Acupuncture in Stomatology – Research, Treatments, and Concepts: by Dr Damiana Corca
“For there was never yet philosopher
That could endure the toothache patiently.”
~William Shakespeare
With my next dental visit drawing near, I “coincidentally” came across the above quote from Shakespeare. Needless to say it immediately occurred to me that my next article should definitely be on teeth – and everything related to them.
A major overview of the disorders involved in stomatology highlighted the need for a holistic approach. We have to be reminded that our teeth, gums, facial muscles, etc. work as a whole within the rest of our body. This being said, many of the disorders such as bleeding gums, excess salivation, excessive cavities, recurrent infections and many others, may have systemic causes and therefore we have to treat the root of the problem rather than pinpoint symptoms.
Some of the therapies effective against dental disorders are Acupuncture, Advanced Manual Techniques, Herbal Therapy, and Homeopathy. This article will only cover Acupuncture and Oriental Medicine concepts. However, I am planning to cover each one of these therapies in future articles.
Scientific Views of the Pain Relieving Effects of Acupuncture
The pain relieving effect of acupuncture is widely recognized and the explanations are various. I have touched upon this aspect in Acupuncture 101, but let’s take these explanations a step further.
The analgesic effect of acupuncture is thought to work by raising the threshold of pain. Specific acupuncture points, commonly known to be effective in pain relief, are used. Such points are selected depending on the source and location of the pain.
As we move towards acupuncture anesthesia, explanations go even deeper. One of the theories that explain how pain is reduced or blocked, even in cases of complex surgeries or dental work is the Gate Control Theory of Pain, a theory promoted by R. Melzack and P.D. Wall in 1965. As the perception of pain is modulated in the Central Nervous System and the normal painful impulses go across these gates, there is a second set of non-painful impulses that are triggered by the needling of acupuncture points. This creates a congestion of the two types of impulses, which leads to the closing of the gates and less pain or no pain results. Other experimental evidence shows that the acupuncture impulses also travel up to the spinal cord and brain through the sympathetic plexuses[i].
The chemical mechanisms open the door to more explanations. Generally, the naturally occurring endorphins seem to play a very important role for the analgesic effect. Serotonin seems to be also activated, along with other over 100 neurotransmitters. Moreover, enkephalin may inhibit pain by “blocking the release of acetycholine and glutamate, thereby reducing the receiving cell’s excitatory input”[ii].
Research Studies – Acupuncture Effectiveness in Dentistry Related Issues
Acupuncture Anesthesia
Acupuncture anesthesia is a system that uses acupuncture points to reduce or eradicate pain during surgery or dental procedures. In China, this type of anesthesia is used in many types of surgeries and is particularly beneficial when a patient is allergic to anesthetics, when there is a liver, kidney or lung condition or the patient is too old to undergo surgery. The patient remains conscious so there is a better control during surgery and the post-operative recovery process is shortened[iii]. In addition, it works better near the midline and above the diaphragm so brain, cranium, dental, neck and chest operations are much more often seen in China. In 1970’s the acupuncture anesthesia was as high as 5% of all surgeries[iv].
A few clinical reports originated in Japan show how acupuncture is used both as anesthetic and analgesic in acute pain[v], while another study from a Chinese Department of Stomatology suggests that acupuncture anesthesia is more efficient in senior patients as their threshold pain line is higher[vi].
Acupuncture point manual stimulation is often combined with electroacupuncture and microsystem acupuncture such as auricular acupuncture.
Microsystem Acupuncture for Pain, Anxiety and Excess Gag Reflex
Auricular acupuncture has won much recognition all over the world and it is used for a wide array of disorders. One of the most common usages in USA is in addiction disorders with a 5-point auricular acupuncture protocol called NADA, which stands for National Acupuncture Detoxification Association. As unbelievable as it might sound, the ear contains some 200 acupuncture points. This should come as no surprise as the ear offers access to many structures of the body. It has a very rich nerve supply from the spinal segments and there is a rich blood supply with sympathetic and parasympathetic fibers running very close to them.
Auricular acupuncture anesthesia, by itself or combined with electroacupunture, is a valuable pain-relieving and sedating tool. Anxiety before dental procedures is not uncommon. A randomized controlled trial conducted by the Department of Oral and Maxillofacial Surgery of the Hannover Medical School, Germany, concludes that auricular acupuncture and intranasal midazolam had about the same level of efficacy in anxiety before a dental procedure[vii]
As I have mentioned before, greater effects are seen when auricular acupuncture is combined with body points and electroacupuncture.
Excess gag reflex can be so severe that it may impede dental procedures. Auricular acupuncture has been found effective in this respect as well. British researchers have published a study in the British Dental Journal, which shows that the gag reflex can be controlled with selected auricular points[viii].
