. The goal is
Delirium: The Next Proposed “Never Event.” Is This Realistic?hospira2010
This document discusses delirium, which has been proposed as a "never event" by CMS. It summarizes evidence that delirium is common in ICU patients, associated with worse outcomes, and risk factors include older age, medications like benzodiazepines and opioids. Multicomponent protocols including monitoring, mobility, and reducing modifiable risk factors can help prevent delirium. Daily interruption of sedation with spontaneous breathing trials may help reduce duration of mechanical ventilation and ICU stay. Alternative sedatives like dexmedetomidine that are less likely to cause delirium should be considered over benzodiazepines when possible.
This document discusses prostate motion and its impact on image-guided radiotherapy for prostate cancer. It finds that the rectum is a major source of interfractional prostate variation. Strategies like rectal emptying can help reduce shifts. Daily imaging allows for reduced planning target volume margins and decreased rectal toxicity despite dose escalation. However, optimal clinical target volume to planning target volume expansions remain unclear due to factors like extracapsular extension and residual errors. Different image guidance methods each have benefits and limitations for margin reduction and dose escalation in prostate cancer radiotherapy.
Similar to Temporomandibular Joint Arthritis in Pediatric Inflammatory Arthropathies (20)
Systemic juvenile idiopathic arthritis (JIA) is a form of juvenile arthritis characterized by fever and systemic symptoms. The presentation, diagnostic criteria, epidemiology, clinical features, and treatment options for systemic JIA were discussed in detail. Treatment involves NSAIDs, methotrexate, corticosteroids, biologic medications that target cytokines like TNF, IL-1, and IL-6 which are implicated in the pathogenesis of systemic inflammation and joint damage in JIA.
This document summarizes a presentation about managing pain from juvenile arthritis (JA) beyond just pills and procedures. It discusses that while medications and surgeries can provide relief, they do not always eliminate pain and have limitations. Alternative strategies discussed include physical activity, nutrition, distraction techniques, relaxation methods, massage, and combining approaches. It also stresses the importance of regular school attendance and addressing any mood or anxiety issues. Finally, it discusses the role of parents in modeling flexible coping and supporting their child's development beyond just their medical condition.
Juvenile Spondyloarthritis and Fever Syndromes by Reema Syed,MD, Assistant Professor of Internal Medicine and Pediatrics, Division of Adult and Pediatric Rheumatology, Saint Louis University
This document provides information and guidance for parents of children with chronic illnesses on managing stress and mental health. It discusses the high rates of pediatric chronic illnesses and common parental responses like guilt, anger, and grief. Parents of children with conditions like Juvenile Idiopathic Arthritis are at heightened risk for depression and anxiety. The document recommends stress reduction strategies for parents like relaxation techniques, social support, and self-care. It provides guidance on identifying signs of poor mental health and obtaining help through counseling, support groups or self-help books.
This document provides information to help patients and families navigate care for juvenile arthritis (JA). It discusses the healthcare team, facilities, equipment, and navigation of insurance. The team includes doctors, nurses, social workers and other specialists. It emphasizes the roles of the primary care doctor, physical/occupational therapists, pharmacists, labs, and ophthalmologists. It also reviews insurance plans like HMO, PPO, Medicaid and explains resources like social workers and state programs for children with special needs.
More from Arthritis Foundation 2012 JA Conference (7)
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DECLARATION OF HELSINKI - History and principlesanaghabharat01
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Temporomandibular Joint Arthritis in Pediatric Inflammatory Arthropathies
1. Temporomandibular Joint
Arthritis in Pediatric
Inflammatory Arthropathies
Randy Q. Cron, MD, PhD
Univ. of Alabama at Birmingham
2. What is the
Temporomandibular Joint?
The temporomandibular joint (TMJ) is a typical
sliding "ball and socket" which has a disc
sandwiched between it. The TMJ is used many
thousands of times a day in moving the jaw,
biting and chewing, talking, yawning, etc. It is
one of the most frequently used of all the joints
in the body.
