Acupuncture Therapy in Orthodontics - A Review- Juniper Publishers
JUNIPER PUBLISHERS-OPEN ACCESS JOURNAL OF
DENTISTRY & ORAL HEALTH
Acupuncture
Therapy in Orthodontics - A Review
Authored by Rohit Kulshrestha
Abstract
Acupuncture is a technique which has originated
in China, in which different health issues are treated by inserting
specially designed needles at various points on the body - acupuncture
points. Acupuncture stimulates the nervous system and alters the
perception and processing of pain signals and also releases natural
painkillers. These painkillers (endorphins and serotonin) are present in
the nervous system. These points serve as a tunnel to deeper
circulating channels and stimulation of these points activates the
body’s natural healing ability. The most common use of acupuncture is in
the management of pain, for which a number of studies have shown it to
be effective, particularly in the treatment of temporomandibular pain.
It is intended that acupuncture may play a promising role in certain
dental conditions like TMJ dysfunction, facial pain, decreasing the
level of anxiety and reducing gag reflex. Aim of this article was to
review acupuncture techniques and related articles in the literature
that have focused on its applications in preventing gag reflex and TMJ
pain.
Keywords: Acupuncture; Temporomandibular joint pain; Gag reflexIntroduction
Acupuncture first originated in china 3000 years ago
[1]. It involves the insertion of needles into various parts of the body
aiming to cure diseases. Still it is being relied as an alternative or
adjunct during various medical therapies and also in dentistry [2].
Early studies state that acupuncture play role in treatment of several
disorders with pain as the primary symptom such as in psychiatric
disorders, sensor-neural deafness, hypertension, asthma, tinnitus,
smoking addictions and obesity [3]. The use of acupuncture in dentistry
has been mentioned by many authors and they have concluded that
acupuncture is effective in various conditions like TMD, pain management
and clinical conditions like Sjogren’s syndrome [4-6]. As research
works on Acupuncture have started only few decades back, there lies a
hint of skepticism among the dental professionals for its use in various
treatment procedures. Acupuncture literally means to puncture with a
needle (Figure 1).
Various Techniques used in Acupuncture
- Traditional body acupuncture (Body needling)
- Microsystems acupuncture
- Electro-acupuncture (electric acupuncture)
- Laser treatment (photo treatment)
- Trigger point acupuncture
- Moxibustion
- Acupressure
- Okibari - Japanese style.
Mechanism of Action
Acupuncture stimulates myelinated nerve fibres present in
muscle, which send impulses to the spinal cord and then activate
the midbrain along with pituitary-hypothalamus. It has been
proved that enkephalin; beta endorphin, serotonin, dynorphin
and noradrenalin are involved in the process [10]. It is known
that a painful stimulation activates two types of nerve fibres in
the peripheral nervous system: A-Delta and C-fibres which will
terminate at the second layer of the black horn. From the second
layer of the black horn, the pain sensation is via inter-neurons
transmitted to the cortex and we will experience a pain [11].
It is accepted that the insertion of a needle in an acupuncture
point will create a small inflammatory process which releases
neurotransmitters such as histamine bradykinin, etc. and
subsequent stimulate A-Delta fibres located in the skin and
muscle. These fibres terminate into the second layer of the black
horn and inhibit the incoming painful sensations by release of
enkephaline [12]. This segmental model is the simplest mode
of action and accounts probably for the pain relieving effect of
acupuncture in most cases [13-15]. From the second layer of the
black horn, the A-Delta fibres continues to its fifth layer, cross
over to the opposite side and ascend via the spinothalamic tract
to the mid brain where the raphe magnus nucleus is stimulated
[16]. Raphe magnus nucleus produces serotonin in the brain and
is believed to play a key role in acupuncture’s mode of action.
Thus, it showed that serotonin is a pro-drug for endorphin which
probably accounts for the central (extra-segmental) effect of
acupuncture [17]. Moreover, it has been shown that serotonin
is a pro-drug for ACTH, which acts via pituitary gland and is
responsible for the increase of cortisol which has been shown
after acupuncture and thus improves the immune system [18].
