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Acupuncture in the Management of Acute Dental Pain

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Acute dental pain is the main reason for seeking dental services to provide urgent dental care; there is consensus about the use of alternative therapies, such as acupuncture, to control dental pain in pre-dental care. This study aimed to evaluate the use of acupuncture in reducing the intensity of acute dental pain in pre-dental care in patients waiting for emergency dental care, and was conducted at the After-Hours Emergency Dental Clinic of Piracicaba Dental School, and at the Emergency Center Dental Specialties I in Piracicaba, São Paulo, Brazil. The sample consisted of 120 patients. The Visual Analog Scale (VAS) was used to measure pain intensity. All patients underwent one session of acupuncture; the points LI4, ST44 and CV23 were selected and were used alone or in combinations. Reduction in pain was observed in 120 patients (mean initial VAS = 6.558 ± 1.886, p < 0; mean final VAS = 0.962 ± 2.163, p < 0.00001). The results of this study indicate that acupuncture analgesia could be a technical adjunct to pain control in patients with acute dental pain, contributing to the restoration of health with social benefit.
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-
ORIGINAL ARTICLE
-
Acupuncture in the Management of Acute
Dental Pain
Ca
´
ssia Maria Grillo, Ronaldo Seichi Wada,
Maria da Luz Rosa
´
rio de Sousa
*
Department of Social Dentistry, Piracicaba Dental School, University of Campinas,
Piracicaba, Sa
˜
o Paulo, Br azil
Available online 11 April 2013
Received: Jul 4, 2012
Revised: Feb 26, 2013
Accepted: Mar 5, 2013
KEYWORDS
acupuncture analgesia;
alternative medicine;
dentistry;
toothache
Abstract
Acute dental pain is the main reason for seeking dental services to provide urgent dental
care; there is consensus about the use of alternative therapies, such as acupuncture, to
control dental pain in pre-dental care. This study aimed to evaluate the use of acupunc-
ture in reducing the intensity of acute dental pain in pre-dental care in patients waiting
for emergency dental care, and was conducted at the After-Hours Emergency Dental
Clinic of Piracicaba Dental School, and at the Emergency Center Dental Specialties I in
Piracicaba, Sa
˜o
Paulo, Brazil. The sample consisted of 120 patients. The Visual Analog
Scale (VAS) was used to measure pain intensity. All patients underwent one session of
acupuncture; the points LI4, ST44 and CV23 were selected and were used alone or in com-
binations. Reduction in pain was observed in 120 patients (mean initial VAS Z 6.558
1.886, p < 0; mean final VAS Z 0.962 2.163, p < 0.00001). The results of this study indi-
cate that acupuncture analgesia could be a technical adjunct to pain control in patients
with acute dental pain, contributing to the restoration of health with social benefit.
1. Introduction
Acute dental pain, experienced by many people, without
distinction of sex, age, or race, is the most common reason
for the demand for health care, especially urgent dental
care provided at emergency care centers [1].
Pain is considered a common symptom of an oral con-
dition [2], and to control it, there is consensus about the
use alternative therapies combined with conventional
treatment. Conventional treatment for acute dental pain
management involves diagnosis of the condition causing the
pain, dental treatment, and drugs [3]. Two groups of drugs
* Corresponding author. Department of Social Dentistry, Piracicaba Dental School University of Campinas, Av. Limeira, 901 e Area
˜o,
Piracicaba CEP 13414-903, Sa
˜
o Paulo, Brazil.
E-mail: luzsousa@fop.unicamp.br
Copyright ª 2014, International Pharmacopuncture Institute
pISSN 2005-2901 eISSN 2093-8152
http://dx.doi.org/10.1016/j.jams.2013.03.005
Available online at www.sciencedirect.com
Journal of Acupuncture and Meridian Studies
journal homepage: www.jams-kpi.com
J Acupunct Meridian Stud 2014;7(2):65e70
are used: non-narcotic analgesics, including anti-
inflammatory steroids, non steroidal anti-inflammatory
drugs (NSAIDs, e.g., ibuprofen, aspirin, mefenamic acid)
and paracetamol (acetaminophen) and narcotics (e.g.,
tramadol) [3,4].
At present, acupuncture is an alternative therapy [5],
the value of which has been recognized as a treatment for
pain [6,7]. In the Geneva WHO 2003 report, pain in
dentistry, including dental pain, facial, and postoperative
pain, were listed among the conditions for which
acupuncture appears to be an effective treatment [8,9].
No scientific literature was found on the use of
acupuncture in the management of acute dental pain in
pre-dental care, among the clinical trials published in the
past 10 years. However, in a systematic literature review
[10], according to data analysis, acupuncture can be
effective in relieving dental pain, either during surgical
procedures or after surgery.
Acupuncture involves inserting thin needles in some
points on the surface of the body, known as acupuncture
points, in order to obtain a therapeutic response, with the
aim of treatment and prevention of disease [11].
When a needle is inserted into the acupoint, a specific
feeling called De qi is felt, which can present as pain,
numbness, heat, weight, or distention around the area
where the needle was inserted, and this feeling can radiate
along the path of the meridian that belongs to the point
stimulated. It is a desired and necessary effect for
acupuncture to be effective [12,13].
The exact mechanism of action of acupuncture has not
yet been established [13]. According to the literature [14],
inserting a needle into an acupoint creates a small inflam-
matory process, with the release of neurotransmitters such
as bradykinin and histamine. Then, the stimuli are con-
ducted to the central nervous system through the thick and
myelinated A-delta fibers, and the thin and unmyelinated C
fibers, located in the skin and muscles. When the stimuli
end on the posterior horn of the spinal cord, they stimulate
enkephalinergic neurons, through synapses, to release
enkephalin, a blocker of substance P (a neurotransmitter
that stimulates pain), thus inhibiting the pain sensation.
