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Systematic reviews

Open Access

Association between juvenile idiopathic arthritis and periodontal diseases: a systematic review and meta-analysis

  • Jin Tang1
  • Linsheng Dong1
  • Jingxuan Ran1
  • Zhaobo Liu1
  • Yadong Li1,*,

1Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Chongqing Medical University, 400016 Chongqing, China

DOI: 10.22514/jocpd.2023.050 Vol.47,Issue 5,September 2023 pp.19-31

Submitted: 22 December 2022 Accepted: 14 March 2023

Published: 03 September 2023

*Corresponding Author(s): Yadong Li E-mail:


Although periodontal diseases have been widely reported in patients with juvenile idiopathic arthritis (JIA), their association with JIA remains controversial. This systematic review and meta-analysis aimed to evaluate the association between JIA and periodontal diseases to facilitate oral health management and periodontal disease prevention in JIA patients. We conducted a comprehensive search of Web of Science, Cochrane Library, PubMed, Embase, Chinese Scientific and Technological Journal (VIP) database, Wan Fang Data, China National Knowledge Infrastructure (CNKI), and China Biomedical Literature Database (CBM) up to 30 September 2022, without publication dates or language restrictions. Two authors independently evaluated observational studies for inclusion, and the quality of the included studies was assessed using the Newcastle Ottawa Scale (NOS) and the Agency for Healthcare Research and Quality (AHRQ). Continuous variables are presented as mean difference (MD) and 95%confidence interval (CI). Parameters of the simplified oral hygiene index (OHI-S), plaque index (PI), gingival index (GI), clinical attachment loss (CAL), and probing depth (PD) were considered as outcome measures and were compared between JIA patients and healthy controls. The initial search comprised 15 studies with a total of 1537 individuals. The meta-analysis showed the parameters of OHI-S (MD = 0.12, 95% CI: 0.04–0.19, p = 0.002), PI (MD = 2.08, 95% CI: 1.67–2.50, p < 0.00001), GI (MD = 0.50, 95% CI: 0.17–0.82, p = 0.003), CAL (MD = 0.22, 95% CI: 0.01–0.43, p = 0.04), and PD (MD = 1.42, 95% CI: 0.08–2.77, p = 0.04) in JIA patients were significantly higher than those of healthy controls. All of the included studies were of high quality. This systematic review and meta-analysis showed a possible association between JIA and periodontal diseases. Therefore, it is recommended to continuously pay attention to the periodontal health of JIA patients and fully explore the underlying mechanism.


Juvenile idiopathic arthritis; Periodontal diseases; Periodontitis; Gingivitis; Meta-analysis

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Jin Tang,Linsheng Dong,Jingxuan Ran,Zhaobo Liu,Yadong Li. Association between juvenile idiopathic arthritis and periodontal diseases: a systematic review and meta-analysis. Journal of Clinical Pediatric Dentistry. 2023. 47(5);19-31.


[1] Barut K, Adrovic A, Şahin S, Kasapçopu Ö. Juvenile idiopathic arthritis. Balkan Medical Journal. 2017; 34: 90–101.

[2] Al-Mayouf SM, Hashad S, Khawaja K, Alrasheedi A, Abdwani R, Abushhaiwia A, et al. Cumulative damage in juvenile idiopathic arthritis: a multicenter study from the pediatric rheumatology Arab group. Arthritis Care & Research. 2021; 73: 586–592.

[3] Conti F, Pontikaki I, D’Andrea M, Ravelli A, De Benedetti F. Patients with juvenile idiopathic arthritis become adults: the role of transitional care. Clinical and Experimental Rheumatology. 2018; 36: 1086–1094.

[4] Garner AJ, Saatchi R, Ward O, Hawley DP. Juvenile idiopathic arthritis: a review of novel diagnostic and monitoring technologies. Healthcare. 2021; 9: 1683.

[5] Stoustrup P, Resnick CM, Abramowicz S, Pedersen TK, Michelotti A, Küseler A, et al. Management of orofacial manifestations of juvenile idiopathic arthritis: interdisciplinary consensus-based recommendations. Arthritis & Rheumatology. 2022; 75: 4–14.

