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BackgroundClassification criteria are often used to standardize the enrollment of patients (pts) in clinical studies. American College of Rheumatology (ACR) classification criteria for giant cell arteritis (GCA)1 are >25 years old. Advances in diagnosis and clinical understanding of GCA make their relevance to current studies questionable.ObjectivesTo compare inclusion criteria for the GiACTA (tocilizumab for GCA) study2 with 1990 ACR GCA classification criteria.MethodsPts were enrolled into GiACTA according to study inclusion criteria and were evaluated as to whether they met the 1990 ACR classification criteria (Table). Data are from a live database.ResultsOf the 251 pts enrolled into GiACTA, 198 (79%) pts met the 1990 ACR classification criteria. The 53 pts who did not fulfill ACR criteria were eligible for GiACTA based on cross-sectional imaging studies and/or polymyalgia rheumatica (PMR) symptoms. In total, 156 (62%) pts had positive temporal artery biopsies (TAB); of these, 24 also had positive imaging findings. The remaining 95 (38%) pts had no TAB or negative TAB; diagnosis of GCA was confirmed by positive findings from large-vessel imaging studies. Positron emission tomography (PET), often coupled with computed tomography (CT), was important in diagnosis. Positive PET/CT findings contributed to GCA diagnosis in 97 (39%) GiACTA pts. CT angiography and magnetic resonance angiography contributed to diagnosis in 14 (6%) and 8 (3%) pts, respectively. New-onset headache, the only GCA symptom in the ACR criteria, was absent in 33% of GiACTA pts. However, other symptoms that often accompany GCA (PMR, scalp tenderness, jaw claudication, ischemia-related vision loss) were present in 62%, 36%, 34%, and 10% of pts, respectively.GiACTA Entry Criteria for the Classification of GCAACR Criteria for the Classification of Giant Cell (Temporal) ArteritisaAge ≥50 yAge at disease onset ≥50 yHistory of ESR ≥50 mm/h (or CRP ≥2.45 mg/dL if ESR unavailable)Elevated ESR ≥50 mm/hAt least one of the following: –Unequivocal cranial symptoms of GCA (new-onset localized headache, scalp or temporal artery tenderness or decreased pulsation, ischemia-related vision loss, or otherwise unexplained mouth or jaw pain on mastication)–Unequivocal symptoms of PMR, defined as shoulder and/or hip girdle pain associated with inflammatory stiffnessNew-onset headacheTemporal artery abnormality (tenderness to palpation or decreased pulsation)At least one of the following: –TAB revealing features of GCA–Evidence of large-vessel vasculitis by angiography or cross-sectional imaging study such as MRA, CTA, or PET-CTPositive TABCRP, C-reactive protein; CTA, computed tomography angiography; ESR, erythrocyte sedimentation rate; MRA, magnetic resonance angiography. aThe presence of ≥3 criteria classifies a patient as having GCA.ConclusionsThe 1990 ACR classification criteria for GCA require updating. Cross-sectional imaging, particularly PET/CT, now plays a major role in establishing the diagnosis of GCA. Symptoms in addition to headache merit consideration as part of revised classification criteria.ReferencesArthritis Rheum 1990;33:1122.Int J Rheumatol 2013;2013:912562. doi: 10.1155/2013/912562.Disclosure of InterestK. Tuckwell Shareholder of: Roche, Employee of: Roche Products Ltd., N. Collinson Shareholder of: Roche, Employee of: Roche Products Ltd., M. Klearman Shareholder of: Roche, Employee of: Genentech, S. Dimonaco Employee of: Roche Products Ltd., J. Stone Grant/research support from: Roche, Genentech, Consultant for: Roche, Genentech

BackgroundMastication requires a high degree of coordination between jaw and neck muscles. The spino-trigeminal system supports the hypothesis that the presence of pain in one of these two regions could affect the motor behaviour of the other. While experimental evidences showed that patients with temporomandibular disorders display electromyographic alterations of the neck flexor and extensor muscle (Armijo-Olivo and Magee, 2013), alterations of the jaw muscles in patients with neck pain have not been investigated yet.ObjectivesTo investigate precision, accuracy and electromyographic activity of jaw muscles contraction during a unilateral bite task in subjects with neck pain.MethodsTen subjects with chronic neck pain and an age and gender-matched sample of healthy individuals volunteered for this study. The