TOPIC : COMPLEMENTARY AND ALTERNATIVE MEDICINE IN GENERAL AND ORAL HEALTH

CONTENTSSubtopicsPages 1. Introduction to Complementary and Alternative Medicine (CAM)22. CAM Practice in General Health2.1 Variation of CAM practice among culture and religion32.2 Plants and CAM102.3 Non-plant organism and CAM122. 4 Integration of CAM and modern medicine in Malaysia 15Health Services3. CAM Practice in Oral Health174. Conclusion195. References 20

1. Introduction to Complementary and Alternative MedicineComplementary and alternative medicine (CAM) is the term for medical products and practices that are not part of standard care. Standard care is what medical doctors, doctors of osteopathy, and allied health professionals, such as nurses and physical therapists, practice. Complementary and alternative medicine (CAM), also referred to as integrative medicine, includes a broad range of healing philosophies, approaches, and therapies. A therapy is generally called complementary when it is used in addition to conventional treatments; it is often called alternative when it is used instead of conventional treatment. Conventional treatments are those that are widely accepted and practiced by the mainstream medical community. Depending on how they are used, some therapies can be considered either complementary or alternative. Complementary and alternative therapies are used in an effort to prevent illness, reduce stress, prevent or reduce side effects and symptoms, or control or cure disease.Globally CAM can define as the following :a. Complementary medicine, in practice refers to a wide range of health interventions originating from different cultures across thousands of years of history.(Scottish Office Department of Health, Complementary Medicine and the National Health Services [London, November 1996]) b. Complementary and Alternative Medicine (CAM) as defined by the National Center for Complementary and Alternative Medicine (NCCAM) is a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine. (NCCAM, USA[ 2007]) c. Complementary and Alternative Medicine (CAM) is a title used to refer to a diverse group of health-related therapies and disciplines which are not considered to be a part of mainstream medical care. Other terms sometimes used to describe them include 'natural medicine', 'non-conventional medicine' and 'holistic medicine'. (House of Lords, Parliament, U.K [November 2000])

2. Complementary and Alternative Medicine Practice in General Health The principle of CAM can be listed as following :a. Mind-body intervention (meditation, prayer)b. Biological based therapy : (herbal, honey, other natural products)c. Manipulative and body-based methods (chiropractics, osteopathic, massage)d. Aromatherapye. Energy therapies (Reiki, Therapeutic touch)f. Bioelectromagnetic-based therapiesIn this assignment

