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DENTAL SCIENCE, MATERIALS AND TECHNOLOGY

ACUPUNCTURE AND
AURICULOTHERAPY APPLIED
TO DENTISTRY

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DENTAL SCIENCE, MATERIALS
AND TECHNOLOGY

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DENTAL SCIENCE, MATERIALS AND TECHNOLOGY

ACUPUNCTURE AND
AURICULOTHERAPY APPLIED
TO DENTISTRY

CAMILA DA SILVA GONALO


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

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 (LAPACISFCM/UNICAMP, Brazil) and Professor
Juan Guzman Quispe-Cabanillas Msc., Coordinator of the Specialization
Course in Acupuncture, at the Hermnio Ometto University Center
UNIARARAS, Brazil. I also would like to thank: Professor Antonio
Carlos Pereira Ph.D., for the teachings in my Masters Degree at
Piracicaba Dental School (FOP/UNICAMP, Brazil); Professor Jorge Vas
Ph.D., responsible for the Pain Treatment UnitDoa 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 Mlaga,
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. ngeles Campos, Inmaculada Aguilar, all professionals in
the Doa Mercedes Health Centre (Spain) and all researchers at
LAPACIS Laboratory for Alternative, Complementary and
Integrative Practices in Health/ FCM-UNICAMP (Brazil). I thank the
Fundao de Amparo Pesquisa do Estado de So Paulo FAPESP,
(Protocol Number 2010/05217-0), for funding this research.

Camila da Silva Gonalo


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

that the inferences, suppositions and conclusions with respect to the


patients 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 (Bells 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, Jgrens 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 patients 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
6 C. S. Gonalo, J. G. Quispe-Cabanillas and N. F. Barros

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
So Paulo USP, State University of Campinas UNICAMP and
Federal University of So 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 --- ---
PC4-PC5-PC6-
Agitation L4 H5- H7-H8
PC7-PC8-PC9
PC3-PC4-PC5-PC6-
Anxiety L10 H1-H3- H4-H7
PC7-PC8- PC9
Dry mouth L5 --- PC3
PC8-PC9-PC6
Headache L6-L7-L9-L10 H2-H3-H5-H6-H7
(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 --- ---
PC3-PC4- PC5-
Fear L10 H3-H4-H5-H6-H7
PC6- PC7 -PC8
Nausea --- --- PC3-PC4-PC5-PC6
Trigeminal
L7 H3 PC8
Neuralgia
8 C. S. Gonalo, J. G. Quispe-Cabanillas and N. F. Barros

Table 01. (Continued)

Affections Lung (L) Heart (H) Pericardium (PC)


Nervousness L4 --- ---
Neurasthenia --- H3-H7-H6-H5 PC4
Toothache L7-L9-L10-L11 H3 ---
H1-H3-H5-H6-H7- PC2- PC3-PC4-
Palpitation L4
H8-H9 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

Adapted from Jun & Jing (2005).

Figure 2. Heart (H) Meridian.

Adapted from Jun & Jing (2005).

Figure 3. Pericardium (PC) Meridian.


10 C. S. Gonalo, J. G. Quispe-Cabanillas and N. F. Barros

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
LV2-LV3-
Headache SP3-SP9-SP6 KD1-KD3
LV4-LV8
Recurrent headache --- --- LV7
Vertex headache --- KD1 ---
Cervicalgia --- KD1 ---
Depression SP3-SP4 --- ---
Deviation of the
--- --- LV3
mouth
Facial edema SP4 --- ---
Facial spasm --- --- ---
Lingual edema --- --- ---
Stomatitis --- KD4 ---
Halitosis --- --- ---
Irritability --- KD3 LV2-LV3
Dry tongue --- KD1-KD4 ---
KD2-KD3-KD4- KD6-
Fear --- LV2
KD21
KD1- KD17- KD20-
Nausea SP3 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 lngua) ---
Nuchal Rigidity --- --- ---
Neck Rigidity --- --- ---
KD1-KD3-KD6-KD7-
Dizziness SP6 LV2-LV3
KD9
Trismus --- KD6 ---
Lingual ulcer --- --- ---
KD1-KD3-KD6-KD7-
Tinnitus SP6 KD9-KD10-KD12-KD13- LV2
KD16
Fonte: Wen (1995); Cobos & Vas (2000); Yamamura (2001); Stux & Pomeranz,
2004; Zhixian & Cols. (2005); Lian et al. (2005); Maciocia (2007).
Results 11

Adapted from Jun & Jing (2005).

Figure 4. Spleen (SP) Meridian.


12 C. S. Gonalo, J. G. Quispe-Cabanillas and N. F. Barros

Adapted from Jun & Jing (2005).

Figure 5. Kidney (KD) Meridian.


Results 13

Adapted from Jun & Jing (2005).

Figure 6. Liver (LV) Meridian.

