Oral and Dental Manifestations of Adult Rheumatoid Arthritis: A Clinical and Radiological Study

Blair, George Stewart (1972) Oral and Dental Manifestations of Adult Rheumatoid Arthritis: A Clinical and Radiological Study. Doctor of Medicine and Surgery thesis, University of Glasgow.

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Four considerations provide the basis for this thesis, namely the necessity for this study, the aptness of the methods used, the oral and dental manifestations of adult rheumatoid arthritis, and the wisdom of undertaking further, similar, research. The necessity for the study is considered, initially, by a description of anatomy and physiology, from which the damaging effects of disease of the structures studied on the affected subjects can be understood. Secondly, the very large number of different radiographic techniques used to examine, especially, the temporomandibular joint but, also, the salivary glands and teeth is described in greater detail than originally intended because no comprehensive record of these could be found in the dental or medical literature. The third consideration is the evidence gained by a thorough review of the literature. No large scale study of a major salivary gland has been reported. The results produced by the various students of the temporomandibular joint, some of which are fairly extensive, at best can be described as confusing. Apparently, no serious consideration has been given to the effect of the general, systemic manifestations of adult rheumatoid arthritis on the dental health of a section of our population suffering from this disabling disease. The need for my investigation is conclusive and emphatic. The methods used to diagnose adult rheumatoid arthritis and Sjogren's syndrome are summarised but not analysed. However the methods I used to investigate the salivary glands, the temporomandibular joint and the teeth are examined in detail. Hydrostatic sialography, although deficient in certain minor respects, is considered to be at least the equal of any other sialographic method in use at the present time. Circular tomography, which has not been used before in any large study of the temporomandibular joint, is an accurate and reproducible technique, superior to others recently advocated because a higher proportion of radiologically clear radiographs are produced by it. Periapical dental radiography is, probably, a less controversial subject but justification is provided for selecting the lower anterior teeth in a large radiological survey if, for any reason, this form of radiography has to be limited. All radiological reporting has been standardised. Clinical examinations have depended to a much greater extent on established methods, the selection of which has been justified. However, the method of measuring the extent of opening of the mouth and clinical and radiological interpretations of "normal opening" and "subluxation" have been strictly defined. In addition, schemes for classifying the state of occlusion and the condition of individual dentures have been suggested. Sialographic abnormalities of the parotid gland in adult rheumatoid arthritis are defined and described. Their incidence in a group of patients with Sjogren's syndrome has been shown to be highly significantly more common than in patients with adult rheumatoid arthritis alone and in control patients. Subjects with Sjogren's syndrome complicated by rheumatoid arthritis appear to have less severe salivary gland involvement than subjects with sicca syndrome. It is proposed, additionally, that there may be a sub-clinical form of Sjogren's syndrome whose detection is assisted by sialography. The technique of hydrostatic sialography has been modified by taking into consideration the more critical assessment of salivary gland involvement in these conditions, obtained by measuring salivary flow rates. The first recorded investigation into the effect of primary osteoarthrosis on the temporomandibular joint is included. It appears that a diagnosis of primary osteoarthrosis of one or more peripheral joints is no indication that the temporomandibular joint is likely, also, to be involved by this condition. On the other hand, adult rheumatoid arthritis has been shown, both clinically and radiologically, to affect the large majority of subjects suffering from this disease. Certain clinical and radiological features described appear to be almost specific for adult rheumatoid arthritis and to correlate with increasing severity of this disease. The oral hygeine of those patients examined, who were suffering from adult rheumatoid arthritis, was poorer than that of control patients and they were much more likely to have lost all their natural teeth at an earlier age than patients not afflicted by this disease. This is, possibly, due to the processes of the disease itself but the latter finding could, also, be a result of the theory of "focal infection" which was in vogue until fairly recently. The results of the dental investigations, in addition, substantiate the findings of other dental health surveys that there is great room for improvement in the general standard of dental fitness in the United Kingdom.

Item Type: Thesis (Doctor of Medicine and Surgery)
Qualification Level: Doctoral
Keywords: Dentistry
Date of Award: 1972
Depositing User: Enlighten Team
Unique ID: glathesis:1972-78519
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 28 Feb 2020 12:09
Last Modified: 28 Feb 2020 12:09
URI: https://theses.gla.ac.uk/id/eprint/78519

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