Severidade da desordem temporomandibular e sua relação com medidas cefalométricas craniocervicais

Abstract

INTRODUÇÃO: Sabe-se que existe uma relação entre a Desordem Temporomandibular (DTM) e a postura craniocervical, porém, além de os estudos apresentarem resultados inconclusivos, a severidade dos sinais e sintomas de DTM não é considerada. OBJETIVO: Correlacionar índices de severidade da DTM com medidas cefalométricas craniocervicais. MATERIAIS E MÉTODOS: Participaram da pesquisa 32 mulheres entre 19 e 35 anos com diagnóstico de DTM (RDC/TMD). A severidade dos sinais e sintomas da DTM foi avaliada pelo Índice Temoromandibular proposto por Pehling, calculado com base nos achados do exame físico do RDC/TMD (eixo I). A postura craniocervical foi avaliada por cefalometria, por meio de 11 medidas referentes à posição da cabeça, coluna cervical, mandíbula e osso hioide. A normalidade dos dados foi testada pelo teste de Lilliefors e as correlações foram realizadas pelo coeficiente de Spearman. RESULTADOS: Foram encontradas correlações negativas e moderadas entre o ângulo CVT/Hor e os Índices Muscular (p = 0,0288) e Temporomandibular (p = 0,0394); entre o ângulo CPL/Hor (anteriorização) quando correlacionado aos Índices Funcional (p = 0,0482) e Muscular (p = 0,0086) e entre distância do hioide à terceira vértebra cervical (Hy/C3) e o Índice Funcional (p = 0,0155). CONCLUSÕES: Constatou-se associação entre a maior severidade do quadro clínico da DTM e a projeção anterior da cabeça, a flexão da coluna cervical baixa e a menor distância do osso hioide à terceira vértebra cervical. Essa relação sugere que as alterações posturais craniocervicais podem contribuir para a maior intensidade dos sinais e sintomas e perpetuação da DTM.

Multimodal physiotherapeutic approach: effects on the temporomandibular disorder diagnosis and severity

“…Moreover, the importance of treatment including not only TMJ and masticatory muscles but also the cervical-scapular area must be taken into account, once the hypoalgesic effects in this area are reflected in other areas due to the activation of descending inhibitory pathways (1). Milanesi et al (8) showed greater severity of TMD through TMI in women with greater forward head posture and flexion of the lower cervical spine, what reinforces the need for a therapeutic approach directed also to craniocervical posture.…”

“…Disorders (RDC/TMD) distinguish. It enables the standardized assessment of the dysfunction, the detection of multiple diagnoses for each TMJ as well as the diagnostic subtypes classification (6,7,8).…”

Cervical-scapular muscles strength and severity of temporomandibular disorder in women with mechanical neck pain

“…Thus, the chronicity of neck pain may potentialize the trigeminal sensitization, favoring pain triggering and a dysfunction of the stomatognathic system, which in this study was con irmed by the greater severity of TMD found in NPG. This result denotes how important is the utilization of indices or scales that quantify TMD severity (14), as they are able to identify subtle changes, even in the absence of a diagnosis for this dysfunction. Moreover, TI allows for the characterization and de inition of the component that contributes the most for TMD severity -muscular, articular or functional -favoring the selection of strategies and speci ic therapeutic interventions in the stomatognathic system, and monitoring the progress of therapeutic outcomes.…”

“…Those changes are thought to be assigned to the re lex inhibition associated with pain, causing damage to the muscular function (10) and favoring the chroni ication of mechanical neck pain (6,11). Although the biomechanical and neuroanatomic relationship between the cervical spine and the stomatognathic system has been veri ied in clinical and experimental studies (12)(13)(14), the link between the dysfunctions affecting these systems remains in dispute.…”

“…The Temporomandibular Index (26) allows for this classi ication, as provides scores regarding the clinical aspects relevant for the diagnosis of TMD such as: limitation of mandibular movement range, muscle and joint pain, as well as the presence of joint noise. Clinically, the utilization of this index makes possible the determination of the dysfunction severity (14) and the veri ication of therapeutic interventions results (27).…”