Evaluar la dimensión antero- posterior (A-P)/medio-lateral (M–L), y la morfología del cóndilo mandibular en pacientes de 18 a 65 años con patrón esquelético Clase I en tomografías computarizadas Cone Beam. Material y Métodos: 71 tomografías fueron evaluadas mediante el software RealScan 2.0. La dimensión fue determinada por los puntos A (más anterior en el plano sagital), P (más posterior en el plano sagital), M (más interno en el plano coronal), L (más externo en plano coronal). Se evaluó la morfología del cóndilo en dos planos coronal y sagital, clasificándose en: redonda, aplanada, convexa y mixta. La dimensión del cóndilo fue analizada por estadística descriptiva y la morfología mediante distribución de frecuencias. Para el análisis bivariado, se aplicó la prueba de t de Student. Resultado: Se obtuvieron las medidas del diámetro A-P del cóndilo derecho (CD) (8,72mm ± 1,25mm) y el izquierdo (CI) (8,50mm ± 1,50mm), el diámetro M-L del CD (19,24mm ± 2,03mm) y el CI (18,97mm ± 1,87mm). Hubo diferencias significativas en la dimensión M-L del CI del sexo masculino en comparación al femenino (p=0.002). La morfología más prevalente del CD (35,21) y CI (23,94) en plano coronal fue de tipo redonda. Conclusión: La dimensión A-P del cóndilo derecho e izquierdo es similar en ambos sexos; sin embargo, existen diferencias en la dimensión M-L del cóndilo izquierdo del sexo masculino. La morfología del cóndilo derecho e izquierdo más prevalente fue la redonda en plano sagital a excepción del plano coronal. / To evaluate the anterior-posterior (A-P)/medial-lateral (M-L) dimension, and morphology of the mandibular condyle in patients aged 18 to 65 years with Class I skeletal pattern on Cone Beam Computed Tomography scans (CBCTs). Materials and Methods: Seventy one CBCTs were evaluated using RealScan 2.0 software. The dimension was determined by points A (most anterior in the sagittal plane), P (most posterior in the sagittal plane), M (most interior in the coronal plane), L (most exterior in the coronal plane). The morphology of the condyle was evaluated in two coronal and sagittal planes, being classified as: round, flat, convex or mixed. The size of the condyle was analyzed by descriptive statistics and the morphology by frequency distribution. For the bivariate analysis, the Student’s t-test was applied. Results: Measurements were obtained for the A-P diameter of the right condyle (RC) (8.72mm ± 1.25mm) and the left condylar (LC) (8.50mm ± 1.50mm), the M-L diameter of the RC (19.24mm ± 2.03mm) and the LC (18.97mm ± 1.87mm). There were significant differences in the male M-L dimension of the LC compared to the female (p=0.002). The most prevalent morphology of RC (35.21) and IQ (23.94) in the coronal plane was round.. Conclusion: The A-P dimension of the right and left condyle is similar in both genders; however, there are differences in the M-L dimension of the left male condyle. The most prevalent morphology of the right and left condyle was round in the sagittal plane with the exception of the coronal plane. / Revisión por pares

This thesis will be organized into three chapters discussing the mechanism underlying the onset and progression of osteoarthritis (OA) in the temporomandibular joint (TMJ). Understanding the mechanism of OA development in the TMJ helps in understanding how OA progresses and how to treat this disease. The goal of this investigation is to examine the process of cartilage degeneration and OA biomarker expression in the TMJ to understand their role in TMJ OA onset and development.Chapter one covers mechanisms that are altered in TMJ OA during disease progression. Using animal models with different stressors such as mechanical disturbances, direct injury, and changes in the extracellular matrix composition revealed the role of the different mechanisms that are up-regulated and down regulated during cartilage destruction. Chapter two will cover a paper I wrote that introduces a novel non-invasive technique applied to mice, which induces an early onset of OA in the TMJ. I developed this technique with the aim to provide a new mouse model where the onset and progression of OA more closely mimic the natural TMJ OA progression in humans. The histopathological analysis of the cartilage demonstrates that onset of OA starts at 2 weeks after treatment induction and is aggravated by week eight. This data demonstrated the effectiveness of our technique in inducing OA in the TMJ. Chapter three will cover a second paper I wrote on the association of RAGE with the progression of OA in the TMJ of mice by using mice with and without RAGE expression. RAGE has been show to contribute to the progression of OA by releasing several pro-inflammatory and catalytic cytokines. Additionally, RAGE has been shown to modulate the expression of specific OA biomarkers, including HtrA-1, Mmp-13, and Tgf-β1 in knee cartilage. The objective of this study was to study the effect of knocking out RAGE on the expression of Mmp-1 3, HtrA-1, and Tgf-β1 in the TMJ. After histophatological and quantitative analysis of biomarkers expression, the results demonstrated for the first time that absence of RAGE expression in the TMJ provides a protective effect against development of TMJ OA in mice.

