Prevalência das desordens temporomandibulares em pacientes com extremidade livre bilateral inferior

Abstract

A prevalencia das desordens temporomandibulares (DTM) nas populacoes por muito tempo foi determinada com base exclusivamente em sinais e sintomas. O objetivo deste trabalho foi determinar a prevalencia das principais DTM, levando em consideracao os tipos mais comuns descritos por Dworkin & LeResche (1992). Material e Método: foram examinados pacientes com extremidade livre bilateral inferior que compareceram a clinica de Odontologia da Universidade de Brasilia e da Universidade Catolica de Brasilia no ano de 2006. Foram realizados exames em 102 pacientes desdentados posteriores bilaterais inferiores com diversas condicoes de suporte oclusal, com ou sem utilizacao de reabilitacao protetica com protese parcial removivel (PPR). Foi aplicado para cada paciente um questionario, abordando aspectos psico-sociais e um formulario, o qual foi executado por um unico examinador. Ambos sao parte do Criterio de Diagnostico para Pesquisa de DTMs (RDC/TMD). O indice de prevalencia foi calculado no pacote estatistico R (versao 2.5.0- R Development Core Team, 2007). Resultados: a prevalencia de DTM na amostra estudada foi de 70.6%. A dor miofascial obteve prevalencia de 16.7%, o deslocamento de disco com reducao de 10.8%, artralgia, osteoartrite e osteoartrose respectivamente 20.6%, 24.5%, 25.5%. Apenas um individuo apresentou deslocamento de disco sem reducao. Os pacientes que usavam PPR apresentaram prevalencia de DTM de 58.8%, aqueles que nunca usaram 73.8% e os que nao usavam no momento do exame, mas ja tinham usado, 80.7%. A frequencia relativa de DTM nos pacientes de 20 a 39 anos, 40 a 59 e com mais de 60 anos foi a mesma. Dentre os individuos com 20 a 39 anos as maiores prevalencias foram de dor miofascial com abertura limitada assim como de artralgia. Nos pacientes de 40 a 59 anos as doencas mais prevalentes foram osteoartrite e osteoartrose. Pacientes com mais de 60 anos apresentaram maior prevalencia de artralgia e osteoartrose. Em relacao ao genero a prevalencia de DTM, nos homens foi de 71.4% e nas mulheres 70.3%. Conclusões: a) A prevalencia de DTM em pacientes com extremidade livre bilateral, nesta amostra, foi da ordem de 70, 6% b) Dentro da amostra estudada, as DTM que acometem as ATM foram as mais prevalentes, tendo a osteoartrite e osteoartrose os maiores indices; c) os pacientes que nao usavam PPR apresentaram frequencias relativas de DTM maiores do que aqueles que a usavam; d) a faixa etaria, assim como o genero nao apresentaram grandes discrepancias nos valores de prevalencia destas doencas. e) a prevalencia de DTM foi semelhante nos individuos com 0 a 2 e 3 a 4 unidades oclusais. ________________________________________________________________________________________ ABSTRACT

Prevalence of temporomandibular disorders (TMD) among the people has been evident for a long time by means of signs and symptoms. The aim of this study is to determine the prevalence of main TMD, considering the most common kinds described by Dworkin and LeResche (1992). Material and Methods: patients with lower bilateral free end who appeared at the Dentistry Clinic of Brasilia University and Catholic University from Brasilia in 2006. 102 patients with lower bilateral free end wearing or not removable partial prosthesis (RPP) were examined. A questionnaire was carried out approaching psychosocial features and a form approached features about a physical exam. Both of them were applied by one examiner. Both are part of a Research Diagnostic Criterium for temporomandibular disorders (RDC/ TMD). The prevalence index was calculated with the help of the statistics pack R (version 2.5.0 – R Development Core team, 2007). Results: In the studied sample, the prevalence was of 16.7% ; the disc displacement had a reduction of 10.8% ; arthralgia, osteoarthritis and osteoarthrosis had 20.6 %, 24.5% and 25.5% respectively. One individual alone presented disc displacement without any reduction. The patients who wore RPP showed a prevalence of TMD of 58.8% . The others who never wore RPP showed 73.8%. However, patients who own it but did not wear it, showed 80.7% of prevalence. The relative frequency of TMD among patients from 20 to 39 years; from 40 to 59 years and those over 60 years had the same frequency. In group of patients from 20 to 39 years the highest prevalence was for miofascial pain with limited opening as well as arthralgia. Among patients from 40 to 59 years, the most prevalent diseases were osteoarthritis and osteoarthrosis. Patients over 60 years showed a higher prevalence of arthralgia and osteoartrosis. In relation to the gender, the prevalence of TMD among men was of 71.4% and among women of 70.3% . Conclusions: a) TMD prevalence among patients with bilateral free end, in the sample, was of 70.6%. b) from this sample, TMD that attacked the temporomandibular joint was the most prevalent, presenting osteoarthitis and osteoarthrosis the highest indexes; c) patients who did not wear RPP presented relative frequencies of TMD higher than the ones who wore it; d) the age and gender did not present big differences in the prevalence values ; e) TMD prevalence was similar among patients from 0 to 2 and from 3 to 4 occlusal units.