Acupuntura e odontologia

DENTAL SCIENCE, MATERIALS AND TECHNOLOGY

ACUPUNCTURE AND AURICULOTHERAPY APPLIED

TO DENTISTRY

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ACUPUNCTURE AND AURICULOTHERAPY APPLIED

TO DENTISTRY

CAMILA DA SILVA GONÇALO JUAN GUZMAN QUISPE-CABANILLAS

AND NELSON FILICE DE BARROS

——————————————— Nova Science Publishers, Inc.

New York

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Published by Nova Science Publishers, Inc. New York

CONTENTS

Preface vii

Acknowledgments ix

Chapter 1 Introduction 1

Chapter 2 Concept of Acupuncture and Search Methodology 5

Chapter 3 Results 7

Chapter 4 Limitations Attributed to the Application of Acupuncture 27

Chapter 5 Efficacy and Benefits of Acupuncture in Dentistry 31

Chapter 6 Is Acupuncture Efficient in the Treatment of Acute Pain? 35

Chapter 7 Is Acupuncture Efficient in the Treatment of Chronic Pain? 37

Chapter 8 What are the Benefits of Acupuncture? 39

Chapter 9 Auriculotherapy and Dentistry 41

Chapter 10 Final Considerations 49

References 51

Index 57

PREFACE With the increasing incorporation of Oriental models of health care

in the West, the perspective of action by professionals in this area has changed and broadened. In the case of dentistry the need to practice it considering a holistic view of the human being has heightened the search for alternative, complementary and integrated treatment options. This perspective has broken the predominant paradigm in which dentists and their spectrum of professional activity have been exclusively conditioned by manual dexterity and the mechanics used in performing operative procedures. This book presents and extensive literature review of meridians, points, benefits and limitations of acupuncture applied to dentistry. The data were obtained by means of reading complete works from various countries, written by different authors: Wen (1995), Gonzalez (1999), Cobos and Vas (2000), Yamamura (2001), Stux and Pomeranz (2004), Lian (2005), Zhixian and Cols. (2005) and Maciocia (2007). Around 200 acupoints for dental action and over sixty types of affections directly linked to the dentist’s area of activity were found. Tables containing combinations of body points have been structured. Three auricular maps have been organized. The findings indicate positive results in the treatment of Temporomandibular Dysfunction (TMD), Xerostomia, Tinnitus and Obstructive sleep apnea. The main limitations of acupuncture in dentistry mentioned in the researched literature refer to the variations in response to acupunctural stimulation; unsatisfactory response presented by certain patients; contraindications and reduced results. This study attained its objective of presenting a literature review on the main meridians and points of acupuncture used in dentistry, as well as the benefits and limitations of this therapy. Bearing in mind the

C. S. Gonçalo, J. G. Quispe-Cabanillas and N. F. Barros viii

scarcity of publications related to this topic, we believe that the present review could facilitate the search for knowledge about acupuncture applied to dentistry.

ACKNOWLEDGMENTS I would like to thank: Antonio Cesar, my father; Vera Maria, my

mother, Alexandre, my brother; Carolina, my sister and Fabio, my love, because they have constantly supported me during my journey though studies that began in 2008. I could not have written this book without them: my teachers Professor Nelson Filice de Barros Ph.D., Coordinator of the Laboratory for Alternative, Complementary and Integrative Practices in Health (LAPACIS–FCM/UNICAMP, Brazil) and Professor Juan Guzman Quispe-Cabanillas Msc., Coordinator of the Specialization Course in Acupuncture, at the Hermínio Ometto University Center–UNIARARAS, Brazil. I also would like to thank: Professor Antonio Carlos Pereira Ph.D., for the teachings in my Master’s Degree at Piracicaba Dental School (FOP/UNICAMP, Brazil); Professor Jorge Vas Ph.D., responsible for the Pain Treatment Unit–Doña Mercedes Health Centre, in Spain who showed me the theoretical and practical basis of acupuncture according to the precepts of Traditional Chinese Medicine and Professor Francisco Martos Crespo Ph.D., (Universidad de Málaga, Spain) for having accepted me as exchange student in this centre. This book is dedicated to the people mentioned above, as well as to: Manuela Modesto, M. Ángeles Campos, Inmaculada Aguilar, all professionals in the Doña Mercedes Health Centre (Spain) and all researchers at “LAPACIS” – Laboratory for Alternative, Complementary and Integrative Practices in Health/ FCM-UNICAMP (Brazil). I thank the Fundação de Amparo à Pesquisa do Estado de São Paulo – FAPESP, (Protocol Number 2010/05217-0), for funding this research.

Camila da Silva Gonçalo

Chapter 1

INTRODUCTION

“Acupuncture used in an adequate manner, considering its limitations, and practiced by qualified professionals, tends to be of great benefit to the Dentist in optimizing the working time in the dental office”.

(Viana et al, 2008)

Since the appearance of dentistry, the dental surgeon has been

dedicated to performing predominantly to clinical – educational – preventive – activities, establishing diagnoses and treatments based on diseases of the oral cavity. With the increasing influx of Oriental models of health care in the West, the perspective of action by professionals in this area has changed and broadened. In this context, the need to practice dentistry with an overall view of the human being, has led to the search for alternative, complementary and integrated treatment options, rupturing the paradigm that the dentist and his/her scope of professional activity are exclusively confined to the manual and mechanical dexterity used in performing operative procedures.

It is known that from the Western perspective, the diagnosis rendered by the health professional, in the majority of cases, is based almost exclusively on the patients report at the time of the consultation. This conduct practically ignores the process that generated the reported manifestations, and also disconsiders the live organism as an undecomposable whole. Starting from this view, it is possible to think

C. S. Gonçalo, J. G. Quispe-Cabanillas and N. F. Barros 2

that the inferences, suppositions and conclusions with respect to the patient’s health status remain imprecise (Jianping, 2001).

Although health professionals who are followers of the precepts of Traditional Chinese Medicine (TCM) also make diagnoses, other sources of information about patients’ health status are used (inspection, listening to complaints, olfactory perception of odors presented, questioning of data, physical exam, examination of the tongue and wrist). The conduct of treatment in TCM is predominantly based on the pattern of differentiation. In other words, the selection of acupuncture points or Chinese medicinal formulas is oriented by the distinction between patterns of diseases and not only by their clinical diagnoses (Maciocia, 2007).

From this point of view, it is considered that the practice of Acupuncture incorporated into Dentistry enables the dentist to act in patients’ health in a manner broader in scope, uniting knowledge, mixing oriental with Western concepts and favoring the wellbeing of these individuals in dental office and extramural environments.

Studies on the use of acupuncture applied in various areas of health, including dentistry are mentioned in the document entitled “Acupuncture: review and analysis of reports on controlled clinical trials”(WHO, 2002). This publication contains results considered valid from the point of view of scientific evidence in the field of health.

Considered an efficacious method for preventive, curative and palliative care of innumerable pathologies, especially of the stomatognathic system (Joahnsson et al. 1991; CFO, 2006), Acupuncture may be applied in dental practice to help in the treatment of dysgeusia (diminished or distorted sense of taste/taste impairment), orofacial pain, anxiety, stress, control of nausea and vomiting, gingivitis, lichen plano, mucositis, parafunctional habits, osteoradionecrosis, halitosis, facial paralysis (Bell’s paralysis), periodontopathies, facial paresthesia, reduction in the quantity of anesthetic - analgesic - anti-inflammatory drugs, radiodermatitis (skin lesion resulting from excessive exposure to ionizing radiation), burning mouth syndrome (BMS), tissue repair, trismus, acute and chronic xerostomia, Jögren’s Syndrome and recurrent aphthous ulceration (Dantas, 2005).

