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Oral health in JIA

Clinical bottom line

Reduced salivary flow occurs in patients with JIA. This could negatively affect oral health, and could explain the increased rate of caries in patients with JIA.


Background

JIA may impact on dental caries, periodontal disease, and involvement of the temperomandibular joint. Increased dental caries have been reported in children with JIA.

Reference

AG Walton et al. Sialochemistry in juvenile idiopathic arthritis. Oral diseases 2002 8: 287-290.


Study

Seventeen randomly selected patients (aged 10-50 years) with JIA were selected, with a similar number of age and sex matched controls. Saliva was collected for in unstimulated and stimulated fashion. There was also a brief review (no search strategy) of dental caries in patients with JIA.

Results

Both unstimulated and stimulated salivary fluid flow was significantly lower in patients with JIA than in controls (Figure 1). calcium and phosphate levels were not different.

Figure 1: Salivary flow rates in patients with JIA and controls

Five studies with one to 120 subjects (about 250 in total) reported higher rates of dental caries in patients with JIA than control subjects. These studies, reporting between 1971 and 1999 were consistent. In the most recent study, the average number of decayed, missing, or filled teeth in JIA patients was 3.4, compared with 1.4 in controls.

Comment

Although a superficially simple study, this has an interesting discussion about the relevance of salivary flow and composition on dental health. High concentrations and calcium and phosphate ions, and pH management, mean that teeth are protected. saliva is supersaturated, above the saturation level of hydroxyapatite, so no erosion of teeth occurs. Reduced flow of saliva could negatively affect tooth structure, leading to increased dental caries.