Orofacial pain — continuous discomfort in the mouth, jaws, and face — can be fairly common and persistent in children with juvenile idiopathic arthritis (JIA), and sufficiently limiting to negatively affecting their quality of life, according to a two-year follow-up study.
The findings were published in the article “Orofacial symptoms and oral health-related quality of life in juvenile idiopathic arthritis: a two-year prospective observational study,” in the journal Pediatric Rheumatology.
Facial pain and subsequent loss of function are frequently associated with the temporomandibular joint, the small joint connecting the jawbone to the skull. Arthritis can deform this joint, so reducing its mobility and that of facial muscles to ultimately having a negative impact on quality of life.
However, little is known about the long-term progression of orofacial symptoms in JIA children, as well as the impact of these symptoms on quality of life.
A team led by researchers from the Aarhus University, in Denmark, and Alberta Children’s Hospital, in Calgary, Canada, investigated the long-term changes in orofacial symptoms reported by JIA children, and their effects on the children’s oral health-related quality of life.
In total, 157 JIA patients under age 20 were enrolled the study between 2014 and 2017.
Participants completed a questionnaire concerning the severity of symptoms within the last two weeks, including orofacial pain frequency, pain intensity, pain location (patients marked the area of pain on a diagram illustrating the head and the neck), loss of function, and symptom characteristics.
At the two-year follow-up, 113 children completed the same questionnaire, plus the Child Perception’s Questionnaire, a validated 31-item questionnaire addressing oral health-related quality of life. Only children who completed the questionnaires at both time points were considered for the analysis.
At the study’s beginning, orofacial symptoms were present in 55% (62 out of 113) of the children, while 45% (51/113) showed no symptoms. Orofacial pain was reported by 53% (60/113) of the children, with almost half of them experiencing pain on a weekly basis. Loss of orofacial function was reported by 36% (41/113).
After two years, pain persisted in 77% (46/60) of the children who reported it initially. Likewise, a persistent loss of function was identified in 66% (27/41) of those who expressed this pain at the study’s start.
Interestingly, pain was more prevalent in the temporomandibular joint and adjacent muscles at the study’s beginning — as is common — but it spread throughout the face over the following two years.
Symptoms associated with JIA also negatively impacted the children’s quality of life, mainly at the emotional and social levels, compared to children without orofacial symptoms.
“[S]elf-reported orofacial pain and functional disability were common findings in a cohort of JIA patients followed over 2 years,” the researchers concluded. “These symptoms seem to persist over time in most patients, and have a significant negative impact on oral health-related quality of life.”
They added, “[w]e strongly recommend incorporating a standardized orofacial examination into the assessment of children diagnosed with JIA.”
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