2.1 Variation of Complementary and Alternative Medicine practice among culture and religionThe use of complementary and alternative medicine (CAM) is likely to vary among racial/ethnic groups because its use is related to cultural and health beliefs. Under this subtopic, I will focus on Chinese, Indian, and Malay based-CAM practice. Chinese In Chinese culture, traditional Chinese medicine (TCM) originated in the region of eastern Asia that today includes China, Tibet, Vietnam, Korea and Japan. Tribal shamans and holy men who lived as hermits in the mountains of China as early as 3500 B.C. practiced what was called the Way of Long Life. This regimen included a diet based on herbs and other plants; kung-fu exercises; and special breathing techniques that were thought to improve vitality and life expectancy.TCM encompasses many different practices, including acupuncture, moxibustion (burning anherbabove the skin to apply heat to acupuncture points), Chinese herbal medicine, tui na (Chinese therapeutic massage), dietary therapy, and tai chi and qi gong (practices that combine specific movements or postures, coordinated breathing, and mental focus). TCM is rooted in the ancient philosophy of Taoism and dates back more than 2,500 years. Traditional systems of medicine also exist in other East and South Asian countries, including Japan (where the traditional herbal medicine is called Kampo) and Korea. *Chinese herbalism will be discussed in 2.2 Plants and Complementary and Alternative Medicine (CAM)AcupunctureAcupuncture can be define as the stimulation of special points on the body, usually by the insertion of fine needles. Dated back to 2000 years ago, originating in the Far East, acupunctureapplies needles, heat, pressure, and other treatments to certain places on the skin to cause a change in the physical functions of the body. The use of acupuncture is part of traditional Chinese medicine(TCM). TCM is a medical system that has been used for thousands of years to prevent,diagnose, and treat disease.The principle of acupuncture was based on the principle of traditional Chinese medicine. According to these, the workings of human body are controlled by a vital force or energy called Qi, which circulates between the organs along channels called meridians. There are 12 main meridians, and theses correspond to 12 major functions or organs of the body. Although they have same names (such as liver, kidney, heart, etc.), Chinese and Western concepts of organs correlate only very loosely. Qi energy must flow in correct strength and quality through each of these meridians and organs for health to be maintained. According to TCM, qi can be unblocked by using acupuncture at certain places on the skin, called acupoints. The acupoints are located along the meridiens and provide means of altering the flow of Qi. Acupoints are places where the meridians come to the surface of the body. There are more than 360 acupoints on the human body, with specific acupoints for each condition being treated.The oldest known medical book in China (second century BC) describes the use of needles to treat medical problems. The use of the treatment spread to other Asian countries and to other regions of the world, including to Europe by the 1700s. In the United States, acupuncture has been used for about 200 years. Research on acupuncture began in the United States in 1976. Twenty years later, theUS Food and Drug Administration(FDA) approved theacupuncture needleas amedical device. Many illnesses are treated with acupuncture. Acupuncture is usually used as an addition toconventional (standard) therapyfor cancer patients. Incancertreatment, its main use is to controlsymptoms, including the following:a. Pain.b. Fatigue.c. Nauseaandvomitingcaused bychemotherapy.d. Weight loss.e. Anxiety.f. Depression.g. Insomnia.h. Poorappetite.i. Dry mouth.j. Hot flashes.k. Nerveproblems.l. Constipationanddiarrhea.In cancer patients, Acupuncture may cause physical responses innerve cells, thepituitary gland,and parts of the brain. These responses can cause the body to releaseproteins,hormones, and brain chemicals that control a number of body functions. It is proposed that, in this way, acupuncture affectsblood pressureand body temperature, boostsimmune systemactivity, and causes the body's natural painkillers, such asendorphins, to be released.Scientificstudies on the use of acupuncture to treat cancer andside effectsof cancer began only recently.Laboratoryandanimal studiessuggest that acupuncture can reduce vomiting caused bychemotherapyand may help the immune system be stronger during chemotherapy. Animal studies support the use of electroacupuncture to relieve cancer pain. Laboratory and animal studies have also looked at how acupuncture works for cancer treatment, such as the role of acupuncture in stimulatingimmune functions, including increasingblood cell countand enhancinglymphocyteandnatural killer cellactivity.Tai ChiTai chi is a centuries-old Chinese martial art that descends from qigong, an ancient Chinese discipline that has its roots in traditional Chinese medicine. According to some records, tai chi dates back as far as 2,500 years. It involves a series of slow, meditative body movements that were originally designed for self-defense and to promote inner peace and calm. Tai chi is proven to improve muscle strength, flexibility, balance and aerobic conditioning. When combined with standard treatment, tai chi appears to be helpful for several medical conditions. Forexample, an hour of tai chi twice a week for 12 weeks reduced pain and improved mood and physical functioning more than standard stretching exercises in people with severe knee osteoarthritis. According to a Korean study published in December 2008 inEvidence-based Complementary and Alternative Medicine, eight weeks of