[6] Rigante D, Bosco A, Esposito S. The etiology of juvenile idiopathic arthritis. Clinical Reviews in Allergy & Immunolo-gy. 2015; 49: 253–261.

[7] Petty RE, Southwood TR, Manners P, Baum J, Glass DN, Goldenberg J, et al. International league of associa-tions for rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. The Journal of Rheumatology. 2004; 31: 390–392.

[8] Kobus A, Bagińska J, Łapińska-Antończuk J, Ławicki S, Kierklo A. Levels of selected matrix metalloproteinases, their inhibitors in saliva, and oral status in juvenile idiopathic arthritis patients vs. healthy controls. BioMed Research International. 2019; 2019: 1–9.

[9] LEKSELL E, ERNBERG M, MAGNUSSON B, HEDENBERG-MAGNUSSON B. Intraoral condition in children with juvenile idiopathic arthritis compared to controls. International Journal of Paediatric Dentistry. 2008; 18: 423–433.

[10] Kobus A, Kierklo A, Zalewska A, Kuźmiuk A, Szajda SD, Ławicki S, et al. Unstimulated salivary flow, pH, proteins and oral health in patients with juvenile idiopathic arthritis. BMC Oral Health. 2017; 17: 94.

[11] Cetrelli L, Bletsa A, Lundestad A, Gil EG, Fischer J, Halbig J, et al. Vitamin D, oral health, and disease charac-teristics in juvenile idiopathic arthritis: a multicenter cross-sectional study. BMC Oral Health. 2022; 22: 333.

[12] Gil EG, Skeie MS, Halbig J, Jönsson B, Lie SA, Rygg M, et al. Oral health-related quality of life in 4–16-year-olds with and without juvenile idiopathic arthritis. BMC Oral Health. 2022; 22: 387.

[13] Stoll ML, Kau CH, Waite PD, Cron RQ. Temporomandibular joint arthri-tis in juvenile idiopathic arthritis, now what? Pediatric Rheumatology. 2018; 16: 32.

[14] Pawlaczyk-Kamieńska A, Kulczyk T, Pawlaczyk-Wróblewska E, Borysewicz-Lewicka M, Niedziela M. Limited mandibular movements as a consequence of unilateral or asymmetrical temporomandibular joint involvement in juvenile idiopathic arthritis patients. Journal of Clinical Medicine. 2020; 9: 2576.

[15] Scolozzi P, Rabufetti A, Hanquinet S, Hofer M, Courvoisier DS, Antonarakis GS. A clinical and MRI retrospective cohort study of patients with juvenile idiopathic arthritis (JIA) to determine if initial temporomandibular joint (TMJ) examination findings are associated with severity of TMJ arthritis. Journal of Cranio-Maxillofacial Surgery. 2022; 50: 328–335.

[16] Pirttiniemi P, Peltomaki T, Muller L, Luder HU. Abnormal mandibular growth and the condylar cartilage. The European Journal of Orthodontics. 2009; 31: 1–11.

[17] Kapila YL. Oral health’s inextricable connection to systemic health: special populations bring to bear multimodal relationships and factors connecting periodontal disease to systemic diseases and conditions. Periodontology. 2021; 87: 11–16.

[18] Yang B, Pang X, Li Z, Chen Z, Wang Y. Immunomodulation in the treatment of periodontitis: progress and perspectives. Frontiers in Immunology. 2021; 12: 781378.

[19] Skeie MS, Gil EG, Cetrelli L, Rosén A, Fischer J, Åstrøm AN, et al. Oral health in children and adolescents with juvenile idiopathic arthritis—a systematic review and meta-analysis. BMC Oral Health. 2019; 19: 285.

[20] Savioli C, Silva CAA, Lin HC, Campos LMMA, Prado EFBG, Siqueira JTT. Dental and facial characteristics of patients with juvenile idiopathic arthritis. Revista do Hospital das Clinicas. 2004; 59: 93–98.

[21] Grevich S, Lee P, Leroux B, Ringold S, Darveau R, Henstorf G, et al. Oral health and plaque microbial profile in juvenile idiopathic arthritis. Pediatric Rheumatology. 2019; 17: 81.

