Acupuncture in the treatment of temporomandibular muscle dysfunction / Acupuntura no tratamento da disfunção temporomandibular muscular

ABSTRACT BACKGROUND AND OBJECTIVES: Temporomandibular dysfunction consists of frequent non-dental pain in the orofacial region of multifactorial origin and interdisciplinary treatment, among them, acupuncture. The treatment of temporomandibular dysfunction acts both in muscle relaxation and pain control, trying to achieve the physical, mental, and emotional balance of the patient, thus reducing anxiety and improving the quality of life. The objective of this study was to evaluate acupuncture as a treatment for temporomandibular dysfunction. METHODS: A total of 34 volunteers screened and selected at the Federal University of Mato Grosso do Sul, diagnosed with muscle dysfunction according to the Research Diagnostic Criteria. They were randomly divided into two equal groups: group 1 treated with occlusal plaque, massage, thermotherapy and self-care guidelines; and group 2 treated with six acupuncture sessions lasting 30 minutes each. The pain was evaluated by the visual analog scale, and an algometer to assess the muscular tension of the temporal and masseter muscles. The limitation of mouth opening was measured with the use of calipers. The Mann-Whitney test was used for the non-normal distribution (visual analog scale and tension threshold) between the two groups (G1 and G2), and the Friedman test to compare the assessment periods (beginning of the treatment, after six weeks and four months) with a significance level of 5%. RESULTS: There was no difference in mouth opening, visual analog scale scores, or muscle tension threshold in relation to the type of treatment used. Both groups improved after six weeks of treatment. There was no statistical difference in the values obtained after six weeks and after four months. CONCLUSION: The statistical results showed that acupuncture increased the muscle tension threshold, improved the mouth opening and reduced pain, being as effective as the most commonly used conventional therapies.

RESUMO JUSTIFICATIVA E OBJETIVOS: A disfunção temporomandibular consiste em dores não dentárias frequentes na região orofacial, de origem multifatorial e de tratamento interdisciplinar. Entre esses tratamentos está a acupuntura. O tratamento da disfunção temporomandibular atua tanto no relaxamento muscular quanto no controle da dor, sistemicamente buscando o equilíbrio físico, mental e emocional do paciente, diminuindo a ansiedade e melhorando a qualidade de vida. Este trabalho teve como objetivo avaliar a acupuntura como tratamento da disfunção temporomandibular. MÉTODOS: Participaram do estudo 34 voluntários triados e selecionados na universidade de Mato Grosso do Sul, diagnosticados com disfunção muscular pelo Research Diagnostic Criteria, e foram divididos aleatoriamente em dois grupos iguais. O grupo 1 foi tratado com placa oclusal, massagem, termoterapia e orientações de autocuidado. O grupo 2 foi tratado com 6 sessões de acupuntura com duração de 30 minutos cada. A dor foi avaliada pela escala analógica visual e com auxílio de um algômetro para avaliar a tensão muscular dos músculos temporal e masseter. A limitação de abertura bucal foi medida com o uso do paquímetro. Para a distribuição não normal (escala analógica visual e limiar de tensão), entre os dois grupos (G1 e G2), foi utilizado o teste Mann-Whitney, e para a comparação entre os períodos de avaliação (início do tratamento, após seis semanas e 4 meses), foi utilizado o teste de Friedman, ao nível de significância de 5%. RESULTADOS: Não houve diferença das medidas de abertura de boca, dos escores de escala analógica visual e de limiar de tensão muscular segundo o tipo de tratamento utilizado. No entanto, em ambos os grupos houve melhora nos parâmetros avaliados após seis semanas de tratamento. Não houve diferença estatística dos valores obtidos após seis semanas e ao final do tratamento, após quatro meses. CONCLUSÃO: Os resultados estatísticos mostraram que a acupuntura aumentou o limiar de tensão muscular, melhorou a abertura de boca e diminuiu a dor. Concluiu-se que a acupuntura foi tão eficiente quanto as terapias convencionais mais utilizadas.

Comparison of the anti-inflammatory effect of dexamethasone and ketorolac in the extractions of third molars.

This double-blind, split-mouth, and randomized study was aimed to compare the efficacy of dexamethasone and ketorolac tromethamine, through the evaluation of pain, edema, and limitation of mouth opening. Thirty-four individuals aged 18-26 years, having bilateral mandibular third molars, in a similar position, were selected. Two different surgical procedures were performed on the same individual by the single surgeon. For an extraction, the individual received 1 capsule of 10 mg ketorolac tromethamine 1 h before surgery and every 8 h for 2 days. For the extraction of the contralateral side, the individual received 1 capsule of 8 mg dexamethasone 1 h before surgery and 1 placebo capsule every 8 h for 2 days. Sodium metamizol, 500 mg, was given as rescue medication in postoperative. Pain was assessed by the Visual Box Scale-11 points (BS-11) at 24 h postoperative. Edema (metric measurement) and the maximum mouth opening (interincisal) were recorded in the pre-operative, 24 h, 48 h, 72 h and 7 days postoperatively. The results showed that both therapeutic treatments used were effective in the postoperative, and there were no statistically significant differences between the groups for the pain and edema variables. However, for the limitation of mouth opening, 24 h and 7 days postoperatively, the dexamethasone group had a lower limitation of mouth opening, behaving better than the ketorolac for this variable in these periods. Due also to the higher margin of safety, the use of dexamethasone as a single dose becomes a more suitable alternative for use in routine surgical extractions of third molars.