Comprovação Científica do Tratamento

Acaba de ser disponibilizado no Pubmed, a maior biblioteca médica online do mundo, o recentíssimo estudo feito pelo Dr Alain Haggiag e o Prof. Speciali (Professor Sênior do departamento de Neurologia da USP- Ribeirão Preto e maior autoridade do pais no estudo das Cefaleias e Enxaquecas) sobre o uso DIVA em pacientes portadores de Cefaleias que vem completar o estudo já publicado em 2018 e realizado com o Prof. Siqueira (chefe de Departamento de Dor Orofacial do HC- FMUSP) :

A new biofeedback approach for the control of masseter and temporal myalgia: Utilization of an awake posterior interocclusal device.

Haggiag A DDS1, de Siqueira JTT DDS, PhD2.
Cranio. 2018 Aug 11:1-7. doi: 10.1080/08869634.2018.1503991.
https://www.ncbi.nlm.nih.gov/pubmed/30099938

A new biofeedback approach for the control of awake bruxism and chronic migraine headache: utilization of an awake posterior interocclusal device.

Haggiag A, Speciali JG. Arq Neuropsiquiatr. 2020. In press.

O sucesso do tratamento com o DIVA® se deve a uma associação de técnicas terapêuticas consagradas e eficientes na abordagem de pacientes portadores de dores crônicas na região da cabeça, como as cefaleias, enxaquecas, disfunção das ATM entre outras.

Os conselhos comportamentais, o uso de dispositivos intra orais (como é o caso do DIVA®) associados aos conceitos do biofeedback constituem, segundo pesquisas mais recentes, a maneira mais eficiente de reverter e controlar certos hábitos nocivos, como o Bruxismo de vigilia. Este último está sendo apontado como um dos grandes responsável pelo desencadeamento e manutenção de muitas dores orofaciais que geram tanto sofrimento.

Os pilares principais que fundamentam o Tratamento DIVA® são as “3 regras de 3”

O que é o tratamento

– Conselhos comportamentais
– Dispositivos intra orais
– Biofeedback

Como é o tratamento

– Não invasivo
– Não medicamentoso
– Reversível

Os objetivos do tratamento

– Conscientização dos maus hábitos
– Reeducação do paciente
– Melhora da qualidade de vida

Para saber mais sobre a historia do desenvolvimento do DIVA®, recomendamos clique aqui e leia a entrevista dada pelo Dr Alain á Sociedade Brasileira de Engenharia Biomédica

~ Dr. Alain Haggiag

Abaixo, citamos alguns estudos científicos relevantes que embasam a abordagem terapêutica com DIVA®:

1. Winocur E, Uziel N, Lisha T, Goldsmith C, Eli I. Self-reported bruxism – associations with perceived stress, motivation for control, dental anxiety and gagging. J. Oral Rehabil. 2011 Jan;38(1):3-11.

2. Sato F, Kino K, Sugisaki M, Haketa T, Amemori Y. Teeth contacting habit as a contributing factor to chronic pain in patients with temporomandibular disorders. J Med Dent Sci. 2006, Jun;53(2):103-9.

3. Glaros AG, Williams K. Tooth contact versus clenching: oral parafunctions and facial pain.; J Orofac Pain. 2012 Summer;26(3):176-80.

4. Farella M, Soneda K, Vilmann A, Thomsen CE, Bakke M. Jaw muscle soreness after tooth-clenching depends on force level. J Dent Res. 2010 Jul;89(7):717-21.

5. Svensson P, Burgaard A, Shclosser S. Fatigue and Pain in human jaw muscles during a sustained, low intensity clenching task. Arch. Biol. Oral 2001 Aug;46(8) :773-7

6. Glaros AG, Williams K, Lausten L, Friesen LR. Tooth contact in patient with temporomandibular disorders. Cranio 2005; 23: 188-193

7. Chen CY, Palla S, Erni S, Sieber M, Gallo LM. Nonfunctional tooth contact in healthy controls and patients with myogenous facial pain. J. Orofacial Pain, 2007, Summer;21(3):185-93.

