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Yıl:2020; Cilt: 12; Sayı: 2>> Özet
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Psikiyatride Güncel Yaklaşımlar; 2020;12(2):205-231
Temporomandibular Bozukluklar ve Bruksizmde Eşlik Eden Psikiyatrik Bozukluklar ve Tedavi Seçenekleri
B Geniş, Ç Hocaoğlu
Çaycuma Devlet Hastanesi, Zonguldak
Temporomandibular bozukluk (TMB) çiğneme kaslarının, temporomandibular eklemin ve bu eklemin çevresindeki 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 toplumun yaklaşık %10'unda, bruksizm %8-20'sinde görülür. TMB ve bruksizm etiyolojisinde birçok faktör etkilidir ve bu faktörler arasında etkileşimler vardır. Biyomekanik, nöromüsküler, biyopsikososyal ve nörobiyolojik faktörler hastalığa katkıda bulunur. Psikiyatrik bozuklukların prevalansı TMB ve bruksizm 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, ileriki çalışmaların gerekliliğini açıkça göstermektedir. Her iki hastalıkta da bilişsel davranışçı terapi kullanımı bir çözüm olabilir. Tedavi seçeneği ne olursa olsun hem diş hekimleri hem de psikiyatrlar multidisipliner bir çalışma ortamında olmalı ve bu hastalıkları biyopsikososyal model çerçevesinde değerlendirmelidir
Comorbid Psychiatric Disorders and Treatment Options in Temporomandibular Disorders and Bruxism
Temporomandibular disorder (TMD) is a clinical condition in which chewing muscles, temporomandibular joint and the structures surrounding this joint are affected. 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 TMD. TMD 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 disorder. The prevalence of psychiatric disorders is high in individuals with TMD and bruxism. Many psychiatric disorders, especially depression and anxiety disorders, accompany TMD and bruxism. The antidepressants used in the treatment of these disorders cause bruxism. This is one of the important challenges in the treatment of TMD and bruxism. The first step in the treatment of TMD and bruxism is to address the basic prevention methods. While amitriptyline use is prominent in TMD 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 use of cognitive behavioral therapy in both disorders may be a solution. Regardless of the treatment option, both dentists and psychiatrists should be in a multidisciplinary working environment and should evaluate these disorders within the framework of the biopsychosocial model.

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