Establish objectives for this seminar This seminar intention is to familiarize everybody gathered here about the acupuncture and how it can be used in application to dentistry. Review current applications for acupuncture I will briefly talk about where acupuncture came from, various modalities of acupuncture, when it arrived in United States, what it is most famous for, and about some applications of it other than dentistry. How does it work? We will learn about how it works in scientific terms and it terms of ancient Chinese metaphorical language. Introduction to acupuncture in dentistry I will introduce a few approaches currently used in dental work with the goal in mind of building better, more comfortable and attractive dental office for current and future patients. Discuss recent clinical findings There are research and statistics available to compare results of traditional medical intervention and acupuncture approach for various dental procedures. We will review those as well. Questions and answers We will have time for questions and answers. At that time I will appreciate if let me know what aspects of acupuncture you would like to learn more about. Presentation Information CONFIDENTIAL
This seminar intention is to familiarize everybody gathered here about the acupuncture and how it can be used in application to dentistry. Presentation Information CONFIDENTIAL
Currently the outline of the dental appointment is the following: 1. Patient arrives for the appointment 2. Dental procedure is performed 3. Patient recovery time Now if we look closer to the picture from the eyes of the patient we might see the following picture: Presentation Information CONFIDENTIAL
Now if we look closer to the picture from your perspective we might see the following picture: Patient arrives for the appointment Distraction techniques are applied – such as TV, music, gentle and caring attitude Anesthesia is applied Dental procedure is performed Instructions for recovery are given to the patient 6. Patient recovery time Presentation Information CONFIDENTIAL
Now if we look closer to the picture from perspective of your patient we might see the following picture: Patient arrives for the appointment Distraction techniques are applied – such as TV, music, gentle and caring attitude Anesthesia is applied Dental procedure is performed Instructions for recovery are given to the patient Patient recovery time However this potentially positive and definitely healing experience is tainted by the patient’s fear, anxiety, and discomfort – often not relieved by the distraction techniques offered by your practice. After the procedure, depends of how complicated it is there is time for recovery. The anesthesia wears off, swelling stays, patient starts experiencing pain and discomfort for another few hours. Often pain killers must be taken to alleviate the discomfort. Of course we should remember there are patients who have good pain tolerance, are positive and not afraid of the visit to the dentist. They are eager to come and see the good results no matter what it takes. But for the majority of the patients all the named above discomforts results in: Presentation Information CONFIDENTIAL
Now if we look closer to the picture from perspective of your patient we might see the following picture: Patient arrives for the appointment Distraction techniques are applied – such as TV, music, gentle and caring attitude Anesthesia is applied Instructions for recovery are given to the patient Dental procedure is performed Patient recovery time However this potentially positive and definitely healing experience is tainted by the patient’s fear, anxiety, and discomfort – often not relieved by the distraction techniques offered by your practice. After the procedure, depends of how complicated it is there is time for recovery. The anesthesia wears off, swelling stays, patient starts experiencing pain and discomfort for another few hours. Often pain killers must be taken to alleviate the discomfort. Of course we should remember there are patients who have good pain tolerance, are positive and not afraid of the visit to the dentist. They are eager to come and see the good results no matter what it takes. But for the majority of the patients all the named above discomforts mean: Presentation Information CONFIDENTIAL
In this presentation we will talk about acupuncture only. However hypnosis is another extremely effective modality helping patients with pain management and recovery. We will talk about it after this seminar if we have time, or we can schedule time for another presentation. Presentation Information CONFIDENTIAL