The stimuli continue mainly through the lateral spinotha-
lamic tract until the brainstem, releasing serotonin, which
is responsible for increased levels of endorphin and ACTH
(adrenocortical hormone), and increasing cortisol in the
adrenal glands, thus ensuring the beneficial effect on the
patient’s stress and anxiety [14].
Acupuncture is considered a safe procedure [12],if
performed by a professional with proper training
[5,11,14,15]. It is a natural, low cost therapeutic resource,
which has an advantage, because the use of conventional
drugs to treat acute dental pain can have adverse effects
such as stomach ulcers and bleeding problems (ibuprofen),
dizziness, constipation, sleep disorders (tramadol) [4], and
hives, skin rashes, and blood dyscrasias (paracetamol) [3].
Acupuncture does not replace conventional surgical
procedures [14]. According to current evidence suggesting
that acupuncture is effective as a symptomatic treatment
of dental pain [16], its use in pain patients awaiting dental
care generates a social benefit and improves the patient’s
physical and emotional condition, thereby contributing to
the success of the professional service.
In view of the foregoing discourse, the objective of this
study was to evaluate the effect of acupuncture on
reducing acute dental pain in patients awaiting care at the
after-hours emergency dental care centers.
2. Material and methods
This study was conducted at the after-hours emergency
dental care center of the Piracicaba Dental School, Uni-
versity of Campinas and at the Emergency Center Dental
Specialties I in Piracicaba (Sa
˜
o Paulo), from September 2009
to July 2010.
The study was conducted in accordance with ethical
criteria, in compliance with the standards required by the
Declaration of Helsinki and was approved by the Research
Ethics Committee of the Piracicaba Dental School FOP/
UNICAMP (number 020/2009).
A convenience sample was used, which included all pa-
tients with acute dental pain, who were waiting for dental
care, aged between 18 years and 90 years and who agreed
to participate in the study by signing the terms of free and
informed consent. Pregnant women and patients partici-
pating in other researches were excluded from the sample.
The survey was carried out in the dental office of the
emergency dental care centers, prior to the activities of
doctors on duty began. To undergo the procedure, the pa-
tient was accommodated in the dental chair. After
acupuncture, all patients were asked whether they would
recommend the procedure to another patient in the same
situation.
During the study, the intensity of pain reported by pa-
tients was measured by a Visual Analog Scale (VAS), ranging
from 0 (VAS 0 Z no pain) to 10 (VAS 10 Z maximum pain);
the initial VAS score was measured at the time of invitation
to participate, and the final VAS score, on completion of the
acupuncture treatment.
The acupoints selected for the study were according to
the therapeutic indication, related to orofacial pain and
dental pain, according to Traditional Chinese Medicine
(TCM).
2.1. Description of points
LI4 (Hegu): fourth point of the large intestine meridian (LI),
located in the back of the hand; point of analgesia in
painful disorders of the face and teeth. It is a point of great
analgesic importance [17]. In its internal pathway, the
meridian is strongly associated with the oral cavity.
ST44 (Nei Ting): penultimate point of the stomach me-
ridian (ST), located in the foot, between the second and
third metatarsal; indicated for toothache and in the
reduction of edema. The stomach meridian runs through
the area around the mouth, mandible, and gums of the
maxilla [18].
CV23 (Lian Quan): penultimate point of the conception
vessel. It is located in the midline of the ventral depression
above the hyoid bone, with the patient sitting with the
neck in extension; indicated for facial pain [18].
Points elected were used individually or combined, with
the aim of reducing the intensity of acute dental pain
(VAS).
66 C.M. Grillo et al.
2.2. Application of the acupuncture
(1) Note the initial VAS.
(2) Inserting a needle into one of the points to get the
feeling of De qi, after the patient reports the De qi
sensation the final VAS was noted and the point used.
(3) In the case of VAS Z 0, indicating no pain, the needle
was removed and acupuncture was concluded.
(4) In cases where there was a reduction in pain, but
VAS > 0 remained, or the pain remained the same, the
first needle remained in the insertion site and another
needle was inserted into one of the two remaining
points elected to obtain a De qi. After the patient re-
ported the De qi sensation, the final VAS was noted.
(5) Similarly, in the case of VAS Z 0, indicating no pain, the
needle was removed and acupuncture was concluded.
(6) If, after association of the second point in the cases of
VAS > 0, a third needle was inserted at the last point,
associated with the two preceding points, acupuncture
was applied and the VAS was recorded in the same way
as in the two previous points, thus ending the
acupuncture application, even if the VAS was > 0
(Fig. 1).
There was no manipulation of the acupuncture needle
(dispersion or tonification). In patients who did not report
feeling the De qi, the needles remained in place for 5
minutes.
The choice of point to begin the acupuncture was
random, and so was the sequence of association of the
points.
In cases of acute pain, acupuncture at the points with
significant analgesic effects (LI4, ST44) provided relief in a
short time [17].
Needle insertion was unilateral on the side of the
referred pain and for patients who reported pain in more
than one tooth on both sides. The needle was inserted on
the side with the severest pain, and the initial VAS recorded
was equivalent to the pain of higher intensity.
At the LI4 and ST44 points, needle insertion was
perpendicular, and at the CV23 point, it was inserted to-
ward the base of the tongue [18].
The depth of needle introduction was appropriate to the
points, respecting the physical constitution, the patient’s
age, and the location of the point [19].