http://www.medicinenet.com/temporomandibular_joint__disorder/page1.htm#1whatis
3. Diagnosis of TMJ Arthritis
• Clinical history
• Physical exam findings
• Imaging studies
5. Asymptomatic TMJ Disease
in JIA
• Twilt, et al. 2004 Percentage of Symptomatic Patients by Age Range
80
– 45% without pain 50% 56% 74%
70
% of Patients
60
50
• Wallace, et al. 2000
40
– 70% asymptomatic
19
0
6
0-
1
-
7-
11
s
s
ge
s
ge
ge
A
A
A
UAB 2010
8. Mouth Opening by Age
Twilt et al. 2004
Age 0-6 6-11 11-16 16-21
(yrs):
Ingervall 49 mm 51 mm
1970
Sheppard 42 mm 46 mm 51 mm 49 mm
1965
- OPG 43 mm 48 mm 53 mm 53 mm
2004
+ OPG 42 mm 43 mm 47 mm 57 mm
2004
9. Normal range of mouth opening
in children ages 5-17 years
97.5%
75%
N = 307
= 47 mm
25%
2.5%
Pediatr Rheumatol Online J. 2012 Jun 20;10(1):17. [Epub ahead of print]
13. JIA Subtype & Frequency of TMJ
Arthritis (orthopantomogram)
70
% with TMJ involvement
60
50
40
30 Subtype
20 N=97
10
0
So Oligo RF+ RF- SEA Psor
Twilt, et al. J. Rheumatol. 2004;31:1418. Twilt
14. 2010 UAB Data, n=183 JIA patients
screened by MRI
Saurenmann
Stoll
Cannizzaro E, Schroeder S, Müller LM, Kellenberger CJ, Saurenmann RK. J Rheumatol. 2011;38:510-5.
Stoll ML, Sharpe T, Beukelman T, Good J, Young D, Cron RQ. J Rheumatol., in press.
15. Morbidity with TMJ Arthritis
in JIA
• TMJ Pain
• Local morning stiffness
• Impaired function (chewing, speaking)
• Pain with chewing
• Decreased mouth opening
• Earache
• Cosmetic appearance (micrognathia,
facial asymmetry)
16. Micrognathia
Pediatr Clin North Am.
2005 Apr;52(2):413-42, vi.
17.
18. Destruction of the
Growth Plate
• Growth plate is very superficial,
located on the surface of the
mandibular condyle head
• Arthritis leads to micrognathia
• Costochondral graft surgery
21. Do Biologics Treat TMJ Arthritis?
Systemic Medication Use in TMJ Arthritic Patients Comparing Any Use vs. Use Only at Time of MRI
80
Have Ever Used
Used At Time of MRI
N=95 60
% of Patients
40
20
0
ID
)
d
TX
ra
oi
SA
M
in
er
Beukelman
k
N
St
na
A
us
pl
r(
to
bi
hi
In
a
F-
TN
Stoll ML, Good J, Sharpe T, Beukelman T, Young D, Waite PD, Cron RQ.
J. Oral Maxillofac. Surg. 2012;70:1802-7.
22. Corticosteroid Injections of
TMJs are Harmful?
• “A cortisone-wrecked and bony ankylosed
temporomandibular joint.”
– Plast Reconstr Surg. 1989;83:1084
• Temporomandibular joint osteoarthrosis.
Histopathological study of the effects of intra-
articular injection of triamcinolone acetonide.
– Intra-articular injection of steroid into human
osteoarthritic temporomandibular joints acts as a lytic
agent (n=44).
– Haddad. Saudi Med J. 2000 Jul;21(7):675-9.
23. Corticosteroids are NOT Evil!
(for inflammatory TMJ disease)
• Vallon, et al. Long-term follow-up of intra-articular
injections into the temporomandibular joint in
patients with rheumatoid arthritis. Swed. Dent. J.
2002;26:149
– 12 year follow up of 21 adult RA patients following
corticosteroid injections (n=11) of TMJs
– long-term progression of joint destruction was low for
both steroid and non-steroid agents
24. Intraarticular Corticosteroids are
Used to Treat Other Joints in JIA
• Intraarticular corticosteroid injection in JIA
are safe and effective
– Review – Cleary, et al. Arch. Dis. Child.
2003;88:192
• Prevents leg length discrepancy
– Sherry, et al. Arthritis Rheum. 1999;42:2330
• 2nd most common therapy to treat
pauciarticular juvenile arthritis
– Cron, et al. J. Rheumatol. 1999;26:2036
25. Intraarticular Corticosteroids for
TMJ Arthritis in JIA
• Martini, et al. J. Rheumatol.