The dentist may use acupuncture by means of points located mainly in the hand and face of patients, thus acting in the reduction of toothache, treatment of labial herpes, bone loss and other orofacial affections. The

Introduction 3

list of Acupuncture applications includes indications of this practice for recovering motor functions harmed as a result of facial paralysis and to help in the treatment of temporomandibular joint (TMJ) dysfunctions. Emphasis is also laid on the sedative and hemostatic effect resulting from function of the acupoints, in addition to other effects, such as the prevention and equilibrium of functions linked to bleeding and simulation of organs that control immune responses: spleen, bone marrow, lymph nodes and thymus (Hong, 2005).

Recognition of the coadjuvant use of acupuncture in dentistry has driven dentists to seek knowledge in this area. In this context the use of this therapy in dentistry may be considered an important instrument directed towards development in the field of health, as it transcends the limit of dental specialties recognized up to now.

The aim of this book is to present data from an extensive literature review about points, meridians, benefits and limitations of acupuncture applied to dentistry.

Chapter 2

CONCEPT OF ACUPUNCTURE AND SEARCH METHODOLOGY

Acupuncture is a therapeutic resource that acts by means of energy

points situated in specific areas of the body, providing stimuli that trigger sensations such as well-being and relaxation. These effects may be obtained by means of implanting needles and seeds in the patient’s skin in the region where the acupoint is situated, or by digital pressure in these areas, which results in the release of endogenous chemical mediators that have analgesic, relaxant and anti-inflammatory action

(Viana et al., 2008). According to Shekelle et al. (2005) literature reviews on the use of

Integrative, Alternative and Complementary Practices (IACP) in health present challenges differing from those conducted on the themes of Western Medicines. The same authors point out that from many aspects, the reviews of IACP are more difficult to perform. In this context, search strategies different from those of the conventional mode are required, and for this reason, we opted to use an adaptation of the search scheme suggested by Davies (2003) to elaborate the review presented in this chapter.

From this perspective, an extensive literature review was conducted, with the scope of seeking the points, meridians, benefits and limitations of acupuncture applied to dentistry. The data were captured by means of reading complete works from various countries, written by different authors: Wen (1995), Gonzalez (1999), Cobos and Vas (2000), Yamamura (2001), Stux and Pomeranz (2004), Lian (2005), Zhixian and


Cols. (2005) and Maciocia (2007). From reading and selecting the content directly related to acupuncture in dentistry, the data were organized in tables, graphs and illustrations.

For inclusion of the findings, we considered that dental patients are frequently attended while positioned lying on the back, due to the anatomic design of the chair traditionally used in the dental office. Thus, the selection of acupoints presented in this chapter started fundamentally from the accessibility of areas of the human body (possibility of visualization and direct access to the site of puncture), based on the working position in the dental office.

With the aim of complementing the findings from the books consulted in this review, a complementary search was conducted in academic studies about the use of acupuncture applied in dental situations, published over the last ten years (2001-2011). For this search three databases of theses and dissertations were researched: University of São Paulo – USP, State University of Campinas – UNICAMP and Federal University of São Paulo – UNIFESP.

We point out that the universe of diagnosis and treatment offered by MTC (Traditional Chinese Medicine) is composed of various subjects linked to the care and maintenance of health. Under these circumstances, the information made available in this chapter represent a fraction of this content, since the illustrations presented as follows refer to the bodily and auricular acupoints most frequently used in the treatment of classical affections that attack the orofacial region.

It is important to emphasize that the results contained in Tables 1 to 4 represent particular indications of each bodily acupoint. These data should not be interpreted as a treatment protocol, or suggestion for the combination of points. The intention of this review was to synthesize information to facilitate and promote approximation between the dentist and the main affections capable of undergoing intervention with the aid of acupuncture. For more detailed guidance on the information related in this text, it is recommended that specific didactic matter on Acupuncture, diagnosis and therapies from the perspective of TCM should be consulted.

Chapter 3

RESULTS

Table 01. Yin Meridians (Hand) - Main acupoints related to dental practice

Affections Lung (L) Heart (H) Pericardium (PC) Tooth Abscess L7 --- ---

Agitation L4 H5- H7-H8 PC4-PC5-PC6- PC7-PC8-PC9

Anxiety L10 H1-H3- H4-H7 PC3-PC4-PC5-PC6-PC7-PC8- PC9

Dry mouth L5 --- PC3

Headache L6-L7-L9-L10 H2-H3-H5-H6-H7 PC8-PC9-PC6 (migraine)

Recurrent headache --- --- --- Vertex headache --- --- --- Cervicalgia L7 --- PC6 Depression --- H3-H7 PC5-PC7 Deviation of the mouth --- --- ---

Facial edema L1-L9 --- --- Facial spasm L7 --- --- Lingual edema --- H7 --- Stomatitis --- --- PC8 Halitosis --- --- PC8 Irritability L5 H7 PC6-PC9 Dry tongue L5 --- ---

Fear L10 H3-H4-H5-H6-H7 PC3-PC4- PC5-PC6- PC7 -PC8

Nausea --- --- PC3-PC4-PC5-PC6 Trigeminal Neuralgia L7 H3 PC8


Table 01. (Continued)

Affections Lung (L) Heart (H) Pericardium (PC) Nervousness L4 --- --- Neurasthenia --- H3-H7-H6-H5 PC4 Toothache L7-L9-L10-L11 H3 ---

Palpitation L4 H1-H3-H5-H6-H7-H8-H9

PC2- PC3-PC4-PC5-PC6-PC7- PC9

Facial Paralysis L7 --- --- Tongue Rigidity --- H5-H4 PC7-PC9 Nuchal Rigidity L7 --- --- Neck Rigidity L7 --- --- Dizziness L10 --- PC6-PC9 Trismus L7 --- --- Lingual ulcer --- H5-H7 PC8 Tinnitus --- H3 PC9

Fonte: Wen (1995); Cobos & Vas (2000); Yamamura (2001); Stux & Pomeranz, 2004; Zhixian & Cols. (2005); Lian et al. (2005); Maciocia (2007).

Adapted from Jun & Jing (2005).

Figure 1. Lung (L) Meridian.

Results 9


Figure 2. Heart (H) Meridian.


Figure 3. Pericardium (PC) Meridian.


Table 02. Yin Meridians (Foot) - Main acupoints related to dental practice

Affections Spleen (SP) Kidney (KD) Liver (LV) Tooth Abscess --- --- --- Agitation SP1-SP2-SP5 KD3-KD4 --- Anxiety SP4 KD1-KD21-KD6-KD9 --- Dry mouth --- KD7 LV2-LV4

Headache SP3-SP9-SP6 KD1-KD3 LV2-LV3-LV4-LV8

Recurrent headache --- --- LV7 Vertex headache --- KD1 --- Cervicalgia --- KD1 --- Depression SP3-SP4 --- --- Deviation of the mouth --- --- LV3

Facial edema SP4 --- --- Facial spasm --- --- --- Lingual edema --- --- --- Stomatitis --- KD4 --- Halitosis --- --- --- Irritability --- KD3 LV2-LV3 Dry tongue --- KD1-KD4 ---

Fear --- KD2-KD3-KD4- KD6-KD21 LV2

Nausea SP3 KD1- KD17- KD20-KD21-KD24-KD23-KD25-KD27

---

Trigeminal Neuralgia --- --- ---

Nervousness --- --- --- Neurasthenia --- KD4 --- Toothache --- KD3 --- Palpitation SP5-SP6 KD4-KD9 LV2 Facial Paralysis --- --- --- Tongue Rigidity SP6 KD4 (raiz da língua) --- Nuchal Rigidity --- --- --- Neck Rigidity --- --- ---

Dizziness SP6 KD1-KD3-KD6-KD7- KD9 LV2-LV3

Trismus --- KD6 --- Lingual ulcer --- --- ---

Tinnitus SP6 KD1-KD3-KD6-KD7- KD9-KD10-KD12-KD13-KD16

LV2


Results 11


Figure 4. Spleen (SP) Meridian.