maximal voluntary bite force (MVC) was measured with a flexible force transducer positioned between the first molar teeth and used to set up a biting task requiring the subjects to match 4 targets (10, 30, 50 and 70%MVC) displayed on a computer monitor. Electromyographic (EMG) signals of the masseter and anterior temporalis muscles were recorded bilaterally. The subject's force performance was measured using error indices from the reference target like the Mean Distance (MD), Offset Error (OE) and the Standard Deviation (SD) of the delivered force. The Root Mean Square (RMS) of the electromyogram was calculated to detect differences in muscular activity. Between-group differences of the force indices (MD, OE, SD) and EMG activity (RMS) were assessed through Kruskal-Wallis test significance level was set to 0.05.ResultsThere were no significant between-group differences in force production for MD (H =0.38, P=0.5), OE (H =1.81, P=0.2) and SD (H =0.26, P=0.6). A significant difference in electromyographic activity was however detected for the masseter muscle (H =7.19, P=0.007, please refer to Figure) but not for temporalis (H =3.82, P=0.05).ConclusionsThis study demonstrates that patients with neck pain present higher masticatory muscle activity during a unilateral biting task. Our results support the strong functional relationship between temporomandibular and neck regions and invite to consider, also in clinical setting, the possibility that a disorder affecting one region can have consequences on the functionality of the other. In fact, even though the motor output was comparable between groups, subjects with neck pain displayed higher RMS activity of masseter muscle to deliver the same force.ReferencesArmijo-Olivo S, Magee D. Cervical musculoskeletal impairments and temporomandibular disorders. J Oral Maxillofac Res. 2013;3:e4.Disclosure of InterestNone declared

Background Temporomandibular joint disorders are common and lead to functional disability not only in temporomandibular joint but also in teeth, soft tissues and components of mastication. Patients with temporomandibular joint (TMJ) disorders report symptoms which include jaw and neck pain, headache and clicking or grating within the joint. Pharmacotherapy, physical therapy modalities, injection and exercise are all used for the treatment of TMJ disorders however no therapies have been shown to be uniquely superior for the treatment of pain or oral dysfunction in this chronic syndrome. Objectives The aim of this study was to evaluate the comparative effects of physical therapy and injection therapy along with the exercises in a group of patients with TMJ disorders. Methods Fourty nine patients with a mean age 37.57±15.14 years were recruited to the study. Patients were evaluated for complaints and clinical findings and then randomly allocated to three treatment groups. All patients got education and learned TMJ exercises to perform as home exercise program. The patients in the first group (n=17) received pharmacotherapy (non-steroidal anti-inflammatory drugs for a duration of 10 days with anti-inflammatory doses), the second group (n=15) received physical therapy comprising superficial local heat and TENS for 10 sessions; the third group (n=17) received hyaluronic acid injection to TMJ. The main outcome measures were pain at rest and movement of jaw assessed by VAS; and mouth opening distance. Oral health impact profile (OHIP-14) was used in all patients to assess people’s perceptions of the social impact of oral disorders on their well-being. All the measurements were performed at baseline, at the end of therapies, one month and three months after therapies. Results Fourteen men and 35 women were completed the study. All patients reported to perform their home exercise program twice a day. Pain by VAS in rest and movement of jaw decreased in all patient groups (5.9±1.4 vs 5.6±1.9 vs 6.2±2.2; 1.1±0.9 vs 1.4±1.1 vs 2.5±1.6 respectively) but the most significant improvement was observed in the injection group than in other groups at first and third months (p<0.05). The improvement in mouth opening distances and well being scores were similar between the groups after first and third months (p>0.05). Conclusions Our results indicated that all of the treatments including pharmacotherapy, physiotherapy, hyaluronic acid injection therapy improved the patients’ pain and functional status at the end of the therapies but hyaluronic acid injection treatment to TMJ were found to be more efficacious and long lasting in regard to pain, than in other therapies. Further studies are needed to confirm our results in larger groups of patients suffering from TMJ disorders. Disclosure of Interest None Declared