Review current applications for acupuncture I will briefly talk about where acupuncture came from, various modalities of acupuncture, when it arrived in United States, what it is most famous for, and about some applications of it other than dentistry. Acupuncture is practiced medical treatments that is over 5,000 years old. Very basically, Acupuncture is the insertion of very fine needles on the body's surface, in order to influence physiological functioning of the body. Acupuncture can also be used in conjunction with heat produced by burning specific herbs, this is called Moxibustion. In addition, a non-invasive method of massage therapy, called Acupressure, can also be effective. The first record of Acupuncture is found in the 4,700 year old Huang Di Nei Jing (Yellow Emperor's Classic of Internal Medicine). This is said to be the oldest medical textbook in the world. It is said to have been written down from even earlier theories by Shen Nung, the father of Chinese Medicine. Shen Nung documented theories about circulation, pulse, and the heart over 4,000 years before European medicine had any concept about them. As the basis of Acupuncture, Shen Nung theorized that the body had an energy force running throughout it. This energy force is known as Qi .The Qi consists of all essential life activities which include the spiritual, emotional, mental and the physical aspects of life. A person's health is influenced by the flow of Qi in the body, in combination with the universal forces of Yin and Yang . (I will discuss Yin and Yang a little later). If the flow of Qi is insufficient, unbalanced or interrupted, Yin and Yang become unbalanced, and illness may occur. Qi travels throughout the body along "Meridians" or special pathways. The Meridians, (or Channels), are the same on both sides of the body (paired). There are fourteen main meridians running vertically up and down the surface of the body. Out of these, there are twelve organ Meridians in each half of the body (remember they are in pairs). There are also two unpaired midline Meridians. There will be a diagram of Acupuncture points for treating diseases of the Meridians at the end of the digestive system paper. (See Appendix 1). The acupuncture points are specific locations where the Meridians come to the surface of the skin, and are easily accessible by "needling," Moxibustion, and Acupressure. The connections between them ensure that there is an even circulation of Qi, a balance between Yin and Yang. Energy constantly flows up and down these pathways. When pathways become obstructed, deficient, excessive, or just unbalanced, Yin and Yang are said to be thrown out of balance. This causes illness. Acupuncture is said to restore the balance. Yin and Yang is an important theory in the discussion of Acupuncture treatment, in relation to the Chinese theory of body systems. As stated earlier Qi is an energy force that runs throughout the body. In addition, Qi is also prevalent throughout nature as well. Qi is comprised of two parts, Yin and Yang. Yin and Yang are opposite forces, that when balanced, work together. Any upset in the balance will result in natural calamities, in nature; and disease in humans. Yin is signified by female attributes, passive, dark, cold, moist, that which moves medially, and deficient of Yang. Yang is signified by male attributes, light, active, warm, dry, that which moves laterally, and deficient of Yin. Nothing is completely Yin or Yang. The most striking example of this is man himself. A man is the combination of his mother (Yin) and and his father (Yang). He contains qualities of both: This is the universal symbol describing the constant flow of yin and yang forces. You'll notice that within yin, there is Yang, and within Yang, there is the genesis of Yin. Whether or not you believe in Taoist philosophy, (which all this is based on), one thing is indisputable: Acupuncture works. Acupuncturists can use as many as nine types of Acupuncture needles, though only six are commonly used today. These needles vary in length, width of shaft, and shape of head. Today, most needles are disposible. They are used once and disgarded in accordance with medical biohazard regulations and guidlines. There are a few different precise methods by which Acupuncturists insert needles. Points can be needled anywhere in the range of 15 degrees to 90 degrees relative to the skin surface, depending on the treatment called for. In most cases, a sensation, felt by the patient, is desired. This sensation, which is not pain, is called deqi (pronounced dah-chee). The following techniques are some which may be used by an Acupuncturist immediately following insertion: Raising and Thrusting, Twirling or Rotation, Combination of Raising/Thrusting and Rotation, Plucking, Scraping (vibrations sent through the needle), and Trembling (another vibration technique). Once again, techniques are carefully chosen based on the ailment. There are a few related procedures that fall into the range of Acupuncture treatments. The first is Electro-Acupuncture. This is the using of very small electrical impulses through the Acupuncture needles. This method is generally used for analgesia (pain relief or prevention). The amount of power used is only a few micro amperes, but the frequency of the current can vary from 5 to 2,000 Hz. The higher frequencies are generally used for surgery (usually abdominal), and the