ORTHODONTIC TREATMENT CONSIDERATIONS IN JUVENILE IDIOPATHIC ARTHRITIS 

Juvenile idiopathic arthritis is defined as swelling or limitation of motion of the joint accompanied by heat, pain or tenderness. Juvenile idiopathic arthritis (JIA) comprises characterized by inflammatory process which occurs before 16 years of age. This causes short term and long term disability in children. Girls are more affected than boys. The prevalence of JIA in  Western countries ranges  from 1/1000 to 4/1000 children where as in India prevalence of JIA is assumed to be around 1.25 per 1000 children.

Orthodontic considerations in patients with JIA

·       The main aim is to allow the child to live as normal life as possible. The functional ability of the TMJ in JIA children must be monitored closely in order to start medical treatment as soon as inflammation begins in the joint. The TMJ in a growing child has immense potential for structural changes and growth can normalize, provided the inflammation is controlled early and mandibular growth is supported^1,2,3.

·       Since wrist joints are frequently affected in these individuals, therefore oral hygiene aids including modified toothbrush handles and electrical toothbrushes is recommended to patients with JIA.

·       A bite splint can be provided to unload the joint during any acute periods of inflammation. A distracted splint has also been suggested to modify mandibular growth in the same way as conventional functional appliances.

·       Profitt and Kjellberg^1,2 concluded that the use of functional appliances in patients is a controversial area. It has been argued that functional appliances and class II elastics put increased stress on the TMJs and should be avoided; however, it has also been suggested that functional appliances protect the joints by relieving the affected TMJ, the aim being to move the mandible into the normal anterior growth rotational pattern thus correcting the skeletal Class II relationship^1,2.

·       NSAIDs are used in the early stages. In severe cases , variety of medicaments such as gold, methotrexate, corticosteroids drugs are prescribed in these patients. These drugs leads to a delay in orthodontic tooth movement and has their own adverse  effects.
       Thus, all these factors are to be  taken into consideration in these patients  while planning for orthodontic treatment.

References;

1.    Burden D, Mullally B, Sandler J. Orthodontic treatment of patients with medical disorders. Eur J Orthod 2001; 23: 363-72

2.    Jennifer E. Weiss, Norman T. Ilowite ; Juvenile Idiopathic Arthritis; Pediatr Clin N Am; 52 2005 ;413 – 44

3.    Gowri Sankar Singaraju etal ; Management Of The Medically Compromised Cases In Orthodontic Practice; Asian Journal of Medical Sciences 1 (2010) 68-74