Temporomandibular Bozukluklar ve Bruksizmde Eşlik Eden Psikiyatrik Bozukluklar ve Tedavi Seçenekleri

Year 2020, Volume 12, Issue 2, 205 - 231, 30.06.2020

Bahadır GENİŞ Çiçek HOCAOĞLU

https://doi.org/10.18863/pgy.570861

Abstract

Temporomandibular bozukluk (TMB) çiğneme kaslarını, temporomandibular eklemi (TME) ve bu eklemi çevreleyen yapıların etkilendiği klinik bir durumdur. Bruksizm, diş sıkma ve taşlamayla stomatognatik yapıların aşırı yüklenmesinin bir sonucu olarak ortaya çıkan, TMB etiyolojisinde yer alan parafoksiyonel bir alışkanlıktır. TMB popülasyonun yaklaşık %10'unda, bruksizm %8-20'sinde görülür. TMB ve bruxism etiyolojisinde birçok faktör etkilidir ve bu faktörler arasında etkileşimler vardır. Biyomekanik, nöromüsküler, biyopsikososyal ve nörobiyolojik faktörler hastalığa katkıda bulunur. Psikiyatrik bozuklukların prevalansı TMB ve bruxism olan bireylerde yüksektir. Birçok psikiyatrik bozukluk, özellikle de depresyon ve anksiyete bozuklukları, TMB ve bruksizme eşlik eder. Bu hastalıkların tedavisinde kullanılan antidepresanlar bruksizme neden olur. Bu, TMB ve bruksizmin tedavisinde önemli zorluklardan biridir. TMB ve bruksizmin tedavisinde ilk adım temel önleme yöntemlerine değinmektir. Amitriptilin kullanımı TMB farmakoterapisinde belirgin olmakla birlikte, bruksizmde buspiron ve klonazepam kullanılan iki önemli ilaçtır. Bu ilaçların küçük örneklerde incelenmesi ve mevcut bilgilerin çoğunlukla vaka raporlarına dayanması gerçeği, ileri ki çalışmaların gerekliliğini açıkça göstermektedir. Her iki hastalıkta da bilişsel davranışçı terapinin yaygın kullanımı bir çözüm olacak ve ilacın yan etkilerini ortadan kaldıracaktır. Tedavi seçeneği ne olursa olsun hem diş hekimleri hem de psikiyatristler multidisipliner bir çalışma ortamında olmalı ve bu hastalıkları biyopsikososyal model çerçevesinde değerlendirmelidir.

Keywords

Temporomandibular Bozukluklar, bruksizm, depresyon, mental bozukluklar, tedavi

Comorbid Psychiatric Disorders and Treatment Options in Temporomandibular Disorders and Bruxism

Abstract

Temporomandibular disorder (TMD) is a clinical condition affecting the masticatory muscles, the temporomandibular joint (TMJ) and the structures surrounding this joint.Bruxism is a parafunctional habit that occurs as a result of overloading of stomatognathic structures with tooth squeezing and grinding, which is included in the etiology of TMB.TMB is seen in approximately 10% of the population and bruxism is seen in 8-20%. Many factors are effective in the etiology of TMD and bruxism, and there are interactions between these factors. Biomechanical, neuromuscular, biopsychosocial and neurobiological factors contribute to the disease. The prevalence of psychiatric disorders is high in individuals with TMB and bruxism. Many psychiatric disorders, especially depression and anxiety disorders, accompany TMB and Bruxism. The antidepressants used in the treatment of these disorders cause bruxism. This is one of the important challenges in the treatment of TMB and bruxism.The first step in the treatment of TMB and bruxism is to address the basic prevention methods. While amitriptyline use is prominent in TMB pharmacotherapy, in bruxism, buspirone and clonazepam are two important drugs used.The study of these drugs in small samples and the fact that the available information is mostly based on case reports clearly shows the necessity of further studies. The widespread use of cognitive behavioral therapy in both disorders will be a solution and eliminate the side effects of medication.Regardless of the treatment option, both dentists and psychiatrists should be in a multidisciplinary working environment and should evaluate these diseases within the framework of the biopsychosocial model.

Keywords

Temporomandibular Disorders, Bruxism, depression, mental disorders, treatment

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