Temporomandibular joint dysfunction
There are numerous clinical studies[ix] that show how acupuncture, either by itself or combined with electroacupuncture, warm needle (moxibustion), magnets and most importantly with advanced manual techniques can promote a healthier temporomadibular joint. Moreover, it can have beneficial effects on the myofascial system and increase the mobility of the whole joint. This is a subject to which I shall dedicate a whole article in the near future, as there is plenty of research, on both acupuncture and advanced manual techniques, showing the many benefits of this common disorder.
Chinese Medicine Concepts in Stomatology
There are numerous Chinese Medicine patterns[x] covering symptoms related to stomatology. For example, bleeding gums is usually related to 3 major patterns – Spleen Deficiency, Yin deficiency, and Excess Fire. If a patient has Spleen Qi deficiency, other symptoms such as bloating, loose stools, easy bruising, and a decreased appetite may be present. If the bleeding is due to a Yin deficiency pattern, then night sweats, dry mouth, or irritability could be experienced. Finally, in Excess fire, extreme hunger and thirst, constipation, etc. may be present along with the bleeding gums. These might be concepts that you are not very familiar with; you may wonder for example, what has Spleen got to do with your teeth or your appetite.
While some of these theories might sound esoteric to you, you have to remember that this entire Chinese Medicine system has proved its efficacy over thousands of years. It has an organized system based on experience and trials over trials. Looking back at the early days of this medicine’s roots, I firmly believe that this system not only proves an excellent paradigm and a high level of thinking but also a good reminder that balance – or homeostasis – will never be an outdated word. I may need to explain more about the Chinese Medicine Organ Systems in one of my next articles. Bur for now, the message I want to convey to you is that Chinese Medicine diagnosing methods based on symptoms, observation, but also on pulse and tongue diagnosis, makes the treatment with Acupuncture (and other Chinese Medicine modalities) an integrative way of treating the whole body while taking care of the many dental disorders.
Gum problems, recurrent infections, excessive cavities, cold sores, temporomandibular joint dysfunction, and trigeminal neuralgia, are but a few of the conditions successfully treated with Chinese Medicine. The research provided in this article offers just a glimpse of the wide application of Acupuncture for dental disorders. Consult an Acupuncture Physician to find out if your condition can be helped with Acupuncture.
This is the first of a series of four articles. Soon to come – an integrative approach to advanced manual techniques, herbal therapy, and homeopathic remedies as they apply to stomatology.
Until then, keep on smiling!
More at: http://blog.elitehealthplex.com
Reference:
[i] Jayasuriya, A. (2006). Clinical Acupuncture. India: B. Jain Publishers Ltd. pp 25-33
[ii] Ibidem
[iii] Shanghai College of Traditional Medicine, Translated and Edited by O’Connor J. and Bensky D. (1995). Acupuncture, A Comprehensive Text. Seattle, WA: Eastland Press. pp 562.
[iv] Mayor F.D. Electroacupuncture, (2007). A practical Manual and Resource. New York: Elsevier Churchill Livingstone. pp 246
[v] Tagichi, R. Evid Based Complement Alternat Med.(2008 Jun);5(2):153-8.
Acupuncture anesthesia and analgesia for clinical acute pain in Japan. Department of Clinical Acupuncture and Moxibustion II Meiji University of Oriental Medicine, Kyoto, Japan.
[vi] Chen W, Wang Y, Wu H, Gu Z. Zhen Ci Yan Jiu. Department of Stomatology of Tong Ji Hospital, Tong Ji Medical University.1991;16(1):1-3, 14. Analysing the effects of tooth extraction under acupuncture anesthesia in 825 cases of senior.
[vii] Karst, M., Winterhalter, M. et al. Auricular Acupuncture for Dental Anxiety: A Randomized Controlled Trial. (Anesth Analg 2007;104:295–300)
[viii] Fiske J, Dickinson C. The role of acupuncture in controlling the gagging reflex using a review of ten cases. British Dental Journal June 9, 2001;190(11):611-613.
http://acupuncturetoday.com/mpacms/at/article.php?id=27879
[ix] Rancan SV, Bataglion C, et al. Ribeirão Preto Dental School, São Paulo University, São Paulo, Brazil. Acupuncture and temporomandibular disorders: a 3-month follow-up EMG study. Altern Complement Med. 2009 Dec;15(12):1307-10.
Wang M, Loo WT, Chou JW. Professor, State Key Laboratory of Oral Diseases, West China of Stomatology College, Sichuan University, Chengdu 610041, People’s Republic of China. Electromyographic responses from the stimulation of the temporalis muscle through facial acupuncture points. J Chiropr Med. 2007 Dec;6(4):146-52.
[x] Maciocia G. (2004). Diagnosis in Chinese Medicine, A Comprehensive Guide. New York: Elsevier Churchill Livingstone. pp 101
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