Objectives: To determine if temporomandibular joint (TMJ) compressive stresses during incisor biting (1) differed between growing children over time, and (2) were correlated with Frankfort Horizontal-mandibular plane angle (FHMPA, 8) and ramus length (Condylion-Gonion (Co-Go), mm). Materials and Methods: Three-dimensional anatomical geometries, FHMPA and Co-Go, were measured longitudinally from lateral and posteroanterior cephalographs1 of children aged 6 (T1), 12 (T2), and 18 (T3) years. Geometries were used in numerical models to estimate subject-specific TMJ eminence shape and forces for incisor bite-forces of 3, 5, and 8 Newtons at T1, T2, and T3, respectively. TMJ compressive stresses were estimated via two steps: First, TMJ force divided by age-dependent mandibular condylar dimensions, and second, modified by loading surfaces' congruency. Analysis of variance and Tukey honest significant difference post-hoc tests, plus repeated measures and mixed effects model analyses were used to evaluate differences in variables between facial groups. Regression analyses tested for correlation between agedependent compressive stresses, FHMPA, and Co-Go. Results: Sixty-five of 842 potential subjects had T1-T3 cephalographs and were grouped by FHMPA at T3. Dolichofacial (FHMPA ≥ 27°, n=36) compared to meso-brachyfacial (FHMPA, 27°, n=29) subjects had significantly larger FHMPA at T1-T3, shorter Co-Go at T2 and T3 (all P < .01), and larger increases in TMJ compressive stresses with age (P < .0001). Higher compressive stresses were correlated with larger FHMPA (all R2 ≥ 0.41) and shorter Co-Go (all R2 ≥ 0.49). Conclusions: Estimated TMJ compressive stress increases from ages 6 to 18 years were significantly larger in dolichofacial compared to meso-brachyfacial subjects and correlated to FHMPA and Co-Go.

No description available.

Syftet med denna studie var att jämföra tre års resultat av enbart lokalanestesi jämfört mot lokalanestesi ochspolning i käkledenpå patienter som lider av smärtande diskdisplacering utan reduktionStudien utfördes från 2003 till 2007 och 45 patienter valdes från sammanlagt 55 utvalda patienter för behandling av TMD till avdelningen för Klinisk bettfysiologi, Odontologiska fakulteten, Malmö högskola, Sverige.Frågeformulär och klinisk undersökning enligt Research Diagnostic Criteria(RDC/TMD), panorama röntgenbilder och magnetisk resonanstomografi utfördes vid start av studien. Tre år efter behandling, sändes ett frågeformulär till 37 patienter.Intensiteten av smärta, fysisk funktion, känslomässig funktion och global förbättring utvärderades.Tjugofyra patienter randomiserades till behandling med lokalanestesi och tjugo patienter randomiserades till behandling med lokalanestesi och spolning. Trettiofyra patienter besvarade enkäten vid 3-års uppföljningen. I en intention-to-treat analys visade det huvudsakliga resultatet att 28/45(62%) hade fått 30% smärtlindring vid uppföljningen. Inga signifikanta skillnader fanns mellan grupperna lokalanestesi och lokalanestesi och spolning avseende smärtlindring, fysisk funktion, känslomässig funktion och global förbättring. Det fanns signifikanta förbättringar (P< 0.05) inom båda grupperna avseendesmärtintensitet, fysisk funktion och emotionell funktion och global förändring vid uppföljning jämfört med start av studien.Eftersom det inte fanns någon skillnader mellan grupperna lokalanestesi och spolningoch enbart lokalanestesii käkleden tre år efter behandling av smärtsam diskdisplacering utan återgång, kan spolning av käkleden ifrågasätts. / The aim of this prospective and longitudinal study was to compare three-year outcomes of local anesthetics compared to anesthetics, arthrocentesis and lavage on patients suffering from painful jaw locking in the TMJThe study was performed from 2003 until 2007 and 45 patients were selected from altogether 55 eligible patients referred for the treatment for TMD to the Department of Stomatognathic Physiology, Faculty of Odontology, Malmö University, Sweden. History questionnaire and clinical examination according toResearch Diagnostic Criteria, panoramic radiographs and Magnetic Resonance Imaging were completed at baseline. A questionnaire was sent three years after treatment to 37 patients. Pain intensity, physical functioning, emotional functioning and global improvement were evaluated.Twenty-five patients were randomised