Figure 5. Kidney (KD) Meridian.

Results 13


Figure 6. Liver (LV) Meridian.

Table 03. Yang Meridians (Hand) - Main acupoints related to dental practice

Affections Large Intestine

(LI) Small Intestine (SM)

San Jiao (SJ)

Affections of the mouth and throat LI7-LI7 SM17 ---

Affections of the head and neck LI4 --- ---

Analgesia LI1-LI4 --- --- Anxiety --- SM 7 SJ1 Temporomandibular Arthritis LI4 SM5 SJ17-SJ21

Temporomandibular Joint Arthrosis --- SM17 ---

Dry mouth LI1 - LI3 --- SJ1-SJ4 Bruxism --- SM16 --- Dental Caries LI6 --- ---

Headache

LI2-LI3-LI4-LI5-LI6-LI7-LI9-LI10-LI11-LI14

SM1- SM2-SM3- SM4- SM7- SM8- SM16

SJ1-SJ2-SJ3-SJ5-SJ9-SJ10-SJ11-SJ12-SJ16-SJ17-SJ18-SJ19-SJ20-SJ21-SJ22-SJ23

Vertex headache --- SM3 --- Occipital headache --- SM6 ---



Affections Large Intestine (LI)

Small Intestine (SM)

San Jiao (SJ)

Cervicalgia --- SM3- SM5- SM12 SJ5-SJ15

Cervicobrachialgia --- --- SJ10 Temporomandibular Dysfunction (TMD) --- --- SJ21

Deviation of the mouth

LI4- LI6- LI7-LI11 SM18 SJ17-SJ21

Speech and Swallowing Difficulties

LI18 --- ---

Difficulty with mastication --- --- SJ21

Neck pain --- SM8- SM15- SM16 SJ4--SJ5-SJ15

Facial edema LI1-LI4-LI7-LI10-LI20 SM8 SJ10-SJ16-SJ17

Maxillary edema --- SM7- SM11 --- Gingival Edema --- SM8 --- Mandibular Edema --- SM9 ---

Migraine --- SM3 SJ2-SJ3-SJ5-SJ10-SJ23

Stomatitis LI7 SM5 SJ1 (úlceras na língua)

Gingivitis LI11 SM5- SM8 SJ2 -SJ20-SJ21 Gingivorrhagia --- --- SJ2 Local Inflammation in the face LI6 --- ---

Fear LI5 SM7 --- Nausea --- SM4 SJ19 Trigeminal Neuralgia LI3- LI19 SM18 SJ16-SJ17 Neurasthenia LI4 SM7 SJ9 Facial Neuralgia LI1-LI7 SM18 SJ17

Toothache

LI 1- LI 2- LI 3- LI 4- LI 5- LI 6- LI7- LI 10- LI 11- LI 19

SM5- SM8- SM18- SM19

SJ1-SJ2-SJ3-SJ5-SJ7-SJ8-SJ9-SJ12-SJ17-SJ19-SJ20-SJ21-SJ23

Palpitation --- --- SJ2-SJ10

Facial Paralysis LI 2- LI 3- LI 4- LI 6- LI 7- LI 19- LI 20

SM18 SJ17-SJ18-SJ19-SJ22-SJ23

Paresthesia LI 10 --- ---

Results 15

Affections Large Intestine (LI)

Small Intestine (SM)

San Jiao (SJ)

Periarthritis of Temporomandibular Joint

--- --- SJ17

Cervical Rigidity --- SM1-SM3-SM4-SM7-SM12-SM14-SM17

SJ5-SJ21

Rigidity in the face LI 7 --- --- Tongue Rigidity LI 5 --- SJ1-SJ5 Nuchal Rigidity --- SM7 SJ16 Neck Rigidity LI 4 SM 3-SM4 SJ12-SJ15-SJ16-SJ20 Sialorrhea LI 18 --- SJ21 Dizziness Dizziness Dizziness Dizziness

Trismus LI 4- LI 19 SM5-SM16-SM19 SJ6-SJ17-SJ21-SJ22

Aphthous UIcers (Aphta) LI 4- LI 7 --- SJ5

Tinnitus LI 1- LI 4- LI 5- LI 6

SM1-SM2-SM3-SM4-SM5-SM9-SM16- SM17-SM19

SJ2-SJ3-SJ4-SJ5-SJ6-SJ7-SJ10-SJ21-SJ2-SJ3-SJ5-SJ17-SJ18-SJ19-SJ20-SJ21-SJ22


Table 04. Yang Meridians (Foot) - Main acupoints related to dental practice

Affections Stomach (ST) Gall Bladder (GB) Bladder (B) Agitation --- GB44 B14

Dental Analgesia ST6(lower jaw) ST7(upper jaw) --- ---

Anxiety ST3 GB44 B14-B15-B44-B64-B66

Temporomandibular Arthritis ST6- ST7- ST44 GB2 ---

Headache

ST2-ST7-ST8-ST9-ST40-ST41- ST42-ST44

GB1-GB2-GB3-GB4-GB5-GB6-GB7-GB8-GB9-GB10-GB11-GB12-GB13-GB14-GB15-GB16-GB17-GB18-GB19-GB20-GB21-GB31-GB34-GB36-GB37-GB38-GB39-GB40-GB41-GB42-GB43-GB44

B1-B2-B3-B4-B5-B6-B7-B9-B10-B11-B12-B18-B22-B27-B37-B40-B56-B58-B59-B60-B62-B63-B64-B65-B66-B67



Affections Stomach (ST) Gall Bladder (GB) Bladder (B)

Headache (Migraine) ST8

GB3-GB4-GB5-GB6-GB7-GB8-GB9-GB12-GB13-GB15-GB17-GB20-GB37-GB38-GB39-GB40-GB41-GB42-GB43-GB44

B10

Vertex headache --- --- B8-B9- B14 Cervicalgia --- GB13-GB17-GB36 B10-B11-B58

Deviation of the mouth

ST1- ST2- ST3- ST4- ST5- ST6- ST7- ST42- ST44

GB2-GB4-GB8-GB14-GB20 B7-B62

Difficulty with mouth opening ST6 GB7 ---

Speech difficulties ST9 ---

Facial pain ST2-ST7-ST41-ST44

GB2-GB3-GB14-GB16 B2

Neck pain ST11 GB12-GB19-GB39 B9

Facial edema

ST3- ST5- ST6- ST25- ST40- ST41- ST42- ST43- ST44- ST45

GB5-GB6-GB7-GB12-GB16-GB34-GB36

---

Facial spasm ST2- ST6 (masseter)- ST7 (masseter)

--- ---

Gingivitis ST7- ST42- ST45 GB9-GB12-GB16 ---

Irritability ST23 --- --- Speech incapacity ST1 --- --- Temporomandibular Joint Luxation ST7 GB2 ---

Fear ST45 GB9 B15-B18-B47-B64

Nausea ST24- ST25- ST36 GB17-GB23-GB24 B21

Trigeminal Neuralgia

ST2- ST3- ST4- ST5- ST6- ST7- ST44

GB1-GB3-GB6-GB7-GB11-GB14 B2

Neurasthenia ST36- ST45 GB6 B10-B14-B15-B43-B47

Results 17

Affections Stomach (ST) Gall Bladder (GB) Bladder (B)

