Chew on This: The Afterbite of Temporomandibular Joint Involvement in Adults With Juvenile Idiopathic Arthritis
Bibliographic record
Abstract
Juvenile idiopathic arthritis (JIA) is a chronic autoimmune disease that continues into adulthood in approximately 50% of patients.1 Growth considerations are unique to pediatric-onset disease and can lead to permanent joint damage. JIA affecting the temporomandibular joint (TMJ) during childhood is particularly subject to irreversible damage if left undetected and untreated. The mandible takes approximately 18 years to complete its growth, longer than most other joints. Thus, assessment of the TMJ needs to consider growth and damage and should be evaluated into adulthood. TMJ arthritis has a reported incidence of 17% to 92% in the literature but more likely occurs 30% to 40% of the time.2,3 TMJ arthritis can occur in isolation or as part of any subtype of JIA.4,5 Clinical manifestations can include decreased mouth opening, pain with chewing, pain with yawning, asymmetrical mouth opening with deviation, TMJ muscular pain, obstructive sleep apnea, and dentofacial abnormalities such as microretrognathia.6 In the end stages, when the TMJ arthritis is quiescent and in remission, TMJ dysfunction may require jaw reconstruction or replacement, and patients often pursue cosmetic reconstruction.2 The TMJ is an elusive joint that is often clinically asymptomatic despite active disease, thus making early detection a challenge.7,8 Prebiologic studies have looked at the progression of TMJ arthritis with magnetic resonance imaging (MRI) studies, and found that over a 27-year period, bilateral TMJ arthritis progressed from 60% to 80% in patients with JIA, and over 50% had worsening of their existing TMJ arthritis.9 With use of biologics, this number is lower because there is better overall control of systemic disease, but possibly more severe disease on the outset, requiring biologic therapy.10 In contrast, Ringold et al surveyed adult rheumatologists internationally, who stated only 25% of their patients … Address correspondence to Dr. E.V. Rozenblyum, Clinical Assistant Professor, Department of Pediatrics, University of Toronto, Pediatric Rheumatologist, Unity Health–St. Michael’s Hospital, 30 Bond Street, 15-014CC, Toronto, ON M5B 1W8, Canada. Email: Evelyn.rozenblyum{at}unityhealth.to.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.013 | 0.003 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".