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


practice

Affections Large Intestine Small Intestine San Jiao (SJ)


(LI) (SM)
Affections of the
LI7-LI7 SM17 ---
mouth and throat
Affections of the
LI4 --- ---
head and neck
Analgesia LI1-LI4 --- ---
Anxiety --- SM 7 SJ1
Temporomandibular
LI4 SM5 SJ17-SJ21
Arthritis
Temporomandibular
--- SM17 ---
Joint Arthrosis
Dry mouth LI1 - LI3 --- SJ1-SJ4
Bruxism --- SM16 ---
Dental Caries LI6 --- ---
SJ1-SJ2-SJ3-SJ5-SJ9-
LI2-LI3-LI4-
SM1- SM2-SM3- SJ10-SJ11-SJ12-
LI5-LI6-LI7-
Headache SM4- SM7- SJ16-SJ17-SJ18-
LI9-LI10-LI11-
SM8- SM16 SJ19-SJ20-SJ21-
LI14
SJ22-SJ23
Vertex headache --- SM3 ---
Occipital headache --- SM6 ---
14 C. S. Gonalo, J. G. Quispe-Cabanillas and N. F. Barros

Table 03. (Continued)

Affections Large Intestine Small Intestine San Jiao (SJ)


(LI) (SM)
SM3- SM5-
Cervicalgia --- SJ5-SJ15
SM12
Cervicobrachialgia --- --- SJ10
Temporomandibular
--- --- SJ21
Dysfunction (TMD)
Deviation of the LI4- LI6- LI7-
SM18 SJ17-SJ21
mouth LI11
Speech and
Swallowing LI18 --- ---
Difficulties
Difficulty with
--- --- SJ21
mastication
SM8- SM15-
Neck pain --- SJ4--SJ5-SJ15
SM16
LI1-LI4-LI7-
Facial edema SM8 SJ10-SJ16-SJ17
LI10-LI20
Maxillary edema --- SM7- SM11 ---
Gingival Edema --- SM8 ---
Mandibular Edema --- SM9 ---
SJ2-SJ3-SJ5-SJ10-
Migraine --- SM3
SJ23
SJ1 (lceras na
Stomatitis LI7 SM5
lngua)
Gingivitis LI11 SM5- SM8 SJ2 -SJ20-SJ21
Gingivorrhagia --- --- SJ2
Local Inflammation
LI6 --- ---
in the face
Fear LI5 SM7 ---
Nausea --- SM4 SJ19
Trigeminal Neuralgia LI3- LI19 SM18 SJ16-SJ17
Neurasthenia LI4 SM7 SJ9
Facial Neuralgia LI1-LI7 SM18 SJ17
LI 1- LI 2- LI
3- LI 4- LI 5- SJ1-SJ2-SJ3-SJ5-SJ7-
SM5- SM8-
Toothache LI 6- LI7- LI SJ8-SJ9-SJ12-SJ17-
SM18- SM19
10- LI 11- LI SJ19-SJ20-SJ21-SJ23
19
Palpitation --- --- SJ2-SJ10
LI 2- LI 3- LI
SJ17-SJ18-SJ19-
Facial Paralysis 4- LI 6- LI 7- SM18
SJ22-SJ23
LI 19- LI 20
Paresthesia LI 10 --- ---
Results 15

Affections Large Intestine Small Intestine San Jiao (SJ)


(LI) (SM)
Periarthritis of
Temporomandibular --- --- SJ17
Joint
SM1-SM3-SM4-
Cervical Rigidity --- SM7-SM12- SJ5-SJ21
SM14-SM17
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
SM5-SM16-
Trismus LI 4- LI 19 SJ6-SJ17-SJ21-SJ22
SM19
Aphthous UIcers
LI 4- LI 7 --- SJ5
(Aphta)
SM1-SM2-SM3- SJ2-SJ3-SJ4-SJ5-SJ6-
LI 1- LI 4- LI SM4-SM5-SM9- SJ7-SJ10-SJ21-SJ2-
Tinnitus
5- LI 6 SM16- SM17- SJ3-SJ5-SJ17-SJ18-
SM19 SJ19-SJ20-SJ21-SJ22
Fonte: Wen (1995); Cobos & Vas (2000); Yamamura (2001); Stux & Pomeranz,
2004; Zhixian & Cols. (2005); Lian et al. (2005); Maciocia (2007).

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


practice

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


Agitation --- GB44 B14
ST6(lower jaw)
Dental Analgesia --- ---
ST7(upper jaw)
B14-B15-B44-
Anxiety ST3 GB44
B64-B66
Temporomandibular
ST6- ST7- ST44 GB2 ---
Arthritis
GB1-GB2-GB3-GB4-
GB5-GB6-GB7-GB8- B1-B2-B3-B4-
GB9-GB10-GB11- B5-B6-B7-B9-
ST2-ST7-ST8- GB12-GB13-GB14- B10-B11-B12-
ST9-ST40- GB15-GB16-GB17- B18-B22-B27-
Headache
ST41- ST42- GB18-GB19-GB20- B37-B40-B56-
ST44 GB21-GB31-GB34- B58-B59-B60-
GB36-GB37-GB38- B62-B63-B64-
GB39-GB40-GB41- B65-B66-B67
GB42-GB43-GB44
16 C. S. Gonalo, J. G. Quispe-Cabanillas and N. F. Barros

Table 04. (Continued)

