Association of sleep quality and psychological aspects with reports of bruxism and TMD in Brazilian dentists during the COVID-19 pandemic

Abstract Dentists are exposed to contamination by SARS-CoV-2 due to dental interventions, leading to a state of alert and potential risk of negative impact in mental health and sleep quality, associated with Temporomandibular Disorder (TMD) and bruxism. Objective: to evaluate the psychosocial status, sleep quality, symptoms of TMD, and bruxism in Brazilian dentists (DSs) during the COVID-19 pandemic. Methodology: The sample (n=641 DSs) was divided into three groups (quarantined DSs; DSs in outpatient care; and frontline professionals), which answered an electronic form containing the TMD Pain Screening Questionnaire (Diagnostic Criteria for Temporomandibular Disorders - DC/TMD), the Pittsburgh Sleep Quality Index (PSQI), the Depression, Anxiety and Stress Scale (DASS-21), and the sleep and awake bruxism questionnaire. ANOVA test and Mann Whitney post-test were used, with Bonferroni adjustment (p<0.016) and a 95% confidence level. Results: Probable TMD was found in 24.3% (n=156) of the participants, while possible sleep and awake bruxism were diagnosed in 58% (n=372) and 53.8% (n=345) of them, respectively. Among all variables evaluated, only symptoms of depression were significantly greater in the quarantined DSs group when compared to those who were working at the clinical care (p=0.002). Working DSs were significantly less likely (OR=0.630, p=0.001) to have depressive symptoms. Those who were not worried or less worried about the pandemic were less likely to experience stress (OR=0.360), anxiety (OR=0.255), and poor sleep quality (OR=0.256). Sleep had a strong positive and moderate correlation with psychological factors on frontline workers and DSs in outpatient care, respectively. Conclusion: The results suggest confinement may have a more negative impact on the life of DSs than the act of being actively working. The concern about Covid-19 and poor sleep quality was significantly prevalent and may negatively affect the quality of life of DSs. Thus, further research on the topic is needed.

Botulinum toxin in pain management of trigeminal neuralgia: literature review / Toxina botulínica no tratamento da dor na neuralgia trigeminal: revisão de literatura

ABSTRACT BACKGROUND AND OBJECTIVES: Botulinum neurotoxin type A has been an interesting therapeutic complement to the conventional treatment of trigeminal neuralgia, especially in patients without satisfactory response to pharmacotherapy and/or surgical procedures. A detailed and comprehensive literature review its important for the description of the available evidence, allowing for a critical view on the topic. Therefore, this study's objective was to describe the scientific evidence on the use of botulinum toxin type A in the trigeminal neuralgia treatment. CONTENTS: Pubmed and Scielo databases were searched using the descriptors: "trigeminal neuralgia and botulinum toxin". Inclusion criteria were human studies (open-label, double-blind, randomized, and placebo-controlled trials) and reviews of the use of botulinum toxin type A in trigeminal neuralgia treatment, published in English, Spanish or Portuguese from January 2008 to March 2020. Twenty-one articles met the inclusion criteria. Overall, studies demonstrated that botulinum toxin type A significantly reduced pain intensity and paroxysmal episodes, as well as improved quality of life. CONCLUSION: Use of botulinum toxin type A in treatment of refractory trigeminal neuralgia shows promising results, but further studies are needed to increase the knowledge and consolidation of this therapeutic alternative.

RESUMO JUSTIFICATIVA E OBJETIVOS: A neurotoxina botulínica do tipo A tem se mostrado interessante como opção terapêutica complementar ao tratamento convencional da neuralgia trigeminal, sobretudo em pacientes sem resposta satisfatória à farmacoterapia e/ou procedimentos cirúrgicos. Uma revisão da literatura detalhada e abrangente se faz importante para descrever as evidências disponíveis e permitir uma visão crítica sobre o tema. Sendo assim, este estudo teve como objetivo apresentar as evidências científicas disponíveis na literatura sobre o uso da neurotoxina botulínica do tipo A no tratamento da neuralgia trigeminal. CONTEÚDO: Foi realizada uma busca nas bases de dados Pubmed e Scielo utilizando-se os seguintes descritores "trigeminal neuralgia and botulinum toxin". Os critérios de inclusão foram estudos em humanos (estudos abertos e ensaios clínicos duplamente encobertos, randomizados e controlados por placebo) e revisões sobre o uso da neurotoxina botulínica do tipo A no tratamento da neuralgia trigeminal nos idiomas inglês, espanhol ou português durante o período de janeiro de 2008 a março de 2020. Apenas 21 artigos preencheram os critérios de inclusão. De um modo geral, os trabalhos demonstraram efeitos significativos da neurotoxina botulínica do tipo A na diminuição da intensidade da dor e no número de episódios paroxísticos, assim como na melhoria da qualidade de vida. CONCLUSÃO: O uso da neurotoxina botulínica do tipo A no tratamento da neuralgia trigeminal refratária apresenta resultados promissores, mas são necessários novos estudos para ampliação do conhecimento e consolidação dessa alternativa terapêutica.