to group anesthetics and 20 patients were randomised to group anesthetics, arthrocentesis and lavage. Thirty-four patients answered the questionnaire at the 3-year follow-up. In an intention-to-treat analysis the primary outcome, showing a ≥30% pain relief, was reported by 28 of 45(62%) patients at the follow-up. No significant differences in improvement were found between group local anesthetics and group anesthetics, arthrocentesis and lavage regarding pain relief, physical functioning, emotional functioning, and global improvement. Significant improvements(P<0.05) were found within both groups regarding pain intensity, physical functioning, emotional functioning and global changes at the follow-up compared to baseline.Since no differences were found between local anesthetics, arthrocentesis and lavage compared to local anesthetics alone of the TMJ three years after treatment of painful disc displacement without reduction, the use of arthrocentesis and lavage can be questioned.

Syfte: Att utreda sambandet mellan den lösliga formen av urokinas-receptorn (suPAR) i saliv hos patienter med artrit i käkleden (A-TMJ) och friska kontroller, för att skapa en grund för vidare forskning av suPAR som prediktor för inflammationsgraden i käkleden hos patienter med A-TMJ.Material och metod: En fall-kontrollstudie utfördes med 6 kontroller (medelåldern 31±11år) och 5 patienter med A-TMJ (medelåldern 24±5år). Undersökningen bestod av salivprov, registrering av blödning vid sondering (BoP), blodprovstagning, och undersökning av tuggsystemet där antalet smärtsamma käkledsrörelser (PM) mättes. Sist samlades käkledvätska in. Halten suPAR analyserades i saliv, plasma och käkledsvätska. Resultat: En signifikant skillnad mellan suPAR i saliv kunde ej påvisas (A-TMJ 4,4±3,91ng/ml, kontroller 4,96±4,80ng/ml), emellertid hade patienter en signifikant högre halt av suPAR i plasma (A-TMJ 2,71±0,62ng/ml, kontroller: 1,86±0,35ng/ml, P=0,017). Halten av suPAR i käkledsvätska mättes till 1,57±1,50ng/ml hos patienter men kunde inte detekteras hos kontroller. BoP mättes till 16±9% hos patienter och 14±7% hos kontroller, och median(IQR) för PM var 3(1) i höger käkled och 0(3) i vänster käkled hos patienter. Slutsatser: (i) Ingen slutsats kan dras gällande sambandet mellan suPAR i saliv och A-TMJ, men (ii) patienter med A-TMJ har till viss mån en högre smärta i käkleden vid käkledsrörelse medan deras koncentration av suPAR i plasma är högre jämfört med friska kontroller. Det verkar som (iii) BoP skulle kunna vara kopplat till suPAR i saliv. Resultat från denna studie bör tolkas med försiktighet på grund av litet stickprov, fortsatt forskning behövs för att klargöra sambandet mellan suPAR i saliv och A-TMJ. / Aims: To investigate the levels of soluble urokinase plasminogen activator receptor (suPAR) in saliva between patients with arthritis in the temporomandibular joint (A-TMJ) and healthy controls to create a foundation for further research of the potential predictive value of suPAR in patients with A-TMJ.Materials and method: A case- control study was conducted, 6 controls (mean age 31±11years) and 5 patients with A-TMJ (mean age 24±5years) enrolled in the study. Saliva, blood, synovial fluid (SF) were sampled, and the masticatory system was examined according to DC/TMD, and bleeding on probing (BoP) was assessed, as was painful mandibular movement (PM). The level of suPAR was analyzed in saliva, plasma and SF.Results: Level of salivary suPAR did not differ significantly between A-TMJ patients and healthy controls (P > 0.05). Patients had a significantly higher level of suPAR in plasma than controls (A-TMJ 2.71±0.62ng/mL, controls: 1.86±0.35ng/mL, P=0.017). suPAR level in SF was measured to 1.57±1.50ng/mL in A-TMJ patients and not detected in controls. BoP was 16±9% in patients and 14±7% in controls, and median(IQR) of PM was 3(1) in the right TMJ and 0(3) in the left in patients.Conclusions: (i) No conclusion can be drawn regarding suPAR in saliva and A-TMJ, but (ii) to some degree A-TMJ patients have higher PM meanwhile their plasma concentration of suPAR is higher than controls. A trend that (iii) higher BoP is connected with higher suPAR in saliva could be distinguished. Results must be interpreted with caution due to small study sample, more research is required to further elucidate the association between suPAR in saliva and A-TMJ.

