Evaluation of Rheumatic Diseases Affecting the Temporomandibular Joint: A Cone Beam Computed Tomography Study and Literature Review

Abstract

Introduction: Due to the silent manifestation of temporomandibular joint (TMJ), dentists and rheumatologists may neglect treatment for this joint.

Aims: The aim of this study was to investigate the TMJ components in patients with various rheumatic diseases and to compare them with a control group based on cone beam computed tomography (CBCT) images.

Materials and methods: This study comprised an assessment of the CBCT images of 65 patients (130 temporomandibular joints) with various rheumatic diseases (mostly rheumatoid arthritis) affecting the TMJ. Moreover, 65 patients (130 temporomandibular joints) with a similar age and gender distribution were examined as the control group. Pathologies were classified into a total of 12 types for the presence of any osseous changes in the condylar head or articular fossa or for joint space narrowing. Statistical analysis of all data was performed with SPSS version 18. The conformity of continuous variables to a normal distribution was examined by the Kolmogorov-Smirnov test. The Mann-Whitney U test was used to compare the means of two independent groups. The Pearson Chi-square test, Yates correction and Fisher's exact test were used in the analysis of categorical variables.

Results: The mean age of the patient and control groups was 50 ± 13 and 48 ± 16, respectively, and no statistically significant difference was found between the patient and control groups in terms of age distribution (p = 0.123). Condylar erosion, condylar flattening, subcondylar sclerosis, osteophytes, subcortical cysts, articular eminence resorption and articular eminence flattening rates were found to be statistically significantly higher in the patient group than in the control group (p < 0.05).

Conclusions: Dentomaxillofacial radiologists should examine the bony components of the TMJ in patients with rheumatic diseases, and a multidisciplinary approach involving a dental specialist and rheumatologist is required.

Keywords: cone beam computed tomography; rheumatic diseases; temporomandibular joint.

Figure 1

Distribution of diseases in the patient group.

Figure 2

Examples of the CBCT images of osseous changes in the temporomandibular joints (TMJs). (A)—flattening of the condyle, subcortical sclerosis and ankylosis in a male with rheumatoid arthritis; (B)—joint space narrowing, subcortical cyst formation, condylar surface and articular eminence resorption in a female with scleroderma; (C)—loose calcified bodies in a male with rheumatoid arthritis; (D)—subcortical cyst formation in a female with psoriatic arthritis; (E)—flattening of the condyle and osteophyte formation in a male with osteoarthritis; (F)—multiple subcortical cysts in a female with rheumatoid arthritis; (G)—progressive condyle erosion in a male with pseudogout; (H)—articular eminence and condyle resorption in a female with SLE.

Figure 3

(A) presents the panoramic radiographic image of a 62–year–old patient diagnosed with rheumatoid arthritis for the past 12 years. Resorption at the anterior part of the mandibular condyle (indicated by a thin white arrow), multiple radiopacities at the condylar head, condylar flattening and a decrease in the joint space (indicated by a thick white arrow) are observed. (B) displays the coronal cone beam computed tomography (CBCT) image of the same patient. Resorption at the anterior part of the mandibular condyle (indicated by a thin white arrow), multiple radiopacities at the condylar head and ankylosis (indicated by a thick white arrow) are observed. The findings are consistent with those observed in panoramic radiography, although the actual extent of the disease can be better determined.