[22] Merle CL, Hoffmann R, Schmickler J, Rühlmann M, Challakh N, Haak R, et al. Comprehensive assessment of orofacial health and disease related parameters in adolescents with juvenile idiopathic arthritis—a cross-sectional study. Journal of Clinical Medicine. 2020; 9: 513

[23] Miranda LA, Fischer RG, Sztajnbok FR, Figueredo CMS, Gustafsson A. Periodontal conditions in patients with juvenile idiopathic arthritis. Journal of Clinical Periodontology. 2003; 30: 969–974.

[24] Barnes MG, Grom AA, Thompson SD, Griffin TA, Luyrink LK, Colbert RA, et al. Biologic similarities based on age at onset in oligoarticular and polyarticular subtypes of juvenile idiopathic arthritis. Arthritis & Rheumatism. 2010; 62: 3249–3258.

[25] Hu Z, Jiang K, Frank MB, Chen Y, Jarvis JN. Complexity and specificity of the neutrophil transcriptomes in juvenile idiopathic arthritis. Scientific Reports. 2016; 6: 27453.

[26] Romero-Sánchez C, Malagón C, Vargas C, Fernanda Torres M, Moreno LC, Rodríguez C, et al. Porphyromonas gingivalis and IgG1 and IgG2 subclass antibodies in patients with juvenile idiopathic arthritis. Journal of Dentistry for Children. 2017; 84: 72–79.

[27] Welbury RR, Thomason JM, Fitzgerald JL, Steen IN, Marshall NJ, Foster HE. Increased prevalence of dental caries and poor oral hygiene in juvenile idiopathic arthritis. Rheumatology. 2003; 42: 1445–1451.

[28] Gil EG, Åstrøm AN, Lie SA, Rygg M, Fischer J, Rosén A, et al. Dental plaque and gingival bleeding in adolescents with juvenile idiopathic arthritis and controls: a multilevel analysis. Acta Odontologica Scandinavica. 2023; 81: 50–65.

[29] Ahmed N, Bloch-Zupan A, Murray KJ, Calvert M, Roberts GJ, Lucas VS. Oral health of children with juvenile idiopathic arthritis. The Journal of Rheumatology. 2004; 31: 1639–1643.

[30] Baniebrahimi G, Vahabi S, Rostamian A. Characteristics and relationship of periodontal disease with juvenile idiopathic and rheumatoid arthritis. Dental Research Journal. 2015; 12: 541.

[31] Stoustrup P, Resnick CM, Abramowicz S, Pedersen TK, Michelotti A, Küseler A, et al. Management of orofacial manifestations of juvenile idiopathic arthritis: interdisciplinary consensus-based recommendations. Arthritis & Rheumatolo-gy. 2023; 75: 4–14.

[32] Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Journal of Clinical Epidemiology. 2009; 62: 1006–1012.

[33] Greene JG, Vermillion JR. The simplified oral hygiene index. The Journal of the American Dental Association. 1964; 68: 7–13.

[34] Löe H. The gingival index, the plaque index and the retention index systems. Journal of Periodontology. 1967; 38: 610–616.

[35] Lindhe J, Socransky SS, Nyman S, Haffajee A, Westfelt E. “Critical prob-ing depths” in periodontal therapy. Journal of Clinical Periodontology. 1982; 9: 323–336.

[36] Stoloff S. NIH news: update from the national asthma education and prevention program 2002. Managed Care. 2003; 12: 5–10.

[37] Pi X, Liu C, Li Z, Guo H, Jiang H, Du M. A meta-analysis of oral health status of children with autism. The Journal of Clinical Pediatric Dentistry. 2020; 44: 1–7.

[38] Wang W, Wu C, Bai D, Chen H, Cai M, Gao J, et al. A meta-analysis of nursing students’ knowledge and attitudes about end-of-life care. Nurse Education Today. 2022; 119: 105570.

[39] Higgins JPT. Measuring inconsistency in meta-analyses. The BMJ. 2003; 327: 557–560.