tai chi classes followed by eight weeks of home practice significantly improved flexibility and slowed the disease process in patients with ankylosing spondylitis, a painful and debilitating inflammatory form of arthritis that affects thespine.IndianIn Indian culture, the most popular traditional medicine system is Ayurveda. AyurvedaorAyurvedic medicineis a system of Hindu traditional medicinenative to theIndian subcontinent. Practices derived from Ayurvedic traditions are a type ofalternative medicine.Ayurveda is a discipline of theupavedaor "auxiliary knowledge" inVedictradition. The origins of Ayurveda are also found in theAtharvaveda, which contains 114 hymns and incantations described as magical cures for disease. Ayurvedic practices include the use of herbal medicines, mineral or metal supplementation (rasa shastra), surgical techniques, opium, and application of oil by massages.ShirodharaShirodharais a form ofAyurvedatherapy that involves gently pouring liquids over the forehead and can be one of the steps involved inPanchakarma. Practised for over 5000 years, shirodhara massage originates from India and is based on the ancient principles of Ayurvedic medicine. Translated from the Sanskrit as a holistic healing science, Ayurveda aims to harmonise the body, mind, senses and soul. Shirodhara is a luxuriant and easy way to achieve instant calm and rejuvenation. It derives from two Sanskrit words:shiroanddhara.Shiromeansheadanddharameansto flow.It involves the warm and consistent flow of aromatic oils on the forehead, specifically on the third eye. This is the chakra point just above and between the eyebrows. It is said to be the seat of human consciousness. The oils are allowed to flow over the scalp and through the hair, creating a blissful sensation. The liquids used in shirodhara depend on what is being treated, but can include oil, milk, buttermilk, coconut water, or even plain water.Shirodhara has been used to treat a variety of conditions including eye diseases,sinusitis, allergicrhinitis, greying of hair, neurological disorders, memory loss,insomnia, hearing impairment,tinnitus,vertigo,Mnire's diseaseand certain types of skin diseases likepsoriasis. It is also used non-medicinally atspasfor its relaxing properties.YogaYoga is a mind and body practice with historical origins in ancient Indian philosophy. Yoga originates from Yajur Veda, which part of a greater system of Vedic knowledge along with Ayurveda. Like other meditative movement practices used for health purposes, various styles of yoga typically combine physical postures, breathing techniques, andmeditationor relaxation. Yoga in its full form combines physical postures, breathing exercises, meditation, and a distinct philosophy.Recent research suggests that a carefully adapted set of yoga poses may reduce low-back pain and improve function. Other studies also suggest that practicing yoga might improve quality of life; reduce stress; lower heart rate and blood pressure; help relieve anxiety, depression, and insomnia; and improve overall physical fitness, strength, and flexibility. One National Center for Complementary and Integrative Health, United States of America (NCCIH)-funded study of 90 people with chronic low-back pain found that participants who practiced Iyengar yoga had significantly less disability, pain, and depression after 6months. In a 2011 study, also funded by NCCIH, researchers compared yoga with conventional stretching exercises or a self-care book in 228 adults with chronic low-back pain. The results showed that both yoga and stretching were more effective than a self-care book for improving function and reducing symptoms due to chronic low-backpain.MalayIn Malay culture, the most popular practice would be in form of massage. There are 2 types massage; traditional Malay massage and traditional postnatal message. Nowadays, Malaysia Health Service has integrated these type of massage in modern medicine and the service is offered at the Integrated Hospital as Traditional & Complementary Medicine (T&CM) practice.Traditional Malay MassageTraditionalurut(massage) combines stretching, long kneading strokes and pressure applied to every part of the body, from the head, face, abdomen, body to the toes of the feet. The therapist only uses the part of their arm from their elbows to their fingertips. The ancient art of traditional Malay massage is a comprehensive and efficient therapy for relaxing the nerves and mind.Traditionally, Malay massage is done without any type of oil. Its a dry massage but nowadays many commercial places uses herbal oils to facilitate the massages to ease kneading. Examples of oils are like ginger, ylang-ylang and coconut which has its own beneficial properties. Malay massage help in facilitating cicrcuation due to pressure created on the muscle that moves the blood to congested areas of the body. It also flushes out excess lactic acid from the muscles and improves the circulation of the lymph fluids. The lymph fluid helps excrete metabolic waste which in turn lowers blood pressure. In addition, it is effective in relieving chronic pain.Traditional Postnatal MassageTraditionally, Malay women who have just given birth are advised to undergo the traditional massage for at least three consecutive days, and if possible, even longer. According to Datin Sharifah Anisah, founder of Nona Roguy (now NR) and author ofEnsiklopedia Perbidanan Melayu(Encyclopaedia of Malay Midwifery), the postnatal massage is believed to improve blood circulation; expel lochia; "lift" the womb and keep it from sagging; break down fat; tone andshape the bodyto help the new mum get her pre-baby body back; and speed up overall recovery fromlabour and birth. The traditional postnatal massage includes breast massage in the belief that it will stimulatemilk production.