lower frequencies for general pain relief. The first reported successful use of Electro-Acupuncture was in 1958 in China for a tonsillectomy. Today, it is a common method of surgical analgesia used in China. Other methods for stimulating Acupuncture points have used Lasers and sound waves (Sonopuncture). A very commonly used treatment in the United States is Auriculotherapy or Ear Acupuncture. The theory is that since the ear has a rich nerve and blood supply, it would have connections all over the body. For this reason, the ear has many Acupuncture points which correspond to many parts and organs of the body. Auricular Acupuncture has been successful in treating problems ranging from obesity to alcoholism, to drug addiction. There are numerous studies either completed, or currently going on which affirms Auricular Acupuncture's effectiveness. (These will be mentioned in detail later on in the paper.) Another popular treatment method is Moxibustion, which is the treatment of diseases by applying heat to Acupuncture points. Acupuncture and Moxibustion are considered complimentary forms of treatment, and are commonly used together. Moxibustion is used for ailments such as bronchial asthma, bronchitis, certain types of paralysis, and arthritic disorders. Cupping is another type of treatment. This is a method of stimulating Acupuncture points by applying suction through a metal, wood or glass jar, in which a partial vacuum has been created. This technique produces blood congestion at the site, and therefore stimulates it. Cupping is used for low backache, sprains, soft tissue injuries, and helping relieve fluid from the lungs in chronic bronchitis. One of the most popular alternatives to Acupuncture is Acupressure. This is simply Acupuncture without needles. Stimulation of the Acupuncture points is performed with the fingers or an instrument with a hard ball shaped head. Another variation of Acupressure is Reflexology (also called Zone Therapy). This is where the soles of the feet and the posterio-inferior regions of the ankle joints are stimulated. Many diseases of the internal organs can be treated in this manner. The question arises, how does Acupuncture work? Scientists have no real answer to this; as you know many of the workings of the body are still a mystery. There are a few prevailing theories. By some unknown process, Acupuncture raises levels of triglycerides, specific hormones, prostaglandins, white blood counts, gamma globulins, opsonins, and overall anti-body levels. This is called the "Augmentation of Immunity" Theory. The "Endorphin" Theory states that Acupuncture stimulates the secretions of endorphins in the body (specifically Enkaphalins). The "Neurotransmitter" Theory states that certain neurotransmitter levels (such as Seratonin and Noradrenaline) are affected by Acupuncture. "Circulatory" Theory: this states that Acupuncture has the effect of constricting or dilating blood vessels. This may be caused by the body's release of Vasodilaters (such as Histamine), in response to Acupuncture. One of the most popular theories is the "Gate Control" Theory. According to this theory, the perception of pain is controlled by a part of the nervous system which regulates the impulse, which will later be interpreted as pain. This part of the nervous system is called the "Gate." If the gate is hit with too many impulses, it becomes overwhelmed, and it closes. This prevents some of the impulses from getting through. The first gates to close would be the ones that are the smallest. The nerve fibers that carry the impulses of pain are rather small nerve fibers called "C" fibers. These are the gates that close during Acupuncture. In the related "Motor Gate" Theory, some forms of paralysis can be overcome by Acupuncture. This is done by reopening a "stuck" gate, which is connected to an Anterior Horn cell. The gate, when closed by a disease, stops motor impulses from reaching muscles. This theory was first stated by Professor Jayasuriya in 1977. In it he goes on to say: "...one of the factors contributing to motor recovery is almost certainly the activation of spindle cells. They are stimulated by Gamma motor neurons. If Acupuncture stimulates the Gamma motor neurons, the discharge causes the contraction of Intrafusal Muscle fibers. This activates the Spindle cells, in the same way as muscle stretching. This will bring about muscle contraction." There are many diseases that can be treated successfully by Acupuncture or its related treatments. The most common ailments currently being treated are: lower backache, Cervical Spondylosis, Condylitis, Arthritic Conditions, Headaches of all kinds (including migraine), Allergic Reactions, general and specific use for Analgesia (including surgery) and relief of muscles spasms. There have also been clinical trials in the use of Acupuncture in treating anxiety disorders and depression. Likewise, very high success rates have been found in treating addictions to alcohol, tobacco (nicotine) and "hard' drugs. Acupuncture can rid the body of the physical dependency, but can not rid the mind of the habit (psychological dependency). For this reason, Acupuncture treatment of addictions has not been fully successful. Presentation Information CONFIDENTIAL
