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Toxina botulínica e bruxismo: controvérsias na atualidade (revisão narrativa)
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Abstract(s)
O bruxismo é uma patologia que consiste no apertamento e/ou ranger dos dentes que afeta o sistema estomatognático e de etiologia multifatorial, afetando crianças e adultos dos dois géneros. Epidemiologicamente, 60 a 70% da população já terá tido um episódio de bruxismo durante a vida, com uma prevalência em adultos que varia entre 8 e 31%. Esta patologia tem uma magnitude clínica considerável devido à sua associação com abrasões, mobilidade dentária, restaurações fraturadas, mialgias, artralgias, hipertrofia muscular e disfunções temporomandibulares. Atualmente, existem diversos tratamentos para o bruxismo, sendo a mais aplicada a utilização de goteiras oclusais. A utilização da toxina botulínica tem sido apresentada como uma proposta de tratamento do bruxismo, tendo a vantagem de não requerer a colaboração do paciente, podendo ser administrada mesmo com ausência de consciência, ou na presença de perturbações psiquiátricas. Esta revisão bibliográfica tem como objetivo analisar as controvérsias atuais no uso da toxina botulínica no tratamento do bruxismo. Para tal, foi efetuada uma pesquisa bibliográfica nas bases de dados PubMed, B-On e ScienceDirect com a seguinte combinação de termos de pesquisa: botox and bruxism, botox and bruxism treatment, botulinum toxin and bruxism. Foram definidos os seguintes critérios de inclusão: publicações escritas em português e inglês, com limite temporal dos últimos 15 anos (2009-2024), de modo a reunir informação pertinente sobre a utilização da toxina botulínica no tratamento do bruxismo. Foram excluídos os artigos que não estavam nas línguas escolhidas, duplicados, sem disponibilidade na íntegra ou que, após a leitura do resumo e do corpo de texto, não atendiam ao objetivo proposto. Desta forma, foram incluídos nesta revisão 58 artigos que se consideraram pertinentes. Verifica-se assim que, em relação ao protocolo de administração da toxina botulínica no bruxismo, existe uma clara disparidade entre autores relativamente ao local de injeção/punção, já que não existe um protocolo padronizado definido. Também em relação à dosagem existem controvérsias, pelo que há a necessidade de estudos que classifiquem e indiquem as doses de acordo com critérios pré-definidos, como por exemplo, dependendo da quantidade de contração rítmica ou mesmo episódios e frequência de bruxismo.
Bruxism is a pathology that consists of clenching and/or grinding of the teeth that affects the stomatognathic system and has a multifactorial etiology, affecting children and adults of both genders. Epidemiologically, 60 to 70% of the population will have had an episode of bruxism during their lifetime, with a prevalence in adults ranging from 8 to 31%. This pathology has a considerable clinical magnitude due to its association with abrasions, tooth mobility, fractured restorations, myalgias, arthralgias, muscle hypertrophy, and temporomandibular disorders. Currently, there are several treatments for bruxism, the most commonly used being the use of occlusal splints. The use of botulinum toxin has been presented as a proposal for the treatment of bruxism, having the advantage of not requiring the patient's cooperation and being able to be administered even in the absence of consciousness or in the presence of psychiatric disorders. This literature review aims to analyze the current controversies in the use of botulinum toxin in the treatment of bruxism. To this end, a literature search was carried out in the following databases: PubMed, B-On, and ScienceDirect with the following combination of search terms: botox and bruxism, botox and bruxism treatment, botulinum toxin and bruxism. The following inclusion criteria were defined: publications written in Portuguese and English, with a time limit of the last 15 years (2009-2024), in order to gather relevant information on the use of botulinum toxin in the treatment of bruxism. Articles that were not in the chosen languages, duplicates, not available in full, or that, after reading the abstract and the body of the text, did not meet the proposed objective were excluded. Thus, 58 articles that were considered pertinent were included in this review. In relation to the protocol for the administration of botulinum toxin in bruxism, there is a clear disparity between authors regarding the injection/puncture site, since there is no standardized protocol defined. There are also controversies regarding dosage, so there is a need for studies that classify and indicate doses according to pre-defined criteria, such as, for example, depending on the amount of rhythmic contraction or even episodes and frequency of bruxism.
Bruxism is a pathology that consists of clenching and/or grinding of the teeth that affects the stomatognathic system and has a multifactorial etiology, affecting children and adults of both genders. Epidemiologically, 60 to 70% of the population will have had an episode of bruxism during their lifetime, with a prevalence in adults ranging from 8 to 31%. This pathology has a considerable clinical magnitude due to its association with abrasions, tooth mobility, fractured restorations, myalgias, arthralgias, muscle hypertrophy, and temporomandibular disorders. Currently, there are several treatments for bruxism, the most commonly used being the use of occlusal splints. The use of botulinum toxin has been presented as a proposal for the treatment of bruxism, having the advantage of not requiring the patient's cooperation and being able to be administered even in the absence of consciousness or in the presence of psychiatric disorders. This literature review aims to analyze the current controversies in the use of botulinum toxin in the treatment of bruxism. To this end, a literature search was carried out in the following databases: PubMed, B-On, and ScienceDirect with the following combination of search terms: botox and bruxism, botox and bruxism treatment, botulinum toxin and bruxism. The following inclusion criteria were defined: publications written in Portuguese and English, with a time limit of the last 15 years (2009-2024), in order to gather relevant information on the use of botulinum toxin in the treatment of bruxism. Articles that were not in the chosen languages, duplicates, not available in full, or that, after reading the abstract and the body of the text, did not meet the proposed objective were excluded. Thus, 58 articles that were considered pertinent were included in this review. In relation to the protocol for the administration of botulinum toxin in bruxism, there is a clear disparity between authors regarding the injection/puncture site, since there is no standardized protocol defined. There are also controversies regarding dosage, so there is a need for studies that classify and indicate doses according to pre-defined criteria, such as, for example, depending on the amount of rhythmic contraction or even episodes and frequency of bruxism.
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Keywords
Bruxismo Toxina botulínica Medicina dentária Ranger de dentes Apertar de dentes Bruxism Botulinum toxin Dentistry Gnashing of teeth Clenching the teeth