2.2 Plants and Complementary and Alternative Medicine (CAM)The use of plants for healing purposes predates human history and forms the origin of much modern medicine. Many conventional drugs originates from plant sources; a century ago, most of the few effective drugs were plant based. Examples, include aspirin (from willow bark), digoxin (from foxglove), quinine (from cinchona bark), and morphine (from the opium poppy). The development of drugs from plant continues, with drug companies engaged in large-scale pharmalogical screening of herbs.Herbalism ("herbology"or"herbal medicine") is use of plants for medicinal purposes, and the study of such use. Plants have been the basis for medical treatments through much of human history, and suchtraditional medicineis still widely practiced today. Herbalism, undoubtly the most popular complementary medicine to this date.Chinese herbalism is one of the major component of traditional Chinese medicine (TCM). In TCM, herbs are often used in conjuction with other techniques, such as acupuncture or massage. Chinese herbalism is a holistic medical system, meaning that it looks at treating patient as a whole person, looking at the mental and spiritual health, as well as the physical health, of the individual. Illness is seen as a disharmony or imbalance among these aspects of the individual. Chinese herbalism has been practiced for over 4000 years. This is examples of popular Chinese herbs:NamePurposes

Ephedra (Ma Huang)To treat asthma and induce sweating

Aconite (Fu Zi)To treat severe cold symptoms and certain arthritic pain

Astragalus (Huang Qi)Immune system builderTo raise Qi or life energy

Licorice (Gan Cou)Perform synergistic effect with other herb and help to attenuate potential adverse effects of stronger herbs.

Panax Ginseng (Ren Shen)Energy booster, immune system enhancer, fatigue relief

Western herbalism is a form of the healing arts that draws from herbal traditions of Europe and the Americas, and that emphasizes the study and use of European and Native American herbs in the treatment and prevemtion of illness. Western herbalism is based on physicians and herbalists clinical experience and traditional knowledge of medicinal plant remedies preserved by oral tradition and in written records over thousands years. Western herbalism, like the much older that traditional Chinese system, relies on the synergistic and curative properties of the plant to treat symptoms and disease and maintain health.In Malaysia, a diverse types of herbs that are available in our land. It has been estimated to have more than 2,000 herbal plants in Malaysia and most of them are unexplored yet. Older generation in Malaysia are still using herbal preparation to treat various ailments from fever to chronic diseases as well as beauty concerns. Some of well-known and widely used herbs such as tongkat ali, kacip fatimah, misai kucing, hempedu bumi, dukung anak, mas cotek, pegaga, mengkudu, halia and roselle.

2.3 Non-plant organism and Complementary and Alternative Medicine (CAM)Non-plant biology based therapy implement the use of organism such as helminth, maggot, Gurra fish, medicinal leech and etc. Each therapy has different advantages and help in treating certain conditions such as wounds, skin problem and immunology problem. Under this subtopic, I will discuss on ichtyotherapy, hirudotherapy, maggot therapy and helminthic therapy.IchthyotherapyThe name ichthyotherapy comes from theGreekname for fish Ichthys. Most often, a type of fish called the Gurra Rufa is used for treating conditions like dermatitis, psoriasis and eczema. These fish are toothless and they feed on the dead cells on the outer layer of the skin, thus cleansing/removing it off bacteria and fungus. Garra rufa is member of the carp and minnow family (Cyprinidae). The Ichthyotherapy treatments are being used inhealth carecenters, wellness centers, hospitals and even Spas. The patient is given a hot water bath, which contains numerous such fish that gently work on your skin to relax and rejuvenate it. All that a patient feels is a tickling and nibbling sensation. This unique alternate therapy first originated in Turkey, and then its use spread across Asian countries. Today, it is popularly used throughout USA, Singapore, Japan, Malaysia and many other Asian Countries, including India.Fish therapy can help individuals in cleaning wounds and treating a number of skin problems. It naturally removes dead cells from the skin and heals dry and itchy skin. The procedure removes not just dead cells, but also all the dirt from the skin and thus facilitates deep cleansing. The skin gets revitalized after Ichthyotherapy. Moreover, this theraphy can helps to get rid of aging cortex and keeps the skin protected against infectious bacteria. Since the fish act on nerve endings, they are helpful for stimulating the nerve system just like acupuncture. There is no pain involved in the procedure. The fish used are toothless and when they nibble on patients skin, it tickles and relaxes every nerve in the body.