The needles used were disposable, sterile, individually
packed, 0.25 25 mm in size, stainless steel, Huan Qiu
brand (Suzhou Huanqiu Acupuncture Medical Appliance Co.
Ltd., Suzhou, Jiangsu, China). Prior to the placement of
needles, skin antisepsis was performed with 70% alcohol and
cotton. The researcher is an experienced acupuncturist.
After acupuncture application, all patients were
instructed to remain in the waiting room and wait for
dental treatment.
2.3. Statistical analysis
The statistical analysis was performed using Microsoft Of-
fice Excel 2007. First, a descriptive analysis of the variable
under review (VAS) was made, to obtain the absolute and
percentage distribution, mean and median, and standard
deviation (SD), initial VAS and VAS after acupuncture. Dif-
ferences between responses were evaluated by ANOVA,
followed by Tukey’s test [20]. Statistical differences were
considered significant at p < 0.05.
2.4. Main outcome measures
The main outcome measure was pain intensity, measured
by VAS. The secondary measure was to achieve VAS Z 0; for
this purpose, we added each acupuncture point to evaluate
the response by the differences between Group 1 (one
acupuncture point), Group 2 (2 acupuncture points), and
Group 3 (3 acupuncture points).
3. Results
One hundred and twenty patients participated in the sur-
vey, aged from 18 years to 71 years, mean age of 35 years
(35.82 11.98). Out of the total number of patients invited
to participate in the study (n Z 317), there was a loss of
62.14% (n Z 197) from the sample, because 145 patients
were without pain at the time of the invitation, 29 patients
had pain and were afraid of the acupuncture needle, 22
patients with pain did not disclose the reason for refusal,
and one patient with pain refused to participate because
without pain, it would not be possible to tell the dentist
which tooth was causing the problem.
Acupuncture significantly decreased the pain intensity
(mean pain value at baseline Z 6.558 1.875 and after
intervention, mean Z 0.963 2.164); the t test was
applied, based on the initial VAS and final VAS scores
(measured in the same individual) to obtain a value of
p < 0.00001; there was a significant reduction in pain. In all
groups, there was a reduction in pain, which can be verified
by observing the mean values (Table 1). The group of pa-
tients who needed one point (n Z 29) to obtain VAS Z 0, on
Figure 1 Sequence of application of acupuncture in this
study.
Acupuncture in the management of acute dental pain 67
an average, had a lower initial VAS score than the group of
patients who needed 2 points (n Z 43), and these in turn,
had a lower mean initial VAS score than the group who
needed three points (n Z 33).
The mean pain reduction scores prior to and after the
application of acupuncture at one point, was statistically
significant (p < 0.0001). Based on these results, the appli-
cation of acupuncture differs statistically from point to
point. At point LI4, we found the largest decrease in pain
assessed prior to and after application of acupuncture; at
point CV23, pain reduction was greater than at point ST44,
but smaller than at point LI4; and at point ST44 we found
less reduction in pain compared with the other points
(Table 2).
As regards the patients who participated in the study, 77
(64.17%) were women and 43 (35.83%) were men (Table 3).
Only 2.5% of patients did not respond to acupuncture,
irrespective of the starting point and of the sequence used.
In the total sample, 119/120 patients (99.17%), would
recommend acupuncture treatment to relieve acute dental
pain in dental pre-care to another patient in the same sit-
uation and 1/120 (0.83%) would not recommend it.
4. Discussion
The results of this study indicated that acupuncture
reduced pain intensity (VAS Z 0), in 72.50% of patients with
acute dental pain, awaiting care in an emergency dental
care center.
The point LI4 (Hegu) had a better analgesic effect
(p < 0.0001), as in other studies [7,13,15,21]. Although it is
located in the hand, LI4 is frequently used for pain control
in cases of oral and craniofacial surgery, because of its
analgesic value in dental-facial pain [12,22,23] .
According to Chinese medicine, pain can be caused by
stagnation of Qi [24], thus the LI4 acupoint was selected
because it is an important point of analgesia [17], and
because the main pathway of its meridian (large intestine)
Yang Ming (hand), its secondary path which passes through
the mandible and maxilla and the meeting point Yuan
[18,24], are used in order to relieve the obstruction of
meridians and collaterals, promoting the free flow of Qi and
thereby eliminating pain [24].
The needling of a specific point contributes to the relief
of pain, and the location of the stimulus determines the
therapeutic effect and physiological response [25] . Each
point has a specific function and indication for its use. For
example, stimulation of certain acupuncture points distant
from the source of pain can provide excellent analgesia,
whereas stimulation of improperly selected points near the
source of pain may be ineffective or even aggravate the
symptoms [13].
With technological advances in neuroimaging, a study [7]
with acupoint LI4 using magnetic resonance imaging (fMRI),
concluded that acupuncture can decrease the activity of
regions of the brain, disabling the limbic system that re-
lates to pain perception, however the small sample size is a
limitation of the study.
LI4 was the point used in a study [22] involving maxil-
lofacial surgery, in which the selection of points was per-
formed individually by selecting distal points and those that
passed next to the surgery site. Acupuncture was per-
formed prior to, during, and after surgery, and the authors
concluded that acupuncture analgesia can be a supplement
to conventional anesthesia in maxillofacial surgery.
We found no previous studies that used the CV23 point for
acute dental pain. This was one of the points used in a study
[22] on the use of acupuncture anesthesia combined with
techniques for performing maxillofacial surgery. The results
suggested that the application was appropriate for this asso-
ciation with clinical surgery for the relief of postoperative
pain, because of the technical simplicity and low cost. In this
study, a reduction in the intensity of acute dental pain was
shown, demonstrating the therapeutic effect of acupuncture
Table 1 Mean, standard deviation, first quartile, and third quartile of initial Visual Analog Scale (VAS), of final VAS, and
according to the number of points applied.