Acupuncture is best known for the control of pain . However, acupuncture can treat a wide variety of common and uncommon disorders. The following is a list of disorders that can be treated by acupuncture (World Health Organization data): Respiratory Acute Sinusitis Acute rhinitis Common cold Acute tonsillitis Acute bronchitis Bronchial asthma Eye Acute conjunctivitis (pinkeye) Nearsightedness (in children) Cataract (without complications) Mouth Toothache, post extraction pain Gingivitis (gum disease) Acute and chronic pharyngitis Gastrointestinal Disorders Hiccups Gastritis Gastric Hyperacidity Ulcers Colitis Constipation Diarrhea Paralytic ileus Neurological and Musculoskeletal Disorders Headache and migraine Trigeminal neuralgia Paralysis following stroke Meniere's disease Neurogenic bladder dysfunction Nocturnal enuresis (bed wetting) Intercostal neuralgia (pain in the ribs) Cervicobrachial syndrome (pain radiating from neck to arm) Frozen shoulder or Tennis elbow Sciatica Low back pain Osteoarthritis In the United States, acupuncture is used frequently for the treatment of chronic pain conditions such as arthritis, bursitis, headache, athletic injuries, and posttraumatic and post surgical pain. It is also used for treating chronic pain associated with immune function dysfunction such as psoriasis (skin disorders), allergies, and asthma. Acupuncture is also found to be effective for the treatment of mind-body disorders such as anxiety, chronic fatigue, irritable bowel syndrome, hypertension, insomnia, PMS, menopausal symptoms, and depression. Some modern application of acupuncture is in the treatment of disorders such as alcoholism, addiction, smoking, and eating disorders. Presentation Information CONFIDENTIAL
The question arises, how does Acupuncture work? Scientists have no real answer to this; as you know many of the workings of the body are still a mystery. There are a few prevailing theories. By some unknown process, Acupuncture raises levels of triglycerides, specific hormones, prostaglandins, white blood counts, gamma globulins, opsonins, and overall anti-body levels. This is called the "Augmentation of Immunity" Theory. The "Endorphin" Theory states that Acupuncture stimulates the secretions of endorphins in the body (specifically Enkaphalins). The "Neurotransmitter" Theory states that certain neurotransmitter levels (such as Seratonin and Noradrenaline) are affected by Acupuncture. "Circulatory" Theory: this states that Acupuncture has the effect of constricting or dilating blood vessels. This may be caused by the body's release of Vasodilaters (such as Histamine), in response to Acupuncture. One of the most popular theories is the "Gate Control" Theory. According to this theory, the perception of pain is controlled by a part of the nervous system which regulates the impulse, which will later be interpreted as pain. This part of the nervous system is called the "Gate." If the gate is hit with too many impulses, it becomes overwhelmed, and it closes. This prevents some of the impulses from getting through. The first gates to close would be the ones that are the smallest. The nerve fibers that carry the impulses of pain are rather small nerve fibers called "C" fibers. These are the gates that close during Acupuncture. In the related "Motor Gate" Theory, some forms of paralysis can be overcome by Acupuncture. This is done by reopening a "stuck" gate, which is connected to an Anterior Horn cell. The gate, when closed by a disease, stops motor impulses from reaching muscles. This theory was first stated by Professor Jayasuriya in 1977. In it he goes on to say: "...one of the factors contributing to motor recovery is almost certainly the activation of spindle cells. They are stimulated by Gamma motor neurons. If Acupuncture stimulates the Gamma motor neurons, the discharge causes the contraction of Intrafusal Muscle fibers. This activates the Spindle cells, in the same way as muscle stretching. This will bring about muscle contraction." There are many diseases that can be treated successfully by Acupuncture or its related treatments. The most common ailments currently being treated are: lower backache, Cervical Spondylosis, Condylitis, Arthritic Conditions, Headaches of all kinds (including migraine), Allergic Reactions, general and specific use for Analgesia (including surgery) and relief of muscles spasms. There have also been clinical trials in the use of Acupuncture in treating anxiety disorders and depression. Likewise, very high success rates have been found in treating addictions to alcohol, tobacco (nicotine) and "hard' drugs. Acupuncture can rid the body of the physical dependency, but can not rid the mind of the habit (psychological dependency). For this reason, Acupuncture treatment of addictions has not been fully successful. Presentation Information CONFIDENTIAL