HirudotherapyHirudotherapy or leech therapy is a treatment using medicinal leeches. Hirudo medicinali, scientific name for medicinal leeches have been used to treat patients for centuries. In the past, leeches have proved to be an effective treatment for a number of conditions including battle wound treatment. Currently leeches may be used to assist in the treatment of abscesses, arthritis, glaucoma, myasthenia gravis, thrombosis and some venous disorders. Medical leeches may also be used in plastic surgery and in some blood circulatory problems. During feeding, leeches secrete a complex mixture of different biologically and pharmacologically active substances into the wound. Hirudin is the prominent constituent of leech saliva. Hirudin that acts as a potent anticoagulant (blood thinner).Hirudotherapy is safe when used appropriately by a medical professional. It has been approved by Food and Drug Administration (FDA) as medical therapy.Maggot therapyMaggot therapyis also known asmaggot debridement therapy(MDT),larval therapy,larva therapy,larvae therapy,biodebridementorbiosurgery. It is a type ofbiotherapyinvolving the introduction of live, disinfectedmaggots(fly larvae) into the non-healing skin and soft tissuewoundof a human or animal for the purpose of cleaning out thenecrotic tissue within a wound (debridement) and disinfection. In maggot debridement therapy, germ-free larvae of therapeutic fly species ("medical grade maggots") are used to treat and manage wounds in a procedure known as "maggot therapy." The maggots are applied to the wound for 2 or 3 days within special dressings to keep the maggots from migrating. Since medicinal maggots can not dissolve or feed on healthy tissue, their natural instinct is to crawl elsewhere as soon as the wounds are clean, or the larvae are satiated. This therapy can improves wound healing and there is trace in evidence of study that maggot therapy benefis in treating diabetic foot ulcers. In 2004, Food and Drug Association (FDA) cleared Medical Maggots for use as a medical device in the United States for the purpose of treatment of the following: a. Non-healing necrotic skin and soft tissue wounds,b. Pressure ulcers,c. Venous stasis ulcers,d. Neuropathic foot ulcers, ande. Non-healing traumatic or post-surgical wounds

Helminthic theraphyHelminthic therapy, an experimental type ofimmunotherapy, is the treatment ofautoimmune diseasesand immune disordersby means of deliberate infestation with ahelminthor with the ova of ahelminth. Helminths are parasitic wormssuch ashookworms,whipworms, andthreadwormsthat have evolved to live within a host organism on which they rely for nutrients.These worms are members of two phyla;Nematoda, which are primarily used in human helminthic therapy, andPlatyhelminths. Helminthic infection has emerged as one possible explanation for the low incidence of autoimmune diseases and allergies in less developed countries such, together with the significant and sustained increase in autoimmune diseases in industrialized countries. This type of therapy still in process of research and the targets are Crohn's disease,ulcerative colitis,inflammatory bowel disease(IBD),multiple sclerosis, andasthma.

2. 4 Integration of Complementary and Alternative Medicine and modern medicine in Malaysia Health ServicesIn Malaysia, the term of Complementary and Alternative Medicine (CAM) is widely known as Traditional and Complementary Medicine and abbreviated as T&CM. In the West, the umbrella term CAM is widely accepted as including both TM and other recent forms of non-standardised medicine. In Malaysia, the term Traditional and Complementary Medicine (T&CM) is used to denote a practice of medicine that is other than the practice of medicine or dental practices utilised by registered medical or dental practitioners. Traditional Medicine (TM) is an ancient medical practice which existed in human societies before the application of modern science to health. It has evolved to reflect different philosophical backgrounds and cultural origins. The practice of modern medicine may be widespread but the use of traditional medicine is still practiced in many countries although it is not always included as a part of the healthcare system recognised by the government. It is one of many types of non-standardised health care services which involve varying levels of training and effeciency.According to National Policy of Traditional & Complementary Medicine Ministry of Health Malaysia (2007), Traditional and Complementary Medicine (T&CM) is a form of health-related practice designed to prevent, treat, and/or manage illnesses and/or preserve the mental and physical well-being of individuals and includes practices such as traditional Malay medicine, Islamic medical practice, traditional Chinese medicine, traditional Indian medicine, homeopathy, and complementary therapies, and excludes medical or dental practices utilised by registered medical or dental practitioners. On 11th January 2006, Malaysia Government had approved the establishment of Integration Medicine Programme which aim to integrate T&CM and modern medicine. 3 hospitals were chosen in phase one apperentice project. Until December 2011, total of 10 hospitals succeed in integrating T&CM with modern health system. T&CM units are incorporated in chosen hospitals, or what we called now as Integrated Hospital. Now, there are 5 types of practice that being offer as the following : a. Traditional Malay Massage for chronic pain and strokeb. Acupuncture for chronic pain and strokec. Herbal treatment as complementary treatment for cancerd. Traditional Postnatal massagee. Shirodhara therapy