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


GB3-GB4-GB5-GB6-
GB7-GB8-GB9-
GB12-GB13-GB15-
Headache
ST8 GB17-GB20-GB37- B10
(Migraine)
GB38-GB39-GB40-
GB41-GB42-GB43-
GB44
Vertex headache --- --- B8-B9- B14
Cervicalgia --- GB13-GB17-GB36 B10-B11-B58
ST1- ST2- ST3-
Deviation of the ST4- ST5- ST6- GB2-GB4-GB8-
B7-B62
mouth ST7- ST42- GB14-GB20
ST44
Difficulty with
ST6 GB7 ---
mouth opening
Speech difficulties ST9 ---
ST2-ST7-ST41- GB2-GB3-GB14-
Facial pain B2
ST44 GB16
Neck pain ST11 GB12-GB19-GB39 B9
ST3- ST5- ST6-
ST25- ST40- GB5-GB6-GB7-
Facial edema ST41- ST42- GB12-GB16-GB34- ---
ST43- ST44- GB36
ST45
ST2- ST6
Facial spasm (masseter)- ST7 --- ---
(masseter)
ST7- ST42-
Gingivitis GB9-GB12-GB16 ---
ST45
Irritability ST23 --- ---
Speech incapacity ST1 --- ---
Temporomandibular
ST7 GB2 ---
Joint Luxation
B15-B18-B47-
Fear ST45 GB9
B64
ST24- ST25-
Nausea GB17-GB23-GB24 B21
ST36
ST2- ST3- ST4-
Trigeminal GB1-GB3-GB6-GB7-
ST5- ST6- ST7- B2
Neuralgia GB11-GB14
ST44
B10-B14-B15-
Neurasthenia ST36- ST45 GB6
B43-B47
Results 17

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


GB2-GB3-GB4 -
ST3-ST4-ST5-
GB5-GB6-GB7-GB9-
Toothache ST6-ST7-ST42- B14
GB10-GB11-GB12-
ST44- ST45
GB16-GB17
ST1-ST2-ST3-
GB1-GB2-GB3-GB4-
ST4-ST5-ST6-
Facial Paralysis GB8-GB12-GB14- B1-B2
ST7-ST8-ST36-
GB20
ST42-ST45
B14- B15-B19-
Palpitation ST36- ST41 GB9-GB19 B43-B44-B64-
B66
Periodontitis ST7 --- ---
Tongue Rigidity ST24 GB11 ---
B7-B10 - B11-
Nuchal Rigidity ST11 GB11-GB12-GB39
B65-B66
GB12-GB19-GB20- B10-B11-B16-
Neck Rigidity ST11
GB21-GB39 B41-B60-B62
Sialorrhea ST4 GB3 ---
Menires
--- GB41 B62
Syndrome
ST4-ST5-ST6- GB3-GB4-GB5-GB7-
Trismus B16-B60-B62
ST7-ST44 GB12-GB20
B2-B3-B5-B6-
GB1-GB2-GB3-GB4- B7-B9-B10-B11-
ST8-ST9-ST36- GB5-GB6-GB8-GB9- B16-B18-B22-
Dizziness ST40-ST41- GB11-GB13 -GB14- B42-B43-B47-
ST45 GB17-GB18-GB19- B58-B60-B62-
GB20-GB39-GB41 B64-B65-B66-
B67
Aphthous UIcers
ST44 --- ---
(Aphta)
GB2-GB3-GB4-GB6-
GB9-GB10-GB11-
GB12-GB15-GB19- B8-B23-B52-
Tinnitus ST1- ST7
GB20-GB41- GB42- B60-B62
GB43-GB44

Fonte: Wen (1995); Cobos & Vas (2000); Yamamura (2001); Stux & Pomeranz,
2004; Zhixian & Cols. (2005); Lian et al. (2005); Maciocia (2007).
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 patients 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.
18 C. S. Gonalo, J. G. Quispe-Cabanillas and N. F. Barros

Adapted from Jun & Jing (2005)

Figure 7. Large Intestine (LI) Meridian.

Adapted from Jun & Jing (2005)

Figure 8. Small Intestine (SM) Meridian.


Results 19

Adapted from Jun & Jing (2005)

Figure 9. San Jiao (SJ) Meridian.


20 C. S. Gonalo, J. G. Quispe-Cabanillas and N. F. Barros

Adapted from Jun & Jing (2005)

Figure 10. Stomach (ST) Meridian.


Results 21

Adapted from Jun & Jing (2005)

Figure 11. Gall Bladder (GB) Meridian.


22 C. S. Gonalo, J. G. Quispe-Cabanillas and N. F. Barros

Adapted from Jun & Jing (2005)

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.
24 C. S. Gonalo, J. G. Quispe-Cabanillas and N. F. Barros