One of the most popular theories is the "Gate Control" Theory. According to this theory, the perception of pain is controlled by a part of the nervous system which regulates the impulse, which will later be interpreted as pain. This part of the nervous system is called the "Gate." If the gate is hit with too many impulses, it becomes overwhelmed, and it closes. This prevents some of the impulses from getting through. The first gates to close would be the ones that are the smallest. The nerve fibers that carry the impulses of pain are rather small nerve fibers called "C" fibers. These are the gates that close during Acupuncture. In the related "Motor Gate" Theory, some forms of paralysis can be overcome by Acupuncture. This is done by reopening a "stuck" gate, which is connected to an Anterior Horn cell. The gate, when closed by a disease, stops motor impulses from reaching muscles. This theory was first stated by Professor Jayasuriya in 1977. In it he goes on to say: "...one of the factors contributing to motor recovery is almost certainly the activation of spindle cells. They are stimulated by Gamma motor neurons. If Acupuncture stimulates the Gamma motor neurons, the discharge causes the contraction of Intrafusal Muscle fibers. This activates the Spindle cells, in the same way as muscle stretching. This will bring about muscle contraction.“ Ok..now we know the "stimuli" that may cause pain. How do these stimuli activate the nervous system? There are specialized "receptors" in the skin and internal organs that are sensitive to stimuli that are painful. These receptors are called "nociceptors" and are free nerve endings connected to small diameter myelinated A and unmyelinated C nerve fibers - these are the nerve fibers that are LACKING in people with congenital insensitivity to pain (here is more information about nerve fibers). Nociception, then, is the response of the nervous system to painful stimulation. When the nociceptors detect a nociceptive stimulus, they send a message to the spinal cord. A famous theory concerning how pain works is called the Gate Control Theory devised by Patrick Wall and Ronald Melzack in 1965. This theory states that pain is a function of the balance between the information traveling into the spinal cord through large nerve fibers and information traveling into the spinal cord through small nerve fibers. Remember, large nerve fibers carry non-nociceptive information and small nerve fibers carry nociceptive information. If the relative amount of activity is greater in large nerve fibers, there should be little or no pain. However, if there is more activity in small nerve fibers, then there will be pain. Here is what the gate control theory looks like: Let's go through the theory step by step: Without any stimulation, both large and small nerve fibers are quiet and the inhibitory interneuron (I) blocks the signal in the projection neuron (P) that connects to the brain. The "gate is closed" and therefore NO PAIN. With non-painful stimulation, large nerve fibers are activated primarily. This activates the projection neuron (P), BUT it ALSO activates the inhibitory interneuron (I) which then BLOCKS the signal in the projection neuron (P) that connects to the brain. The "gate is closed" and therefore NO PAIN. With pain stimulation, small nerve fibers become active. They activate the projection neurons (P) and BLOCK the inhibitory interneuron (I). Because activity of the inhibitory interneuron is blocked, it CANNOT block the output of the projection neuron that connects with the brain. The "gate is open", therefore, PAIN!! Presentation Information CONFIDENTIAL
There are multiple applications for the acupuncture related to dental procedures. It all depends on the patient’s needs and details of the dental procedure he/she is receiving. Several reviews have investigated the role of acupuncture in dentistry and concluded that acupuncture could supplement conventional treatment modalities for the treatment of dental pain, facial pain, gagging reflex, and temporomandibular dysfunction. Our study is the first controlled investigation comparing auricular acupuncture directly to benzodiazepine, placebo-acupuncture, and no treatment. The findings suggest auricular acupuncture as a suitable and easy method to reduce dental anxiety. In contrast to midazolam, auricular acupuncture was not associated with prolonged sedation and the risk of respiratory depression. Avoiding these side effects may result in earlier discharge from the dental office and decreased costs. With the results of this study the anxiety-reducing effect of auricular acupuncture has been confirmed and is similar to that found for preoperative anxiety and anxiety in pre-hospital transport settings. Overall, there is a substantial body of data showing that auricular acupuncture is worthwhile and should be considered as a sedative and tranquilizing treatment. However, there are no data available regarding the exact mechanism of ear acupuncture, but somatotopic orientation of the ear points suggests regionally specific effects on relevant structures of the human brain. In the context of body acupuncture, this suggestion is supported by functional magnetic resonance imaging findings in humans and immunohistochemistry findings in animal experiments. Presentation Information CONFIDENTIAL
