Efeitos do tratamento da dor dos músculos mastigatórios com aparelho interoclusal ou toxina botulínica A: um ensaio clínico randomizado

Abstract

Bruxism is a motor behavior of multifactorial etiology considered as an activity of the masticatory muscles mediated by the central nervous system, which can occur duringsleep or wakefulness. The negative consequences related to this behavior can affect the quality of life of individuals in several ways. Although there are several clinical studies about different treatments for bruxism, there is still no consensus in the literature about the effectiveness of these treatments in relation to decreasing the patient's pain. The present dissertation was divided into three studies, the first study being a randomized clinical trial to evaluate the effectiveness of two therapies in the management of masticatory muscle pain in patients with probable bruxism. The second study was a prospective clinical study nested in the randomized clinical trial to assess the impact of pain on oral health-related quality of life. The third study was a prospective clinical study nested in the randomized clinical trial to assess craniocervical posture after treatment of muscle pain. Sixty patients were included in the study and randomized to receive treatment with an interocclusal device or botulinum toxin-A. The DC / TMD questionnaires and the OHIP-14 questionnaires were used to assess the outcomes, in addition to a radiograph of the lateral norm of the cervical spine to assess the cranio-cervical posture in 3 different periods: before treatment and after 3 and 6 months. It can be noted that there was a decrease in the chance of higher pain scores 3 and 6 months after the start of treatment (0.26 [0.12-0.55]; p <0.001), however, with no statistically significant difference between treatments (p = 0.414). No differences were found for OHIP-14 scores between treatments applied to patients (0.83 [0.38-1.80], p = 0.494) or between times in the same treatment group, with p = 0.09 for the botulinum toxin-A group and p = 0.1159 for the occlusal splint group. However, when analyzing the distribution of OHIP-14 scores, there was a decrease in the negative impact of quality of life related to oral health over the period evaluated, although without statistically significant differences. In addition, no statistically significant differences were detected in the evaluation of head posture (p = 0.9669) and in the evaluation of the kyphosis angle (p = 1.0321) between patients undergoing both therapies, in any evaluation period. Thus, the treatment of probable bruxism with an interocclusal device or botulinum toxin-A proved to be effective in reducing pain in the masticatory muscles after 3 and 6 months. It was also effective in changing the perception of quality of life related to oral health, with a reduction in the negative impact of the consequences of behavior on quality of life, in addition to the positive change in depressive, anxious and psychosomatic symptoms. However, there was no influence of treatments on cranio-cervical posture in the evaluation of kyphosis angle and head posture of the investigated patients. It can be concluded that the use of interocclusal devices or the application of botulinum toxin-A can be used to reduce pain and improve the quality of life of individuals with probable bruxism.