Eficácia da placa estabilizadora associada ao aconselhamento no tratamento da dor miofascial crônica e na melhora da qualidade de vida de pacientes com desordens temporomandibulares

Abstract

Temporomandibular disorders are a group of chronic painful conditions and are accompanied by a variety of clinical and emotional factors that negatively affect the quality of life of patients, which make diagnosis and treatment more complex. Within this context, the aim of this blind and placebo-controlled clinical trial was to evaluate the efficacy of stabilization splints associated with counseling to treat myofascial pain and improve quality of life of these patients. For this purpose, we used a sample of 37 women, aged between 20 and 55 years and diagnosed with myofascial pain determined by Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). The volunteers were randomly placed into two groups: an experimental group, which received stabilization occlusal splint therapy associated with counseling; and a control group that received sham occlusal intervention (non-occlusal appliance) associated with counseling. The therapeutic procedures were instituted for three months and conducted by the same therapist, blinded to the randomization process. The patients were assessed every two weeks for twelve weeks and the trial outcomes were investigated by an investigator blinded to the intervention received by patients. The primary outcome was the assessment of physical symptomatology by a monthly verification of intensity of spontaneous pain indicated by the Visual Analogue Scale (VAS). Secondary outcomes were the evaluation of the level of disability related to chronic pain and symptoms of depression and somatization using the RDC/TMD Axis II, which was applied before and after therapy. Another outcome studied was the implication of symptomatic improvement in quality of life of patients that was assessed using the Oral Health Impact Profile (OHIP-14). The results revealed that after the second month of intervention, the experimental group presented significantly lower values of spontaneous pain intensity (p ≤ 0.05) than control group. In the experimental group, 95% of the volunteers first classified as Grades II and III on the Graded Chronic Pain Scale (GCPS) began to show symptoms compatible with Grade I after the interventions; in control group, this was found in 61% of the individuals. Regarding the psychosocial aspects, levels of symptoms of depression and somatization changed after interventions were adopted in the two groups; as for the symptoms of depression, the experimental group showed a significant decrease in comparison with control group (p ≤ 0.05), while there was no difference between groups for the symptoms of somatization. The therapies adopted resulted in positive effects on the quality of life of patients with a significantly greater impact in the experimental group (p ≤ 0.05), particularly regarding the limitations on the physical, psychological and social aspects. The stabilization splint associated with counseling was effective in reducing physical symptoms of temporomandibular disorders and it reduced levels of disability, depression and somatization associated with chronic pain with a positive impact on oral health-related quality of life.