Regular dental care, including dental visits at least every six months, are very important in the treatment of juvenile rheumatoid arthritis. It is estimated that 60 percent of children with polyarticular arthritis have problems with the temporomandibular joint or TMJ. This joint, in front of the ears where the lower jaw connects to the base of the skull, connects the jawbone to the skull, allowing the jaw to open and close when we eat, talk or yawn. Arthritis may affect this joint in the same way it does others, causing pain, stiffness and altered growth. Further, if the lower jaw does not develop properly, it may create an overbite.

Anything that disturbs the normal structure or functioning of the TMJ can result in significant pain and impairment and cause it to make a clicking sound. If your child has a TMJ problem, the dentist may recommend a consultation with an orthodontist.

Treatments for TMJ problems include jaw exercises, massage, physical therapy, warm compresses, the use of dental appliances, and occasionally injections of hyaluronic acid substitutes.  When temporomandibular joint inflammation is more serious, usually detected through magnetic resonance imaging, the use of intra-articular (means “within the cavity of the joint”) corticosteroid injections may be used to control the inflammation. In rare cases, surgery is used to correct this condition.

Because children with juvenile rheumatoid arthritis may have limited jaw movement, brushing and flossing teeth can be difficult. But flossing, even if painful, is very important. Researchers speculate that bacteria from the mouth may enter the bloodstream and contribute to inflammation and artery clogging. Your child's dentist may suggest various toothbrush handles, electric toothbrushes, floss holders, toothpicks and rinses that will help your child maintain healthy teeth and gums.

Medications for juvenile rheumatoid arthritis may also affect your child's bones and teeth, as well as oral health and development. Always inform your dentist about the status of your child’s rheumatoid arthritis and the medications he or she is taking. The dentist will consider these when planning basic treatment or oral surgery, as well as giving your child anesthesia or sedation. Older children who have had joint replacements may require antibiotics before dental treatment.

A child with active arthritis may not always have the stamina for even routine dental work. If possible, schedule appointments when your child has the greatest amount of stamina, or schedule shorter appointments.