Toothache ST3-ST4-ST5-ST6-ST7-ST42-ST44- ST45

GB2-GB3-GB4 -GB5-GB6-GB7-GB9-GB10-GB11-GB12-GB16-GB17

B14

Facial Paralysis

ST1-ST2-ST3-ST4-ST5-ST6- ST7-ST8-ST36-ST42-ST45

GB1-GB2-GB3-GB4-GB8-GB12-GB14-GB20

B1-B2

Palpitation ST36- ST41 GB9-GB19 B14- B15-B19-B43-B44-B64-B66

Periodontitis ST7 --- --- Tongue Rigidity ST24 GB11 ---

Nuchal Rigidity ST11 GB11-GB12-GB39 B7-B10 - B11-B65-B66

Neck Rigidity ST11 GB12-GB19-GB20-GB21-GB39

B10-B11-B16-B41-B60-B62

Sialorrhea ST4 GB3 --- Meniére´s Syndrome --- GB41 B62

Trismus ST4-ST5-ST6-ST7-ST44

GB3-GB4-GB5-GB7-GB12-GB20 B16-B60-B62

Dizziness ST8-ST9-ST36-ST40-ST41-ST45

GB1-GB2-GB3-GB4-GB5-GB6-GB8-GB9-GB11-GB13 -GB14-GB17-GB18-GB19-GB20-GB39-GB41

B2-B3-B5-B6-B7-B9-B10-B11-B16-B18-B22-B42-B43-B47-B58-B60-B62-B64-B65-B66-B67

Aphthous UIcers (Aphta) ST44 --- ---

Tinnitus ST1- ST7

GB2-GB3-GB4-GB6-GB9-GB10-GB11-GB12-GB15-GB19-GB20-GB41- GB42-GB43-GB44

B8-B23-B52-B60-B62


Note: In the Du Mai (DM) channel, at least 19 acupoints related to affections that attack the orofacial area are found. However, due to the patient’s position in the dental chair (inclusion criterion established by the authors) the acupoints located in the trajectory of the Du Mai canal have not been mentioned.


Adapted from Jun & Jing (2005)

Figure 7. Large Intestine (LI) Meridian.


Figure 8. Small Intestine (SM) Meridian.

Results 19


Figure 9. San Jiao (SJ) Meridian.



Figure 10. Stomach (ST) Meridian.

Results 21


Figure 11. Gall Bladder (GB) Meridian.



Figure 12. Bladder (B) Meridian.

To facilitate viewing of the meridians and acupoints found in our study, we developed the graphic 1.

This graph shows the frequency of the most commonly used acupoints and their meridians based on our findings.

Results 23

Graphic 1. Frequency of the most commonly used acupoints in dentistry and their meridians.

The graph illustrates the frequency of the most commonly used acupoints according to the literature review. Therefore, we find for dental use: 39 acupoints on the Bladder Meridian, 34 acupoints on the Gall Bladder Meridian, 22 acupoints on the San Jiao Meridian; 20 acupoints on the Stomach Meridian, 18 acupoints on the Kidney Meridian, 17 acupoints acupoints on the Small Intestine Meridian, 16 acupoints on the Large Intestine Meridian, 9 acupoints on the Heart Meridian, 8 acupoints on the Pericardium Meridian, 7 acupoints on the Spleen Meridian, 8 acupoints on the Lung Meridian and 5 acupoints on the Liver Meridian.

We found 8 academic studies on acupuncture applied to affections related to dentistry. All these studies reported positive results. The main results are organized in table 5.


Table 5. Academic Studied about the use of acupuncture with the possibility of application in dental situations

Affection Reference Results

Temporomandibular Dysfunction

Electromyographic analysis of the temporal and masseter muscles and bite force in individuals with temporomandibular dysfunction before and after treatment with acupuncture. Rancan, Sandra Valéria (2008) – USP Master’s Dissertation.

Electromyographic activity of the masseter and temporal muscles diminished after treatment with acupuncture when the maintenance of postures such as rest, protrusion and right and left laterality and tooth clenching were evaluated, being significant at the level of 0.05 for the at rest situation.

Nausea

Prospective study of the value of acupuncture in the control of nausea and vomiting in breast cancer patients submitted to adjuvant chemotherapy. Chung, Wu Tu (2007) – USP Doctoral Thesis.

Classical acupuncture diminished the intensity and duration of nausea and vomiting from the first to seventh day post-chemotherapy. Classical and auricular acupuncture diminished the intensity of nausea from the eighth to twenty-first day post-chemotherapy.

Xerostomia

Evaluation of acupuncture as a method of preventive and curative treatment of xerostomia resulting from radiotherapy. Braga, Fábio do Prado Florence (2006) – USP Master’s Dissertation.

It was verified that acupuncture increased the salivary flow. Acupuncture was shown to be an important method of treatment for xerostomia resulting from radiotherapy, since it achieved a significant reliability of efficacy, which allows us to indicate it and suggest making the preventive method available in treatment centers.

Cervicalgia

Applications of acupuncture and auriculotherapy in the dental scenarios and in primary health attention. Gonçalo, Camila da Silva (2010) UNICAMP Master's Dissertation.

The application of classical acupuncture provided a significant reduction in pain intensity, consumption of analgesics, incapacity and sleep disorders caused by pain (p< 0.0001) in patients with chronic cervicalgia , attended at a basic public health unit.

Myofascial pain of the trapezium muscle

The effect of electroacupuncture in the treatment of muscular pain. Aranha, Maria Fernanda Montans (2010) Master's Dissertation.

Electroacupuncture (EA) was effective for the relief of myofascial pain of the trapezium muscle.

Results 25

Affection Reference Results

Both an immediate effect after each application of EA and a cumulative effect were observed, especially as from the third session. The premenstrual and menstrual phase appears to be related to the increase in the pain threshold observed in the sixth session. It was concluded that EA was effective in the relief of myofascial pain in the evaluated sample.

Tinnitus

Effect of acupuncture on otoacoustic emissions of patients with tinnitus. Azevedo, Renata Frasson de (2005) UNIFESP Master’s Dissertation.

The use of acupuncture relieved the symptoms of tinnitus. The results showed a statistically significant difference in the amplitude of the otoacoustic emissions before and after the application of acupuncture for the intervention 1(puncture 4.5 cm above the apex of the ear).

Obstructive Sleep Apnea

Treatment of the obstructive sleep apnea-hypopnea syndrome with acupuncture. Freire, Anaflávia de Oliveira (2004) UNIFESP Doctoral Thesis.

There was a significant reduction in the apnea-hypopnea index (mean before = 19.9; mean after = 10.1. P = 0.005), as well as in the number of respiratory events (mean before = 116.1; mean after = 66.5. P = 0.005) in the acupuncture group, but not in the placebo group (sham).

The immediate and mediate effect of acupuncture in the treatment of patients with obstructive sleep apnea syndrome. Sugai, Gisele Cristina Machado (2009) UNIFESP Doctoral Thesis.

In relation to the immediate effect of acupuncture there was significant reduction in the time of beginning of sleep (p = 0.011; p= 0.005), of the apnea-hypopnea index (p=0.042; p=0.005) respiratory events 9p=0.0011, p=0.009) and of micro-awakenings (p=0.011, p=0.021) in the manual acupuncture and 10Hz electroacupuncture groups, before and after the treatment.

Note: Not all of the studies contained in this table were developed in the field of dentistry. The table illustrates the efficacy of acupuncture and its therapeutic applications in manifestations that may be treated by the dentist.

