Tratamento da disfunção temporomandibular e dor orofacial no âmbito do Sistema Único de Saúde

Abstract

Temporomandibular Disorder (TMD) is a group of painful conditions that mainly affect the temporomandibular joints and/or chewing muscles, being considered the most common cause of orofacial pain (OFP) of non-odontogenic origin. Given the demand from patients with this dysfunction who seek care in the Brazilian Unified Health System (SUS) and cannot access adequate treatment, this research aimed to analyze the care network for individuals with TMD and DOF in the SUS, from the perspective of managers; the knowledge of dental surgeons (DSs) working in the primary health care network (PHC) about this dysfunction and the budgetary impact of the proposal to offer occlusal devices (ODs) in secondary care (SC). To this end, electronic questionnaires were applied to municipal oral health managers throughout Brazil to understand the clinical procedures applied to patients with TMD and OFP at the PHC and SC levels. Electronic questionnaires were also administered DSs who work in PHC to assess their knowledge about the etiology, diagnosis and treatment of this disorder, in addition to the availability of services for patient referral. Furthermore, a partial economic health assessment was carried out, through Budgetary Impact Analysis (AIO) using the bottom-up micro-costing technique obtaining clinical and laboratory costs of manufacturing OD in Dental Specialty Centers from the perspective of the SUS. The data obtained were tabulated and analyzed using descriptive and inferential statistics using a significance level of 5% (p <0.05). There were representatives from all geographic regions of Brazil (managers, n=96; DSs, n=371), but the majority were from the South region (managers - 37.5%; DSs - 45.9%). Most managers reported that both in PHC (n=82; 85.5%) and in SC (n=68; 70.5%) patients with TMD are not treated. Furthermore, the majority stated that there were no specific protocols or training courses for professionals to care for these patients. The majority of DSs reported that they do not treat patients with TMD (n=209; 56.3%), nor do they know of public services in their municipality for referral (n=268; 72,2%) and deemed it necessary to implement of specialized services for this type of care in the SUS (n=363; 97.8%). In general, DSs demonstrated limited knowledge about the etiology, diagnosis and treatment of TMD, overestimating the importance of occlusion and more invasive management options. For all domains, DTM and OFP specialists agreed with the literature on a greater number of questions, with statistically significant differences between them and the other DSs. There was no statistically significant difference between geographic regions and training time. The final cost for making the occlusal device, including a return session for adjustments, was R$ 149,81. This amount was subtracted from the percentage passed on by the Ministry of Health to the municipalities. Considering a sensitivity analysis of 25%, there may be a variation for the best and worst case scenarios, respectively R$ 104,93 and R$194,71. The incremental impact on the budget of the total number of Brazilian municipalities for the offer of 4,240,551 DOs over 5 years was R$635,276,945.31.It is concluded that, from the perspective of SUS oral health managers, there are flaws in the care network for patients with TMD and OFP, with a deficit in the provision of services in both primary and secondary care. The AP DSs demonstrated limited knowledge about this dysfunction and difficulties in referring patients. The cost of making an occlusal device was R$149.81. Despite the limitations of the study, it is expected to contribute to the reorganization of oral health services, allowing access and comprehensive treatment to these patients with the least economic impact.