8. Eversole LR, Machado L. Temporomandibular joint internal derangements and associated neuromuscular disorders.; J Am Dent Assoc. 1985 Jan;110(1):69-79.

9. McCreary CP, Clark GT, Merril RL, Flack V, Oakley ME. Psychological distress and diagnostic subgroups of temporomandibular disorder patients. Pain. 1991 Jan;44(1):29-34.

10. Glaros AG. Temporomandibular disorders and facial pain: a psychophysiological perspective. Appl. Psychophysiol Biofeedback. 2008 Sep;33(3):161-71.

11. Siqueira T. e Teixeira J.; Dores Orofaciais – Diagnóstico e tratamento. Artes medicas, 2012

12. Manfredini D, Winocur E,Guarda-Nardini L, PaesaniD, Lobbezoo F. Epidemiology of bruxism in adults: a systematic review of the literature. J Orofac Pain. 2013 Spring; 27(2):99-110

13. Glaros AG, Urban D, Locke J. Headache and temporomandibular disorders: evidence for diagnostic and behavioural overlap. Cephalalgia. 2007 Jun;27(6):542-9.

14. Glaros AG, Williams K, Lausten L, Friesen LR. Tooth contact in patient with temporomandibular disorders. Cranio 2005; 23: 188-193

15. Haggerty C, Glaros AG, Glass EG. Ecological momentary assessment of parafunctional clenching in TMD. J. Dental Res. 2000; 79-605

16. Dawson A. Experimental tooth clenching. A model for studying mechanisms of muscle pain. Swed Dent J Suppl. 2013;(228):9-94.

17. Farella M, Soneda K, Vilmann A, Thomsen CE, Bakke M. Jaw muscle soreness after tooth-clenching depends on force level. J Dent Res. 2010 Jul;89(7):717-21.

18. Dao TT, Lavigne GJ. Oral splints: the crutches for temporomandibular disorders and bruxism? Crit. Rev. Oral Biol. Med. 1998;9(3):345-61.

19. Camparis CM, Siqueira JT. Sleep bruxism: clinical aspects and characteristics in patients with and without chronic orofacial pain. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod. 2006 Feb;101(2):188-93.

20. Slade GD, Ohrbach R, Greenspan JD, Fillingim RB, Bair E, Sanders AE, et al. Painful Temporomandibular disorder: Decade of Discovery from OPPERA Studies. J Dent Res. 2016 Sep;95(10):1084-92.

21. Eric Bair, Sheila Gaynord, Gary D. Slade, Richard Ohrbachg, Roger B. Fillingimh, Joel D. Greenspan, et al. Identification of clusters of individuals relevant to temporomandibular disorders and other chronic pain conditions: the OPPERA study. Pain 2016, 157>1266–1278.

22. Camparis CM, Formigoni G, Teixeira MJ, Bittencourt LR, Tufik S, de Siqueira JT. Sleep bruxism and temporomandibular disorder: Clinical and polysomnographic evaluation.; Arch Oral Biol. 2006 Sep;51(9):721-8.

23. Siqueira JT, Camparis CM, de Siqueira SR, Teixeira MJ, Bittencourt L, Tufik S. Effects of localized versus widespread TMD pain on sleep parameters in patients with bruxism: A single-night polysomnographic study. Arch Oral Biol. 2017 Apr;76:36-41.

24. de Leeuw, Reny and Klasser, Gary D. Orofacial Pain: Guidelines for Assessment, Diagnosis, and Management, Fifth Edition, 2013

25. International Classification of Sleep Disorders: Diagnostic and Coding Manual. 2. Westchester: American Academy of Sleep Medicine; 2005

26. Ilovar S, Zolger D, Castrillon E, Car J, Huckvale. Biofeedback for treatment of awake and sleep bruxism in adults: systematic review protocol. Syst Rev. 2014 May 2;3:42.

27. De Boever JA, Nilner M, Orthlieb JD, Steenks MH; Educational Committee of the European Academy of Craniomandibular Disorders . Recommendations by the EACD for examination, diagnosis, and management of patients with temporomandibular disorders and orofacial pain by the general dental practitioner. J Orofac Pain. 2008 Summer;22(3):268-78.