Chapter 4

LIMITATIONS ATTRIBUTED TO THE APPLICATION OF ACUPUNCTURE

Variations in the response to Acupuncture have been attributed to the

individual characteristics of the beings submitted to this therapy. In humans this type of variation is clearly related in the literature, according to White (2001). According to Jayasuriya (1995) patients with deficient formation of endorphins, or genetic deficiency in the endorphin receptors, tend to respond unsatisfactorily to the stimulus of acupuncture.

As regards the “therapeutic dose” of acupuncture, it is known that up to now there is no real consensus on this subject, bearing in mind its complexity, which involves the dilemma in the choice of the combination of acupoints, number of needles implanted, diameter of the needles used, depth of stimulation of these needles, as well as the type of stimulation applied to them (electrical stimulation, manual stimulation, etc.) in addition to the time these instruments remain “in situ” (Filshie & Cummings, 2001).

On the adverse effects of acupuncture, Kaptchuk (2002) mentions that in rare circumstances this therapy may produce complications associated with the type of needle used. The same author mentions that the transmission of infectious diseases, occurrence of pneumothorax, and other problems associated with the perforation of structures and fractures of needles are some of the negative results capable of occurring in the practice of acupuncture, particularly if the acupuncturist has not been adequately trained.

Some of the contra-indications related to the use of acupuncture were mentioned by Bannerman (1980), thus it is not considered suitable to


apply acupuncture on dermatitis, tumoral areas and in individuals with pace-makers. According to Altman (1992) instituting treatment with acupuncture before preparing a detailed diagnosis is contra-indicated; as such conduct makes it possible for alterations and masking of the clinical signs presented by patients to occur.

According to the researched literature, in the period of gestation, acupuncture sessions are not contra-indicated, however, some acupoints with properties that have act to dilate the neck of the womb, or that promote uterine contraction, must be avoided as a precaution, considering the health status of these patients (Rogers, 1981).

In order to enable both the patient and professional to enjoy the benefits of acupuncture, it is necessary to know the anatomy of the human body, respect the principles of biosafety, count the needles inserted at the beginning and end of the session (Viana et al.2008), in addition to performing puncture of the points with the patient lying in a supine position (facing the ceiling), lying in a prone position (facing the floor) or lying on the side. It is relevant to mention that there is high incidence of a state of torpor manifested by the patient immediately on conclusion of the acupuncture session, and this represents a potential risk to patients that leave the clinic and drive their vehicles (Rampes & Peuker, 2001).

The use of acupuncture in dentistry enables results to be obtained, which have been proved to be positive, in various specific affections in this field of health. Nevertheless, the need is pointed out for caution in view of some of the limitations of the technique, such as, for example, for cases of Temporomandibular Dysfunction (TMD) of degenerative origin (fractures, tumors, luxation, osteoarthrosis, ankylosis and disc displacement) in which the results obtained with the application of acupuncture have been shown to be unsatisfactory. In this context, toothache, because it is triggered as a result of various causes of distinct natures (pulpitis, dentinal sensitivity, periodontitis, tooth fracture and alveolitis) also represents and condition in which the efficacy of acupuncture has shown reduced results. In cases of idiopathic trigeminal neuralgia, positive and satisfactory results can be obtained with the use of acupuncture (Viana et al.2008).

As regards the placebo effect and other segmental approaches to acupuncture, according to the literature, it was verified that different postures related to this therapeutic resource exert an influence on the

Limitations Attributed to the Application of Acupuncture 29

result of treatment, and that various observations about traditional acupuncture could not be explained by means of this segmented reasoning. In this context, Filshie and Cummings (2001) mentioned the example of the acupoint PC 6, which is not recognized as a trigger point, nor is it recognized as a segmental point for acting on the stomach, nevertheless, its efficacy in cases of nauseas and vomiting has been evidenced in the literature.

Publications relative to adverse effects attributed to the use of Acupuncture, including other areas in addition to Dentistry, do not present information sufficiently suited to allowing one to make a critical evaluation of these studies. Rampes and Peuker (2001) suggested that future publications covering this subject, should state specifically mentioned details, such as the type of acupuncture applied, qualification of the professional who implanted the needles, time interval of duration of the supposed adverse reaction, possibility of reverting this situation, in addition to other factors that may represent a “confounding” factor in the interpretation of the results.

Chapter 5

EFFICACY AND BENEFITS OF ACUPUNCTURE IN DENTISTRY

Pain is considered one of the chief complaints that affect the

population in general, and motivates patients to seek attendance at hospitals, various clinics and consulting rooms that offer different forms and types of treatments, from allopathy through to traditional medicines (Chinese, Ayurvedic, Andine, etc.). As this is a complaint that comprises various origins and factors that indicate imbalance of the body, it is one of the most studied manifestations in biomedicine.

When compared with other medical specialties, in Dentistry a greater frequency of situations is verified, in which Pain is involved (Rocha et al., 2003). Within a classification with reference to the time in which it is manifested, Pain may be classified as Acute (with rapid and recent onset) or Chronic (with gradual onset and prolonged manifestation). It is considered a debilitating pathology, consequently leading to compromise in physical psychological and, behavioral aspects, and a worsening in the quality of life. Simultaneously, it becomes a public health concern, as one third of the population will present some type of chronic pain during their lives. (Elliott et al., 1999).

In dentistry, Acute or Chronic Pain is one of the most common complaints predominantly manifested by patients, being one of the main reasons for seeking dental attendance.

Toothaches are more limiting and frequent in under-developed countries, in which education or prophylactic guidance as regards dental care is scarce, making it a public health problem that generates high costs


to health systems. This scenario has slowly been changing in some countries (Agbor & Naidoo, 2011). We emphasize that the aim of this topic, inserted in this chapter, is not to approach the theme of dentistry in the mentioned countries, but to discourse with respect to the efficacy of Acupuncture in Dentistry.

From the biomedical point of view, the instruments at ones disposal, by means of which one can affirm whether a technique is efficient or not, are scientific data, that are published by researchers in indexed publications, based on experiments performed in laboratories, or by conducting randomized controlled trial (RCT). According to (Sackett, et al., 1997) well designed RCT are less propense to inducing error, when compared with other types of designs.

In this sense, from the point of view of biomedicine, the large majority of existent studies on the efficacy of acupuncture do not meet the requirements that assure the good quality of RCT, one of the most common observations in these studies concerns the question of methodological limitations, mainly due to the nature and complexity of acupuncture and of Traditional Chinese Medicine (TCM) itself. When one asks the question: “Is acupuncture efficient?”, the first characteristic one should consider is the oriental origin of acupuncture, which differs from the principles that rule Conventional Medicine. The pillars of TCM serve as the foundations of this medicine which embraces various theories, such as: the theory of Yin and Yang, theory of the 5 elements, theory of zang-fu, etc. In addition to the innumerable styles of practice, these oriental theories are frequently unknown by (Western) biomedical researchers and impose limitations on preparing a well designed RCT and consequently results in studies with methodological limitations.

Considering methodological questions and greater facility in understanding the efficacy of acupuncture, we have classified the dental affections, in a generic manner, into two large groups:

1. The Group of dental affections that are manifested by acute pain

of Odontogenic or Dental Origin: Reversible pulpitis; irreversible pulpitis; pulp necrosis; periapical abscess; symptomatic periodontitis; perichoronaritis; traumatic occlusion (after restorations); periodontal abscess; tooth injuries (tooth and/or restoration fractures ) (Rocha et al., 2003).