Syfte Syftet med litteraturöversikten var att beskriva förekomst av whiplashtrauma hos TMD patienter. Metod En systematisk litteratursökning av PubMed, CochraneLibrary och Bandolier databaser genomfördes för artiklar publicerade från 1 januari 1966 till 11 november 2011. Den systematiska sökningen identifierade121 artiklar. Efter borttagning av brev till redaktion och författarinlägg, utfördes en initial screening av abstract på 108 artiklar. Efter den initiala screeningen lästes 32 artiklar i fulltext med tillämpning av inklusions- och exklusionskriterier. Två av författarna utvärderade den metodologiska kvaliteten på de inkluderade studierna. Resultat Sex studier mötte inklusionskriterierna och inkluderades i rapporten. Den rapporterade förekomsten av whiplashtrauma hos TMD populationerna varierade mellan 8,4 % och 70 % (median 35 %). Förekomst av whiplashtrauma hos kontrollgrupperna varierade mellan 1,7 % och 18 %. TMD patienter med historik av whiplashtrauma rapporterade gravare TMD symptom och mer smärta jämfört med TMD patienter utan nackskada.Konklusion Resultaten från denna litteraturöversikt visar en högre förekomst av whiplashtrauma hos TMD patienter vilket tyder på att whiplashtrauma kan vara en riskfaktor för TMD. Stora variationer sågs mellan de olika inkluderade studierna och i samtliga studier fanns också brister gällande diagnoskriterier. Sammantaget så gör dessa begränsningar det svårt att bedöma traumaförekomst hos TMD patienter och i vilken utsträckning whiplashskada kan bidra till utvecklingen av TMD. Fler väldesignade studier som använder tydligt definierade diagnostiska kriterier med hög reliabilitet och validitet som t.ex RDC/TMD behövs för att kunna dra en säkrare slutsats om TMD vid whiplashtrauma. / Aim The aim ofthis systemic literature review was to describe the prevalence of whiplash trauma in TMD populations. Method A systemic literature search of the PubMed, Cochrane Library and Bandolier databases was carried out for articles published from 1 January 1966 to 11 November 2011. This systemic search identified 121 articles. After exclusion of letters to editor and author replies, an initial screening of the abstracts of 108 articles was carried out. After the initial screening 32 articles were read in full text applying the inclusion and exclusion criteria. Two of the authors evaluated the methodological quality of the included studies. Result Six studies matched the inclusion criteria and were included in the review. The reported prevalence of whiplash trauma in the TMD populations varied from 8.4% to 70% (median 35%). The prevalence of whiplash trauma in the control groups varied from1.7% to 18%.TMD patients with a history of whiplash trauma reported more TMD symptom and more pain compared to TMD patient without a neck injury.Conclusion The results from this literature review show a higher prevalence of whiplash trauma in TMD patients which indicate that whiplash trauma could be risk factor for TMD. A large variation could be seen between the included studies and there were also weaknesses with regard to the diagnostic criteria. In summery we suggest that these limitations make it difficult to assess the prevalence of neck trauma in TMD patients and to which extent a whiplash injury can contribute to the development of TMD. More well designed studies using the RDC/TMD criteria and well-defined criteria with high reliability and validity for whiplash trauma are needed in order to make a more reliable conclusion.