Table 5. Academic Studied about the use of acupuncture with the


possibility of application in dental situations

Affection Reference Results


Electromyographic Electromyographic activity of the
analysis of the temporal masseter and temporal muscles
and masseter muscles and diminished after treatment with
bite force in individuals acupuncture when the
Temporomandibular with temporomandibular maintenance of postures such as
Dysfunction dysfunction before and rest, protrusion and right and left
after treatment with laterality and tooth clenching were
acupuncture. Rancan, evaluated, being significant at the
Sandra Valria (2008) level of 0.05 for the at rest
USP Masters Dissertation. situation.
Classical acupuncture diminished
Prospective study of the
the intensity and duration of
value of acupuncture in the
nausea and vomiting from the first
control of nausea and
to seventh day post-
vomiting in breast cancer
Nausea chemotherapy. Classical and
patients submitted to
auricular acupuncture diminished
adjuvant chemotherapy.
the intensity of nausea from the
Chung, Wu Tu (2007)
eighth to twenty-first day post-
USP Doctoral Thesis.
chemotherapy.
It was verified that acupuncture
increased the salivary flow.
Evaluation of acupuncture Acupuncture was shown to be an
as a method of preventive important method of treatment for
and curative treatment of xerostomia resulting from
Xerostomia xerostomia resulting from radiotherapy, since it achieved a
radiotherapy. Braga, Fbio significant reliability of efficacy,
do Prado Florence (2006) which allows us to indicate it and
USP Masters Dissertation. suggest making the preventive
method available in treatment
centers.
The application of classical
Applications of
acupuncture provided a significant
acupuncture and
reduction in pain intensity,
auriculotherapy in the
consumption of analgesics,
dental scenarios and in
Cervicalgia incapacity and sleep disorders
primary health attention.
caused by pain (p< 0.0001) in
Gonalo, Camila da Silva
patients with chronic cervicalgia ,
(2010) UNICAMP
attended at a basic public health
Master's Dissertation.
unit.
The effect of
electroacupuncture in the Electroacupuncture (EA) was
Myofascial pain of
treatment of muscular pain. effective for the relief of
the trapezium
Aranha, Maria Fernanda myofascial pain of the trapezium
muscle
Montans (2010) Master's muscle.
Dissertation.
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.
The use of acupuncture relieved
the symptoms of tinnitus. The
Effect of acupuncture on
results showed a statistically
otoacoustic emissions of
significant difference in the
patients with tinnitus.
Tinnitus amplitude of the otoacoustic
Azevedo, Renata Frasson
emissions before and after the
de (2005) UNIFESP
application of acupuncture for the
Masters Dissertation.
intervention 1(puncture 4.5 cm
above the apex of the ear).
There was a significant reduction
Treatment of the in the apnea-hypopnea index
obstructive sleep apnea- (mean before = 19.9; mean after =
hypopnea syndrome with 10.1. P = 0.005), as well as in the
Obstructive Sleep
acupuncture. Freire, number of respiratory events
Apnea
Anaflvia de Oliveira (mean before = 116.1; mean after
(2004) UNIFESP Doctoral = 66.5. P = 0.005) in the
Thesis. acupuncture group, but not in the
placebo group (sham).
In relation to the immediate effect
of acupuncture there was
The immediate and significant reduction in the time of
mediate effect of beginning of sleep (p = 0.011; p=
acupuncture in the 0.005), of the apnea-hypopnea
treatment of patients with index (p=0.042; p=0.005)
obstructive sleep apnea respiratory events 9p=0.0011,
syndrome. Sugai, Gisele p=0.009) and of micro-
Cristina Machado (2009) awakenings (p=0.011, p=0.021) in
UNIFESP Doctoral Thesis. 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
28 C. S. Gonalo, J. G. Quispe-Cabanillas and N. F. Barros

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
32 C. S. Gonalo, J. G. Quispe-Cabanillas and N. F. Barros

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.
38 C. S. Gonalo, J. G. Quispe-Cabanillas and N. F. Barros

(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 (Gonalo 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
40 C. S. Gonalo, J. G. Quispe-Cabanillas and N. F. Barros

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,
42 C. S. Gonalo, J. G. Quispe-Cabanillas and N. F. Barros

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 surgeons 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.
44 C. S. Gonalo, J. G. Quispe-Cabanillas and N. F. Barros

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
Heart, spleen, mouth, endocrine, adrenal, allergies, shenmen,
Aphtha
bleeding at the ear apex
Periodontitis Mouth, shenmen, san jiao, adrenal, stomach, large intestine, kidney
Mouth, trachea, adrenal, spleen, large intestine, stomach, upper jaw,
Gengivorrhagia
or lower jaw
Lichen Planus Bleeding at the ear apex, lung, liver, spleen, endocrine, adrenal
Nausea /
Stomach, sympathetic, cardia, occipital, subcortex
Vomiting
Headache Bleeding at the ear apex, shenmen, subcrtex
Cervicalgia Neck area, shenmen, kidney, endocrine, minor occipital nerve, liver
San jiao, mouth, subcortex, brain stem, liver, spleen, large intestine,
Facial Spasm
lesser occipital nerve, shenmen, occipital
Palsy San jiao, brain stem, subcortex, endocrine, adrenal, spleen, liver
Trigeminal Auriculotemporal nerve, san jiao, subcortex, brain stem, shenmen,
Neuralgia occipital
Bleeding at the ear apex, shenmem, heart, subcortex, occipital, area
Neurasthenia
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
Elimination of inflammation, reduction of fever, reduction of
Helix 1
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
Toothache and dental analgesia
1 and 2
Neurasthenia Nervous exhaustion
Palate and floor Toothaches, temporomandibular arthritis, analgesia for tooth
of mouth extraction, mouth ulcers
Tongue Glossitis and dyslalia by weakness of the tongue
Upper and Lower
Temporomandibular arthritis, tooth extraction, toothache
Jaw
Auriculotherapy and Dentistry 45