Finally, Serotonin has a direct effect on the cortex and it is likely
that the beneficial effect of acupuncture on anxiety and stress is
because of this direct effect [19]. It has been suggested that the
pituitary gland plays role in the production of endorphin.
Uses in Dentistry
Acupuncture has been widely used in dentistry in different
parts of the world. There have been reports of randomized
controlled trials on the analgesic effect of acupuncture for
postoperative pain from various dental procedures which include
extractions, pulp devitalization, and acute apical periodontitis
[20-23]. Systematic review of papers on the use of acupuncture
in dentistry which had been published between 1966 and 1996
were assessed. It was found that 11 out of 15 randomized
controlled studies with blind controls had appropriate statistics
and sufficient follow-ups. This showed that standard acupuncture
was more effective than a placebo or sham acupuncture [24-
25]. It was concluded that acupuncture should be considered a
reasonable alternative to current dental practice as an analgesic
[26]. Its use in the treatment of temporomandibular joint
dysfunction was also supported in these studies.
Uses in Orthodontics
Gag reflex
Gagging has been defined as an ejector contraction of the muscles of the pharyngeal sphincter. It is a normal protective reflex which is designed to protect the airway and remove irritant material from the posterior oropharynx and the upper gastrointestinal tract [27]. Its causes can be somatic, brought about by stimulating certain trigger areas in the oral cavity or psychogenic, which is induced by thought stimulus modulated by higher brain centres. Hyperactive gag reflex can be a hindrance to dental procedures, such as taking of alginate impression for diagnostic and record keeping procedures. The use of acupuncture points like PC6 Neiguan and CV24 Chengjiang (Figure 2) have been reported to significantly reduce gag reflex [28]. Auricular acupuncture is used for treating severe gag reflex and the role of acupuncture as a method of controlling the gag reflex is safe and quick [29]. The anti gagging point located on the ear corresponds with the skin of the external acoustic meatus which is innervated by the auricular branch of the vagus nerve and that adjacent to the auricle (innervated by the auriculotemporal which is a branch of the mandibular division of the trigeminal nerve). The branches of both vagus and trigeminal nerves are responsible for the sensory and motor function of the larynx, pharynx, and palatal region. It can be suggested that stimulation of the anti gagging auricular acupuncture point may inhibit the muscular activity, thus reducing the gag reflex [30,31]. Reports suggest that auricular acupuncture is helpful in treating severe gag reflex [32]. The acupuncture point PC6 Neiguan, located on the palmer side of the forearm — two inches above the transverse crease of the wrist, belongs to the pericardium meridian, which has the effect of “calming the heart which houses the spirit”. It was proposed that acupuncture may trigger an increase in circulating β-Endorphine, which binds to the opioid receptor, creating an anti-emetic effect [33]. More studies to verify the effectiveness of acupuncture in controlling gag reflex should be carried out. Various controlled trials have postulated that ear acupuncture is as effective as intranasal midazolam for reducing dental anxiety and reducing the gag reflex [34-35]. Rosted et al. [36] examined the effect of acupuncture administered prior to dental treatment on patients’ level of anxiety. 21 case reports were submitted eight dentists submitted regarding their treatments for dental anxiety. Beck Anxiety Inventory (BAI) assessed the anxiety levels before and after acupuncture treatment. All patients received an acupuncture treatment for 5 minutes before the planned dental treatment. There was a significant reduction in median value of BAI scores just after treatment (26.5 reduced to 11.5; P < 0.01), and it was possible to perform the treatment in all 20 cases after acupuncture treatment.
A clinical study by Sari and Sari [37] assessed the role of
acupuncture for treating orthodontic patients with gag reflex.