Background The most common causes of aortitis are the large-vessel vasculitis, although it also is associated with several other rheumatologic diseases. Giant cell arteritis (GCA) is the most common form of large vessel vasculitis (1). Because aortic inflammation has no symptoms until complications arise, aorta has been believed to be uncommon target of the disease. However, aortic involvement has been estimated to occur in up to 18% with GCA, but some studies marks than in early histological proven GCA any degree of thickening of the abdominal aorta may be found in up to 27% of patients (2). Objectives To describe the presence of isolated aortitis as a presentation of GCA without typical clinical symptoms. Methods We included all the patients diagnosed of CGA in our hospital from 1991 to 2011, according to the American College of Rheumatology (ACR) classification criteria. Statistical analysis was performed using the SSPS vs. 15.0. Results Among the 174 patients with GCA, 124 were women (70.9%) and 50 men (29.1%). Mean age at diagnosis was 76 years (51-92). Typical symptoms at presentation were headache in 150 (86.2%), intermittent claudication of the muscles of mastication in 93 patients (53.4%), constitutional syndrome in 84 (48.3%), polymyalgia rheumatic syndrome in 74 (42.5%), fever in 38 (21.8%), permanent visual loss in 51 (29.3%), and amaurosis fugax in 25 (14.4%). Temporal artery biopsy was performed in 162 patients (93%), with intimal hyperplasia in 94 (54%), inflammatory infiltrate in 91 (52.3%), presence of giant cells in 80 (46%), and internal elastic lamina disruption in 62 (35.6%). Artery biopsy was normal in 9 patients (5.2%). Most frequently, the combination of typical clinical symptoms in the setting of an aged patient triggered the suspicion of GCA. However, in three patients the only clinical manifestations were weight loss and asthenia. In this clinical setting a thoracic-abdominal scan was performed with the suspicion of disseminated neoplasm and a diagnosis of isolated aortitis was made. One of the patients had floating thrombi attached to the wall of the aorta, probably secondary to aortitis. In front of the presence of an elevated acute reactants and an aortitis, a temporal artery biopsy was carried out, demonstrating the presence of a GCA. In this subset of patients, mean age was 74.3 years old (70-77), and raised erythrocyte sedimentation rate (mean 97) and anemia (mean 83 gr/l) was present in the three. Good evolution of the aortitis was seen in the three patients. Conclusions Aortic involvement in the acute phase of GCA is probably also more frequent than estimated because it is symptomatic in only a minority of patients. The presence of isolated aortitis should rule out a diagnosis of GCA, even though the absence of typical symptoms. References Martínez-Valle F, Solans-Laqué R., Bosch-Gil J, Vilardell-Tarrés M. Aortic involvement in giant cell arteritis. Autoimm Rev 2010 May;9(7):521-4. Agard C., Barrier J, Dupas B, Ponge T, Mahr A, et al. Aortic involvement in recent-onset giant cell (temporal) arteritis: a case-control prospective study using helical aortic computed tomodensitometric scan. Arthritis and Rheum 2008. 59(5): 670-6. Disclosure of Interest None Declared

Background Temporomandibular joint (TMJ) inflammation in patients with juvenile idiopathic arthritis (JIA) may interfere with optimal joint and muscular function. Orofacial symptoms are common clinical findings in relation to TMJ arthritis in adolescence. Knowledge about their clinical manifestation is important for TMJ arthritis diagnosis, treatment choice and outcome evaluation. Objectives The aim of this prospective study was to evaluate and describe the frequency, the main complaints and the localisation of TMJ arthritis-related orofacial symptoms. Additionally, the smallest detectable differences for minimal, average and maximal pain were estimated. Methods Thirty-three patients with JIA and arthritis-related orofacial symptoms in relation to 55 affected TMJs were included in the present questionnaire study (mean age 14.11 years). All patient were asked to