Evaluation of conservative treatments for temporomandibular disorders in pain, quality of life, depressive symptoms and anxiety: a randomized clinical trial
Temporomandibular Joint. Disorders. Pain. Anxiety. Depression. Quality of Life.
Introduction: temporomandibular disorder (TMD) is understood as a set of clinical problems involving the masticatory muscles, the temporomandibular joint (TMJ) and associated structures, with several forms of conservative treatments. Objective: to evaluate the influence of conservative treatments craniopuncture, laser acupuncture therapy, occlusal plaque, counseling and manual therapy on pain, anxiety and depression symptoms and quality of life in patients with TMD. Material and methods: diagnosed through the Diagnostic Criteria for TMD (DC/TMD), eighty five (85) patients with TMD were randomly divided into five treatment groups: laser acupuncture therapy (LA) (n=15), craniopuncture (CR) (n=15), occlusal plaque (PO) (n=19), counseling (AC) (n=16) and manual therapy (TM) (n=20). Thus, they were evaluated before starting therapy, after one month and three months of treatment using the DC/TMD and regarding anxiety, depression, quality of life and pain, using the questionnaires, Beck's Anxiety Inventory (BAI), Beck's Depression Inventory (BDI), World Health Organization Quality of Life Questionnaire (WHOQOL), Impact of Oral Health on Quality of Life (OHIP-14) and Visual Analogue Scale (VAS). The data obtained were analyzed by SPSS (Statistical Package for the Social Science) 22.0 with the Friedman test between times and Wilcoxon post-test, as well as the Kruskal Wallis test between groups with Mann Whitney post-test. Results: It has been observed a statistically significant difference between the groups in the assessment of pain by the VAS at one month (p=0,001) and three months of treatment (p=0,005), in the assessment of anxiety symptoms by the BAI one month after the therapy (p=0,000), on the impact of oral health on quality of life by OHIP-14 with three months of treatment (p=0,008), with more favorable results for the groups treated with PO and TM. It has been noticed a significant improvement over time in pain by VAS for PO (p=0,003), AC (p=0,003), CR (p=0,032) and TM (p=0,000); in anxiety symptoms by BAI for PO (p=0,003); in the depressive symptoms by BDI for PO (p=0,024), AC (p=0,022) and TM (p=0,006); on quality of life by WHOQOL-general for TM (p=0,004) and on the impact of oral health on quality of life by OHIP-14 for PO (p=0,001), AC (p=0,015) and TM (p=0,001). Conclusion: in general, PO and MT stood out in relation to the other groups in most parameters, but all groups improved over time in some parameter evaluated, except for LA. Therefore, the use of the evaluated conservative therapies is recommended, except for LA, in the treatment of TMD.