From the Departments of *Anesthesiology, †Oral and Maxillofacial Surgery, ‡Biometrics, and §Physical Medicine and Rehabilitation, Pain Clinic, Hannover Medical School, Hannover, Germany. Patient anxiety before dental treatment is common. It was estimated that 31% of adults are fearful of dental treatment (1). Moreover, many studies worldwide report that about 10% of people have a dental phobia (2). Patients who are highly anxious about receiving dental treatment may delay or cancel appointments, often at short notice. The avoiding behavior as well as the anxiety previous to dental treatment have a negative impact on dental treatment and dental health and may result in referrals to hospital sedation units for routine dental care. Presentation Information CONFIDENTIAL
Some people start experiencing anxiety and phobia a few days before their appointment. Some – when they step into the office. Some – when they see dental instruments and lab coats. These reactions can be a result of low pain threshold or can have a psychological base. Often it is a reaction conditioned for many years of negative experiences and it takes time to recondition these reactions. Sometimes it never happens no matter how pleasant and positive experiences your office offers. These patients can greatly benefit from alternative choices presented to them. Alternative choices alter their expectations of the upcoming procedure – they give their mind and body a choice to select more appropriate response to the treatment. Patient feels that he/she is heard and her/his concerns are being addressed in individualized fashion. Every patient’s presentation is different and points selection is unique. Even if only 10 minutes more – the patient feels more relaxed and ready for the procedure. The “unusual” pre-procedure serves as a distraction. Some people strongly believe in acupuncture either by personal experience or by stories heard, and it by itself can be very helpful. Previous reports have suggested that (auricular) acupuncture can be used for the treatment of chronic anxiety as well as acute situational anxiety (5–7), but its efficacy has not been studied in a direct head-to-head comparison with a standard drug treatment. Therefore, we designed a study to determine whether auricular acupuncture can decrease acute dental anxiety and compared it with the standard pharmacological sedative medication midazolam, noninvasive placebo auricular acupuncture, and no treatment. To our knowledge, this is the first study comparing auricular acupuncture to intranasal midazolam for reducing dental anxiety. We demonstrated that, in the treatment of dental anxiety, no difference between auricular acupuncture and intranasal midazolam could be detected, but that the active interventions were superior to no treatment. Furthermore, the anxiety-reducing effect started as early as 30 min after insertion of the needles or application of midazolam, respectively. The duration of sedation was less prolonged in the auricular acupuncture group than in the midazolam group. The significantly better treatment conditions in the active intervention groups suggest clinical significance. Auricular acupuncture provided the same improved patient compliance during the dental procedure without prolonged sedation. Some patients reported a burning sensation when they received intranasal midazolam. No adverse events from auricular acupuncture were observed in any patient. Shen men, HT7, PC6, SP6 - relaxation Presentation Information CONFIDENTIAL
Auricular acupuncture is found to be effective during dental procedure. Of course it doesn’t work as a miracle and doesn’t work with everybody but it does work for many people. Presentation Information CONFIDENTIAL
Acupuncture activates the healing process of the body, boosts immune system and aiding the recovery. It had been scientifically proved that acupuncture stimulates midbrain and hypothalamus releasing serotonin and dopamine responsible for the feeling of overall well-being. In recent research study after the removal of 3 rd molar patient was treated either was acupuncture or placebo (unspecified). Subjects treated with acupuncture reported 181 minutes pain-free time compared with 71 minutes in the placebo group. Both acupuncture and codeine groups were found to reduce the pain compared to the placebo group. Avoiding side effects of the medication may result in earlier discharge from the dental office and decreased costs. The word is derived from endo genous ( inside the body) and m orphin e( morphine like effect) Hence , endorphins are chemicals produced by the brain during certain periods that have effects similar to