Giancarlo de la Torre Canales

This project aims to evaluate the effects of aesthetic and therapeutic applications of Botulinum Toxin type A in dentistry. To achieve this objective, the following variables will be evaluated: durability of botulinum toxin in aesthetic applications, efficacy and safety of botulinum toxin as a treatment for temporomandibular joint arthralgia and hypertrophy of the masseter muscle. Furthermore, this project will seek to validate the possible association between adverse effects caused by botulinum toxin type A and doses and number of applications necessary to develop them.

INTRODUCTION/CONTEXTUALIZATION The pain and functional limitation associated with oral impairment results in physical, psychological and social disability, which in turn leads to patient disability. Clinical studies demonstrate that there is an improvement in the quality of life in patients who received oral rehabilitation, especially in the elderly and edentulous. However, few studies significantly assess important comorbidities that may interfere with these results, such as awake bruxism, emotional aspects and signs and symptoms of temporomandibular disorders. According to the American Academy of Orofacial Pain, Temporomandibular Disorder (TMD) is defined as a set of disorders involving the temporomandibular joint (TMJ), masticatory muscles and associated structures. Signs and symptoms include pain in the muscles of mastication and TMJ, temporomandibular joint noises (clicking and crackling) and limitations in mandibular movement. Other symptoms reported by patients are otological manifestations such as tinnitus, ear fullness and vertigo. Many aspects of TMD etiology are unclear. In contrast to dental/occlusal causes, for which the supporting evidence is not definitive, there is definitive support for a biopsychosocial and multifactorial history, illustrating the complex interplay between biological (e.g., hormonal) mechanisms, psychological states and traits, conditions environmental and macro and microtrauma. Parafunctional habits such as sleep and wake bruxism are commonly observed during periods of anxiety or stress in humans. This stereotyped oral behavior can provide an outlet for emotional tension. It is possible to see the close relationship between TMD, bruxism, anxiety disorders and quality of life in patients with tooth loss, and how these factors influence each other. Systematic reviews on the subject have encouraged the development of studies with standardized protocols, which assess signs and symptoms and emotional characteristics over time, that is, through longitudinal studies in a specific population. GOALS Evaluate factors related to temporomandibular disorders, bruxism, anxiety and quality of life in patients undergoing oral rehabilitation. - Monitor and verify the behavior of TMD's and awake bruxism in periods of greater stress in patients with dental prostheses

- To verify the efficiency of an interocclusal device after oral rehabilitation in controlling waking bruxism

- To evaluate the signs and symptoms of TMD and the presence of awake bruxism in patients who received oral rehabilitation. - Evaluate the effect of rehabilitation treatment on the control of awake bruxism and quality of life. METHODOLOGY This project has the competence to develop prospective clinical studies which will be carried out in the premises of the Centro Universitário Ingá - UNINGÁ, including the Dentistry Clinic and the classrooms of Block H. The study population will be patients from integrated clinics I and IV, integral and night, treated with any type of dental prosthesis. Patients who meet the inclusion and exclusion criteria, after signing an informed consent form to participate in this study, will be able to compose the sample. The participants will be submitted to different evaluations that include from clinical protocols and in the form of questionnaires, to quantitative functional evaluations. The evaluation tools used in this work will be: palpation of the muscles of mastication and TMJ, measurement of mandibular movements (DC/TMD), application of the ProDTMulti protocol to measure the severity of signs and symptoms of TMD, difficulty in chewing, application of the Beck Anxiety Inventory, application of the Perceived Stress Scale (PSC), use of the DTM Clinica application.