2001;28:1689
– Case report of arthroscopic synovectomy
followed by IA triamcinalone hexacetonide
(10 mg) in 15 yo girl with JIA
– Decreased pain, increased function and
mouth opening
Zulian
28. Pre-Injection MRI Findings
• TMJ effusions in 13/23
• Bony erosions in 19/23
• Condylar flattening 17/23
Arabshahi, et al. Arthritis Rheum. 2005 Nov;52(11):3563-9.
29. Sedation for Treatment
• Deep intravenous sedation (in combination)
– 1-3 µg/kg fentanyl citrate
– 2-5 mg/kg pentobarbital sodium
– 0.1-0.3 mg/kg midazolam hydrochloride
• Continuous cardio-respiratory monitoring
– Cahill, et al. AJR Am. J. Roentgenol. 2007;188:182-186.
30. Therapeutic Approach
• Performed by experienced pediatric interventional
radiologists
• Child placed supine in CT scanner with head rotated 45o
away from TMJ to be injected
• Axial CT imaging in area of interest
• Sterile preparation of access site anterior to tragus
• Local anesthesia with bicarbonate buffered 1% lidocaine
(30 gauge needle)
• CT confirmation of needle placement in mandibular fossa
• Injection of triamcinalone acetonide (1cc = 40 mg) into TMJ
with 18 or 21 gauge needle
– Cahill, et al. AJR Am. J. Roentgenol. 2007;188:182-186.
34. Resolution of Effusion Following
Intraarticular Steroid Injection
Pre Post
Arabshahi & Cron. Curr Opin Rheumatol. 2006;18:490-495.
35. Retrospective Study Results
• 13/23 with pain prior to injections (only 3 with pain
following injections)
• Tooth to tooth gap increased from 3.59+/-0.725 to
4.07+/-0.606 (P=0.0017)
– 43% of patients had a T-T gap increase >0.5 cm.
• In 23 TMJs followed up by MRI:
– 11/23 absent or decreased effusions
– 2/23 increased effusions (both re-injected)
– Bony resorption remained stable in the majority of pts
Arabshahi, et al. Arthritis Rheum. 2005 Nov;52(11):3563-9.
36. Increase in Tooth-to-Tooth
Gap (< 6 yrs old)
Tooth-tooth gap, ages 0-6 (n=5)
5
4
3
2
s
n
n
al
io
io
rm
ct
ct
je
je
no
-in
in
e-
st
pr
po
37. Increase in Tooth-to-Tooth
Gap (7-10 yrs old)
Tooth-tooth gap, age 7-10 (n=10)
6
5
cm
4
3
P=
2
s
n
n
al
io
io
rm
ct
ct
je
je
no
-in
in
e-
st
pr
po
38. Increase in Tooth-to-Tooth
Gap (11-16 yrs old)
Tooth-tooth gap, age 11-16(n=5)
7.5
5.0
cm
2.5 P=
P=
s
n
n
al
io
io
rm
ct
ct
je
je
no
-in
in
e-
st
pr
po
39. Complications/Side Effects
• Accidental injection of 1cc of ethanol prior to
injection of corticosteroids
• Increase in TMJ pain following injection (n=2)
• No infections, subcutaneous atrophy, or
hypopigmentation at injection sites
• Cushingoid features in one child injected by
oromaxillofacial surgery (prior to this study)
Arabshahi, et al. Arthritis Rheum. 2005 Nov;52(11):3563-9.
40. Summary of
Retrospective Study
• CT-guided corticosteroid injection of the
TMJ in children with JIA appears safe
• Corticosteroid injection of TMJ arthritis in
children with JIA is associated with
decreased TMJ pain, increased mouth
opening, and decreased TMJ effusions
as detected by MRI
• +ANA and polyarticular disease may be
risk factors for TMJ arthritis
Arabshahi, et al. Arthritis Rheum. 2005 Nov;52(11):3563-9.
41. Intraarticular corticosteroids for
TMJ arthritis in JIA
Zurich
Seattle
Germany
Philly
Ringold S, Cron RQ. Pediatr Rheumatol Online J. 2009 May 29;7(1):11.
42. Toronto
Connolly
Pediatr Radiol. Pediatr Radiol. 2010;40:1498-504.
