Eficácia dos exercícios mandibulares para dor temporomandibular na terapia da apneia obstrutiva do sono com aparelhos orais: uma revisão sistemática

Abstract

Study Objectives: Mandibular advancement devices (MAD) have become a common treatment for mild to moderate Obstructive Sleep Apnea (OSA). However, the use of a MAD can cause temporomandibular joint and muscle pain. The objective of this review was to evaluate the effect of mandibular exercises in Temporomandibular Dysfunction (TMD) pain control in OSA therapy with MAD. Methods: A systematic review of Randomized controlled trials was undertaken. Databases were searched up to March, 2019 including trials with adult patients, combining three groups of keywords: sleep apnea, obstructive AND occlusal splints or oral device or oral appliance or intraoral device or intraoral appliance or dental device or mandibular advancement device AND mandibular exercises or jaw-opening exercise. Two reviewers independently assessed eligibility, extracted data, and systematically assessed reporting quality. Results: Initially, 43 studies met eligibility criteria, however, 24 of them were duplicates. After title and abstract analysis, six articles were selected for full reading of the text. After assessing risk of bias, two articles were included in this review. These studies suggest that mandibular exercises are effective in TMD pain control in MAD therapy. Conclusion: Mandibular exercises are effective in the prevention or reduction of TMD pain in OSA therapy with MAD. However, it was not possible to set the ideal frequency and the most appropriate type of exercises. Based on the results of this systematic review, the paucity of effective evidence-based data indicates the further need of clinical studies to improve clinical management.