Acupuncture for Dentistry and Orofacial Pain

The scope of the present handbook is to provide the knowledge currently available to the dental professional in the field of acupuncture as a useful tool for dental diseases and orofacial pain. It offers to the dental clinician both a sound and updated knowledge of the theoretical bases of the acupuncture, a discipline that today has gained full recognition. This book will provide the scientific evidence of efficacy and safety in many medical fields, and a comprehensive overview of clinical applications of acupuncture in the different dental areas and orofacial pain. The fundamental theories of acupuncture can be summarized in these three mechanisms: 1. Acupuncture needles can stimulate the afferent nerves (Type I and II) or A-delta fibers which send impulses to the upper centers. At the CNS level, enkephalin and dynorphin are mostly involved in blockage of pain in the spinothalamic tract. 2. Acupuncture stimulates midbrain structures by activating cells in the periaqueductal gray matter and the raphe nucleus. In response, they send descending signals through the dorsolateral tract, causing the release of the monoamines norepinephrine and serotonin in the spinal cord. 3. Stimulation of pituitary-hypothalamic complex provokes the systemic release of beta-endorphin into the blood, which can result in the release of adrenocorticotropic hormone. Pain is a multidimensional phenomenon. It is among other things, influenced by cognition, context, mood, and many individual differences such as gender or genetic makeup. Western Trigger Point Therapy as popularized by Janet Travell, consisted of injecting local anesthetic into painful areas of muscles. In doing research, some investigators compared injecting local anesthetic into painful areas of muscles, to a control group of just needling the area without injecting any substance, and they found that both treatments were effective. That was the beginning of dry needling. Dry needling evolved from Trigger Point Therapy as popularized by Travell, at first using a hollow needle without local anesthetic to activate the trigger point. Acupuncture needles were not utilized for dry needling until 1979, when Acupuncture became popular in the United States. Acupuncture needles were safer and produced less bleeding and bruising. Melzack R, Et, Al, looked at 2 criteria: the spatial distribution and the associated pain pattern of trigger points and compared them to classical acupuncture points. A 71% correspondence was found, suggesting that Trigger points and acupuncture points, though discovered independently, represent the same phenomenon. Some of the dental conditions for which acupuncture can be used effectively include: - Dental pain acute and postoperative - Dental anxiety - Nausea and gag reflex. - Xerostomia (dry mouth) and sialorrrhea - Paresthesia or anesthesia of the oral and perioral structures. - Orofacial Pain ( see next chapter) Orofacial pain (OFP) is a general term covering any pain which is felt in the mouth, jaws and the face. Orofacial pain is a common symptom, and there are many causes. It is estimated that over 95% of cases of orofacial pain result from dental causes. After dental pain, the second most common cause of orofacial pain are the Temporomandibular Disorders (TMD). All other causes of orofacial pain are rare in comparison, although the full differential diagnosis is extensive. The term Temporomandibular Disorders (TMD) comprise a number of conditions characterized by signs and symptoms involving the temporomandibular joint (TMJ), masticatory muscles, or both. An acupuncture treatment plan must include a good history, including past medical history, an extensive examination with special attention to painful joints, nerve abnormalities, tender points found in muscle palpation, with attention to any distant pain referral. After all this information is gathered, a good diagnosis can be made, and based on this diagnosis, an acupuncture treatment plan can be developed. The individualized diagnosis based acupuncture treatment plan should select one or more distal points to draw the pain away. Distal points have more of a central nervous system effect. Then local points in the area of the patients complaint will be chosen, based on those points that are tender, which are often Ashi points. Local points have more of a segmental effect, as well as a local trigger point effect. Then, auxillary points based on the patient’s condition, will be chosen to reduce stress, anxiety, or give a general feeling of well-being. For example, a patient diagnosed with myofascial pain of the masticatory muscles and anxiety might have acupuncture needles placed in the distal points of LI 4 and ST 36 to draw the pain away. Then local points such as ST 6 and any other tender Ashi points in the masseter and temporalis muscles will be needled. GV 20 can then be used to give a calming of anxiety and general well-being. 1. Dental Acupuncture Points and Indications. LI-4, Large Intestine 4, Hegu, Hoku Location: On the dorsum of the hand between the 1st and 2nd metacarpal bones, slightly to the index finger side. the thumb and forefinger together, go up the crease between the two, then to the top of the medial adductor pollicis muscle towards the index finger. Needling technique: perpendicular insertion, 10 to 20 mm. Caution: Not to be used in pregnant women. Indications: LI-4 is the most important analgesic point, most frequently used point, and stimulation of this point relieves pain in all parts of the body. It is especially important for dental and orofacial pain. It is used for tooth pain, jaw/face pain and headache. It also has a strong relaxation effect, probably due to endorphin release. • INDICATIONS; TMD PAIN, TMJ SYNOVITIS, TMJ OSTEOARTHRITIS, MYOFASCIAL PAIN, FIBROMYALGIA, NEUROPATHIC PAIN, NECK PAIN, HEADACHE, TENSION AND MIGRAINE, TOOTH ACHE, ANALGESIA OF MOUTH, DRY MOUTH, BURNING MOUTH and TONGUE, TINNITIS, and RELAXATION.