morphine and other opioid drugs . They however, do not cause dependence and addiction like the drugs. Another significant difference is with regard to the duration of action. Endorphins ( which are made up of smaller subunits of proteins called peptides ) are rapidly degraded by the body's enzymes unlike externally administered drugs which tend to act for long periods. Their effect is brought about by activating certain receptors and modifying the transmission of other chemicals that communicate between nerve cells. Endorphins are most commonly released during periods of pain and stress. In addition to lowering pain, they also have several positive effects on mood and even boost the immune system. This has potential implications in management of precancerous cells and research is going on in this regard. Also use Traumeel – apply gel and take pills. Shortens recovery time to 1/2 Presentation Information CONFIDENTIAL
Some patients are particularly sensitive to dental equipment, which may cause them to gag uncontrollably when an instrument such as a mirror or drill is placed in the mouth. Others are so terrified, either due to a bad prior experience or to stories they've heard about bad dental experiences, that the mere thought of dental treatment causes them to gag even before any work has begun. “ The gagging reflex is a psychological reaction which safeguards the airway from foreign bodies ,” said Janice Fisk at the Department of Sedation and Special Care Dentistry in London in a recent article in the British Dental Journal. “In some people, this response is exaggerated to the extent that the acceptance/provision of dental treatment is not possible.” Traditional Chinese Medicine (TCM) has been making headlines in the past few years for its contribution to dentistry – namely using acupuncture to treat patients suffering from serious gag reflexes at dental offices. Studies have asserted that acupuncture, when applied to dentistry, is a safe, cheap, quick, and relatively non-invasive technique to control the gag reflex in patients. “ Acupuncture needles were inserted into a specific anti-gagging point on each ear, manipulated briefly and left in situ ,” said Fiske about her study. “Dental treatment was then carried out and the effectiveness of the acupuncture in preventing gagging was assessed. After treatment, the needles were removed and the patient discharged. All acupuncture was carried out by a dentist trained in its use.” Results were quite positive: “Dental treatment could be carried out in all cases and at all visits ,” Fiske said. In another study at Weston Park Hospital in Sheffield, UK, doctors observed similar results. “Before acupuncture, the patients that had moderate to severe [gag reflexes] and after acupuncture the [gag reflex] had reduced to a level which only complicated dental treatment slightly. ” “ Ear acupuncture was successful in controlling the gag reflex,” concluded Fisk in her article. “It is a safe, quick, inexpensive, and relatively noninvasive technique. ” Including simple acupuncture techniques in dental medicine can greatly increase not only the effectiveness of treatment performed, but also decrease anxiety and fear in the minds of patients. Researchers in Great Britain appear to have found a solution to the problem of dental gagging. According to a new study published in the British Dental Journal , stimulation of an acupuncture point on the ear prior to undergoing treatment effectively controls the gag reflex, allowing dentists to perform a variety of procedures without compromising the patient's safety and comfort. The investigators chose 10 people between the ages of 40 and 65, each of whom had been referred to a sedation unit because of an exaggerated gag reflex. All of the subjects were rated either a four or five (out of five points) on the Gagging Severity Index, making conventional treatment impossible and having an adverse affect on their ability to seek a dentist for care. Prior to referral, six people were able to receive treatment only with intravenous sedation; two were unable to receive treatment because of their gag reflexes; and two had avoided dental care altogether out of fear. Before being treated by the dentist, each patient received acupuncture at a point on the upper part of the ear between the concha and triangular fossa. The researchers used a fine needle (7mm) into the anti-gagging point of each ear to a depth of three millimeters. The needles were manipulated for 30 seconds prior to dental treatment and remained in place until the patient was discharged. Using ear acupuncture, the patients underwent a total of 25 dental treatment episodes. Episodes ranged from routine forms of care, such as fillings, impressions and teeth cleaning, to more complicated procedures, including extractions, root canals and biopsies. All of the patients tolerated the acupuncture extremely well; according to the researchers, "there were no reactions to the technique." Only two episodes of mild gagging were noted, and