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Terapias injetáveis das disfunções temporomandibulares em medicina dentária : toxina botulínica e ácido hialurónico
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Authors
Abstract(s)
A Disfunção Temporomandibular e a Dor Orofacial são dois grandes desafios para o médico dentista, este facto prende-se com a dificuldade em saber o fator etiofisiopatológico por detrás da patologia e dos sintomas, assim como fazer um diagnóstico diferencial e aplicar um tratamento eficaz. A abordagem terapêutica destes doentes é por norma Multidisciplinar, podendo ser mais ou menos conservadora, e mais ou menos invasiva, tal vai depender das estruturas envolvidas, bem como da influência dos eventuais transtornos psicológicos
presentes. As terapias injetáveis na Disfunção Temporomandibular, tem-se revelado uma modalidade de tratamento com resultados promissores.
A terapêutica injetável de toxina botulínica (TB) atualmente desempenha um papel fundamental na gestão de muitas doenças orofaciais e dentárias, podendo desencadear um efeito analgésico e relaxante muscular nas perturbações neuromusculares e dor músculoesquelética.
Estas caraterísticas tornaram a TB uma terapia de interesse para as DTM. Um outro fármaco injetável usado em Medicina Dentária é o ácido hialurónico, útil não apenas em tratamentos periodontais como nas papilas interdentais e estéticos, mas também na articulação temporomandibular para lubrificação e diminuição do desgaste articular, tornando-o um agente terapêutico nas DTM.
O objetivo desta monografia consistiu numa revisão bibliográfica da literatura científica sobre as terapias injetáveis para tratar problemas na ATM, nomeadamente injeções intramusculares da toxina botulínica e infiltrações intra-articulares do ácido hialurónico.
Nesta revisão da literatura pretendeu realçar-se as características destes injetáveis de modo a evidenciar, à luz da literatura atual, a sua efetividade e segurança e se são alternativas viáveis a outros tratamentos, visto tratar-se de técnicas clínicas minimamente invasivas e que tornam desnecessário um tratamento cirúrgico.
A toxina botulínica e o ácido hialurónico estão a ganhar grande interesse no momento atual; no entanto apesar dos resultados positivos, existem ainda questões para lidar com este tipo de tratamentos devido à variedade de tipos de disfunções temporomandibulares e a sua etiologia multifatorial, pelo que se sugere a realização de mais estudos controlados sobre a terapêutica injetável com estes fármacos.
Temporomandibular Dysfunction and Orofacial Pain are two major challenges for the dentist, this fact is related to the difficulty in knowing the etiopathological factor behind the pathology and symptoms, as well as making a differential diagnosis and applying an effective treatment. The therapeutic approach for these patients is usually multidisciplinary, and can be more or less conservative, and more or less invasive, depending on the structures involved, as well as the influence of any psychological disorders present. Injectable therapies in temporomandibular dysfunction have proven to be a promising treatment modality. Injectable botulinum toxin (TB) therapy currently plays a key role in the management of many orofacial and dental diseases, and can trigger an analgesic and muscle relaxant effect in neuromuscular disorders and musculoskeletal pain. These characteristics have made TB a therapy of interest for TMD. Another injectable drug used in dentistry is hyaluronic acid, useful not only in periodontal treatments such as interdental papillae and aesthetics, but also in the temporomandibular joint for lubrication and reduction of joint wear, making it a therapeutic agent in TMD. The aim of this monograph was a bibliographic review of the scientific literature on injectable therapies to treat TMJ problems, namely intramuscular injections of botulinum toxin and intra-articular infiltrations of hyaluronic acid. This literature review aimed to highlight the characteristics of these injectables in order to show, in the light of the current literature, their effectiveness and safety, and whether they are viable alternatives to other treatments, since they are minimally invasive clinical techniques that make surgical treatment unnecessary. Botulinum toxin and hyaluronic acid are gaining great interest at the present time; however, despite the positive results, there are still issues to deal with this type of treatments due to the variety of types of temporomandibular dysfunctions and their multifactorial etiology, so it is suggested that further controlled studies on the injectable therapy with these drugs should be carried out.
Temporomandibular Dysfunction and Orofacial Pain are two major challenges for the dentist, this fact is related to the difficulty in knowing the etiopathological factor behind the pathology and symptoms, as well as making a differential diagnosis and applying an effective treatment. The therapeutic approach for these patients is usually multidisciplinary, and can be more or less conservative, and more or less invasive, depending on the structures involved, as well as the influence of any psychological disorders present. Injectable therapies in temporomandibular dysfunction have proven to be a promising treatment modality. Injectable botulinum toxin (TB) therapy currently plays a key role in the management of many orofacial and dental diseases, and can trigger an analgesic and muscle relaxant effect in neuromuscular disorders and musculoskeletal pain. These characteristics have made TB a therapy of interest for TMD. Another injectable drug used in dentistry is hyaluronic acid, useful not only in periodontal treatments such as interdental papillae and aesthetics, but also in the temporomandibular joint for lubrication and reduction of joint wear, making it a therapeutic agent in TMD. The aim of this monograph was a bibliographic review of the scientific literature on injectable therapies to treat TMJ problems, namely intramuscular injections of botulinum toxin and intra-articular infiltrations of hyaluronic acid. This literature review aimed to highlight the characteristics of these injectables in order to show, in the light of the current literature, their effectiveness and safety, and whether they are viable alternatives to other treatments, since they are minimally invasive clinical techniques that make surgical treatment unnecessary. Botulinum toxin and hyaluronic acid are gaining great interest at the present time; however, despite the positive results, there are still issues to deal with this type of treatments due to the variety of types of temporomandibular dysfunctions and their multifactorial etiology, so it is suggested that further controlled studies on the injectable therapy with these drugs should be carried out.
Description
Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas Moniz
Keywords
Articulação temporomandibular Disfunções temporomandibulares Toxina botulínica Ácido hialurónico