43. Prospective Study of TMJ
Arthritis in JIA
• Determine the point prevalence of TMJ arthritis at
disease onset in children with JIA using MRI and
ultrasound
• Subaim: comparative study of MRI versus ultrasound
for diagnosing TMJ arthritis
• Development of a screening protocol to predict those
children with JIA at greatest risk for developing TMJ
arthritis
• Using demographics, serologies, physical
examination, CHAQ, and questionnaire on TMJ
functionality/pain
44. Inclusion Criteria:
• Meet the diagnostic criteria for JIA
• Able to complete study within 8 weeks of
diagnosis
Exclusion Criteria:
• Inability to undergo MRI due to metal
implants, braces, pacemakers
50. MRI Findings
• All the patients with effusion AND
enhancement AND condylar flattening had
polyarticular disease.
• All the patients with effusion AND
enhancement but NO condylar flattening had
oligoarticular disease.
• No other correlations with MRI pattern and
age/ duration of disease/ JIA subtype/
CHAQ score/ serologies. Goldsmith
52. Comparison of MRI and US
Findings
Comparison of MRI and US in
detection of effusions and
condylar erosions
(n=40 TMJs)
20
MRI
number of TMJs
US
Concordance
10
0
effusions erosions
TMJ appearance
54. Summary of Acute vs
Chronic Findings
• Acute: presence of effusion or enhancement
– Seen in all but two patients (83% bilateral)
• Chronic: presence of condylar flattening
– Seen in 69% by MRI, most with Poly JIA, 26% by US
• Concordance of MRI and US:
– 0% agreement in detection of effusions
– 22% agreement in detection of condylar flattening
• Length of disease, CHAQ score, and erythrocyte sedimentation rate (ESR) did
NOT correlate significantly with either chronicity or acuity on MRI.
57. TMJ Arthritis: Prevalence, Diagnosis, and
Predictors of Active Disease
• What we’ve learned:
– Prevalence of TMJ arthritis is quite high
– Unable to establish predictors of active
disease at this time given the high
prevalence
– MRI appears much more sensitive than US
in detecting early inflammatory changes in
the TMJ, especially given operator
Pam Weiss, MD
dependence of US
Weiss, et al. Arthritis Rheum. 2008;58:1189-96.
59. Credit Where Credit is Due
CHOP Rheumatology CHOP Radiology
Bita Arabshahi Anne Marie Cahill
Esi DeWitt Robin Kaye
Pam Fitch Marissa Bilaniuk
Sandy Burnham Ann Johnson
David Sherry Kevin Baskin
Carol Wallace (Seattle)
60.
61. Questions that Arise:
• Since bilateral enhancement is so common,
could it be a normal post-contrast finding?
• Could condylar flattening by itself, or with
enhancement, be a normal finding?
• If the above is true: 50% of the kids currently
found to have abnormal TMJs by MRI could
be normal.
• Therefore: Important to have controls,
especially to help make treatment decisions.
62. Synovial Enhancement in a
Normal Control
C
T1-weighted parasagittal MRI image with fat saturation of the TMJ joint of a normal 7
year old child, showing synovial enhancement (arrow) superior to the condyle (C).
63. Acta Radiol. 2009 Dec;50(10):1182-6.
96 Children without autoimmune disease screened
94% entirely normal TMJ MRI
Tzaribachev
64. Treatment of TMJ Arthritis in JIA
without radiographic guidance
Peter D. Waite, M.P.H., D.D.S., M.D.
University of Alabama at Birmingham
66. P = .001
J. Oral Maxillofac. Surg. 2012;70:1802-7.
67. Mouth Opening Improved
Following IA-Steroids to TMJs
Post-lnjection MIO Changes
Improvement
7% Worsening
Unchanged
27%
65%
Stoll ML, Good J, Sharpe T, Beukelman T, Young D, Waite PD, Cron RQ.
J. Oral Maxillofac. Surg. 2012;70:1802-7.
68. All JIA Subtypes Respond to
IA-Steroids
M IO Change by Subtype
6
4.56
5
4
2.82
2.20
3
1.50 1.54
mm
2
1 -0.67
0
-1
A
d
tic
ic
o
)
eg
lig
te
ER
m
ia
N
ia
e
O
or
F-
-2
st
nt
Ps
(R
Sy
e
er
ly
iff
Po
nd
U
Stoll ML, Good J, Sharpe T, Beukelman T, Young D, Waite PD, Cron RQ.
J. Oral Maxillofac. Surg. 2012;70:1802-7.
69. MRI Findings Improved
Following IA-Steroids to TMJs
Post-Injection MRI Results
Some Improvement
Complete Resolution
Unchanged or Worse
34%
49%
Young
17%
Stoll ML, Good J, Sharpe T, Beukelman T, Young D, Waite PD, Cron RQ.