Pain Number of
points
Mean Standard
deviation
1
Quartile Median 3
Quartile
Initial (n Z 29) 1 5.6896 1.7341 5 6 6
Initial (n Z 43) 2 6.3488 1.6018 5 6 7
Prior to 2 points 2 3.6744 1.8480 2 3 4.5
Initial (n Z 15) 3 6.8333 2.3350 5 7 8.75
Prior to 2 points 3 4.9333 1.9988 3.5 4.5 6.25
Prior to 3 points 3 2.4333 1.8113 1.25 2 3
Initial (n Z 33) >3 7.4697 1.7497 6 8 9
Prior to 2 points >3 6.1061 2.0262 5 6 8
Prior to 3 points >3 4.7879 2.0001 3 4 6
After 3 points >3 3.5000 2.8723 1 2 6
Table 2 Mean pain reduction prior to and after applica-
tion of acupuncture in a point.
Point Mean difference in pain prior to and after
ST44 1.5000*
CV23 2.8333*
LI4 3.9149*
*Points differed statistically, according to Tukey’s test
(p < 0.005).
68 C.M. Grillo et al.
in promoting dental analgesia. Moreover, at this acupuncture
point, patients reported the sensation of De qi as a tingling, as
though the jaw had been anesthetized.
Point ST44 alone did not reduce pain intensity, although
the stomach meridian, Yang Ming (foot) goes through the
face and to be the Ying point that promotes the free flow Qi
and pain relief [18,24]. This differed from the literature
[12,25], in which it was reported that ST44 is a point of
great analgesic importance, designed to treat acute pain.
According to the literature [5], the therapeutic effect of
each point has been defined, and they can be combined
with other points to perform a specific treatment, as in this
study, when we used CV23, ST44, and LI4.
In this study, needle insertion was unilateral on the side
of the pain reported by the patient, in agreement with
another study [12] that evaluated the use of acupuncture
for postoperative pain control in third molar surgery. In this
case, the acupuncture needle was inserted on the side of
the extracted tooth. In the mentioned study, the partici-
pant’s eyes were covered during treatment in both the
placebo and acupuncture groups. Those in the placebo
group were not needled and treatment received was tap-
ped with plastic tubing in areas near the acupoints chosen
for the acupuncture group. Pain parameters in the
acupuncture group were observed to be significantly
improved postoperatively. The ideal time for acupuncture
has been shown to be the time immediately after the
operation [12].
In our study, due to individual variation, we were un-
successful in applying acupuncture in 2.5% of patients, a
result that differs from another study, in which the value
was 10% [13].
During the study no patient had adverse reactions to the
treatment, however, the literature [16] reports that 7e11%
of patients treated with acupuncture, have adverse re-
actions such as sweating, dizziness, drowsiness, and
bleeding. In our clinical practice, we consider it important
to note the number of needles inserted and the related
acupoints, so that all are removed at the end of the session.
In this study, more women (64.17%) sought the assistance
of emergency services when compared to men (35.83%);
preventive health habits are more associated with women.
Most patients (99.17%) would recommend acupuncture
therapy to another patient in the same situation, in
agreement with another study [26], which evaluated pa-
tients with problems of temporomandibular disorder
treated for 18e20 years. Patients who received acupunc-
ture, occlusal splint, and other therapies (physiotherapy,
drugs, etc.), said they would recommend the treatment to
another patient with similar complaints.
The study sample did not meet the external validity of
the results; we cannot infer that the results apply to the
Table 3 Number and percentage of patients without pain (VAS Z 0) and with pain (VAS > 0), after application of 1, 2 ,and 3
points, according to gender.
Pain After application Points applied
*
Female Male Total of
patients (MþF)
%
VAS Z 0 1 13 8 21 17.50
1 point 2 0 0 0 0.00
3 7 1 8 6.67
Subtotal 20 9 29 24.17
1e2 2 0 2 1.67
1e3 7 4 11 9.17
2 points (sequence) 2e1 5 1 6 5.00
2e3 4 3 7 5.83
3e1 4 3 7 5.83
3e2 8 2 10 8.33
Subtotal 30 13 43 35.83
1e3 1 2 3 2.50
1e3e2 0 1 1 0.83
3 points (sequence) 2e1e3 1 1 2 1.67
2e3e1 1 1 2 1.67
3e1e2 1 1 2 1.67
3e2e1 2 3 5 4.17
Subtotal 6 9 15 12.50
VAS > 01e2e3 2 2 4 3.33
1e3e2 2 3 5 4.17
3 points (sequence) 2e1e3 1 1 2 1.67
2e3e1 7 2 9 7.50
3e1e2 2 1 3 2.50
3e2e1 7 3 10 8.33
Subtotal 21 12 33 27.5
Total 77 43 120 100.00
F Z female; M Z male; VAS Z Visual Analog Scale.
* Identification of points: 1 Z LI4; 2 Z ST44; and 3 Z Cv23.
Acupuncture in the management of acute dental pain 69
whole population, because of the small sample size, and we
could not split the group by gender.
It is recommended that in further studies, the profes-
sional who performs the acupuncture should not be the
same as the one who performs the data collection, and that
studies should be conducted to evaluate the duration of the
effect of acupuncture, which was done in this study.