fill out an examination-questionnaire concerning: duration, frequency, localisation and characterise their orofacial pain. Duplicate visual analogue scale (VAS) assessments concerning average, maximal and minimal orofacial pain-intensity were carried out 45 minutes apart. Results The majority of the patients were girls (31/34, 94%). Orofacial symptoms were seen most often during mastication and maximal mouth opening procedures. Persistent orofacial symptoms were rare. The TMJ area in combination with the masseter muscle region was the orofacial region where symptoms were most common. The smallest detectable differences for minimal, average and maximal pain were between 11 and 14 mm on a VAS. Conclusions This study offers new knowledge about TMJ arthritis-related orofacial symptoms that may aid diagnosis and clinical decision-making. The findings also allow us to suggest that TMJ arthritis-related orofacial symptoms should be understood as a product of the primary TMJ inflammation in combination with secondary myogenic and functional issues. Disclosure of Interest None Declared

Background Rheumatoid arthritis (RA) can affect any synovial joint. Unlike the hand, ever so valued in the physical examination of patients with RA, the joints in the area of the jaw and neck may also be affected in this disease and have their involvement usually underdiagnosed. There are few studies evaluating the incidence of orofacial alteration in the examination as well as the correlation between bite force (BF) and clinical and functional parameters in these patients. Objectives The aim of our study was to compare the orofacial evaluation of women with RA with a control group, correlating orofacial function parameters with clinical disease activity in RA patients and hand strength in RA patients and control subjects. Methods We conducted a cross-sectional study with 150 women: half of them (n=75) were RA patients and the others (n=75) consisted the control group. The two groups were paired by age. All individuals we evaluated in relation to: pain duringmandibular function; TMJ pain at rest; TMJ sounds; tiredness during mastication; complaint of changes in the occlusion pattern; vertical range of motion of the mandible; reports chewing fatigue;reports of bruxism; reports of feeling morning stiffness in the TMJ; pain in TMJ lateral pole; BF of three regions: incisors and molars; assess the pinch (key,tip, palmar) and grip strenght; DASH and HAQ questionnaires; DAS 28 and OHIP14 questionnaire (Oral Health Impact Profile). Results The mean age (±SD) of the RA group was 49.2 years (±9.4) and 47.4 (±10.0) of the control group (p=0.244). Duration of disease of the RA group was 12.66 years (±9,32). Only 2 (2.6%) patients in the RA group reported TMJ pain at rest and during function; it was observed in RA and control group respectively: sounds in 36 (48.0%), 11 (14.6%); mouth opening in 44.13 mm (± 6.95), 46.48 mm (± 6.09); chewing fatigue in12 (16.0%), 5 (6.6%); pain inlateral pole TMJ in 29 (38.6%), 6 (8%); sleep bruxism in 21 (28.0%), 19 (25.3%); wakefulness bruxism in 13 (17.3%), 13 (17.3%); changes in the occlusion pattern in 7 (9.3%),1 (1.3%). The mean BF values of the RA and control groups in the three regions (incisors, right molars and left molars) were respectively: Incisor 92.8N (± 53.8), 126.5N (± 59.8), p=0.002; right molars 154.7N (± 104.4), 252.7N (± 149.7), p<0.001; 170.3N left molars (± 121.0), 249.2N (± 155.7), p=0.002. p<0.001; In RA group, there was no correlation between the BF and OHIP-14, DASH and DAS-28,was correlation and incisor force and key pinch (r=0.317,p=0.006), palmar pinch (r=0,317,p=0.006), and HAQ (r =- 0,488, p=0.0001);molar force and key pinch (r=0,275,p=0.032) and HAQ (r=-0.256,p=0.045). Conclusions We found women with RA have lower BF and more signs and symptoms in the orofacial region when compared to healthy ones. There was correlation between the BF and functional parametersand pinch strength in these patients. Disclosure of Interest None Declared

