Avaliação de tratamentos conservadores da disfunção temporomandibular na dor, qualidade de vida, sintomas depressivos e ansiedade: ensaio clínico randomizado

Abstract

Introduction: temporomandibular disorder (TMD) is understood as a set of clinical problems involving the masticatory muscles, the temporomandibular joint (TMJ) and associated structures, with several forms of conservative treatments. Objective: to evaluate the influence of conservative treatments craniopuncture, laser acupuncture therapy, occlusal plaque, counseling and physiotherapy on pain, anxiety and depression symptoms and quality of life in patients with TMD. Material and methods: diagnosed through the Diagnostic Criteria for TMD (DC/TMD), seventy eight (78) patients with TMD were divided into five treatment groups: laser acupuncture therapy (LA) (n=13), craniopuncture (CR) (n=13), occlusal plaque (PO) (n=17), counseling (AC) (n=15) and physiotherapy (FT) (n=20). Thus, they were evaluated before starting therapy, after one month and three months of treatment using the DC/TMD and regarding anxiety, depression, quality of life and pain, using the questionnaires, Beck's Anxiety Inventory (BAI), Beck's Depression Inventory (BDI), World Health Organization Quality of Life Questionnaire (WHOQOL), Impact of Oral Health on Quality of Life (OHIP-14) and Visual Analogue Scale (VAS). The data obtained were analyzed by SPSS (Statistical Package for the Social Science) 22.0 with the Friedman test between times and Wilcoxon post-test, as well as the Kruskal Wallis test between groups with Mann Whitney post-test. Results: It has been observed a statistically significant difference between the groups in the assessment of pain by the VAS at one month (p=0,005) and three months of treatment (p=0,002), in the assessment of anxiety symptoms by the BAI one month after the therapy (p=0,000), on the impact of oral health on quality of life by OHIP-14 with three months of treatment (p=0,001), with more favorable results for the groups treated with PO and FT. It has been noticed a significant improvement over time in pain by VAS for PO (p=0,003), AC (p=0,007), CR (p=0,043) and FT (p=0,000); in anxiety symptoms by BAI for PO (p=0,000); in the depressive symptoms by BDI for PO (p=0,014), AC (p=0,046) and FT (p=0,006); on quality of life by WHOQOL-general for PO (p=0,035) and FT (p=0,004) and on the impact of oral health on quality of life by OHIP-14 for PO (p=0,000), AC (p=0,031) and FT (p=0,001). Conclusion: in general, PO and FT stood out in relation to the other groups in most parameters, but most groups improved over time in some parameter evaluated. Therefore, the use of the evaluated conservative therapies is recommended in the treatment of TMD.