Pain that leads to a patient seeking emergency dental
care can result from various diseases or dental, oral, and
facial conditions, or those in nearby structures, therefore,
the use of drugs should be restricted to situations of real
necessity [3] and should be indicated by the dentist after
his diagnosis. Therein lies the importance of pain control in
pre-service therapy practice, using a simple, low cost
technique, without any adverse effects, for the benefit of
the patient awaiting conventional treatment.
In conclusion, the results of this study indicated that the
effects promoted by acupuncture analgesia could be a
technical adjunct to pain control in patients with acute
dental pain, contributing to the restoration of health with
social benefit. However, further studies are needed to in-
crease the understanding of its effects.
Disclosure statement
The author affirms there are no conflicts of interest and the
author has no financial interest related to the material of
this manuscript.
Acknowledgements
The authors thank Dr. Jou E. Jia and Dr. Jorge E. Sato for
their cooperation in the selection of acupuncture points. No
financial support was received for this study.
References
1. Anderson R. Patient expectations of emergency dental ser-
vices: a qualitative interview study. Br Dent J. 2004;197:
331e334.
2. Lalabonova HR, Staneva M, Dobreva D. Pain, stress, anxiety and
psychotherapeutic modalities for their management in dental
practice. J Imab. 2005;2:31e33.
3. Hargreaves K, Abbott PV. Drugs for pain management in
dentistry. Aust Dent J. 2005;50(Suppl. 2):S14eS22.
4. Analgesics in Dentistry. CME Resource; 2010:1e36.
5. Kaptchuk TJ. Acupuncture: theory, efficacy, and practice. Ann
Intern Med. 2002;136:374e383.
6. Wang SM, Kain ZN, White PF. Acupuncture analgesia: II. Clinical
considerations. Anesth Analg. 2008;106:611e621.
7. Shen YF, Goddard G. Functional MRI and acupuncture (large
intestine 4 acupoint) in patients with myofascial pain of the
jaw muscles: A pilot randomized trial. J Orofac Pain. 2009;23:
353e359.
8. World Health Organization. Acupuncture: review and analysis
of reports on controlled clinical trials. Genebra: World Health
Organization; 2003.
9. Wong LB. acupuncture in dentistry: its possible role and
application. Proc Sing Healthc. 2012;21:48e56.
10. Ernst E, Pittler MH. The effectiveness of acupuncture in
treating acute dental pain: a systematic review. Br Dent J.
1998;184:443e447.
11. Mangal B, Sugandhi A, Kumathalli KI, Sridhar R. Alternative
medicine in periodontal therapy e a review. J Acupunct Me-
ridian Stud. 2012;5:51e56.
12. Lao L, Bergman S, Hamilton GR, Langenberg P, Berman B.
Evaluation of acupuncture for pain control after oral surgery: a
placebo-controlled trial. Arch Otolaryngol Head Neck Surg.
1999;125:567e572.
13. Chernyak GV, Sessler DI. Perioperative acupuncture and
related techniques. Anesthesiology. 2005;102:1031e1078.
14. Rosted P. Introduction to acupuncture in dentistry. Br Dent J.
2000;189:136e140.
15. Vachiramon A, Wang WC, Vachimaron T. The use acupuncture
in implant dentistry. Implant Dent. 2004;13:58e64.
16. Ernst E. Acupuncture e a critical analysis. J Intern Med.
2006;
259:125e137.
17. Stux G, Pomeranz B. Basics of Acupuncture. 5th ed. Berlim:
Springer-Verlag; 1997.
18. Lian LY, Chen CY, Hammes M, Kolster BC. Pictorial Atlas of
Acupuncture an Illustrated Manual of Acupuncture Points.
Slovenia: H.f.ullmann; 2005.
19. Lu DP, Lu GP. Anatomical relevance of some acupuncture
points in the head and neck region that dictate medical or
dental application depending on depth of needle insertion.
Acupunct Electrother Res. 2003;28:145e156.
20. Montgomery DC. Design and Analysis of Experiments. 6th ed.
Hoboken: John Wiley & Sons; 2005.
21. Lu DP, Lu GP, Gabriel PL. Comparing the clinical effect of five
varying locations of LI4 acupoint. Acupunct Electrother Res.
2008;33:135e143.
22. Pohodenko-Chudakova IO. Acupuncture analgesia and its
application in cranio-maxillofacial surgical procedures. J Cra-
niomaxillofac Surg. 2005;33:118e122.
23. Kim KS, Kim KN, Hwang KG, Park CJ. Capsicum plaster at the
Hegu point reduces postoperative analgesic requirement after
orthognathic surgery. Anesth Analg. 2009;108:992e996.
24. Hu WL, Chang CH, Hung YC, Shieh TY. Acupuncture anesthesia
for complicated dental extractions in patients with lidocaine
allergy. J Altern Complement Med. 2009;15:1149e1152.
25. Lin JG, Chen WL. Review: acupuncture analgesia in clinical
trials. Am J Chin Med. 2009;37:1e18.
26. Bergstro
¨m
I, List T, Magnussoni TA. A follow-up study of subjec-
tive symptoms of temporomandibular disorders in patients who
received acupuncture and/or interocclusal appliance therapy
18e20 years earlier. Acta Odontol Scand. 2008;66:88e92.
70 C.M. Grillo et al.
... and coping skills can be done by employing various strategies of psychology in children with dental anxiety. 17,21 Results have shown that all the distraction techniques used in the present study showed a statistically significant reduction in the anxiety levels at different time intervals. In children who were subjected to hypnosis, there was a higher reduction in the pulse rate when compared to acupressure, audiovisual aids, and the control group which was statistically significant. ...