List of T&CM practices and respective hospital that offered them. (Courtesy of T&CM Division, Ministry of Health, Malaysia)

3. Complementary and Alternative Medicine practice in Oral HealthThe practice of Complementary and Alternative Medicine (CAM) in dentistry is not as par as the general health field. These are limited journals and papers describing the use of complementary and alternative medical systems for dental problems. Eventhough, the usage of plant-based and herbs medicine are quite prevalent in dentistry. Example of herbs used is combined extracts from Centella asiatica and Punica granatum, medical herbs, which have been reported to promote tissue healing and modulate host immune responses. Sastravaha et al studied the effects of extracts from these herbs on the healing of periodontal tissues following scaling and root planing in adults with periodontitis. Biodegradable chips were formulated using the herbal extracts. These chips were placed in areas with periodontal pocket depths of 5-8 mm following scaling and root planing. Nonmedicated chips served as placebo controls. Pocket depth, attachment level, bleeding on probing, gingival index, and plaque index were recorded at baseline, 3 months, and 6 months. Treated pockets showed significant reduction in pocket depth and attachment levels with only modest improvement in bleeding and plaque scores. The authors concluded that C. asiatica and P. granatum extracts plus scaling and root planing significantly reduced the clinical signs of chronic periodontitis. The efficacy of an herbal-based mouthrinse to reduce gingival inflammation was investigated by Pistorius et al. Eighty-nine patients were involved and divided into 3 groups: treated with an oral irrigator with subgingival tips and an herbal-based mouthrinse, treated with the oral irrigator and a conventional mouthwash, and treated with a conventional mouthwash without subgingival application. The gingival index, sulcus bleeding index, plaque index, and gingival sulcus probing depths were measured at baseline, 4 weeks, 8 weeks, and 12 weeks. After 12 weeks a significant reduction in sulcus bleeding index and plaque index was noted in the patients treated with the herbal-based mouthrinse. The study concluded that subgingival irrigation with a herbal-based mouthrinse can be recommended as an adjunctive treatment to reduce gingival inflammation.Other plant-based CAM in dentistry is miswak. Themiswakis ateeth cleaning twigmade from theSalvadora persica tree. A traditional alternative to the moderntoothbrush, it has a long, well-documented history and is reputed for its medicinal benefits. It also features prominently inIslamic hygienical jurisprudence. In Malaysia, miswak is known asKayu Sugi(Malayfor 'chewing stick'). Many epidemiological studies revealed thatS. persicamiswak had strong anti-decay effects. In a dental health survey conducted in Sudan,Emslie (1966)reported a lower caries prevalence among miswak users than among toothbrush users. Subsequent studies (Baghdady and Ghose, 1979; Sathananthan et al., 1996; Younes and El-Angbawi, 1982) found similar lower caries incidences among school children using miswak. Olsson (1978)reported that chewing sticks reduced dental caries more effectively than did conventional toothbrushes. In addition to its anticariogenic effect, themiswakalso aid in strengthening thegumsand eliminatingtoothaches. Furthermore, it is reputed to create a fragrance in the mouth, eliminatebad breath, improve sensitivity of taste-buds and promote cleaner teeth.The use of acupuncture also being included as CAM in the management of selected dental problems. Acupuncture had been used as an analgesic and anesthetic and to treat facial pain, postoperative pain, and temporomandibular dysfunction syndrome. Acupuncture may help relieve dental pain by:a. stimulating nerves located in muscles and other tissues, which leads to release of endorphins and other neurohumoral factors (e.g. neuropeptide Y, serotonin), and changes the processing of pain in the brain and spinal cord b. reducing the cardiovascular reflex elicited by toothache, which is associated with the adrenergic systemc. increasing the release of adenosine, which has antinociceptive properties d. reducing inflammation, by promoting release of vascular and immunomodulatory Ayuverda has introduced variety of remedy for common oral disease such as oil pulling. Oil Pullingis an age-old remedy that uses natural substances to clean and detoxify teeth and gums. Evidence shows that it is beneficial in improving gums and removing harmful bacteria. Practitioners of oil pulling claim it is capable of improving oral and systemic health, including a benefit in conditions such asheadaches,migraines,diabetes mellitus,asthma, andacne, as well aswhitening teeth. Its promoters claim it works by "pulling out" toxins, which are known asamainAyurvedic medicine, and thereby reducinginflammation.ConclusionGenerally, there are many other examples of Complementary and Alternative medicine practice such as aromatherapy, homeopathic medicine, naturopathic medicine, reiki, osteophatic medicine. Complementary and alternative medicine are being used in hospitals and clinics in growing numbers. The awareness and accepted validity of complementary and alternative medicine is a part of transforming the culture of medicine. The integration medicine should be the main subject in developing medical research to improve patients self direct care for healing and recovery.As the complementary and alternative medicine has their own advantages, they also have disadvantages such as harmful side effects to balance them out. Therefore, in order to reduce adverse effect and decrease failure rate in integrative therapy, patient should only use the FDA-approved therapy.

