EPIDEMIOLOGY OF TEMPOROMANDIBULAR JOINT INVOLVEMENT IN RHEUMATIC PATHOLOGY

The main aim of this study was to evaluate the frequency of temporomandibular joint (TMJ) disorders in patients with various rheumatic conditions and to define the accurate assessment protocol. We performed a prospective observational study in 1052 consecutive patients with various inflammatory (433 rheumatoid arthritis, RA; 258 ankylosing spondylitis, AS; 103 psoriatic arthritis, PsA; 32 juvenile idiopathic arthritis, JIA) and degenerative (226 osteoarthritis, OA) rheumatic disorders attending at least once the rheumatology department. Patients were classified in six study groups, as follows: group A comprising 152 RA; group B: 55 AS; group C: 44 PsA; group D: 22 JIA; group E: 42 patients with osteoarthritis (OA); and group F or the control group. All patients were evaluated according to the same standardized protocol including several variables e.g. demographics, epidemiologic, clinical, biological and imaging parameters according to the underlying rheumatic condition. TMJ and dental-periodontal system were also examined. Statistical analysis was done in SAS 4.3 program, p<0.05; differences among groups were calculated using the Probability calculator for descriptive statistics, the χ2 test, the Pearson “r” correlations and Breakdown one way ANOVA tests. In conclusion, TMJ pathology displayed an increased prevalence in all groups, irrespective of the inflammatory or degenerative rheumatic disorders as compared to the control grou

The Complement System, T Cell Response, and Cytokine Shift in Normotensive versus Pre-Eclamptic and Lupus Pregnancy

Successful pregnancy requires an immunological shift with T helper CD4+ bias based on disbalance Th1/Th17 versus Th2/T regulatory (Tregs) required to induce tolerance against the semi-allogeneic fetus and placenta and to support fetal growth. Considered a pregnancy-specific hypertensive disorder, pre-eclampsia is characterized by multifaceted organ involvement related to impaired maternal immune tolerance to paternal antigens triggered by hypoxic placental injury as well as excessive local and systemic anti-angiogenic and inflammatory factor synthesis. Both systemic and local Th1/Th2 shift further expands to Th17 cells and their cytokines (IL-17) complemented by suppressive Treg and Th2 cytokines (IL-10, IL-4); alterations in Th17 and Tregs cause hypertension during pregnancy throughout vasoactive factors and endothelial dysfunction, providing an explanatory link between immunological and vascular events in the pathobiology of pre-eclamptic pregnancy. Apart from immunological changes representative of normotensive pregnancy, lupus pregnancy is generally defined by higher serum pro-inflammatory cytokines, lower Th2 polarization, defective and lower number of Tregs, potential blockade of complement inhibitors by anti-phospholipid antibodies, and similar immune alterations to those seen in pre-eclampsia. The current review underpins the immune mechanisms of pre-eclampsia focusing on local (placental) and systemic (maternal) aberrant adaptive and innate immune response versus normotensive pregnancy and pregnancy in systemic autoimmune conditions, particularly lupus

Volumetric Cone Beam Computed Tomography for the Assessment of Oral Manifestations in Systemic Sclerosis: Data from an EUSTAR Cohort

Background: Oral health issues are commonly reported in systemic sclerosis (SSc), comprising a broad spectrum of manifestations, e.g., reduced mouth opening, periodontal disease, increased periodontal ligament (PDL) space width, and mandibular resorption. We aimed to assess oral radiographic abnormalities, particularly PDL space widening and erosions, and to identify potential relations with disease measures. Methods: cross-sectional study in 43 SSc and matching controls receiving systematic oral assessments (full mouth dental/periodontal) and imaging (radiographs and cone beam computed tomography (CBCT)). Associations between disease variables and radiologic findings were investigated by univariate and multivariate analysis (SPSS-v.20, p &lt; 0.05). Results: CBCT demonstrated generalized PDL space widening in up to half SSc, with at least one tooth involved, essentially in the posterior region (p &lt; 0.05). Significant correlations between number of teeth with PDL space widening and disease severity, skin score, disease subset, topoisomerase I specificity, age, and disease duration were reported (p &lt; 0.05). Additionally, mandibular erosions were described in one out of four patients, commonly condylar erosions. Conclusions: Tridimensional CBCT approach confirmed widening of PDL and mandibular erosions as common dental findings in scleroderma. Furthermore, widened PDL spaces correlated with several disease characteristics including severity, skin extent, and antibody profile

