The Prevalence of Oropharyngeal Dysphagia in Adults Presenting with Temporomandibular Disorders Associated with Rheumatoid Arthritis: A Systematic Review and Meta-analysis

Abstract

Temporomandibular disorders (TMDs) are the most frequent non-dental orofacial pain disorders and may be associated with rheumatoid arthritis (RA), resulting in oropharyngeal dysphagia (OD). However, clinicians' understanding of involvement with OD caused by RA-related TMDs is limited and the methodological quality of research in this field has been criticised. Therefore, the aim of this study was to systematically review the prevalence of oral preparatory and oral stage signs and symptoms of OD in adults presenting with TMDs associated with RA. A systematic review of the literature was completed. The following electronic databases were searched from inception to February 2016, with no date/language restriction: EMBASE, PubMed, CINAHL, Web of Science, Elsevier Scopus, Science Direct, AMED, The Cochrane Database of Systematic Reviews, and ProQuest Dissertations and Theses A & I. Grey literature and reference lists of the included studies were also searched. Studies reporting the frequency of OD in adults presenting with TMD and RA were included. Study eligibility and quality were assessed by three independent reviewers. Methodological quality was assessed using the Down's and Black tool. The search yielded 19 eligible studies. Typical difficulties experienced by RA patients included impaired swallowing (24.63%), impaired masticatory ability (30.69%), masticatory pain (35.58%), and masticatory fatigue (21.26%). No eligible studies reported figures relating to the prevalence of weight loss. Eligible studies were deemed on average to be of moderate quality. Study limitations included the small number of studies which met the inclusion criteria and the limited amount of studies utilising objective assessments. Valid and reliable prospective research is urgently required to address the assessment and treatment of swallowing difficulties in RA as TMJ involvement may produce signs and symptoms of OD.

Modified Diet Use in Adults with Temporomandibular Disorders related to Rheumatoid Arthritis: A Systematic Review

“…A previously piloted electronic form 16 was used in data extraction by 2 independent reviewers. Full consensus was reached regarding data extracted, although a third independent author was available to mediate disputes, if required.…”

“…If data from primary studies published within the previous 10 years was found to be missing/unclear, primary authors were contacted using standardised email templates. 16 Studies were excluded in cases of no response from authors following 2 contact attempts.…”

“… 11 These changes in TMJ structure and function result in the development of temporomandibular disorders (TMDs) in up to 84% of adult patients presenting with RA, 12 – 15 with signs and symptoms including restricted ranges of mandibular motion, pain on mandibular functioning, and impaired mastication across a range of consistencies. 16 As such, these physiological difficulties may result in adults with RA altering their diet to include greater levels of soft foods which are easier to consume, yet which may be deficient in certain essential vitamins, minerals, nutrients, and calories, and which therefore may lead to unintentional weight changes.…”

Deglutição no envelhecimento e a odontologia

“…Pode-se adquirir a disfagia a partir de diversas etiologias, incluindo doenças neurológicas, como demência, doença de Parkinson, esclerose múltipla e acidente vascular cerebral 36 . Câncer de cabeça e de pescoço, cirurgia da coluna cervical, traumatismo cranioencefálico, fibromialgia, artrite reumatoide e doença pulmonar obstrutiva crônica também estão associados ao seu desenvolvimento, assim como muitas síndromes genéticas 37,38,39 . Além disso, o envelhecimento ativo está associado à sua propensão 40 .…”

Rheumatologist’s Views on Oral Stage Dysphagia in adults with Rheumatoid Arthritis of the Temporomandibular Joint: An Irish Perspective

“…Recent research suggests that 30.69% and 24.63% of adults with RA affecting the TMJ experience impaired mastication and swallowing, respectively, while masticatory pain (29.97%) and fatigue (21.26%) also affect a sizeable cohort. 4 However, there is a lack of cohort-specific TMD assessments or evidence-based interventions for the rheumatologist to use with these patients. Research has suggested that as a consequence of this lack of resources, rheumatologists may under-estimate the presence of TMJ involvement, which may result in limited treatment and potential residual deficits.…”