28. Fujisawa , Kanemura K, Tanabe N, Gohdo Y, Watanabe A, Iizuka T, Sato M, Ishibashi K. Determination of daytime clenching events in subjects with and without self-reported clenching. J Oral Rehabil. 2013 Oct;40(10):731-6.

29. Lobbezoo F, Ahlberg J, Glaros AG, Kato T, Koyano K, Lavigne GJ, de Leeuw R, Manfredini D, Svensson P, Winocur E. Bruxism defined and graded: an international consensus. J Oral Rehabil. 2013 Jan;40(1):2-4.

30. Richard Ohrbach and Justin Durham. Biopsychosocial Aspects of Orofacial Pain. Contemporary Oral Medicine, C.S. Farah et al. (eds.), 2017,

31. Eric Schiffman, Richard Ohrbach, Thomas List, Gary Anderson, Rigmor Jensen, Mike T John, Donald Nixdorf, Jean-Paul Goulet, Wenjun Kang, Ed Truelove, Al Clavel, James Fricton, and John Look. Diagnostic criteria for headache attributed to temporomandibular disorders. Cephalalgia. 2012 July ; 32(9): 683–692

32. Glaros AG1, Kim-Weroha N, Lausten L, Franklin KL.Comparison of habit reversal and a behaviorally-modified dental treatment for temporomandibular disorders: a pilot investigation. Appl Psychophysiol Biofeedback. 2007 Dec;32(3-4):149-54.

Comprovação Científica do Tratamento

Os pilares principais que fundamentam o Tratamento DIVA® são as “3 regras de 3”

O que é o tratamento

Como é o tratamento

Os objetivos do tratamento

Abaixo, citamos alguns estudos científicos relevantes que embasam a abordagem terapêutica com DIVA®:

1. Winocur E, Uziel N, Lisha T, Goldsmith C, Eli I. Self-reported bruxism – associations with perceived stress, motivation for control, dental anxiety and gagging. J. Oral Rehabil. 2011 Jan;38(1):3-11.

2. Sato F, Kino K, Sugisaki M, Haketa T, Amemori Y. Teeth contacting habit as a contributing factor to chronic pain in patients with temporomandibular disorders. J Med Dent Sci. 2006, Jun;53(2):103-9.

3. Glaros AG, Williams K. Tooth contact versus clenching: oral parafunctions and facial pain.; J Orofac Pain. 2012 Summer;26(3):176-80.

4. Farella M, Soneda K, Vilmann A, Thomsen CE, Bakke M. Jaw muscle soreness after tooth-clenching depends on force level. J Dent Res. 2010 Jul;89(7):717-21.

5. Svensson P, Burgaard A, Shclosser S. Fatigue and Pain in human jaw muscles during a sustained, low intensity clenching task. Arch. Biol. Oral 2001 Aug;46(8) :773-7

6. Glaros AG, Williams K, Lausten L, Friesen LR. Tooth contact in patient with temporomandibular disorders. Cranio 2005; 23: 188-193

7. Chen CY, Palla S, Erni S, Sieber M, Gallo LM. Nonfunctional tooth contact in healthy controls and patients with myogenous facial pain. J. Orofacial Pain, 2007, Summer;21(3):185-93.

8. Eversole LR, Machado L. Temporomandibular joint internal derangements and associated neuromuscular disorders.; J Am Dent Assoc. 1985 Jan;110(1):69-79.

9. McCreary CP, Clark GT, Merril RL, Flack V, Oakley ME. Psychological distress and diagnostic subgroups of temporomandibular disorder patients. Pain. 1991 Jan;44(1):29-34.

10. Glaros AG. Temporomandibular disorders and facial pain: a psychophysiological perspective. Appl. Psychophysiol Biofeedback. 2008 Sep;33(3):161-71.

11. Siqueira T. e Teixeira J.; Dores Orofaciais – Diagnóstico e tratamento. Artes medicas, 2012

12. Manfredini D, Winocur E,Guarda-Nardini L, PaesaniD, Lobbezoo F. Epidemiology of bruxism in adults: a systematic review of the literature. J Orofac Pain. 2013 Spring; 27(2):99-110

13. Glaros AG, Urban D, Locke J. Headache and temporomandibular disorders: evidence for diagnostic and behavioural overlap. Cephalalgia. 2007 Jun;27(6):542-9.