Introduction: Despite a decrease in the number of adult edentulous individuals, the number of individuals who lose all their teeth and need complete dentures is on the increase. One of the most important principles of fabrication of complete dentures is to achieve patient satisfaction. In the present cross-sectional study, the gradual trend of patients' satisfaction with complete dentures was evaluated. Materials and methods: In a descriptive study with pre- and post-test design, carried out in 2013 on 30 patients referring to the Department of Prosthodontics, Tabriz Faulty of Dentistry, the patients' gradual satisfaction with complete dentures was evaluated one week and 2 months after delivery of dentures in 7 aspects, including masticatory efficacy, satisfaction with mastication of soft and hard foods, ease of cleaning of dentures, perception of food tastes, articulation and overall satisfaction. A researcher-made questionnaire was used, whose validity and reliability had been confirmed. The questionnaire determined the patients' satisfaction by a value ranging from zero to 10. Repeated-measures ANOVA was used to analyze data. Results: Thirty subjects were included in the present study. Changes in patients' satisfaction from the first week to the second month were significant in terms of mastication of soft and hard food items, ease of cleaning the dentures, articulation and overall satisfaction (P=0.022, P=0.023, P=0.018, P=0.001 and P=0.001, respectively). Changes in patients' satisfaction with masticatory efficacy and perception of food tastes from the first week to the second month were not statistically significant (P=0.092 and P=0.144). Conclusion: In the present study, patients' satisfaction increased in all the aspects. Although such increase in satisfaction with mastication of soft and hard foods, ease of cleaning the dentures, articulation and overall satisfaction was statistically significant, it was not significant in relation to perception of food tastes and masticatory efficacy.

Objectives: The presence of signs and symptoms of craniocervical dysfunction areincreasingly recognized in patients with temporomandibular disorders. This study aimsto establish the role of cervical dysfunction in myofascial pain.Methods: A total of 20 patients of myofascial pain with cervical dysfunction and 20 patientswith only myofascial pain were considered for the study (Group 1 and Group 2). Followinghistory of tenderness of muscles of mastication, stiff ness of neck muscles, limitation of mouthopening, temporomandibular joint tenderness and assessment of Visual Analog Scale (VAS),patients were examined for muscles of mastication, maximum comfortable mouth opening,temporomandibular joint tenderness, neck muscles and cervical range of motion. Patientsin - Group 1 were treated with physiotherapy to the cervical muscles and Group 2 patientswere given physiotherapy to the muscles of mastication. Patients were assessed for the relief ofsigns and symptoms of myofascial pain post treatment and every month for 3 months.Results: Both the groups responded equally well to physiotherapy with reduction inVAS, number of tender muscles and increased maximum comfortable mouth openingpost treatment and during the follow-up.Interpretation and Conclusions: Physiotherapy to the neck muscles brought aboutsignifi cant improvement in the signs and symptoms of myofascial pain and hence cervicaldysfunction could be one of the extrinsic etiologies for myofascial pain.

The presence of attachment loss in the furcation is one of the most serious anatomical sequela of periodontitis. Furcations are not accessible for professional debridement, since their entrance is small compared with the size of periodontal instruments, and they present with ridges, convexities, and concavities that make it difficult for clinicians to debride effectively. In cases, where advanced defects are seen, treatment may involve combining, endodontics, periodontics, and prosthodontics so that the teeth are retained in whole or in part. Advances in dentistry have provided the opportunity for clinicians to provide patients with the option of retaining their teeth in the long-term. Such teeth can be useful as independent units of mastication or as abutments in simple fixed bridges. This article presents three cases of mandibular molar furcation involvement, which were treated by three different therapeutic modalities. Clinical Relevance to Interdisciplinary Dentistry Management of a furcation involved tooth requires an inter-disciplinary approach to enhance the long-term prognosis. The success rate of resective procedures is high if the case selection, treatment plan, treatment sequence are well-executed. The importance of inter-disciplinary approach is highlighted by the success of these clinical scenarios.