Bruxismo durante o Sono
DOI:
https://doi.org/10.34024/rnc.2003.v11.8888Palavras-chave:
Ranger de dentes, bruxismo durante o sono, ratamento comportamental e farmacológicoResumo
Bruxismo durante o sono (BS) é uma parassonia caracterizada por movimentos involuntários e estereotipados com ranger dos dentes durante o sono. A prevalência do BS é igual nos dois sexos, variando de 3% a 20% na população geral, sendo mais comum nos jovens. O BS secundário é causado por transtornos neurológicos ou pode estar associado a transtornos primários do sono e antidepressivos inibidores seletivos da recaptação da serotonina. Já o BS primário apresenta fatores de predisposição genética ou psicológica, má oclusão dentária, disfunção leve dos gânglios da base e combinações desses fatores. Os principais sinais e sintomas do BS incluem o ruído característico de ranger dos dentes, desgaste dentário, dor local, hipertrofia dos músculos masseteres e temporais, cefaléias, disfunção da articulação temporomandibular, sono de má qualidade e sonolência diurna. O diagnóstico clínico de BS é feito por meio da história do paciente, do cônjuge e do exame odontológico. A polissonografia documenta a presença de episódios de ranger dos dentes, permitindo identificar alterações da arquitetura do sono, presença de microdespertares, abalos mioclônicos de membros inferiores, roncos e distúrbios respiratórios sonodependentes. O tratamento deve ser direcionado para os fatores etiológicos com base no BS secundário. Não existe tratamento-padrão para o BS primário, devendo este ser individualizado ao paciente. O tratamento odontológico do BS primário e secundário com placas de repouso tem como objetivo prevenir danos das estruturas orofaciais e aliviar dor craniofacial. O tratamento comportamental inclui técnicas de relaxamento, abstinência de cafeína e tabaco. O tratamento farmacológico do BS primário e secundário emprega drogas agonistas dopaminérgicas, benzodiazepínicos ansiolíticos, buspirona, hipnóticos não-benzodiazepínicos, como o zolpidem, relaxantes musculares, certos antidepressivos, como mirtazapina, nefazodona, trazodona, bupopriona e drogas antiepilépticas, como a gabapentina. Aplicações locais de toxina botulínica nos músculos masseteres e temporais podem ser utilizadas em casos de bruxismo intenso não-responsivo à terapêutica convencional.
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Publicado: 2003-03-31
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