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Standardizing the Clinical Orofacial Examination in Juvenile Idiopathic Arthritis: An Interdisciplinary,

Peter Stoustrup^1,2, Troels Herlin^3,4, Lynn Spiegel^3,4

¹From the Section of Orthodontics, Department of Dentistry and Oral Health, Aarhus University, Aarhus; Pediatric Rheumatology Clinic, Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus; Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Section of Orthodontics, Aarhus University, Aarhus, Denmark; Department of Pediatrics, Division of Rheumatology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario; Department of Pediatrics, Cumming School of Medicine, University of Calgary and Alberta Children's Hospital, Calgary, Alberta, Canada; Department of Orthodontics, University Hospital Tübingen, Tübingen, Germany. pstoustrup@odont.au.dk.

The Journal of Rheumatology

|December 3, 2019

Abstract

Objective:

To develop a consensus-based, standardized, short (< 3 min) clinical examination protocol to assess the multidimensional, orofacial manifestations of juvenile idiopathic arthritis (JIA).

Methods:

The study was conducted by a multidisciplinary task force from the Temporomandibular Joint Juvenile Arthritis Working Group (TMJaw). The study used an acknowledged sequential approach involving (1) a global multidisciplinary online questionnaire study, (2) a systematic literature review and consensus meetings to identify items for inclusion, (3) pilot testing of included items, (4) test of reliability in 22 subjects with JIA by 4 examiners, (5) test of construct validity in a case-control study involving 167 subjects, and (6) establishment of final recommendations.

Results:

Six items were recommended for the final examination protocol: (1) clinician-assessed pain location, (2) temporomandibular (TMJ) joint pain on palpation (open and closed mouth), (3) mandibular deviation at maximal mouth opening (≥ 3 mm), (4) maximal unassisted mouth opening capacity, (5) frontal facial symmetry, and (6) facial profile. All recommended items showed acceptable reliability and construct validity. The average mean examination time was 2 min and 42 s (SD ± 38.5 s).

Conclusion:

A consensus-based, short clinical examination protocol was developed. The protocol takes less than 3 min to complete and provides information about orofacial symptoms, TMJ dysfunction, and dentofacial deformity. The standardized examination protocol is applicable to routine clinical care, as well as future research studies.

Keywords:

ARTHRITIS CLINICAL EXAMINATION FACE JUVENILE IDIOPATHIC ARTHRITIS TEMPOROMANDIBULAR JOINT

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