Name of point Indication


Cheek Trigeminal neuralgia, facial tics, facial paralysis, trismus
Internal and
Deafness, tinnitus, decreased hearing, dizziness
External Ear
Frontal Frontal headache, neurasthenia, insomnia
Parotid (Salivary)
Parotitis, parotid duct obstruction
Gland
Brain Regulates arousal or impairment of the cerebral cortex
Dizziness Dizziness, vertigo, Meniere's disease
Cervicalgia, trismus, neck pain, prevention of nausea, anti-
Occipital
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
Stomach, sympathetic, shen men, esophagus
Vomiting
Trigeminal
Cheek, upper and lower jaw, shen men
Neuralgia
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
Occipital, stomach, external ear, shen-men, dizziness,
Vertigo, 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.
46 C. S. Gonalo, J. G. Quispe-Cabanillas and N. F. Barros

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

This figure illustrates the combination of the acupoints suggested in


table 08.
Auriculotherapy and Dentistry 47

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 Auricular points corresponding to incised area, shemen,
wound pain lung
Hiccup Puncture of tender points in the middle region of the ear
Vomit Stomach, lung, spleen, shenmen
Hysteria Heart, brain, occiput, shemen
48 C. S. Gonalo, J. G. Quispe-Cabanillas and N. F. Barros

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

This figure illustrates the combination of the acupoints suggested in


table 10.
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 Gonalo for cooperating
with the development of the illustrations contained in this book.
REFERENCES

Abbate S. Chinese Auricular Acupuncture. Boca Raton, CRC Press;


2004.
Allison G, Kravitz E. Auricular chondritis secondary to acupuncture. N.
Engl. J. Med. 293:780-1975.
Altman S. Terapia pela acupuntura na clnica de pequenos animais. In:
Ettinger SJ. Tratado de medicina interna veterinria: molstias do
co e do gato. So Paulo: Manole, 1992.
Aranha MFM. O efeito da eletroacupuntura no tratamento da dor
muscular. Dissertao de Mestrado. Universidade Estadual de
Campinas (UNICAMP), 2010.
Azevedo RF. Efeito da acupuntura sobre as emisses otoacsticas de
pacientes com zumbido. Dissertao de Mestrado. Universidade
Federal de So Paulo (UNIFESP), 2005.
Bannerman RH. The World Health Organization viewpoint on
acupuncture. American Journal of Acupuncture, 1980; 8(3): 231-
235.
Braga FPF. Avaliao da acupuntura como mtodo de tratamento
preventivo e curativo de xerostomia decorrente da radioterapia.
Dissertao de Mestrado. Universidade de So Paulo (USP), 2006.
CFO - Conselho Federal de Odontologia. Tese central para o frum
sobre terapias complementares em Odontologia. Brasil, setembro.
See: http://www.crosp.org.br/FORUMTC/2006/Acupuntura.pdf.
Accessed: 29 nov. 2007.
Chung WT. Estudo prospectivo do valor da acupuntura no controle da
nusea e vmitos em pacientes de cncer de mama submetidas a
52 C. S. Gonalo, J. G. Quispe-Cabanillas and N. F. Barros

quimioterapia adjuvante. Tese Doutorado. Universidade de So


Paulo (USP), 2007.
Cobos R, Vas J. Manual de Acupuntura y Moxibustin. Beijing: Editora
Morning Glory; 2000.
Dantas, C.S.G; Barbosa, R.N.S; Casimiro, J.J. Analgesia natural Atravs
de uma nova tcnica alternativa. International Journal of Dentistry
2005; 4(3): 80-124. See: http://www.ufpe.br/ijd /resumos.doc.
Accessed: 03 jul. 2007.
Davidi E, Paz A, Duchman H, Luntz M, Potasman I. Perichondritis of the
Auricle: Analysis of 114 Cases. IMAJ, vol 13, jan 2011.
Davies, PT. Systematic Reviews: How Are They Different from What
We Already Do? in Anderson, L. and Bennett, N. (Eds), Developing
Educational Leadership for Policy and Practice, London, Sage
Publications; 2003.
Davis O, Powell W. Auriculr Perichondritis secondary to Acupuncture.
Arch. Otolryngol,111(11):770-1,1985.
Diehl V. The bridge between patient and doctor: the shift from CAM to
integrative medicine. Hematology Am Soc Hematol Educ Program.
2009; 320-5.
Elliott AM, Smith BH, Penny KI, Smith WC, Chambers WA. The
epidemiology of chronic pain in the community. Lancet 1999 Oct
9:354(9186):1248-52.
Ernest E, Pittler MH. The effectiveness of acupuncture in treating acute
dental pain: A systematic review, Br Dent J. 1998; 184:443-447.
Facco E, Liguori A, Petti F, Zanette G, Coluzzi F, De Nardin M, Mattia
C. Traditional acupuncture in migraine: a controlled, randomized
study. Headache. 2008 Mar; 48(3):398-407.
Filshie J, Cummings M. Efeitos adversos da Acupuntura. In: Ernst E,
White A. Acupuntura. Uma avaliao cientfica. So Paulo: Manole,
2001.
Freire AO. Tratamento da sndrome de apnia-hipopnia obstrutiva do
sono pela acupuntura. Tese de Doutorado. Universidade Federal de
So Paulo (UNIFESP), 2004.
Gilbert, J G. Auricular complication of acupunture. N. Z. Med. J.,
100(819): 141-2, 1987.
Gonalo CS, Pereira AC. Observaciones clnicas sobre la eficacia del uso
de la acupuntura y auriculoterapia como recurso teraputico en
References 53

