Page 8 - SPEMD_61-2

46 rev port estomatol med dent cir maxilofac. 2020;61(2):45-51

Efeito da estimulação elétrica funcional no bruxismo do sono
– estudo clínico randomizado

r e s u m o

Palavras-chave: Objetivos: Ensaio clínico randomizado para comparação dos efeitos de 4 e 8 semanas do uso
Biofeedback consecutivo de estimulação elétrica funcional na dor autorreferida, atividade muscular da
Estimulação elétrica funcional mandíbula e intensidade média no ranger de dentes durante o sono por mais de 6 meses.
Rangido Métodos: Este ensaio clínico randomizado estudou 48 pacientes diagnosticados de acordo
Dor com métodos estabelecidos, com bruxismo do sono e dor miofascial. Os pacientes foram
Bruxismo do sono alocados aleatoriamente no grupo I – estimulação elétrica funcional de 4 semanas (n=24) e
Músculo temporal no grupo II – 8 semanas de estimulação elétrica funcional (n=24). Os parâmetros primários
avaliados foram o número de episódios presentes na eletromiografia por hora de sono, va-
lores de dor na escala numérica de dor e intensidade média de rangido por noite. Foram
utilizados modelos de análise de variância para comparar os resultados, estabelecendo-se
um nível de significância de 5%.
Resultados: Houve redução estatisticamente significante (p<0,05) no nível de dor (-71,7% e
-71,2%, respetivamente) e intensidade média de rangido (-37,4% e -44,9%, respetivamente) no
seguimento de 6 meses para o grupo I. A estimulação elétrica funcional reduziu a dor e a inten-
sidade média de rangido por noite em pacientes com dor miofascial e bruxismo do sono (diag-
nóstico definitivo), com uma correlação positiva (p<0,05) entre os dois parâmetros primários.
Conclusões: Os resultados deste estudo sugerem que a estimulação elétrica funcional em
protocolos de 4 e 8 semanas são eficazes na redução dos sintomas dos pacientes relaciona-
dos ao bruxismo do sono. (Rev Port Estomatol Med Dent Cir Maxilofac. 2020;61(2):45-51)
© 2020 Sociedade Portuguesa de Estomatologia e Medicina Dentária.
Published by SPEMD. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).

abnormal dental wear, sounds associated with bruxism, and
Introduction
muscle discomfort, fatigue or stiffness when awaking. 9,10 Self-
Bruxism, in general, is a repetitive muscle condition charac- -reporting, together with clinical examination methods, can
terized by the grinding and/or clenching of the teeth when define a “probable” SB diagnosis, but the definite diagnosis
awake or asleep. International consensus on its definition should be based on electrophysiological monitoring undertak-
1
gave rise to several questions, as sleep and awake bruxism are en in sleep clinics or with a portable device.
generally considered different behaviors observed during One of the therapeutic targets in a patient with bruxism
2
sleep and wakefulness, respectively. Sleep bruxism (SB) is is to modify or decrease the parafunctional activity. Several
defined as a repetitive jaw muscle activity characterized by techniques have been used to control it, namely, hypnosis,
clenching or grinding of the teeth or bracing or thrusting of occlusal adjustment, muscle relaxant splints, physiotherapy
the mandible during sleep. Even though, according to the and muscle -relaxing exercises, medication, acupuncture,
3
current view, bruxism is regulated mainly centrally, and not and biofeedback, 6,11-13 but, to date, there is little evidence on
peripherally (i.e., not caused by anatomical factors like cer- the effectiveness of the different treatments. More recent-
14
tain characteristics of dental occlusion and articulation), its ly, a therapeutic alternative based on a contingent electrical
etiology is still controversial. Clinical and scientific evidence stimulation (CES) mechanism has achieved promising re-
2
suggest that bruxism could be related to periods of physical sults. 14,15 It consists of a signal that is sent to the temporal
4
16
and emotional stress and the anticipation of such periods, or masseter muscle, inducing immediate relaxation. The
with a multifactorial pattern being the most plausible hy- literature suggests that biofeedback devices could be linked
pothesis, in which psychosocial and pathomorphological fac- to the relaxation reflex (or exteroceptive suppression peri-
tors interact with peripheral morphological factors. 4,5 od), 14,17,18 thus presenting an alternative to conventional
SB can generate high occlusal forces, which are sustained treatments for the remission and control of parafunctional
by the teeth, supporting tissues, and temporomandibular joint. activity. 8,12,19,20 Several authors have reported it as an effec-
It can cause attrition, tooth wear and fracture, hypersensitiv- tive method for a faster alleviation of chronic headache
ity, periodontal ligament lesions, pulpitis and tooth necrosis, symptoms, myofascial pain, and muscular inflammation
fatigue and muscle pain, buccal movement limitations, tem- when compared to other therapeutic alternatives. 15,21 How-
poral region headaches, and temporomandibular disorders. 6-8 ever, the duration of treatment needed to obtain a measur-
The diagnosis of SB can be based on reported tooth grinding able relaxation of the jaw muscles and effective stabilization
or clenching accompanied by one of the following three signs: of the symptoms is still unclear.