... Recent decades have seen an upsurge in the development of psychological techniques in behavioral science that not only reduce the anxiety of the patient in the long run and the use of pharmacological techniques. 16,17 Psychotherapeutic methods have proven to be effective in reducing the patient's fear and anxiety associated with dentistry. However, the literature shows a lacuna in studies conducted on children as most of the studies has been conducted involving adults. ...
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Aim: The present study aimed to assess and compare the efficacy of acupressure, hypnosis and audiovisual aids in reducing anxiety in children during the administration of local anesthesia (LA). Methodology: Two hundred apparently healthy children were selected randomly between 6 and 10 years of age and were divided into 4 groups with 50 children in each group. Group I: children were subjected to hypnosis, group II: acupressure, group III: AV aids i.e., VPT, and group IV: children were the control group where no anxiety-reducing techniques were used during administration of LA. The anxiety scores were recorded at three different time intervals by recording the pulse rate (PR), respiratory rate (RR) and anxiety rate (AR) and subjected to statistical analysis. Results: The results showed that, all the three distraction techniques showed a significant reduction in PR, RR and AR at all time intervals, when compared to the control group. A significant reduction in PR, RR and AR was seen in the hypnosis group when compared to acupressure and only PR in comparison to AV aids. There was no significant difference between group II and III in reducing anxiety. Conclusion: The present study indicates that all the three distraction techniques were effective in reducing anxiety in children. Hypnosis was most promising, followed by audiovisual aids and acupressure. Clinical significance: The techniques can be utilized in a day-to-day practice to manage patients with anxiety. Keywords: Acupressure, Anxiety rate, audiovisual aid, Hypnosis, Pulse rate, Respiratory rate.
... Acupuncture has demonstrated a good efficacy against conditions such as dizziness and headache, [15] primary dysmenorrhea, [16] trigeminal neuralgia, [17] dental pain, [18] acute lower back pain, [19] and stroke sequelae. [20] Therefore, the Program for Emergency Treatment with Chinese Medicine, which was officially implemented in 2018, has nine primary indications, including dizziness, acute abdomen pain (ileus), chest tightness (chest pain and palpitations), soft tissue pain, menstrual pain, migraine, cancer pain, bone and joint-related pain, and brain stroke. ...
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Acupuncture can be conveniently used for pain control in patients with a variety of conditions, and it has obvious effects on various acute pains. In 2018, we implemented a program for emergency treatment with Chinese medicine to promote the integration of Chinese and Western medicine at the Emergency Department (ED). Ileus is a common cause of abdominal pain among patients in the ED, and it is an indication for emergency treatment with Chinese medicine. This study investigated the efficacy of acupuncture as a traditional Chinese medicine (TCM)-based treatment method for the treatment of patients with ileus in the ED. We analyzed data of patients with ileus, who visited ED between January and December 2019, and compared the length of ED stay between the Western medicine group and the Western medicine plus acupuncture group. Furthermore, pain intensity was measured by a visual analogue scale before and after acupuncture. We found that the length of ED stay was 10.8 hours lesser in the Western medicine plus acupuncture group than in the Western medicine group (P = .04), and the visual analogue scale score decreased by 2.0 on average from before to after acupuncture treatment (P = .02). Acupuncture treatment was effective and rapid in relieving the symptoms and discomfort in patients with ileus and in reducing their length of stay in the ED.
... It is an adjunct to pain control and is effective as a symptomatic treatment of dental pain. [26] 8. Audio Analgesia Introduced by Gardner and Licklider, Audio analgesia involves the use of music and noise in suppressing pain. Earphones are given to patients who can then control the acoustic stimulation with the help of a control box. ...
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Understanding pain for better management is very crucial for any healthcare practitioner. Dental pain can be caused by several factors and can be of different types. The first step for managing dental pain is acquiring an accurate diagnosis. Assessment of pain is done using rating scales like Visual Analog scales and in the form of Questionnaires. Once diagnosis is made, there are various options that can be used alone or in combination for better management of pain. Unless the underlying cause of pain is removed none of the methods of pain control would work. There are many pharmacological and non-pharmacological approaches for relieving dental pain. Dental Anxiety can also lower threshold of pain in patients for which behavioural management should be attempted. Premedication before administering anaesthesia has also shown to make management of pain easier. The keystone of pain management is prescribing analgesics like NSAIDS, aspirin, and few opioids like morphine. Another method commonly used is the use of anaesthetics which can be given either topically or in injectable forms. Analgesia or conscious sedation can help overcome dental phobia and is used profoundly in children. Other alternative methods like hypnosis, acupuncture and audio-analgesia have also proven to be efficient for pain management. Recently, lasers have been studied for pain control too. Use of virtual reality for distraction methods has also shown to be effective. Various time-honoured home remedies are also used for the management of pain. Therefore, one must understand that approach to pain management is multidimensional.
... Functionally, swallowing related response was attenuated by chemoinhibition of PVH in the PSD model. EA at CV23 was used to treat for kinds of diseases, including acute dental pain 29 , essential tremor 30 , cranial nerve palsy 31 , stroke 32 and swallowing disorders 2,6,15,33 . Acupuncture at CV23 has been evidenced to activate specific brain regions, including NA 15, 33 , VLM 2, 15 , NTS 15 , striatum 34 , central amygdala (CeA) 35 www.nature.com/scientificreports/ ...
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... Acupuncture is a safe practise when conducted by someone who has received sufficient training. It's a pain reliever that also works as a symptomatic treatment for dental pain 25 . ...