odontologa. Revista Internacional de Acupuntura, Vol. 3, N. 4,


2009, pgs. 201-206
Gonalo CS. Aplicaes da acupuntura e auriculoterapia no cenrio
odontolgico e na ateno primria em sade. Dissertao de
Mestrado. Universidade Estadual de Campinas (UNICAMP), 2010.
Gonzales EG. Auriculoterapia: Escola Huang Li Chun. So Paulo: Roca;
1999.
Harris, PE. Acupressure: a review of literature. Complementary
Therapies in Medicine. 5:156-161, 1997.
Hong JP. Acupuntura, de terapia alternativa a especialidade mdica. So
Paulo: Ceimec; 2005 Wen, TS. Acupuntura Clssica Chinesa. So
Paulo: Editora Cultrix, 1995.
Huang LC. Tratamiento auricular: formulas y prescripciones. Estados
Unidos: Centro internacional de Investigacin y Entrenamiento em
Medicina Auricular, 2002.
Iorio CR, Siqueira AAF, Yamamura Y (2010) Physicians reasons for
specializing in acupuncture. Rev bras educ med. Jun 34(2):247-252.
Jayasuriya A. As bases cintficas da Acupuntura. Rio de Janeiro:
EditoraSohaku-in,1995.
Jianping H. Metodologia da medicina tradicional chinesa. So Paulo:
Roca, 2001.
Johansson A, Wenneberg B, Wagersten C, Haraldson T. Acupuncture in
treatment of facial muscular pain. Acta Odontol Scand. 1991 Jun;
49(3): 153-8.
Juan Agbor AM, Naidoo S. Knowledge and practice of traditional
healers in oral health in the Bui Division, Cameroon. J Ethnobiol
Ethnomed. 2011; Jan 15; 7:6.
Kaptchuk TJ. Acupuncture: Theory, Efficacy and Practice. Annals of
Internal Medicine, 2002; (136):5
Karst M, Winterhalter M, Munte S, Francki B, Hondronikos A, Eckardt
A, Hoy L, Buhck H, Bernateck M, Fink M. Auricular acupuncture
for dental anxiety: a randomized controlled trial. Anesthesia &
Analgesia 2007; 104(2):295-300.
Katsoulis J, Ausfeld-Hafter B, Windecker-Gtaz I,Katsoulis K,
Blagojevic N, Mericske-Stern R. Laser acupuncture for myofascial
pain of the masticatory muscles . A controlled pilot study Schweiz
Monatsschr Zahnmed, Vol. 120, 3/2010.
54 C. S. Gonalo, J. G. Quispe-Cabanillas and N. F. Barros

Kitade T, Ohyabu H. Analgesic effects of acupuncture on pain after


mandibular wisdom tooth extraction. Acupunct Electrother Res.
2000; 25(2): 109-15.
Lao L, Bergman S, Hamilton GR, Langenberg P, Berman B. Evaluation
of acupuncture for pain control after oral surgery: A placebo-
controlled trial. Arch Otolaryngol Head Neck Surg. 1999; 125:567-
572.
Lian LY, Chen CY, Hammes M, Kolster BC. Pictorial Atlas of
Acupuncture an Illustrated Manual Of Acupuncture Points. United
Kingdom: Konemann, 2005.
Linstron CJ, Lucent FE. Infection of the external ear. In: Bailey BJ. Head
and Neck surgery-Otolaringology, Philadelphia JB. Lippincott
Company, 1993. 1542-1556.
Lipszyc M. Manual de Auriculoterapia. Argentina: Kier Editorial; 2004.
Lu DP, Lu GP, Reed JF 3rd. Acupuncture/acupressure to treat gagging
dental patients: a clinical study of anti-gagging effects. Gen Dent.
2000 Jul-Aug; 48(4): 446-52.
Maciocia G. Os fundamentos da Medicina Chinesa. So Paulo: Roca,
2007.
Maciocia G. Os fundamentos da medicina chinesa: um texto abangente
para acupunturistas e fitoterapeutas. So Paulo: Roca, 2007.
Martnez Pecino F, Arnau IS, Aquino MBN. Eficacia de la acupuntura en
el dolor lumbar y en el dolor agudo en diferentes situaciones. Sevilla:
Agencia de Evaluacin de Tecnologas Sanitarias de Andaluca;
2007.
Mogil JS, Davis KD, Derbyshire SW. The necessity of animal models in
pain research, Pain. 2010; oct; 151(1):12-7.
Patel M, Gutzwiller F, Paccaud F, Marazzi A. A meta-analysis of
acupuncture for chronic pain, Int J Epidemiol. 1989; 18:900-906.
Pinto SR, Ramos R. Pericondrite do pavilho auricular em conseqncia
de acupuntura. Rev. Bras. Otorrinolaringol. 1997; 63(3): 589-592.
Pomeranz B. Scientific research into acupuncture for the relief of pain. J
Alt. Compl. Med 2:53-0, 1996.
Ramos S, Pinto LF, Ramos RF. Pericondrite do pavilho auricular em
conseqncia da acupuntura. Revista Brasileira de
Otorrinolaringologia. Vol. 63 / Edio 6 / Perodo: Novembro -
Dezembro de 1997.
References 55