Efficacy and Benefits of Acupuncture in Dentistry 33

2. The Group of dental affections that are manifested by chronic pain: Pain of myofascial origin (myofascial dysfunctions and disturbances related to TMJ); pain of neurovascular origin (migraines); pain of neuropathic origin (trigeminal neuralgia, neuralgia of the glossopharynx and neuritis) (Rocha et al., 2003).

We point out that not all dental problems may be grouped in this

manner, nor is the efficacy of acupuncture simply reduced to the treatment of pain, nevertheless, as it is a recurrent theme, undissociable from clinical dental attendance, we have judged it necessary to approach it in a special manner.

Chapter 6

IS ACUPUNCTURE EFFICIENT IN THE TREATMENT OF ACUTE PAIN?

To be able to answer this question, scientists have conducted many

experimental studies with animals. There is a much quoted study by Pomeranz (1996), who suggests the neural mechanism through which acupuncture would have an analgesic effect. In addition to the experimental studies in animals, studies in humans have also been used to explain the efficacy of acupuncture in acute pain.

Ernst and Pittler (1998), in a systematic review, concluded that acupuncture is efficacious in pain relief during or after dental surgeries. The authors mentioned that the mechanisms of action of the analgesic effects could be the release of endorphin via afferent blockage and/or via efferent inhibition. Furthermore, Lao et al. (1999), showed the efficacy of acupuncture compared with the placebo, indicating that acupuncture significantly inhibits pain before it starts. This fact suggests that acupuncture is more effective when applied preventively and not after the onset of pain. They also suggest that acupuncture functions as a protector against some adverse effects resulting from tooth extraction surgery, and that this therapeutic resource may be valuable when applied as an analgesic for other types of acute pain, in addition to toothache.

Other RCT have demonstrated favorable results from the use of acupuncture in dentistry in acute affections, such as: Reducing the degree of acute pre-surgical dental anxiety (Karst et al.,2007) and reducing pain after mandibular third molar extraction (Kitade et al.,2000).

Chapter 7

IS ACUPUNCTURE EFFICIENT IN THE TREATMENT OF CHRONIC PAIN?

On the efficacy of acupuncture in chronic pain, there are limited

experimental studies conducted in animals, among these, the most frequently used models refer to the study of acute pain. In addition to the above-mentioned limitation, we point out the difficulty of managing and conducting chronic pain studies in animals, and the difficulty of obtaining approval from ethics committees under these circumstances (Mogil et al., 2010).

One the other hand, the publication of various studies conducted with human beings was found. However, the majority of these presented methodological deficiencies which impede a definitive conclusion based on their findings. We exemplify this by means of a meta-analysis study about chronic pain conducted by Patel et al. (1989). In this meta-analysis it was observed that the results coming from the researched sub-groups attained statistical significance in favor of acupuncture. However, although the majority of the results apparently favored acupuncture, it is not possible to affirm that this therapy was efficient in the researched cases, as the studies included in this meta-analysis presented methodological deficiencies, particularly with reference to blindness.

In the panel of consensus of the Acupuncture Conference of 1998, promoted by The National Institutes of Health (NIH), the findings showed that acupuncture was efficient in the treatment of post-operative nauseas and vomiting, resulting from chemotherapy in adults, and was probably also efficient for nausea resulting from pregnancy. Lu et al.


(2000) and Somri et al. (2001) verified a reduction in nausea, vomiting and pharyngeal reflex in dental attendance.

The efficacy of acupuncture was also found in other chronic dental affections, such as: Reduction in pain intensity of oromyofascial and craniomandibular disorders (Schmid-Schwap et al., 2006; Smith et al., 2007; Simma et al., 2009, Katsoulis et al, 2010;) and reduction in pain intensity as a result of migraine (Facco et al., 2008).

There are also dental conditions in which acupuncture may not be efficient, such as, for example, in cases of TMD of degenerative origin (fractures, tumors, luxation, osteoarthrosis, ankylosis and disc displacement), and in cases of pulpitis, dentinal sensitivity, periodontitis, tooth fracture and also in cases of alveolitis, the efficacy of acupuncture may be minimal or have hardly relevant results (Gonçalo and Pereira, 2010).

Chapter 8

WHAT ARE THE BENEFITS OF ACUPUNCTURE?

The lack of treatments for various affections of health within

biomedicine makes it possible for acupuncture to be used as an adjuvant therapy in many pathologies, including those of a dental nature, showing it to be efficient, as previously mentioned. In this sense, the adhesion to acupuncture by patients owes, among other reasons, to the characteristics of the technique itself, which preaches the search for homostasis of the body as a whole, including its physical, emotional and spiritual parts (Diehl, 2009).

A great concern of health systems, professionals who act in this area and patients is the high consumption of drugs in the treatment of various pathologies, some of which are hardly effective in the treatment and frequently result in adverse reactions in consumers.

From this perspective acupuncture presents benefits, as the contra-indications are rare, provided that it is applied by a well trained professional. As a result, the application of this therapeutic resource also leads to diminished drug consumption, a fact that results in diminishing costs to health systems and patients (Iorio et al., 2010).

In dentistry, there are various benefits, particularly considering that it is an easy technique to learn and one that the dentist can practice. It has also been shown to be an important instrument for the dentist, as it provides pain relief and can be used in a preventive manner to eliminate painful manifestations. Another benefit of the use of acupuncture in dentistry concerns the question of being anxiolytic, as acupuncture helps


to diminish patients' aversion to dental treatments, thus contributing to a better patient-professional relationship.

Chapter 9

AURICULOTHERAPY AND DENTISTRY Auriculotherapy is a therapeutic resource based on the somatotopic

reflex system located in the external surface of the ear, whose mechanism of action is similar to that of the somatotopic system of the cerebral cortex (Martinez Pecino, 2008). Therefore, in auriculotherapy, stimulus is applied in points that are directly related to the brain, obtaining the result by means of the reflex action of this structure on organs and their functions (Lipszyc, 2004).

In other words, the points situated in the auricular pavillion represent areas that directly connect this part of the body with the internal organs, the main and collateral meridians, members, bones and tissues. The auricular acupoints are portals whose energy from the organs and meridians is transported up to the surface of the auricular pavillion. Thus, from this perspective it is possible to diagnose and treat infirmities, as the acupoints situated in the ear have the capacity to reflect both the on the physiological function and pathological change in the body (Huang, 2002).

According to Abbate (2004) there are over ten modalities of auricular acupuncture and this therapy can be performed by means of various artifacts, such as digital pressure, seeds, spheres, magnetic spheres, electrical energy, among others.

When associated with Acupuncture, auriculotherapy is capable of potentiating and dynamizing the process of reestablishing the equilibrium of the body that receives these interventions (Sousa, 1997). However,


both in bodily acupuncture and auricular acupuncture, it is important to take care of antisepsis to avoid infections in the punctured area.

A therapeutic resource widely used by acupuncturists, auricular acupuncture may result in complications, the incidence of which has increased over the last few years. Promotion of repair/reconstruction of the site affected by complications, in the majority of cases, requires aggressive clinical-surgical procedures, such as, for example, in the occurrence of perichondritis established in this site (Pinto AND Ramos, 1997).

According to Allison and Kravitz (1975), Davis and Powell (1985) and Gilbert (1987) acupuncture should be considered a form of penetrant trauma that may induce perichondritis or chondritis in the auricula. According to Linstron and Lucente (1993) perichondritis, inflammation of the perichondrium, and chondritis, an inflammatory process of the cartilage, may occur as a consequence of accidental or surgical traumatism of the outer ear or because of cutaneous infection of the external acoustic meatus. The cartilage, which is avascular, may suffer bacterial invasion setting off necrosis and deformity (Turkeltaub, 1990). Ramos et al. (1997) and Davidi et al. (2011) emphasized that auricular acupuncture performed by needles causes penetrant trauma that may cause perichondritis.