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Any healthcare professional must be able to understand pain in order to better manage it. Dental pain can be caused by a variety of things and can manifest itself in many ways. Getting an appropriate diagnosis is the first step in dealing with tooth discomfort. Pain is evaluated using rating tools such as the Visual Analog Scale and questionnaires. Following a diagnosis, a variety of strategies for pain management can be utilized alone or in combination. None of the pain-relieving approaches will work until the underlying source of the pain is addressed. Dental pain can be relieved using a variety of pharmacological and non-pharmacological methods. Patients with dental anxiety may have a decreased pain tolerance, which should be addressed with behavioral treatment. Premedication prior to anaesthetic administration has also been found to improve pain management. Analgesics like NSAIDS, aspirin and a few opioids like morphine are the cornerstones of pain management. Anaesthetics, which can be applied topically or in injectable forms, are another regularly utilized approach. Dental phobia can be overcome with analgesia or conscious sedation, which is commonly used in youngsters. Hypnosis, acupuncture and audio-analgesia have all been shown to be effective in the treatment of pain. Lasers have recently been investigated for the treatment of pain. Virtual reality has also been proven to be successful as a distraction tool. Pain can also be managed with a variety of tried-and-true home treatments. As a result, it's crucial to recognize that pain treatment is a multifaceted process.
... Stimulation of GB34 activates the prefrontal cortex, the precentral gyrus and putamen in patients with Parkinson's disease; areas of the brain that exhibit dysfunction due to nigral dopamine depletion (Yeo et al., 2014). LI4 (Hegu) is located on the dorsum of the hand and LI11 (Quchi) at the elbow; both are suggested to be particularly useful for improving neck-shoulder-arm disorders (Shiro et al., 2014), with clinical evidence describing the relief of stress, facial pain, headache, toothache, neck, and shoulder pain (LI4) (He et al., 2004;Shen et al., 2009;Pavão et al., 2010;Grillo et al., 2014;Wang et al., 2015), pain-related conditions, and common fever (LI11) (Choi et al., 2018). Acupoints ST34 (Liangqiu, above the laterosuperior border of the patella), ST35 (Dubi, at the lower border of the patellar) and ST36 (Zusanli, on the anterior of the leg lateral to the edge of the tibia, below ST35) are effective for postoperative pain control (Liu et al., 2015); stimulation of ST36 is frequently used to treat dyskinesia and facilitate motor recovery after stroke, to treat pain, hypertension, and other physiological dysfunctions (Sun et al., 2019) such as migraine . ...
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The extensive involvement of the endocannabinoid system (ECS) in vital physiological and cognitive processes of the human body has inspired many investigations into the role of the ECS and drugs, and therapies that target this system and its receptors. Activation of cannabinoid receptors 1 and 2 (CB1 and CB2) by cannabinoid treatments, including synthetic cannabinoids, alleviates behavioral responses to inflammatory and neuropathic pain. An increasing body of scientific evidence details how electroacupuncture (EA) treatments achieve effective analgesia and reduce inflammation by modulating cannabinoid signaling, without the adverse effects resulting from synthetic cannabinoid administration. CB1 receptors in the ventrolateral area of the periaqueductal gray are critically important for the mechanisms of the EA antinociceptive effect, while peripheral CB2 receptors are related to the anti-inflammatory effects of EA. This review explores the evidence detailing the endocannabinoid mechanisms involved in EA antinociception.
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As Práticas Integrativas e Complementares (PICs) são oferecidas pelo Sistema Unico de Saude (SUS) à populacao brasileira. O objetivo é descrever a experiência com acupuntura no serviço de extensão da Faculdade de Odontologia de Piracicaba da Universidade Estadual de Campinas (FOP/UNICAMP) que ocorre desde 2007. Os dados vieram de fichas de atendimento na clínica da FOP nos cursos de extensão de Acupuntura no período de 2007 a 2018 e no Centro de Especialidades Odontológicas (CEO) do Município de Piracicaba no ano de 2018, para demonstrar o impacto dos atendimentos na população. Foi também analisado o perfil dos alunos que realizaram o cursos ao longo desses anos, e que atenderam os pacientes que procuraram atendimento. A maioria dos usuários era do sexo feminino, adultos, com maior procura por alterações cabeça e pescoço e provenientes do próprio local de atendimento. Metade não tinha experiência prévia com acupuntura e a maioria esperava que a acupuntura resolveria seu problema. Entre 2007 e 2018, 12 acupunturistas acompanharam o desenvolvimentos dos cursos de extensão e 31 alunos se inscreveram para cursá-lo, dos quais 2 fizeram pós graduação na área. Desde o primeiro curso de extensão em 2007 os atendimentos com acupuntura da população propiciou aquisição de habilidades por parte dos alunos e dos prestadores de serviço voluntário, bem como proveu atenção aos pacientes que procuraram o serviço e confiavam na solução do problema, tendo assim os cursos de extensão um impacto positivo sobre os alunos dos cursos, a população atendida e a universidade.
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Introducción: desde una mirada biológica, el dolor dental es un síntoma que indica daño en la pulpa dental. Sin embargo, desde una perspectiva centrada en el ser humano, se considera un proceso en donde se expresan elementos sustanciales de la cultura de la salud; en particular, las representaciones simbólicas sobre la boca y los dientes, y las diferentes estrategias que utiliza la población para solventar esta dolencia. El objetivo comprender la manera en que la población Pijao entiende y atiende sus dolores dentales. Método: estudio etnográfico. Uso de herramientas como análisis documental, observación participante, entrevistas semi-estructuradas y diario de campo. Resultados: este dolor es común en la población, y se relaciona con la presencia de caries dental e indica el inicio de la pérdida dental. La manera en que se entiende y atiende se relaciona con las representaciones simbólicas sobre la boca y los dientes, y sobre sus enfermedades y su atención. Su tratamiento inicial se da en el ámbito familiar a través de recursos herbolarios y farmacéuticos. Debido a su intensidad, las personas acuden a la atención odontológica por su eficacia terapéutica. Es el principal motivo de consulta odontológica. Conclusiones: el dolor dental es un proceso en donde los sujetos instituyen una conciencia sobre su cuerpo. Igualmente, indica malas condiciones de salud bucal, dificultades en la implementación de políticas de Atención Primaria en Salud Bucal, y la existencia de barreras económicas y culturales de acceso a las instituciones sanitarias.