Rampes H, Peucker E. Efeitos adversos da Acupuntura. In: Ernst E,


White A. Acupuntura. Uma avaliao cientfica. So Paulo: Manole,
2001.
Rancan SV. Anlise eletromiogrfica dos msculos temporal e masseter
e fora de mordida em indivduos com disfuno temporomandibular
muscular antes e aps tratamento com acupuntura. Dissertao de
Mestrado. Universidade de So Paulo (USP), 2008.
Rocha RG, Tortamano N, Adde CA, Simone JL, Perez FEG. O controle
da dor em odontologia atravs da teraputica medicamentosa. In:
Anais do 15 Conclave Odontolgico Internacional de Campinas -
n.104, Mar/Abr, 2003.
Rogers AM. Serious complications of acupuncture or acupuncture
abuses? Am J Acupunct 1981;9:347-351.
Sackett DL, Richardson WS, Rosemberg W, Haynes RB (1997)
Evidence-based medicine: How to practice and teach EBM.
Churchill Livignstone, New York, pp4-5.
Schimd-Schwap M, Simma-Kletschka I, Stockner A, Sengstbratl M,
Gleditsch J, Kundi M, Piehslinger E. Oral acupuncture in the
therapy of craniomandibular dysfunction syndrome a randomized
controlled trial (RCT). Wien Klin Wochenschr (2006) 118/12: 36
42.
Shekelle PG, Morton SC, Suttorp MJ, Buscemi N, Friesen C.
Challenges in systematic reviews of complementary and alternative
medicine topics. Ann Intern Med. 2005; 142:1042-1047.
Simma I, Gleditsch JM, Simma L, Piehslinger E. Immediate effects of
microsystem acupuncture in patients with oromyofacial pain and
craniomandibular disorders (CMD): a double-blind, placebo-
controlled trial. Br Dent J. 2009 Oct 30.
Smith P, Mosscrop D, Davies S, Sloan P, Al-Ani Z. The efficacy of
acupuncture in the treatment of temporomandibular joint myofascial
pain: a randomised controlled trial. J Dent. 2007 Mar; 35(3): 259-67.
Somri M, Vaida SJ, Sabo E, Yassain G, Gankin I, Gaitini LA.
Acupuncture versus ondansetron in the prevention of postoperative
vomiting A study of children undergoing dental surgery .
Anaesthesia, 2001, 56, pages 927-932.
Sousa MP. Tratado de auriculoterapia. Braslia: Instituto Yang; 1997.
Stux G, Pomeranz B. Bases da Acupuntura. So Paulo: Editorial
Premier; 2004.
56 C. S. Gonalo, J. G. Quispe-Cabanillas and N. F. Barros

Sugai GCM. Efeito imediato e mediato da acupuntura no tratamento de


pacientes portadores da sndrome de apnia obstrutiva do sono. Tese
de Doutorado. Universidade Federal de So Paulo (UNIFESP),
2009.
Turkeltaub SH & Habal M. 13. Acute pseudomonas chondritis as a
sequel to ear piercing. Ann. Plast. Sur. 24(3): 279-82, 1990.
Vianna RS, Souza AG, da Silva BC, Berlinck TA, Dias KRHC.
Acupuntura e sua aplicao na Odontologia. UFES Rev Odontol.
2008; 10(4): 48-52.
Wen, TS. Acupuntura Clssica Chinesa. So Paulo: Editora Cultrix,
1995.
White A. Neurofisiologia da analgesia por acupuntura. In: Ernst E. &
White A. Acupuntura uma avaliao cientfica. So Paulo: Manole,
2001.
WHO - World Health Organization. Acupuncture: review and analysis of
reports on controlled clinical trials. Suia: World Health
Organization (WHO), 2002.
Yamamura Y. Acupuntura Tradicional: a arte de inserir. So Paulo:
Roca, 2001.
Zhixian L. & Cols. English-Chinese Collegiate Textbooks in Traditional
Chinese Medicine for Institutions of Traditional Chinese Medicine
of Higher Learning. Beijing: University of Traditional Chinese
Medicine; 2005.
INDEX

Beijing, 52, 56
A benefits, vii, 3, 5, 28, 39, 49
biosafety, 28, 42
access, 6
bleeding, 3, 44
accessibility, 6
blindness, 37
acupuncture, vii, ix, 2, 3, 5, 6, 23, 24, 25,
blood, 42, 44
27, 28, 29, 32, 33, 35, 37, 38, 39, 40,
blood pressure, 44
41, 42, 45, 49, 51, 52, 53, 54, 55
blood supply, 42
adaptation, 5
bone(s), 2, 41
adhesion, 39
bone marrow, 3
adults, 37
brain, 41, 44, 45, 47
adverse effects, 27, 29, 35
brain stem, 44
alternative medicine, 55
Brazil, ix
alveolitis, 28, 38
breast cancer, 24
amplitude, 25
analgesic, 2, 5, 35, 44, 45
anatomy, 28 C
ankylosis, 28, 38
anti-inflammatory drugs, 2 CAM, 52
anxiety, 2, 35, 53 Cameroon, 53
apex, 25, 44, 47 caries, 45
apnea, 25 cartilage, 42
Argentina, 54 cerebral cortex, 41, 45
arousal, 45 challenges, 5
arthritis, 44, 47 chemical, 5
aversion, 40 chemotherapy, 24, 37
children, 55
chondritis, 42, 51, 56
B classification, 31
clinical trials, 2, 56
behavioral aspects, 31
58 Index

collateral, 41
community, 52
F
complexity, 27, 32
facial tics, 45
complications, 27, 42, 55
fever, 44
consensus, 27, 37
force, 23
consulting, 31
formation, 27
consumers, 39
foundations, 32
consumption, 24, 39
fractures, 27, 28, 32, 38
controlled studies, 32
funding, ix
covering, 29