J. Oral Maxillofac. Surg. 2012;70:1802-7.
70. What do we do for TMJ arthritis
not responsive to IA-steroids?
• Many have already failed repeated (2 or
more) IA-steroid injections.
• The vast majority are already on high
dose, aggressive systemic arthritis therapy
(e.g. methotrexate and anti-TNF agents at
high doses).
71. Intra-articular anti-TNF to
treat TMJ arthritis
• Scand J Rheumatol. 2008 Mar-Apr;37(2):155-7.
Alstergren
• Successful treatment with multiple intra-articular injections of
infliximab in a patient with psoriatic arthritis.
• Alstergren P, Larsson PT, Kopp S.
• Department of Clinical Oral Physiology, Institute of Odontology, Karolinska
Institutet, Huddinge, Sweden. per.alstergren@ki.se
• Abstract
• This case report presents the clinical and radiographic course of
temporomandibular joint (TMJ) involvement in a patient with severe TMJ
symptoms from psoriatic arthritis (PsA) resistant to both systemic infliximab
and intra-articular glucocorticoid and who therefore received multiple intra-
articular infliximab injections for 36 weeks. TMJ symptoms improved after
the first bilateral intra-articular infliximab injections but even more so after
the second injections. The considerable improvement remained for the 36
weeks studied. Bilateral computerized tomography showed no progression
in radiographic changes during the treatment. No adverse reaction was
observed from the intra-articular injections.
72. Intra-articular Infliximab Treatment of
Refractory TMJ Arthritis in Children with JIA
Morlandt
Stoll ML, Morlandt A,
Terrawattanapong S,
Young D, Waite PD,
Cron RQ. Manuscript
submitted.
Intra-articular: steroids anti-TNF
Unchanged or improved
Pre-post IACI Pre-post IAII p-value
Acute changes 9 / 34 (26%) 23 / 34 (68%) 0.001
Chronic changes 9 / 34 (26%) 21 / 34 (62%) 0.008
73. Do non-JIA children with other
rheumatic diseases develop TMJ
arthritis?
• Many other pediatric rheumatic disorders
are associated with arthritis (SLE,
myositis, sarcoidosis, Sjogren, MCTD,
etc.).
• Some children with the above disorders
have PE findings or complaints
suggestive of TMJ arthritis.
75. Screening for TMJ Arthritis in
Other Pediatric Arthritides
Fain
Fain ET, Atkinson GP, Weiser P, Beukelman T, Cron RQ.
J Rheumatol. 2011 Oct;38(10):2272-3
76. TMJ Arthritis in Pediatric
Sjogren and Sarcoidosis
Atkinson
Fain ET, Atkinson GP, Weiser P, Beukelman T, Cron RQ.
J Rheumatol. 2011 Oct;38(10):2272-3
77. Contrast weighted MRI sagittal section through the TMJ of a
child with juvenile dematomyositis.
C: condyle; Arrow indicates synovial enhancement after administration of contrast.
78. TMJ Arthritis in Pediatric
JDMS and MCTD
MIO with Post
Patient Age at positive TMJ Peripheral injection Repeat
number dx Gender Dx MRI Deviation arthritis MIO TMJ
1 15y female MCTD 3.2 yes yes
2 16y female MCTD 3.6 yes yes
3 12y female MCTD 4.8 no yes
4 4y female JDMS 3 no no 3.4 Negative
5 20m female JDMS 3.1 no no 4.20 Negative
6 10y female JDMS 4.6 no yes Active
7 5y male JDMS 1.85 yes yes
Peter Weiser, Stephen Johnson, Robert M. Lowe, Randy Q. Cron.
Submitted for publication.
Weiser
79. Things to Consider
• 50-75% of children with JIA develop TMJ arthritis.
• All subtypes of JIA develop TMJ arthritis.
• TMJ arthritis is frequently asymptomatic.
• Inflammation of the TMJ leads to growth plate arrest
(micrognathia).
• MRI is the most sensitive modality for detecting TMJ arthritis.
• Intraarticular corticosteroid injection is effective treatment for
TMJ arthritis in JIA.
• TMJ arthritis can develop while being treated with methotrexate
plus a TNF inhibitor.
• TMJ arthritis may be active while other joints are in remission.
• Intraarticular infliximab injection treats refractory TMJ arthritis.
• Children with sarcoidosis, Sjogren, JDMS, and MCTD can
develop destructive TMJ arthritis.