Due to the reduced blood supply that runs through the auricular pavillion, this area of the human body represents a site of risk, bearing in mind that such characteristics make it considerably more difficult to combat infections established there. Thus, for biosafety reasons, at present it is recommended that auriculotherapy should be performed by means of non-invasive modalities, such as acupressure, a technique consisting of manipulation without needles, of the same acupoints as those of auriculotherapy performed by means of needles (Harris, 1997).

Bibliographic findings revealed the existence of considerable difficulty in identifying the auricular points, mainly attributed to the varied nomenclature used by innumerable authors describing the same auricular acupoint. In this context, to minimize these doubts, the illustrations presented as follows, follow the nomenclature of the “standard scheme of auricular points” described by Ernesto Garcia Gonzales – School of Huang Li Chun (Figure 13), Yamamura (Figure 14) and Zhixian and Cols. (Figure 15)

Auriculotherapy and Dentistry 43

These illustrations were adapted to the context of the theme approached in this chapter, highlighting the main points related to the dental surgeon’s area of professional activity.

Figure 13. Auricular pavilion and main acupoints used in dentistry (adapted from Gonzales, 1999).

This figure illustrates the combination of the acupoints suggested in table 06.


Table 06. Combination of ear points for treatment of oral diseases (adapted from Gonzales, 1999)

Afection Combination of ear points Toothache Mouth, san jiao, *upper or lower jaw, tooth, shenmen

Aphtha Heart, spleen, mouth, endocrine, adrenal, allergies, shenmen, bleeding at the ear apex

Periodontitis Mouth, shenmen, san jiao, adrenal, stomach, large intestine, kidney

Gengivorrhagia Mouth, trachea, adrenal, spleen, large intestine, stomach, upper jaw, or lower jaw

Lichen Planus Bleeding at the ear apex, lung, liver, spleen, endocrine, adrenal Nausea / Vomiting Stomach, sympathetic, cardia, occipital, subcortex

Headache Bleeding at the ear apex, shenmen, subcórtex Cervicalgia Neck area, shenmen, kidney, endocrine, minor occipital nerve, liver

Facial Spasm San jiao, mouth, subcortex, brain stem, liver, spleen, large intestine, lesser occipital nerve, shenmen, occipital

Palsy San jiao, brain stem, subcortex, endocrine, adrenal, spleen, liver Trigeminal Neuralgia

Auriculotemporal nerve, san jiao, subcortex, brain stem, shenmen, occipital

Neurasthenia Bleeding at the ear apex, shenmem, heart, subcortex, occipital, area and point of neurasthenia

*If the pain is located in the upper jaw, the use of additional point "stomach" is recommended, if pain is localized in the lower jaw, the additional point must be "large intestine.

Table 07. Functions of the ear points and main indications for the practice of auriculotherapy in dentistry

(adapted from Yamamura, 2001)

Name of point Indication Ear apex Sedation and analgesia, inflammation control Amygdala Tonsillitis, pharyngitis and laryngitis

Helix 1 Elimination of inflammation, reduction of fever, reduction of blood pressure

Hypotensive Lowering blood pressure and treatment of hypertensive headaches Shen-Men Many diseases, analgesic point Cervical Arthritis, arthrosis and cervical spine rigidity Tooth Anesthesia 1 and 2 Toothache and dental analgesia

Neurasthenia Nervous exhaustion Palate and floor of mouth

Toothaches, temporomandibular arthritis, analgesia for tooth extraction, mouth ulcers

Tongue Glossitis and dyslalia by weakness of the tongue Upper and Lower Jaw Temporomandibular arthritis, tooth extraction, toothache


Name of point Indication Cheek Trigeminal neuralgia, facial tics, facial paralysis, trismus Internal and External Ear Deafness, tinnitus, decreased hearing, dizziness

Frontal Frontal headache, neurasthenia, insomnia Parotid (Salivary) Gland Parotitis, parotid duct obstruction

Brain Regulates arousal or impairment of the cerebral cortex Dizziness Dizziness, vertigo, Meniere's disease

Occipital Cervicalgia, trismus, neck pain, prevention of nausea, anti-inflammatory, sedative, analgesic

Vertex Vertex headache and dizziness Toothache Toothache Kidney Bone diseases, teeth, gums, deafness, headache and neurasthenia Pancreas Headache, migrain

Table 08. Combination of ear points for treatment of oral diseases

(adapted from Yamamura, 2001)

Afection Combination of ear points Aphtha Mouth, stomach, spleen, shen-men, endocrine, tongue Anxiety Rim, shen men, occipital, heart, stomach Caries* Upper and lower jaw, shen men, toothache Headache Occipital, front, brain, shen men, sympathetic Tooth mobility Kidney, upper and lower jaw, occipital Toothache Upper and lower jaw, shen men, dental anesthetic 1 e 2 Migrain San jiao, shen-men, gall bladder Stomatitis Mouth, glandular secretion, shen men, lung, stomach, liver Pharyngitis Pharynx, larynx, endocrine, suprarenal glands Nausea and Vomiting Stomach, sympathetic, shen men, esophagus

Trigeminal Neuralgia Cheek, upper and lower jaw, shen men

Toothache Upper and lower jaw, shen men, toothache Facial Paralysis Cheek, occipital, eyes, mouth, subcortex Trismus Upper and lower jaw, mouth, pharynx, kidney Aphthous Ulcers Mouth, endocrine, shen men, tongue

Vertigo, Dizziness Occipital, stomach, external ear, shen-men, dizziness, vertex

Tinnitus Rim, occipital, external ear, internal ear, suprarenal glands * When the books about the Traditional Chinese Medicine (TCM) refer that

auriculotherapy/ acupuncture treats the "caries" they refer to pain decurrent from caries.


Figure 14. Auricular pavilion and main acupoints used in dentistry (adapted from Yamamura, 2001).



Table 09. Functions of the ear points and main indications for the practice of auriculotherapy in dentistry (adapted from Zhixian &

Cols., 2005) Name of point Indication Cervical vertebrae Pain in the corresponding region Shenmen Pain, inflamation, External Ear Tinnitus, deafness, dizziness Occiput Dizziness, headache, insomnia Forehaed Yangmin type headache Brain Insomnia, tinnitus due to kidney deficiency Mouth Facial paralysis, stomatitis Cardiac Orifice Nervous vomiting Small Intestine Palpitation Pancrease and Biliary Tract Migraine Kindey Tinnitus, deafness, Cavum Conchae Insomnia, palpitation Facial Area Facial paralysis, disease of face Tongue Glossitis Jaw Toothache, mandibular arthritis No. 4 of Ear Lobe Toothache Internal Ear Tinnitus, hypoacusis, aural vertigo Back Auricle Headache The Root of the Lower Auricle Headache Ermigen Headache Heart Headache, insomnia Kidney Headache, insomnia,dizziness

Table 10. Selecting points on the ear for treatment of dental diseases

(adapted from Zhixian & Cols. 2005) Afection Combination of ear points Headache Front, occiput, brain, middle border, apex of the ear Nuchal Rigidity Front, critical points in the area of the cervical spine Dizziness Kidney, shen men, internal ear Postoperative wound pain

Auricular points corresponding to incised area, shemen, lung

Hiccup Puncture of tender points in the middle region of the ear Vomit Stomach, lung, spleen, shenmen Hysteria Heart, brain, occiput, shemen


Figure 15. Auricular pavilion and main acupoints used in dentistry (adapted from Zhixian & Cols.,2005).


