Dental Pain
« Pain Management | Posted on 11/25/2008 07:26 am by JeanPaulAcupuncture and Dentistry
A recent review analysed 16 trials of the analgesic effect of acupuncture and found that the majority of the studies showed some positive effect, although the experimental nature of some of the studies made the evaluation of practical use difficult. However, in summary it may be stated that where trials are competently constructed and executed there is a body of scientific evidence supporting the efficacy of acupuncture within dental practice.
How does it work?
Acupuncture activates small myelinated nerve fibres in muscle, which send impulses to the spinal cord and then activate the midbrain and pituitary-hypothalamus. It has been shown that enkephalin, beta-endorphin, dynorphin, serotonin and noradrenalin are involved in this process. It is well known that a painful stimulation will activate two types of nerve fibres in the peripheral nervous system: A- -fibres and C-fibres which primarily will terminate at the second layer of the back horn. From the second layer of the back horn, the pain sensation is via interneurons transmitted to the cortex and we will experience a pain.
Today it is generally accepted that insertion of a needle in an acupuncture point will create a small inflammatory process with release neurotransmitters such as bradykinin, histamine, etc. and subsequent stimulate A- -fibres located in the skin and muscle. The A- -fibres terminate in the second layer of the back horn and inhibits the incoming painful sensations by release of enkephaline. This segmental model is the most simple mode of action and accounts probably for the pain relieving effect of acupuncture in most cases.
The practicalities of acupuncture
Does acupuncture always work?
No, and neither does anything else! It is not a miracle cure and in general if a significant improvement has not occurred after three sessions it is not worth continuing. There are two reasons for this: (i) some patients fail to respond to acupuncture per se, (ii) the original diagnosis could be wrong. A lack of response should always result in re-examination and refinement of the diagnosis.
How many treatments are needed?
One large-scale study found that the average number of treatments required to control the disorders of a mixed group of 350 patients was five, although clearly it is unrealistic to expect to gain control of chronic conditions with only a couple of treatments; indeed control of orofacial conditions such as trigeminal neuralgia may require several cycles of treatments.
How soon can one expect a result?
It is not uncommon for patients to report some benefit immediately, especially in acute headache and torticollis. This will probably only last for a day or so, the period of relief extending with each successive treatment until control is achieved.
Can there be adverse effects associated with acupuncture?
Contrary to the popular belief that conventional medicine is beset by untoward sequelae and that ‘alternative’ techniques are totally safe; there have been numerous reports of adverse effects after acupuncture. These are (to mention a few) pneumothorax, endocarditis and hepatitis some resulting in fatalities. However, it must be appreciated that most of these result from ignorance of basic anatomy or because of non applying aseptic procedures by non medical/dental qualified practitioners. When these are factored out of analysis, acupuncture proves to be a very safe technique in the hands of a properly trained practitioner.
Conclusion
In general acupuncture should be regarded as a supplement to conventional treatment. As a sole analgesic for operative intervention its value is questionable; however, in control of post-operative pain and in the management of TMD and facial pain it may be a valuable addition to the therapeutic armamentarium of the general dental practitioner. These skills may be acquired with a short postgraduate training programme.