D G

gestation, 28
deficiency(s), 27, 37, 47
gingivitis, 2
dental care, 31
graph, 22
dentist, vii, 1, 2, 6, 25, 39
guidance, 6, 31
depth, 27
dermatitis, 28
developed countries, 31 H
diseases, 1, 2, 27, 44, 45, 47
displacement, 28, 38 halitosis, 2
dizziness, 45, 47 headache, 7, 10, 13, 16, 45, 47
drug consumption, 39 health, vii, 1, 2, 3, 5, 6, 24, 28, 32, 39, 49
drugs, 39 health care, vii, 1, 49
health status, 2, 28
herpes, 2
E
human, vii, 1, 6, 28, 37, 42
human body, 6, 28, 42
edema, 7, 10, 14, 16
education, 31
endocrine, 44, 45 I
endorphins, 27
energy, 5, 41 idiopathic, 28
environments, 2 immune response, 3
epidemiology, 52 incidence, 28, 42
equilibrium, 3, 41 individual character, 27
esophagus, 45 individual characteristics, 27
ethics, 37 individuals, 2, 23, 28
evidence, 2 infection, 42
exposure, 2 inferences, 2
extraction, 35, 44, 54 inflammation, 42, 44
inhibition, 35
insomnia, 45, 47
intervention, 6, 25
Index 59

ionizing radiation, 2 neuralgia, 33, 45


neurasthenia, 44, 45
neuritis, 33
K

kidney, 44, 45, 47 O

obstruction, 45
L obstructive sleep apnea, 25
occlusion, 32
large intestine, 44
oral cavity, 1
laryngitis, 44
oral diseases, 44, 45
larynx, 45
oral health, 53
laterality, 23
organism, 1
lichen, 2
organize, 49
liver, 44, 45
organs, 3, 41
love, ix
otoacoustic emissions, 25
lying, 6, 28
lymph, 3
lymph node, 3 P

pain, 2, 14, 16, 24, 25, 31, 32, 33, 35, 37,
M 38, 39, 44, 45, 47, 52, 53, 54, 55
palliative, 2
majority, 1, 32, 37, 42
paralysis, 2, 3, 45, 47
manipulation, 42
parotid, 45
masking, 28
parotid duct, 45
masseter, 16, 23, 55
pathology, 31
matter, 6
perforation, 27
medical, 31
periodontal, 32
medicine, 32, 52, 55
periodontitis, 28, 32, 38
meta-analysis, 37, 54
pharyngitis, 44
migraines, 33
pharynx, 45
mixing, 2
Philadelphia, 54
models, vii, 1, 37, 54
pilot study, 53
motivation, 49
placebo, 25, 29, 35, 54, 55
mouth ulcers, 44
pneumothorax, 27
muscles, 23, 53
population, 31
pregnancy, 37
N prevention, 3, 45, 55
principles, 28, 32
National Institutes of Health, 37 professionals, vii, ix, 1, 2, 39
nausea, 2, 24, 37, 45 prophylactic, 31
necrosis, 32, 42 public health, 24, 31
nerve, 44 pulp, 32
60 Index

spleen, 3, 44, 45, 47


Q state, 28, 29
stimulation, vii, 27
quality of life, 31
stimulus, 27, 41
questioning, 2
stomach, 29, 44, 45
stomatitis, 47
R stress, 2
structure, 41
radiotherapy, 24 symptoms, 25
reactions, 39 syndrome, 2, 25, 55
reading, vii, 5
reasoning, 29
T
receptors, 27
reconstruction, 42
teachers, ix
reflex action, 41
teeth, 45
relaxation, 5
therapy, vii, 3, 27, 37, 39, 41, 55
reliability, 24
third molar, 35
relief, 24, 25, 35, 39, 54
thymus, 3
repair, 2, 42
tinnitus, 25, 45, 47
requirements, 32
tissue, 2
researchers, ix, 32
tooth, 23, 28, 32, 35, 38, 44, 54
response, vii, 27
tooth injuries, 32
restoration, 32
trachea, 44
RH, 51
trajectory, 17
risk, 28, 42
transmission, 27
trapezium, 24
S trauma, 42
treatment, vii, 1, 2, 6, 23, 24, 25, 28, 29,
scarcity, viii, 49 33, 37, 39, 44, 45, 47, 53, 55
scope, 1, 2, 5 trial, 53, 54, 55
secretion, 45 trigeminal neuralgia, 28, 33
sedative, 3, 45 tumors, 28, 38
sensations, 5
sensitivity, 28, 38
U
sham, 25
showing, 39
ulcer, 8, 10
signs, 28
United, 54
simulation, 3
United Kingdom, 54
skin, 2, 5
universe, 6
sleep apnea, vii
sleep disorders, 24
SP, 10, 11 V
Spain, ix
spine, 44, 47 variations, vii
Index 61

vehicles, 28 well-being, 5
vertebrae, 47 World Health Organization (WHO), 2,
vertigo, 45, 47 51, 56
visualization, 6
vomiting, 2, 24, 29, 37, 47, 55
X

W xerostomia, 2, 24, 51

weakness, 44