References Website :1.National Cancer Institute. (2013). Acupuncture. Retrieved October 24, 2013 from http://www.cancer.gov/cancertopics/pdq/cam/acupuncture/patient/page22. National Center for Complementary and Alternative Health (NCCIH). (2009). Traditional Chinese Medicine : An Introduction. Retrieved March, 2009 from https://nccih.nih.gov/health/whatiscam/chinesemed.htm3.Traditional & Complementary Medicine Division, Ministry of Health. Hospital Integrasi. http://tcm.moh.gov.my/v4/bmelayu/modules/mastop_publish/?tac=154. British Acupuncture Council. (2015). Dentistry. Retrieved February 4, 2015 from http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/dentistry.html5. Harvard Health Publications. (2009). The Health Benefits of Tai Chi. Retrieved May 1, 2009 from http://www.health.harvard.edu/staying-healthy/the-health-benefits-of-tai-chi

Journal :1. Amruthesh S. Dentistry and Ayuverda IV: Classification and management of common oral diseases. Indian J Dent Res 2008; 19:52-612. Pistorius A, Willershausen B, Steinmeier EM, Kreislert M. Efficacy of subgingival irrigation using herbal extracts on gingival inflammation. J Periodontol 2003;74(5):616-22.3. Sastravaha G, Yotnuengnit P, Booncong P, Sangtherapitikul P. Adjunctive periodontal treatment with Centella asiatica and Punica granatum extracts. A preliminary study. J Int Acad Periodontol 2003;5(4):106-15.4. James W. Little. Complementary and alternative medicine: Impact on dentistry. Elsevier Inc .Vol. 98 No. 2 August 20046. Sweet, GK. The importance of complementary and alternative medicine in the participatory movement. J Participat Med. 2011 Jan 26; 3:e7.

Article :1. An-Fu Hsiao, Mitchell D. Wong, Michael S. Goldstein, Hong-Jian Yu, Ronald M. Andersen, E. Richard Brown, Lida M. Becerra, and Neil S. Wenger. The Journal of Alternative and Complementary Medicine. April 2006, 12(3): 281-290. doi:10.1089/acm.2006.12.281.2. Hasan S. Halamany. A review on miswak (Salvadora persica) and its effect on various aspects of oral health. April 2012, 24(2): 6369. doi:10.1016/j.sdentj.2011.12.004

Books 1. Rankin-Box D. and Williamson E.M.(2006), Complementary Medicine. A guide for pharmacy. Churchill Livingston Elsevier.2. Traditional & Complementary Medicine Medicine. (2011). Traditional and Complementary Medicine Programme in Malaysia. Traditional and Complementary Medicine Division Ministry of Health Malaysia. ISBN 978-967-10715-0-2 Retrieved from http://tcm.moh.gov.my/v4/pdf/handbook.pdf1