14. Glaros AG, Williams K, Lausten L, Friesen LR. Tooth contact in patient with temporomandibular disorders. Cranio 2005; 23: 188-193

15. Haggerty C, Glaros AG, Glass EG. Ecological momentary assessment of parafunctional clenching in TMD. J. Dental Res. 2000; 79-605

16. Dawson A. Experimental tooth clenching. A model for studying mechanisms of muscle pain. Swed Dent J Suppl. 2013;(228):9-94.

17. Farella M, Soneda K, Vilmann A, Thomsen CE, Bakke M. Jaw muscle soreness after tooth-clenching depends on force level. J Dent Res. 2010 Jul;89(7):717-21.

18. Dao TT, Lavigne GJ. Oral splints: the crutches for temporomandibular disorders and bruxism? Crit. Rev. Oral Biol. Med. 1998;9(3):345-61.

19. Camparis CM, Siqueira JT. Sleep bruxism: clinical aspects and characteristics in patients with and without chronic orofacial pain. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod. 2006 Feb;101(2):188-93.

20. Slade GD, Ohrbach R, Greenspan JD, Fillingim RB, Bair E, Sanders AE, et al. Painful Temporomandibular disorder: Decade of Discovery from OPPERA Studies. J Dent Res. 2016 Sep;95(10):1084-92.

21. Eric Bair, Sheila Gaynord, Gary D. Slade, Richard Ohrbachg, Roger B. Fillingimh, Joel D. Greenspan, et al. Identification of clusters of individuals relevant to temporomandibular disorders and other chronic pain conditions: the OPPERA study. Pain 2016, 157>1266–1278.

22. Camparis CM, Formigoni G, Teixeira MJ, Bittencourt LR, Tufik S, de Siqueira JT. Sleep bruxism and temporomandibular disorder: Clinical and polysomnographic evaluation.; Arch Oral Biol. 2006 Sep;51(9):721-8.

23. Siqueira JT, Camparis CM, de Siqueira SR, Teixeira MJ, Bittencourt L, Tufik S. Effects of localized versus widespread TMD pain on sleep parameters in patients with bruxism: A single-night polysomnographic study. Arch Oral Biol. 2017 Apr;76:36-41.

24. de Leeuw, Reny and Klasser, Gary D. Orofacial Pain: Guidelines for Assessment, Diagnosis, and Management, Fifth Edition, 2013

25. International Classification of Sleep Disorders: Diagnostic and Coding Manual. 2. Westchester: American Academy of Sleep Medicine; 2005

26. Ilovar S, Zolger D, Castrillon E, Car J, Huckvale. Biofeedback for treatment of awake and sleep bruxism in adults: systematic review protocol. Syst Rev. 2014 May 2;3:42.

28. Fujisawa , Kanemura K, Tanabe N, Gohdo Y, Watanabe A, Iizuka T, Sato M, Ishibashi K. Determination of daytime clenching events in subjects with and without self-reported clenching. J Oral Rehabil. 2013 Oct;40(10):731-6.

29. Lobbezoo F, Ahlberg J, Glaros AG, Kato T, Koyano K, Lavigne GJ, de Leeuw R, Manfredini D, Svensson P, Winocur E. Bruxism defined and graded: an international consensus. J Oral Rehabil. 2013 Jan;40(1):2-4.

30. Richard Ohrbach and Justin Durham. Biopsychosocial Aspects of Orofacial Pain. Contemporary Oral Medicine, C.S. Farah et al. (eds.), 2017,

32. Glaros AG1, Kim-Weroha N, Lausten L, Franklin KL.Comparison of habit reversal and a behaviorally-modified dental treatment for temporomandibular disorders: a pilot investigation. Appl Psychophysiol Biofeedback. 2007 Dec;32(3-4):149-54.

33. What is Biofeedback Therapy and Who Can Benefit? Last updated Tue 10 January 2017 -By Joseph Nordqvist, Reviewed by Timothy J. Legg, PhD, CRNP

34. American Migraine Foundation