A major physiological risk factor of temporomandibular disorders (TMD) is sensitization of peripheral and central nervous system pain processing pathways. Calcium channel, voltage-dependent, alpha-2/delta subunit-1 (CACNA2D1) has a crucial role in relaying nociceptive information in the spinal dorsal horn. Up-regulation of CACNA2D1 results in abnormal excitatory synapse formation and enhanced presynaptic excitatory neurotransmitter release. Blocking CACNA2D1 with gabapentinoid-class drugs relieves orofacial hypersensitivity. Drs. Foley, Horton, and Sciote previously reported that in a small sample group (n=12), CACNA2D1 expression was greater in males than females, but increased in women with TMD. The objectives of this study are to corroborate these data and investigate expression patterns of other ion channel and conducting system genes. Additionally, since the null polymorphism ACTN3-577XX associates with muscle fiber microdamage during eccentric contraction, we tested for possible gene associations with ACTN3-R577XX genotypes. Masseter muscle samples came from human subjects (n=23 male; 48 female) with malocclusions undergoing orthognathic surgery. This population had skeletal disharmony of the jaws and thus was prone to eccentric contraction. Three males and eighteen females were diagnosed with localized masticatory myalgia. Muscle total RNA was isolated and CACNA2D1, CACNA1S, GABARAP, and TRPM7 expression was quantified using RT-PCR. Expression of these genes were compared based on TMD status and various characteristics that may influence TMD including: sex, age, facial symmetry, sagittal dimension, vertical dimension, ACTN3-577 genotype and fiber type. CACNA2D1 expression differed significantly between sexes, overall (p&lt;0.02), and without TMD (p=0.001). Women with (n=13) and without (n=23) TMD differed significantly (p&lt;0.03). CACNA2D1 expression was also significantly higher (p=0.031) in subjects below age 25. Similarly, GABARAP expression was significantly higher (p=0.001) for patients younger than 25 and for patients less than or equal to age 18 (p=0.013). Otherwise, CACNA1S, TRPM7 and GABARAP differences were not significant. GABARAP expression differed, but not significantly by sex and for the ACTN3-577XX-null genotype. In a population of malocclusion patients, masseter muscle CACNA2D1 expression is significantly higher than CACNA1S, TRPM7, and GABARAP. CACNA2D1 expression is greater in males than females without TMD. However, CACNA2D1 expression increases significantly in females with TMD-associated myalgia. This may support evidence for calcium channel regulation of nociception differences seen between sexes in TMD. It was also found that expression of CACNA2D1 and GABARAP is significantly higher in younger subjects. Additionally, observations presented here suggest potential influence of ACTN3-null condition on function of GABARAP. / Oral Biology

Introduction: The purpose of this study was to subclassify the types of facial asymmetries present in a pre-surgical dentofacial deformity patient population to determine the prevalence of each subcategory. Associations between the craniofacial characteristics of each asymmetry and pre-surgical Jaw Pain and Function Questionnaire (JPFQ) scores, diagnosis of temporomandibular disorders (TMD), and posterior facial asymmetry (PFA) as determined by nasal septum deviation were analyzed. In addition, the data will aid in the development of a phenomics database to allow for subsequent genotyping and gene expression evaluation from patient saliva and masseter muscle samples that were obtained at the time of corrective orthognathic surgery. Methods: Pre-surgical posterio-anterior (PA) cephalograms, submentovertex (SMV) and panoramic (PAN) radiographs from 92 pre-surgical dentofacial deformity patients at the Department of Oral and Maxillofacial Surgery, University of Lille, France were collected to evaluate facial asymmetry. PAs were traced and analyzed according to the Grummons Simplified Frontal analysis and Ramal Height analysis (Dolphin Imaging). SMVs were analyzed by the refined clinical system of the Ritucci and Burstone analysis proposed by Arnold et al along with original angular measurements for maxillary, mandibular, and nasal septum deviations (ImageJ). PFA was determined by a nasal septum deviation greater than 15 degrees. Lastly, PANs were evaluated visually for condylar pathologies. A comprehensive diagnostic decision tree for facial asymmetry was formulated based upon the current literature for normal variation of landmarks and the study design. Patient diagnosis via the decision tree was compared to visual examination of the appropriate x-rays to verify accuracy. Using this decision tree, patients were classified into subtypes and prevalence of each was calculated to form a phenomics database for future research on genotyping and gene expression. Associations