Chapter 10

FINAL CONSIDERATIONS The proposal of this book arose from the idea of approximating

dental surgeons to the perspective of holistic health care by means of an approach proposed by TCM: acupuncture. Thus our intention was not to construct a complete treatise on traditional acupuncture, but to compile data and organize them in a practical and useful manner with the purpose of contributing to motivation of the search for knowledge about this therapeutic resource applied to dentistry. In this sense, the present chapter fulfilled its objective, insofar as it presents the main findings (points, meridians, benefits and limitations of acupuncture in dentistry) captured by an extensive literature review. Bearing in mind the scarcity of publications related to this topic, we believe that the present review could facilitate the search for knowledge about acupuncture applied to dentistry.

The Authors thank: Designer Carolina Gonçalo for cooperating with the development of the illustrations contained in this book.

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INDEX

A

access, 6 accessibility, 6 acupuncture, vii, ix, 2, 3, 5, 6, 23, 24, 25,

27, 28, 29, 32, 33, 35, 37, 38, 39, 40, 41, 42, 45, 49, 51, 52, 53, 54, 55

adaptation, 5 adhesion, 39 adults, 37 adverse effects, 27, 29, 35 alternative medicine, 55 alveolitis, 28, 38 amplitude, 25 analgesic, 2, 5, 35, 44, 45 anatomy, 28 ankylosis, 28, 38 anti-inflammatory drugs, 2 anxiety, 2, 35, 53 apex, 25, 44, 47 apnea, 25 Argentina, 54 arousal, 45 arthritis, 44, 47 aversion, 40

B

behavioral aspects, 31

Beijing, 52, 56 benefits, vii, 3, 5, 28, 39, 49 biosafety, 28, 42 bleeding, 3, 44 blindness, 37 blood, 42, 44 blood pressure, 44 blood supply, 42 bone(s), 2, 41 bone marrow, 3 brain, 41, 44, 45, 47 brain stem, 44 Brazil, ix breast cancer, 24

C

CAM, 52 Cameroon, 53 caries, 45 cartilage, 42 cerebral cortex, 41, 45 challenges, 5 chemical, 5 chemotherapy, 24, 37 children, 55 chondritis, 42, 51, 56 classification, 31 clinical trials, 2, 56

Index 58

collateral, 41 community, 52 complexity, 27, 32 complications, 27, 42, 55 consensus, 27, 37 consulting, 31 consumers, 39 consumption, 24, 39 controlled studies, 32 covering, 29

D

deficiency(s), 27, 37, 47 dental care, 31 dentist, vii, 1, 2, 6, 25, 39 depth, 27 dermatitis, 28 developed countries, 31 diseases, 1, 2, 27, 44, 45, 47 displacement, 28, 38 dizziness, 45, 47 drug consumption, 39 drugs, 39

E

edema, 7, 10, 14, 16 education, 31 endocrine, 44, 45 endorphins, 27 energy, 5, 41 environments, 2 epidemiology, 52 equilibrium, 3, 41 esophagus, 45 ethics, 37 evidence, 2 exposure, 2 extraction, 35, 44, 54

F

facial tics, 45 fever, 44 force, 23 formation, 27 foundations, 32 fractures, 27, 28, 32, 38 funding, ix

G

gestation, 28 gingivitis, 2 graph, 22 guidance, 6, 31

H

halitosis, 2 headache, 7, 10, 13, 16, 45, 47 health, vii, 1, 2, 3, 5, 6, 24, 28, 32, 39, 49 health care, vii, 1, 49 health status, 2, 28 herpes, 2 human, vii, 1, 6, 28, 37, 42 human body, 6, 28, 42

I

idiopathic, 28 immune response, 3 incidence, 28, 42 individual character, 27 individual characteristics, 27 individuals, 2, 23, 28 infection, 42 inferences, 2 inflammation, 42, 44 inhibition, 35 insomnia, 45, 47 intervention, 6, 25

Index 59

ionizing radiation, 2

K

kidney, 44, 45, 47

L

large intestine, 44 laryngitis, 44 larynx, 45 laterality, 23 lichen, 2 liver, 44, 45 love, ix lying, 6, 28 lymph, 3 lymph node, 3

M

majority, 1, 32, 37, 42 manipulation, 42 masking, 28 masseter, 16, 23, 55 matter, 6 medical, 31 medicine, 32, 52, 55 meta-analysis, 37, 54 migraines, 33 mixing, 2 models, vii, 1, 37, 54 motivation, 49 mouth ulcers, 44 muscles, 23, 53

N

National Institutes of Health, 37 nausea, 2, 24, 37, 45 necrosis, 32, 42 nerve, 44

neuralgia, 33, 45 neurasthenia, 44, 45 neuritis, 33

O

obstruction, 45 obstructive sleep apnea, 25 occlusion, 32 oral cavity, 1 oral diseases, 44, 45 oral health, 53 organism, 1 organize, 49 organs, 3, 41 otoacoustic emissions, 25

P

pain, 2, 14, 16, 24, 25, 31, 32, 33, 35, 37, 38, 39, 44, 45, 47, 52, 53, 54, 55

palliative, 2 paralysis, 2, 3, 45, 47 parotid, 45 parotid duct, 45 pathology, 31 perforation, 27 periodontal, 32 periodontitis, 28, 32, 38 pharyngitis, 44 pharynx, 45 Philadelphia, 54 pilot study, 53 placebo, 25, 29, 35, 54, 55 pneumothorax, 27 population, 31 pregnancy, 37 prevention, 3, 45, 55 principles, 28, 32 professionals, vii, ix, 1, 2, 39 prophylactic, 31 public health, 24, 31 pulp, 32

Index 60

Q

quality of life, 31 questioning, 2

R

radiotherapy, 24 reactions, 39 reading, vii, 5 reasoning, 29 receptors, 27 reconstruction, 42 reflex action, 41 relaxation, 5 reliability, 24 relief, 24, 25, 35, 39, 54 repair, 2, 42 requirements, 32 researchers, ix, 32 response, vii, 27 restoration, 32 RH, 51 risk, 28, 42

S

scarcity, viii, 49 scope, 1, 2, 5 secretion, 45 sedative, 3, 45 sensations, 5 sensitivity, 28, 38 sham, 25 showing, 39 signs, 28 simulation, 3 skin, 2, 5 sleep apnea, vii sleep disorders, 24 SP, 10, 11 Spain, ix spine, 44, 47

spleen, 3, 44, 45, 47 state, 28, 29 stimulation, vii, 27 stimulus, 27, 41 stomach, 29, 44, 45 stomatitis, 47 stress, 2 structure, 41 symptoms, 25 syndrome, 2, 25, 55

T

teachers, ix teeth, 45 therapy, vii, 3, 27, 37, 39, 41, 55 third molar, 35 thymus, 3 tinnitus, 25, 45, 47 tissue, 2 tooth, 23, 28, 32, 35, 38, 44, 54 tooth injuries, 32 trachea, 44 trajectory, 17 transmission, 27 trapezium, 24 trauma, 42 treatment, vii, 1, 2, 6, 23, 24, 25, 28, 29,

33, 37, 39, 44, 45, 47, 53, 55 trial, 53, 54, 55 trigeminal neuralgia, 28, 33 tumors, 28, 38

U

ulcer, 8, 10 United, 54 United Kingdom, 54 universe, 6

V

variations, vii

Index 61

vehicles, 28 vertebrae, 47 vertigo, 45, 47 visualization, 6 vomiting, 2, 24, 29, 37, 47, 55

W

weakness, 44

well-being, 5 World Health Organization (WHO), 2,

51, 56

X

xerostomia, 2, 24, 51

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