TEMPOROMANDIBULAR JOINT INVOLVEMENT IN RHEUMATOID ARTHRITIS PATIENTS - CORRELATIONS WITH DISEASE ACTIVITY AND QUALITY OF LIFE

The aim of this study was to assess symptoms and signs of temporomandibular joint (TMJ) involvement in patients with rheumatoid arthritis and to offer a complex outlook of the TMJ evaluation in routine practice in rheumatic patients. We performed a prospective observational study in consecutive patients with different inflammatory and degenerative rheumatic conditions and secondary TMJ involvement, aiming to realise a complex (epidemiological, clinical, biological and imaging) description of TMJ pathology. The results of the present study showed that TMJ involvement was usually reported in different RA subtypes. The presence of TMJ issues was significantly associated with several individual RA parameters defining disease activity such as tender and swollen joints and also with disability and impaired life quality as suggested by high HAQ scores. TMJ pathology remains a major cause of altered quality of life in patients with chronic inflammatory rheumatic conditions such as RA

TEMPOROMANDIBULAR JOINT IN JUVENILE IDIOPATHIC ARTRITIS: AN IMAGING STUDY AND ERGONOMIC CONSIDERATIONS

Temporomandibular joint (TMJ) may be involved in different JIA subtypes, with a prevalence ranging between 40 to 70%, leading to various degrees of disability, mainly related to pain, inflammation, reduced mandibular mobility, damage of the condyle and secondary masticatory muscle impairment. The aim of the present work was to describe TMJ involvement in different subtypes of JIA, based on a complex epidemiological, clinical and imaging approach. We performed a prospective observational study on 22 consecutive JIA attending an academic rheumatology department. Imagistic assessments comprised: (i) an X-ray of vertebral (lumbar and cervical spine) as well as peripheral joints in order to support the diagnosis and to evaluate the stage of the disease; (ii) a TMJ ultrasonography; (iii) a TMJ CT scan; and (iv) a CBCT. The following parameters were evaluated in our patients: demographics and general characteristics (sex, age, duration of disease, JIA onset); TMJ-related data e.g. spontaneous or provoked unilateral or bilateral TMJ pain measured on a visual analog scale (VAS), accompanied by morning stiffness or stiffness after rest; clicking and crepitation were noted in the context mandible mobilization; muscle contracture (masseter, temporal, internal pterygoid); parafunctions; TMJ imaging; dental, gingival and occlusal status. TMJ involvement is classically described among JIA patients, presenting with various clinical signs and symptoms and different degrees of inflammation and condylar damage

MUSCULOSKELETAL ISSUES AMONG DENTAL MEDICINE STUDENTS: A CROSS-SECTIONAL STUDY

The burden of work-related musculoskeletal pathology among dental professionals is widely recognized, particularly associated with specific risk factors in routine practice. Aim of the study: The main objective of our study was to evaluate musculoskeletal issues in students in dentistry based on their participation in different levels of professional activities, and to identify potential risk factors. Material and methods: We performed a cross-sectional study in 100 consecutive students attending the School of Dentistry, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, classified in two main groups: 50 students in their first and second year of study, not engaged in specific dental work (group A) and 50 students in their third to sixth year, already performing professional activities in patient (group B). A predefined questionnaire survey was applied in all students, including general data, risk factors for musculoskeletal problems, and information on pain (vertebral, hand) and muscle spasm as main musculoskeletal complains potentially related to their professional doings. Conclusions: Ergonomic postures adopted by the student / dentist in routine practice as well as ergonomic dental instruments are usually associated with less vertebral (lumbar spine) and hand pathology. Ergonomic principles must be applied in routine dental practice and the student educated about prevention of musculoskeletal pathology