between the subclassifications, mean pre-surgical JPFQ scores, temporomandibular joint (TMJ) clinical examination results (TMD+ or TMD-), and the diagnosis of posterior facial asymmetry (PFA+ or PFA-) were completed. Results: Sixty-two patients were able to fulfill all radiographic requirements to arrive at a diagnosis. Eighteen patients demonstrated facial asymmetry that fell within normal biological variation while the other 44 were diagnosed as having a form of facial asymmetry – Cranial Base Asymmetry: 11 female, 6 male; Non-Condylar Mandibular Asymmetry: 5 female, 3 male; Hemimandibular Elongation: 2 female, 3 male; Maxillary Asymmetry: 3 female, 1 male; Idiopathic Condylar Resorption: 3 female, 1 male; Atypical Asymmetry: 3 female, 1 male; Hemimandibular Hyperplasia: 1 female, 0 male; and Maxillary Base & Mandibular Body Asymmetry: 0 female, 1 male. JPFQ scores for symmetric patients ((x ) ̅= 5.33) and asymmetric patients (x ̅= 4.57) were non-significant overall, however, differences between gender were noted (female symmetric (x ) ̅= 6.13, male symmetric (x ) ̅= 1.33, female asymmetric (x ) ̅= 5.36, male asymmetric (x ) ̅= 3.19). TMD was diagnosed by pre-surgical TMJ examinations and MRIs. Four symmetric patients (3 female, 1 male) were positively diagnosed with TMD while 14 asymmetric patients (11 female, 1 male) also were diagnosed. PFA was diagnosed when nasal septum deviation was greater than 15 degrees – 25⁰ to ≤35⁰: 9 patients; &gt;35⁰ to ≤45⁰: 3 patients; &gt;45⁰: 1 patient. Twenty patients with a positive PFA were asymmetric while the other 8 symmetric. Twenty-one patients with PFA were female while the other 7 were male. Conclusion: A comprehensive diagnostic decision tree for facial asymmetry classification was formulated and validated. With it, it was found that: Females have increased JPFQ scores and clinical diagnosis of TMD versus males. Asymmetric females have decreased JPFQ scores, but increased prevalence of TMD. Presence of PFA does not appear to be a strong influence on development of facial asymmetry but is significantly linked to the presence of TMD. PFA is present in nearly half of all dentofacial deformity subjects. Mandibular asymmetry is most commonly associated with increased JPFQ scores and presence of TMD. However, Hemimandibular Hyperplasia, a particular and less common form of mandibular asymmetry, never associated with TMD. One form of mandibular and mid-facial asymmetry, Atypical Asymmetry, had a relatively high prevalence of TMD. Future directions for this research include continuation of genotypic description of IGF1 and Nodal biologic pathways to determine how gene expression levels in masseter muscle and patient genotypes differ in the eight subclassifications of craniofacial asymmetry compared to the symmetric population. / Oral Biology

Para analisar e investigar as variáveis clínicas e radiográficas da articulação temporomandibular e do aparelho mastigatório de um grupo portadores de artrite reumatóide (AR) e de um grupo controle portadores de disfunção temporomandibular (DTM) foram avaliados 102 pacientes com artrite reumatóide e 70 pacientes com disfunção temporomandibular sem artrite reumatoide. Este estudo analisou a prevalência de DTM, o estado psicológico e gera as alterações radiográficas e a presença e características da dor articular e/ou muscular no segmento facial de ambos os grupos. Verificou-se que os paciente com AR apresentaram acomentimento da ATM e dores nos músculos da mastigação mas com menos freqüência que nos pacientes com DTM. Por outro lado, a presença de osteoartrite e osteoartrose na ATM foi mais evidente nos pacientes com AR que no grupo controle. Estas características foram compatíveis com o comprometimento da ATM pela própria doença. A dor no paciente com DTM foi difusa e com intensidade moderada a forte realçado por apresentarem maior croncidade / To evaluate and investigate clinical and radiological variables of the temporomandibular joint (TMJ) and masticatory system in 102 patients with rheumatoid arthritis (RA) and in control group consisted of 70 patients with temporomandibular disorders (TMD) without rheumatoid arthritis. This study analysed in both groups the prevalence of temporomandibular dysfunction, character of concerning self-rated mental well-being, radiographic alterations and presenting and character of temporomandibular joint pain and/or masticatory muscle pain in the face segment. In spite of the patients with RA showed masticatory pain dysfunction, the frequency was lower than in the patients with TMD. The RA group was reported development of TMJ symptoms like osteoarthrosis and osteoarthritis. This development is associated with functional impairment in the other joints of the body and severity of the RA systemic disease. In the control group the pain in the face segment and masticatory system was general with moderate to high intensity