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Resumen Objetivo Evaluación de los niveles de energía de pacientes con dolor dental antes y después de acupuntura o dipirona. Diseño Análisis de parámetros de energía de un ensayo clínico aleatorio doble ciego. Emplazamiento FOP-UNICAM (Facultad de Odontología de Piracicaba, Universidad Estatal de Campinas) en Piracicaba, São Paulo, Brasil. Participantes El ensayo clínico incluyó a 56 voluntarios asignados al azar en 4 grupos: acupuntura, acupuntura placebo, dipirona y dipirona placebo. Los voluntarios seleccionados presentaron dolor de la pieza dentaria de origen pulpar con escala de dolor por encima de 4. Intervenciones Antes de realizar cualquier intervención terapéutica, a los voluntarios se les midió su nivel de energía mediante el método Ryodoraku. Después de este procedimiento, cada voluntario recibió tratamiento según su grupo. Después de 20 min, a los voluntarios se les midieron nuevamente sus niveles de energía y dolor. Mediciones principales Ryodoraku y escala de dolor. Resultados Todos los pacientes tenían un perfil energético con deficiencia antes de realizar intervenciones. Hubo una reducción numérica en la energía en todos los grupos después de las intervenciones. El meridiano del Riñón fue el que presentó el mayor desequilibrio de lateralidad antes de las intervenciones. No hubo relación entre el lado del dolor dental y el lado con la energía más alta del meridiano con el mayor desequilibrio de lateralidad. Conclusiones Los pacientes con dolor de la pieza dentaria mostraron deficiencia de energía antes de las intervenciones terapéuticas, con un mayor desequilibrio en el meridiano del Riñón y con una mayor pérdida de energía cuando se usa la acupuntura placebo.
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Background: Myofascial pain of the jaw is a frequently encountered chronic pain syndrome. Recent trends have shown that alternative medicine, such as acupuncture, is becoming a popular treatment modality for this syndrome; however, little is known about the physiology behind acupuncture. Functional magnetic resonance imaging (fMRI) has been used with wide success in the mapping of human brain functions to better understand treatment and disease. Objective: To examine the effects of acupuncture at LI 4 on brain activations through fMRI on patients with chronic myofascial pain. Design, Setting, and Participants: Randomized, placebo-controlled, single-blinded pilot study conducted at a university dental clinic on 12 adults with myofascial pain of the jaw who had not undergone acupuncture treatment. Intervention: Manual stimulation of LI 4 with dry needling acupuncture or sham acupuncture after clenching for 2 minutes while undergoing fMRI. Main Outcome Measures: All blood oxygen level dependent (BOLD)-related signal contrasts were made between the rest period after clenching and the first 5 minutes of acupuncture treatment. Results: Acupuncture induced significant activation of the primary sensory cortex and significant deactivation of the limbic system. Conclusions: Acupuncture performed at LI 4 deactivated the limbic system, suggesting that acupuncture decreases the activity of brain sites related to pain.
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AbstRAct This article reviews the possible role and application of acupuncture in dentistry. The use of acupuncture in Traditional Chinese Medicine (TCM) has a long history and for the past forty years, many studies have been conducted to understand the scientific basis behind its therapeutic effects in Western medicine. The possible application of acupuncture in the dental field like managing post-operative pain, orofacial pain, xerostomia, Bell's palsy and dental anxiety will be discussed in detail. The inherent challenges in conducting clinical trials in acupuncture using the evidence-based medicine model will also be covered. It is envisioned that acupuncture may play a promising role in complementing conventional treatment in certain dental conditions and more studies with improved methodology should be carried out to verify its application.
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Periodontal diseases continue to be most commonly occurring oral diseases in modern times. Many therapeutic modalities have been tried and tested to relieve these problems. The conventional therapy--scaling and root planing (SRP)--stands out to be the most used mode of treatment, and other treatments remain applicable as adjuncts to SRP, including acupuncture, acupressure, and aromatherapy. The present article discusses the applications of the abovementioned therapeutic modes and their relevance in current scenarios. Alternative medicine may be preferred as an adjunct to conventional periodontal therapy to relieve pain, bad breath, gingival inflammation, mouth ulcers, and mouth sores.
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An introduction to the practical application of acupuncture in dentistry is presented in the light of current research. It is concluded that acupuncture could supplement conventional treatment modalities. Its value in the treatment of temporomandibular dysfunction syndrome and facial pain has been well documented and supported by randomised controlled trials. Although it may be useful in the control of post-operative pain, its use as sole analgesia for operative care is questionable. The mode of action of acupuncture can be explained with reference to modern neurophysiology. A short training course can allow the technique to be an effective tool in every dentist's hands.
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We reviewed 21 sources in the literature and made an exhaustive analysis of the stress-related anxiety states generated by pain during dental treatment. Different psy- chological and psychotherapeutic modalities for their man- agement were discussed. The results of the study suggest that dental practitioners must know and use such modali- ties, and, if unable to deal with anxiety states, require con- sultation with psychotherapist.
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2., Rev. and Enl. Ed Bibliogr. na konci kapitol a s. 287-291