ERGONOMICS AND PREVENTION OF MUSCULOSKELETAL – WORK RELATED PATHOLOGY IN DENTISTRY: A PILOT STUDY

Dentistry is acknowledged as an outstandingly practical domain of medicine, with an excessive and extensive role of the hand acting in a professional dental environment, with specific working postures, repetitive movements and using different dental instruments. The main objective of our study was to evaluate occupational-hand pathology in dentists and potential trigger factors and to highlight the role of physical therapy in preventing and management of different musculoskeletal issues in dentistry settings. We performed a prospective 12-months study on 30 dentists (20 women), aged between 30 and 60 years, working in private practice aiming to assess professional hand involvement. Enrolled dentists were classified in two equal groups, according to their participation in a kinetic program: group A, dentists performing an individual kinetic program on a daily basis, and group B, dentists without being involved in a physical therapy program. All subjects were followed-up for 12 months. A specific questionnaire derived from the Cornell Musculoskeletal Discomfort Questionnaire was applied in all cases, evaluating different musculoskeletal items such as pain, paresthesias, muscle spasm and amyotrophy, but also joint mobility (wrist, metacarpophalangeal joints).Work-related hand pathology is widely confirmed among dentists, specifically connected to different professional factors such as working postures and movements, number of working hours, cumulative time and experience, as well as type of devices and tools handled. Moreover, dentistry performed according to ergonomic settings is essential in order to reduce the burden of musculoskeletal features and to improve related disability and working performance. Work-related hand pathology accounts for significant morbidity and physical discomfort among dental professionals. With a multifaceted pathobiology ranging from inflammatory to degenerative damage of both soft tissue, nerve and joints (wrist and fingers), musculoskeletal issues are typically linked to professional triggers during routine practice in dentistry

Bleeding after Hysterectomy: Recommendations and What to Expect

Bleeding after gynecological surgery remains an infrequent life-threatening complication, demanding appropriate medical and surgical management. Classified as early/“reactionary” and delayed/secondary, unexpected postoperative hemorrhage may arise regardless of the route or subtype of hysterectomy. Timely recognition and prompt intervention to arrest bleeding are essential strategies for the suitable outcome of the patient. The present chapter presents an overview on different aspects of bleeding after hysterectomy such as incidence rate, risk factors, mechanisms, and management techniques aiming to expand knowledge and skills in recognizing and treating this unpredicted potentially serious problem. Furthermore, we intend to offer a guide toward standardizing treatment practice across bleeding issues following hysterectomy considering clear recommendations and algorithms

Exploring the Role of Interleukin-6 Receptor Inhibitor Tocilizumab in Patients with Active Rheumatoid Arthritis and Periodontal Disease

Background: The aim of our study was to explore the influence of weekly subcutaneous administration of interleukin-6 (IL-6) receptor inhibitor tocilizumab (TCZ) on periodontal status in a local longitudinal study of patients with rheumatoid arthritis (RA) and periodontal disease (PD). Methods: We performed a 6-month prospective study in 51 patients with chronic periodontitis and moderate-to-severe RA starting TCZ in accordance with local recommendations. Extensive rheumatologic (clinical activity, inflammatory, serological biomarkers) and periodontal (visible plaque index, gingival index, bleeding on probing, probing pocket depth, clinical attachment loss) assessments were done. Changes in RA activity and periodontal status were reassessed after 3 and 6 months. Results: We demonstrated significant correlations between periodontal status, disease activity, and serologic biomarkers (p &lt; 0.05). Tocilizumab significantly improved the gingival index scores and decreased the number of sites with bleeding on probing after only 3 months (p &lt; 0.05), while the probing pocket depth significantly decreased after 6 months; overall, clinical attachment loss presented only slight changes without any statistical significance as well as teeth count and plaque levels (p &gt; 0.05). Conclusion: IL-6 inhibition is able to improve periodontal outcomes in patients with RA and concomitant PD, which is essentially related to a dramatic decrease in serum inflammatory mediators

STUDY REGARDING CORRELATIONS BETWEEN CARIOUS DISEASE INDICES AND CERVICAL-FACIAL RADIOTHERAPY

The aim of this study was to determine if cervical-facial radiotherapy can influence the carious disease indices in relation to duration, total dose and session’s number. Materials and method The study group included 18 patients following cervical-facial radiotherapy for oro-maxillo-facial cancers (6 females, 12 males, age 45-70). The radiotherapy was performed with a dose 200cGy per session, 50Gy total dose, 30 number sessions, sessions duration 7 minutes. The clinical examen and paraclinical tests were performed on all patients included in study. DMFS, RFR, RFS, pH were determined. The results show a positive correlation between DMFS, RFS, radiation dose and number of radiotherapy sessions. Negative correlation was observed between RFR, salivary pH and the radiotherapy sessions duration. Conclusions The patients following cervical-facial radiotherapy present xerostomia and constitute a high cariogenic risk group