all of the subjects were able to travel home without assistance. Many of the participants expressed their joy at being able to undergo treatment without gagging. Some patients said they had "tried everything" to control their gag reflexes before taking part in the study. Others reported that because of their fear, they had avoided seeing a dentist and worried how they would cope if faced with a dental emergency. One patient even reported she had searched "for the last 20 years" trying to find a cure for her dental gagging before turning to acupuncture. While the scientists were unable to determine how acupuncture suppressed the gag reflex, they did offer a possible explanation. In the traditional theories of auricular acupuncture, different ear points are associated with different body parts and are roughly equivalent to those of a fetus mapped out on the external surface of the ear. In this instance, the anti-gagging point did not correspond to the traditional location of the head on the lobe of the ear. In describing the technique's mechanism of action, however, they observed that one of the main nerves involved in swallowing, the vagus nerve, also supplies the part of the ear that contains the anti-gagging acupuncture point. The point is also adjacent to a branch of the trigeminal nerve. Together, the trigeminal and vagus nerves are responsible for much of the sensory and motor functions of the larynx, pharynx and palate. "One can only speculate that in some way, as yet not understood, stimulation of the anti-gagging points activates mechanisms that inhibit the muscle activity of the gag reflex," they wrote. Presentation Information CONFIDENTIAL
This report evaluates the effect of meridian acupuncture treatment on trigeminal neuralgia. Ten patients aged 26 to 67 years (mean 55.4 years) who visited the outpatient Dental Anesthesiology Clinic at Tsurumi University Dental Hospital from 1985 to 1990 were studied. Five of the patients suffered from idiopathic and five from symptomatic trigeminal neuralgia. The patients underwent meridian treatment by acupuncture alone or acupuncture combined with moxibustion. The acupuncture method used was primarily basic treatment employing only needles without electrical stimulation. Meridian acupuncture treatments were repeated from two to four times a month. Five patients were restored to a pain-free state. The other five patients noted a decrease in pain, but with some level of pain remaining (significant pain in one patient). It is concluded that meridian acupuncture treatment is useful and can be one therapeutic approach in the management of trigeminal neuralgia. The International Association for the Study of Pain (IASP) and the International Headache Society (IHS) have similar diagnostic criteria to diagnose TGN 1 (Table 1). Trigeminal neuralgia can be associated with structural problems inside the skull, but usually no treatable cause is found. The trigeminal nerve is divided into three branches: V1, which innervates the forehead and eye; V2, the cheek; and V3, the jaw. The pain of trigeminal neuralgia can occur in one or all of these areas. It is often a sudden, sharp or electric shock-like pain of short duration (seconds to minutes). It can be bilateral, but in such cases it usually begins on one side of the face. Pain related to TGN can be triggered by opening the mouth to talk, laugh, chew, brush one's teeth, or by wind or a touch on the face. Surgery may cause side effects such as nerve injury or cerebrospinal fluid leak. A number of published articles support the benefits of using oriental medicine or acupuncture to treat TGN. Two articles are considered here as representative of this literature: "Observation on the Effect of Acupuncture Treatment in 300 Cases of Primary Trigeminal Neuralgia" by Xu and Ge 20 and "Practical Application of Meridian Acupuncture Treatment for Trigeminal Neuralgia" by Satoshi, Yasumichi, Yoshihiro and Ichirou. 21 Xu and Ge evaluated the effects of local points to treat trigeminal neuralgia. Treatment was given every other day, with 10 sessions constituting a course. The point protocol used was as follows: branch I was involved in 10 cases ( meizhong, an extra point), branch II was in 51 cases (St 2), branch III in 28 cases (St 7), branches I and II in 36 cases ( meizhong and St 2), branches II and III in 146 cases (St 2 and St 7), branches I, II and III in 29 cases ( meizhong , St 2 and St 7) were treated with acupuncture only. One hundred thirty-eight of 300 people showed immediate and complete relief of symptoms. This study did not report the patients' TCM patterns. Xu and Ge directly stimulated the acupuncture points overlying the trigeminal nerves. The reader is left to assume that all TGN is caused by the same pathological mechanism and therefore should be treated by the same group of points on the affected side. ST7, GB2, ST19, - local Opposite side – LI4 Same side – SJ3, GB34,32,31 Presentation Information CONFIDENTIAL
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