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Efeitos de um programa de terapia manual e exercícios terapêutico associados a um programa de exercício aeróbio de 6 semanas na disfunção temporomandibular muscular
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Abstract(s)
Introdução: A disfunção temporomandibular (DTM) é uma condição que pode afetar os músculos mastigatórios e conduzir ao aparecimento de dor e à diminuição da qualidade de vida. O objetivo deste estudo é a comparação dos efeitos de um programa de terapia manual e exercícios terapêuticos com um programa de terapia manual e exercícios terapêutico associado a exercício aeróbio de 6 semanas, na intensidade da dor, na amplitude de abertura oral, no limiar de tolerância de dor à pressão, na ansiedade e na qualidade de vida da saúde oral em sujeitos com DTM muscular.
Metodologia: Ensaio clínico controlado, com 18 participantes diagnosticados através do Diagnostic Criteria for Temporomandibular Disorders (DC-TMD) com DTM muscular e divididos em dois grupos: G1 (26,8±7,92) com 11 participantes que realizou um programa de terapia manual e exercícios terapêuticos (uma vez por semana durante 30 minutos) e G2 (26,9±6,62) , com 7 participantes que realizou o mesmo programa de G1 (uma vez por semana durante 30 minutos) associado a exercício aeróbio de intensidade moderada (duas vezes por semana durante 30 minutos). Foi avaliada a intensidade da dor através da escala numérica da dor (NPRS), o limiar de tolerância de dor à pressão (PPT) através do algómetro, a amplitude de abertura oral máxima confortável (AMC) e forçada (AMF) através do paquímetro, a ansiedade através da Generalized Anxiety Disorder (GAD-7) e qualidade de vida relacionada com a saúde oral (QdRVSO) através da Oral Health Impact Profile (OHIP-14). O primeiro momento de avaliação (T1) foi realizado antes de se iniciar a intervenção e o segundo momento de avaliação (T2) 48h após o término do programa de 6 semanas.
Resultados: Houve uma diminuição significativa da NPRS, um aumento significativo da AMC, AMF e da OHIP-14 em G1 e G2 entre T1 e T2. No PPT verificou-se um aumento significativo no masséter direito (MD) e temporal esquerdo (TE) no G1 e G2, e no masséter esquerdo (ME) e temporal direito (TD) apenas no G2. G1 e G2 apresentaram diferenças significativas no aumento do PPT, com o G2 a obter melhores resultados. Não se verificaram diferenças significativas na GAD-7.
Conclusão: O programa de terapia manual e exercícios terapêuticos e o programa de terapia manual e exercícios terapêutico associado a exercício aeróbio conduziram a uma diminuição da dor, aumento de amplitude oral e melhoria da qualidade de vida ao fim de 6 semanas de intervenção. O programa de terapia manual e exercícios terapêutico associado a exercício aeróbio promoveu um maior aumento do limiar de tolerância de dor à pressão.
Introduction: Temporomandibular disorders (TMD) is a condition that can affect the masticatory muscles, leading to pain and reduced quality of life. The aim of this study is to compare the effects of a manual therapy and therapeutic exercise program with a similar program combined with aerobic exercise over six weeks on pain intensity, maximum mouth opening, pressure pain threshold, anxiety, and oral health-related quality of life in individuals with muscular TMD. Methodology: This is a controlled clinical trial with 18 participants diagnosed with muscular TMD according to the Diagnostic Criteria for Temporomandibular Disorders (DC-TMD). Participants were divided into two groups: G1 (26.8±7.92 years old), consisting of 11 participants who underwent a manual therapy and therapeutic exercise program (once a week for 30 minutes), and G2 (26.9±6.62 years old), consisting of 7 participants who underwent the same program as G1 (once a week for 30 minutes) combined with moderate-intensity aerobic exercise (twice a week for 30 minutes). Pain intensity was assessed using the Numeric Pain Rating Scale (NPRS), pressure pain threshold (PPT) using an algometer, maximum comfortable (AMC) and forced (AMF) mouth opening using a calliper, anxiety using the Generalized Anxiety Disorder-7 (GAD-7), and oral health-related quality of life (OHRQoL) using the Oral Health Impact Profile-14 (OHIP-14). The first assessment (T1) was conducted before the intervention, and the second assessment (T2) was performed 48 hours after completing the six-week program. Results: There was a significant decrease in NPRS scores and a significant increase in AMC, AMF, and OHIP-14 scores in both G1 and G2 between T1 and T2. Regarding PPT, a significant increase was observed in the right masseter (RM) and left temporalis (LT) in both groups, while the left masseter (LM) and right temporalis (RT) showed a significant increase only in G2. Both G1 and G2 exhibited significant differences in PPT improvement, with G2 achieving better results. No significant differences were found in GAD-7 scores. Conclusion: Both the manual therapy and therapeutic exercise program and the manual therapy and therapeutic exercise program combined with aerobic exercise led to a reduction in pain, an increase in mouth opening amplitude, and an improvement in quality of life after six weeks of intervention. The program that included aerobic exercise promoted a greater increase in the pressure pain threshold, suggesting an additional benefit of this combined approach.
Introduction: Temporomandibular disorders (TMD) is a condition that can affect the masticatory muscles, leading to pain and reduced quality of life. The aim of this study is to compare the effects of a manual therapy and therapeutic exercise program with a similar program combined with aerobic exercise over six weeks on pain intensity, maximum mouth opening, pressure pain threshold, anxiety, and oral health-related quality of life in individuals with muscular TMD. Methodology: This is a controlled clinical trial with 18 participants diagnosed with muscular TMD according to the Diagnostic Criteria for Temporomandibular Disorders (DC-TMD). Participants were divided into two groups: G1 (26.8±7.92 years old), consisting of 11 participants who underwent a manual therapy and therapeutic exercise program (once a week for 30 minutes), and G2 (26.9±6.62 years old), consisting of 7 participants who underwent the same program as G1 (once a week for 30 minutes) combined with moderate-intensity aerobic exercise (twice a week for 30 minutes). Pain intensity was assessed using the Numeric Pain Rating Scale (NPRS), pressure pain threshold (PPT) using an algometer, maximum comfortable (AMC) and forced (AMF) mouth opening using a calliper, anxiety using the Generalized Anxiety Disorder-7 (GAD-7), and oral health-related quality of life (OHRQoL) using the Oral Health Impact Profile-14 (OHIP-14). The first assessment (T1) was conducted before the intervention, and the second assessment (T2) was performed 48 hours after completing the six-week program. Results: There was a significant decrease in NPRS scores and a significant increase in AMC, AMF, and OHIP-14 scores in both G1 and G2 between T1 and T2. Regarding PPT, a significant increase was observed in the right masseter (RM) and left temporalis (LT) in both groups, while the left masseter (LM) and right temporalis (RT) showed a significant increase only in G2. Both G1 and G2 exhibited significant differences in PPT improvement, with G2 achieving better results. No significant differences were found in GAD-7 scores. Conclusion: Both the manual therapy and therapeutic exercise program and the manual therapy and therapeutic exercise program combined with aerobic exercise led to a reduction in pain, an increase in mouth opening amplitude, and an improvement in quality of life after six weeks of intervention. The program that included aerobic exercise promoted a greater increase in the pressure pain threshold, suggesting an additional benefit of this combined approach.
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Keywords
Disfunção temporomandibular Dor Ansiedade Qualidade de vida relacionada com a saúde oral Fisioterapia Amplitude de abertura oral