The study also investigated two acupuncture approaches for
orthodontic patients with the gag reflex. Each patient had an
maxillary alginate impression taken and that patient’s gag reflex
was evaluated using the Gagging Severity Index (GSI). After
applying acupuncture, a second impression was taken, and the
Gagging Prevention Index (GPI) was then used to evaluate the
patient’s gag reflex. There was a significant decrease in GPI values,
compared to GSI values, was observed in the treatment groups,
compared with a placebo group. The researchers concluded that
acupuncture points used were successful in controlling the gag
reflex in orthodontic patients.
Management of temporomandibular disorders and pain
Temporomandibular Disorders (TMDs) involves a group
of conditions that affect the temporomandibular joint (TMJ),
and the associated head and neck musculoskeletal structures
and muscles of mastication [38]. Acupuncture therapy is not
helpful in treating TMD caused by structural anomalies like disc
displacement and degenerative changes, it may aid in relieving
pain and discomfort associated with the conditions, especially
of muscular origin [39]. As documented, acupuncture helps in
muscle relaxation and reduces muscle spasms. Relaxing the
lateral Pterygoid muscles minimizes the anterior displacing force
on the meniscus of TMJ and helps in alleviate TMJ clicking [40].
The efficacy of acupuncture in symptomatic curing of TMDs was
conducted from a systematic review of randomised controlled
trials for assessing [41]. Nineteen reports were included and
the review suggests moderate evidence for acupuncture to be
effective intervention to reduce TMDs symptoms, though more
studies of larger sample sizes are needed to investigate the longterm
efficacy of acupuncture [42].
Raustia et al. [43] compared the efficacy of acupuncture
with conventional treatment modalities in the management of
TMD. It was found that both the methods had similar effect on a
number or subjective and objective variables [43]. List et al. [44]
compared occlusal splint and acupuncture with a control group.
It was found that both occlusal splint and acupuncture reduced
symptoms compared with the control group. Acupuncture gave
a better subjective result than the occlusal splint. List et al. [44]
treated patients with facial pain with acupuncture. It was found
that acupuncture may be a realistic alternative to conventional
treatment.
Discussion
From various clinical trials it was tested and concluded
that acupuncture could play a promising role in complementing
conventional treatment modalities as acupuncture is generally
safe and nontoxic it produces very negligible adverse reactions.
After performing various research of acupuncture’s therapeutic
effects has been recognised, even though the mechanisms are
still not understood properly. A better understanding of the
underlying mechanisms for how acupuncture works would help
future researchers to perform large-scale experimental studies
with better experimental prototype to confirm acupuncture’s
applications in dentistry and other areas. As believed that
conventional medicine is with side effect and that ‘alternative’
techniques are totally safe; numerous reports of adverse effects
after acupuncture are present. These are (to mention a few)
Endocarditis and hepatitis Pneumothorax some resulting in
fatalities [45]. However, it must be appreciated that most of these
result are from ignorance of basic human anatomy or because
of non applying aseptic procedures carried out by non-medical/
dental qualified practitioners. When these are figured out of
analysis, acupuncture proves to be a very safe technique in the
hands of a properly trained practitioner.
Conclusion
The application of acupuncture has a long history and proves
to be an effective treatment modality. Be it in control of postoperative
pain or in the management of TMD and facial pain it
may be a useful alternative to the conventional armamentarium
of the general dental practitioner. Although the mechanism of
action and positive clinical trials lag much behind the widespread
use, physicians should know its potential applications for better
treatment of their patients. Some physicians must take training
to administer acupuncture. Acupuncture is not a miracle cure
which is going to replace the drill. However, the technique
can be an adjunct to conventional treatments in facial pain,
TMDs, pain management Sjoegrens syndrome, and in anxiety
and phobias. Acupuncture has a scientific background and the
efficiency has been tested in a number of clinical trials including
pain management, TMD, facial pain, and increasing of the pain
threshold. Proper training is essential because Acupuncture has
adverse effect. The technique can be mastered by any dentist
after a short training programme.
For more Open Access Journals in Juniper Publishers please
click on: https://juniperpublishers.com
For more articles
in Open Access Journal of Dentistry & Oral Health please click on:
Comments
Post a Comment