[40] Esteves Lima RP, Cyrino RM, de Carvalho Dutra B, Oliveira da Silveira J, Martins CC, Miranda Cota LO, et al. Association between periodontitis and gestational diabetes mellitus: systematic review and meta-analysis. Journal of Periodontology. 2016; 87: 48–57.

[41] Pugliese C, van der Vinne RTA, Campos LMA, Guardieiro PR, Saviolli C, Bonfá E, et al. Juvenile idiopathic arthritis activity and function ability: deleterious effects in periodontal disease? Clinical Rheumatology. 2016; 35: 81–91.

[42] Reichert S, Machulla HKG, Fuchs C, John V, Schaller H, Stein J. Is there a relationship between juvenile idiopathic arthritis and periodontitis?Journal of Clinical Periodontology. 2006; 33: 317–323.

[43] Miranda LA, Braga F, Fischer RG, Sztajnbok FR, Figueredo CMS, Gustafsson A. Changes in periodontal and rheumatological conditions after 2 years in patients with juvenile idiopathic arthritis. Journal of Periodontology. 2006; 77: 1695–1700.

[44] Havemose-Poulsen A, Westergaard J, Stoltze K, Skjødt H, Danneskiold-Samsøe B, Locht H, et al. Periodontal and hematological characteristics associated with aggressive periodontitis, juvenile idiopathic arthritis, and rheumatoid arthritis. Journal of Periodontology. 2006; 77: 280–288.

[45] Feres de Melo AR, Ferreira de Souza A, de Oliveira Perestrelo B, Leite MF. Clinical oral and salivary parameters of children with juvenile idiopathic arthritis. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology. 2014; 117: 75–80.

[46] Santos D, Silva C, Silva M. Oral health and quality of life of children and adolescents with juvenile idiopathic arthritis according to their caregivers’ perceptions. Special Care in Dentistry. 2015; 35: 272–278.

[47] Silva C, Albuquerque P, Assis P, Lopes C, Anníbal H, Lago MCA, et al. Does flossing before or after brushing influence the reduction in the plaque index? A systematic review and meta‐analysis. International Journal of Dental Hygiene. 2022; 20: 18–25.

[48] Lange L, Thiele GM, McCracken C, Wang G, Ponder LA, Angeles-Han ST, et al. Symptoms of periodontitis and antibody responses to porphyromonas gingivalis in juvenile idiopathic arthritis. Pediatric Rheumatology. 2016; 14: 8.

[49] Zekre F, Cimaz R, Paul M, Giani T,Waeckel L,Berger AE, et al. Increased immunity against the oral germs porphyromonas gingivalis and prevotella intermedia in different categories of juvenile idiopathic arthritis. Biomedicines. 2022; 10: 2613.

[50] Pari A, Ilango P, Subbareddy V, Katamreddy V, Parthasarthy H. Gingival diseases in childhood—a review. Journal of Clinical and Diagnostic Research. 2014; 8: ZE01–ZE4.

[51] Kao KT, Denker M, Zacharin M, Wong SC. Pubertal abnormalities in adolescents with chronic disease. Best Practice & Research Clinical Endocrinology & Metabolism. 2019; 33: 101275.

[52] Silva TL, Braga FS, Sztajnbok FR, Souza AA, Silva F deB, Fischer RG, et al. Reduction in alveolar bone den-sity of patients with juvenile idiopathic arthritis. Revista Brasileira de Reumatologia. 2012; 52: 38–43.

[53] Chouinard A, Kaban LB, Peacock ZS. Acquired abnormalities of the temporomandibular joint. Oral and Maxillofacial Surgery Clinics of North America. 2018; 30: 83–96.

[54] STOUSTRUP P, KRISTENSEN KD, VERNA C, KÜSELER A, HERLIN T, PEDERSEN TK. Orofacial symptoms related to temporomandibular joint arthritis in juvenile idiopathic arthritis: smallest detectable difference in self-reported pain intensity. The Journal of Rheumatology. 2012; 39: 2352–2358.

[55] Leksell E, Ernberg M, Magnusson B, Hedenberg-Magnusson B. Orofacial pain and dysfunction in children with juve-nile idiopathic arthritis: a case-control study. Scandinavian Journal of Rheumatology. 2012; 41: 375–378.

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