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Efeito de um programa multimodal versus goteira oclusaL de 6 semanas na dor, abertura oral e qualidade de vida em adultos com disfunção temporomandibular (DTM) : um ensaio clínico controlado
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Abstract(s)
A disfunção temporomandibular (DTM) é uma condição de etiologia multifatorial que acomete a articulação temporomandibular (ATM), os músculos mastigatórios e estruturas associadas, impactando negativamente na qualidade de vida dos pacientes. Este estudo teve como objetivo avaliar e comparar o efeito de um programa multimodal (terapia manual combinada com exercícios terapêuticos) versus goteira oclusal, na modulação da dor, abertura oral e qualidade de vida de saúde oral (QdVRSO) no tratamento de adultos com DTM muscular com limitação da abertura oral durante 6 semanas. O ensaio clínico controlado incluiu 24 participantes com idades compreendidas entre os 18 e 50 anos, divididos em dois grupos experimentais: G1 (realizou um programa multimodal, uma vez por semana durante 30 minutos) e G2 (utilizou goteira oclusal diariamente, durante a noite). Os participantes foram avaliados em dois momentos, inicial e final, quanto à intensidade da dor, amplitude de abertura oral, limiar de tolerância de dor à pressão (PPT) e QdVRSO. Os resultados demonstraram que ambos os grupos obtiveram melhorias significativas na intensidade da dor, amplitude de abertura oral e QdVRSO, destacando a eficácia dessas abordagens conservadoras. O programa multimodal demonstrou superioridade no aumento da amplitude de abertura oral e na melhoria do PPT, enquanto a goteira oclusal apresentou maior eficácia na diminuição da intensidade da dor. A única diferença estatisticamente significativa entre os grupos foi observada no PPT, com melhorias significativas apenas no G1, o que pode indicar que o programa teve um maior contributo para a ativação das vias inibitórias descendentes de modulação da dor. Porém, os resultados demonstram que ambas as intervenções são válidas no tratamento de pacientes com DTM.
Temporomandibular Disorders (TMD) is a multifactorial condition affecting the temporomandibular joint (TMJ), masticatory muscles, and associated structures, negatively impacting patients' quality of life. This study aimed to evaluate and compare the effects of a multimodal program (manual therapy combined with therapeutic exercises) versus an occlusal splint on pain modulation, mouth opening, and oral health-related quality of life (OHRQoL) in the treatment of adults with muscular TMD and restricted mouth opening over a six-week period. A controlled clinical trial was conducted with 24 participants aged between 18 and 50 years, who were divided into two experimental groups: G1 (received a multimodal program once a week for 30 minutes) and G2 (used an occlusal splint nightly). Participants were assessed at two time points, baseline and post-intervention, for pain intensity, mouth opening range, pressure pain threshold (PPT), and OHRQoL. The results demonstrated significant improvements in pain intensity, mouth opening range, and OHRQoL in both groups, highlighting the efficacy of these conservative approaches. The multimodal program showed superior effectiveness in increasing mouth opening range and improving PPT, while the occlusal splint was more effective in reducing pain intensity. The only statistically significant difference between the groups was observed in PPT, with significant improvements exclusively in G1, suggesting that the multimodal program may contribute more to the activation of descending pain modulation pathways. However, the findings indicate that both interventions are valid treatment options for patients with TMD.
Temporomandibular Disorders (TMD) is a multifactorial condition affecting the temporomandibular joint (TMJ), masticatory muscles, and associated structures, negatively impacting patients' quality of life. This study aimed to evaluate and compare the effects of a multimodal program (manual therapy combined with therapeutic exercises) versus an occlusal splint on pain modulation, mouth opening, and oral health-related quality of life (OHRQoL) in the treatment of adults with muscular TMD and restricted mouth opening over a six-week period. A controlled clinical trial was conducted with 24 participants aged between 18 and 50 years, who were divided into two experimental groups: G1 (received a multimodal program once a week for 30 minutes) and G2 (used an occlusal splint nightly). Participants were assessed at two time points, baseline and post-intervention, for pain intensity, mouth opening range, pressure pain threshold (PPT), and OHRQoL. The results demonstrated significant improvements in pain intensity, mouth opening range, and OHRQoL in both groups, highlighting the efficacy of these conservative approaches. The multimodal program showed superior effectiveness in increasing mouth opening range and improving PPT, while the occlusal splint was more effective in reducing pain intensity. The only statistically significant difference between the groups was observed in PPT, with significant improvements exclusively in G1, suggesting that the multimodal program may contribute more to the activation of descending pain modulation pathways. However, the findings indicate that both interventions are valid treatment options for patients with TMD.
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Keywords
Disfunção temporomandibular Fisioterapia Goteira oclusal Modulação da dor Qualidade de vida relacionada com a saúde oral