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rev port estomatol med dent cir maxilofac . 2018;59(1):24-29 25

Analise de concordância entre dois questionários
para auto relato de bruxismo

r e s u m o

Palavras-chave: Objetivo: Ainda não há um consenso sobre a fisiopatogenia e o diagnóstico de bruxismo. Este
Concordância estudo analisou a concordância entre dois questionários de auto-relato para diagnóstico de
Bruxismo “possível” bruxismo.
Diagnóstico Métodos: Uma amostra consecutiva não probabilística foi constituída por pacientes reabili-
tados com prótese fixas sobre implantes de 2010 a 2016. A amostra foi constituída por dados
de 65 pacientes (42 mulheres) em tratamento para reabilitação com próteses sobre implan-
tes, que responderam dois questionários padronizados para diagnóstico de bruxismo. Os
dados foram analisados de forma descritiva e por teste de concordância com coeficiente
Kappa.
Resultados: Observou-se que 50% dos pacientes com diagnóstico positivo em Q1 também
tiveram no Q2. Um total de 46,1% dos pacientes que tiveram diagnóstico positivo em Q2
também tiveram no Q1. Para o diagnóstico negativo de bruxismo, 86,79% dos pacientes com
diagnóstico negativo em Q1 também tiveram no Q2 e 88,46% dos pacientes com diagnóstico
negativo em Q2 também tiveram no Q1. Os resultados mostraram uma baixa-moderada
concordância (Kappa = 0,356) entre os dois questionários de auto-relato.
Conclusões: Os resultados sugerem que, embora o uso de questionários de auto-relato de
bruxismo seja um método de fácil aplicação clínica, os instrumentos são limitados para um
preciso diagnóstico “possível” de bruxismo. (Rev Port Estomatol Med Dent Cir Maxilofac.
2018;59(1):24-29)
© 2018 Sociedade Portuguesa de Estomatologia e Medicina Dentária.
Publicado por SPEMD. Este é um artigo Open Access sob uma licença CC BY-NC-ND
(http://creativecommons.org/licenses/by-nc-nd/4.0/).

trophysiologic monitoring systems enable a definitive diagno-
Introduction
sis and are used in sleep clinics or as portable devices. 8-10 Lab-
Bruxism is a repetitive muscle activity characterized by the oratory recording methods include electroencephalogram
grinding and/or clenching of the teeth when awake or sleep- (EEG), electromyography (EMG), electrocardiogram (ECG), and
ing. Sleep bruxism is an unconscious activity of grinding thermal sensors with simultaneous audio-video recordings.
8,9
1
and/or tightening the teeth while the individual is sleeping, However, these methods also have their limitations, including
while diurnal bruxism is a semi-voluntary activity of the the necessity for the patient to leave their habitual environ-
10
mandible characterized by the act of clenching both dental ment and spend the night in sleep laboratories. On the oth-
arches. 1,2,3 Bruxism is considered a potential factor of tempo- er hand, the use of portable devices does not allow simultane-
romandibular disorders, muscle pain, dental wear, failure of ous audio-video recordings, thus causing bruxism to be
8
restorations and dental prostheses, and loss of periodontal confused with other orofacial activities (sighs, cough, speech).
1
support. In addition, excessive occlusal load has been sug- On clinical examination, the presence of tooth wear may indi-
gested to lead to peri-implant bone loss or even failure of cate that the patient suffers from bruxism. Such wear and
8,9
dental implants and increased rates of complications. 3 tear must be differentiated from that of individuals with oth-
It is still controversial whether bruxism should be categorized er harmful habits and/or excessively acidic diets. Although
as a habit, a disorder, or a risk factor for other disorders. Although dental wear may aid in the clinical diagnosis of bruxism, it is
9
an international consensus on the subject was published in usually considered a secondary factor. It may indicate that
2013, other authors argue that there is insufficient evidence sup- the patient has a history of bruxism but not necessarily that
1
porting the notion that bruxism is a disease per se or a risk factor they currently suffer from bruxism. Also, about 40% of the pop-
for other disorders. The prevalence of bruxism is also unclear, ulation without bruxism develop dental wear and tear over
4
11
but it is believed to be present in 6%-20% of the general popula- time. Hypertrophy of the masseter muscle can also be con-
tion, affecting 14%-20% of children under 11 years, 5%-8% of the sidered a secondary factor and should be differentiated from
7
adult population, and as low as 3% of individuals over 60 years, 8 inflammatory edema, tumors, and other syndromes. 8
thus showing a decreasing trend over time. Several different instruments have been developed for the
The methods for diagnosing bruxism include self-report- diagnosis of sleep and diurnal bruxism, such as self-reporting
ing, clinical examination of dental wear, and examination with questionnaires. Self-reporting questionnaires are a practical
specific devices in sleep laboratories (polysomnography). Elec- method for large-scale use; however, their highly subjective