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Dental Tribune Asia Pacific Edition No.4, 2017

12 SCIENCE & PRACTICE Dental Tribune Asia Pacific Edition | 4/2017 puncture therapy can help to al- leviate postoperative pain, al- though heterogeneity in terms of methodological details among the studies reviewed may limit the conclusions that can be drawn.11 The practical implication of acu- puncture therapy in alleviating postoperative pain may be help- ing to reduce the patients’ de- pendence on systemic analgesic medications. It is well docu- mented that the use of non-steroi- dal anti-inlammatory drugs for pain control is associated with increased risk of gastrointestinal complications, like ulceration and bleeding. A randomised place- bo-controlled trial was conducted to evaluate the eficacy of acu- puncture in treating postopera- tive oral surgery pain.12 The treat- ment group that received real acu- puncture treatment immediately after the surgical removal of im- pacted lower third molars had a signiicantly longer pain-free postoperative period (172.9 min- utes) compared with the placebo group (93.8 minutes). More im- portantly, the treatment group took a signiicantly longer time A patient receiving acupuncture treatment (left).—Modern prepacked, sterilised acupuncture needles used for treatment(right). injection.9 The be reduced if acupuncture is given before results showed that, in the group in which local acupuncture points SI19 (tinggong), ST5 (daying) and ST6 (jiache)—within the innervations of the mandibular branch of the trigeminal nerve—were stimu- lated before an inferior alveolar nerve block was given using prilo- caine hydrochloride, the induc- tion time was 62 seconds, versus 119 seconds in the control group, in which only the nerve block was given. Findings from this study suggest that regional acupunc- ture can accelerate the induction time after an inferior alveolar nerve block. The results of another study indicate that acupuncture before inferior alveolar nerve block may increase its effective- ness in endodontic treatment of mandibular molars with sympto- matic irreversible pulpitis.10 Several studies have shown that acupuncture can reduce post- operative pain. A systematic re- view of 16 studies found that acu- Environmental, acquired and genetic risk factors Fig. 2: Pathogenesis of periodon- tal disease.3  Host immuno- inlammatory response  Speciic pathogenic bacteria  AD  Connective tissue and bone metabolism  Clinical expression of disease initiation and progression (242.1 minutes) to request analge- sic medication compared with the placebo group (166.2 minutes). They also took signiicantly less medication (1.1 tablets of 600 mg acetaminophen with 60 mg co- deine) compared with the placebo group (1.65 tablets); this difference was still evident at the seven-day follow-up (7.7 tablets versus 11.3 tablets). More randomised con- trolled clinical trials to verify the role of acupuncture therapy in dental pain management, par- ticularly in postoperative pain, may be warranted. Management of temporoman- dibular joint dysfunction syndrome and orofacial pain Temporomandibular joint dys- function syndrome (TMD) is a term that includes a group of con- ditions that affect the temporo- mandibular joint (TMJ), the mus- cles of mastication, and the associ- ated head and neck musculoskel- etal structures. The clinical diagnostic criteria for TMD clas- sify the most common forms of TMD into the main subgroups of masticatory muscle disorder, TMJ internal derangement and TMJ de- generative joint disease.13 The treatment of TMD de- pends on the aetiologies of the conditions. While acupuncture therapy may not be useful in eliminating the cause if it is due to structural anomalies, like capsuli- tis and degenerative changes, it may help to relieve the pain and discomfort associated with the conditions, especially if it is mus- cular in nature. It has been docu- mented that acupuncture can help in muscle relaxation and re- duce muscle spasm. Relaxing the lateral pterygoid muscles can re- duce the anterior displacing force on the meniscus of the TMJ and help to minimise TMJ clicking. A systematic review of 19 ran- domised controlled trials was con- ducted to assess the effectiveness of acupuncture for symptomatic treatment of TMD.14 The indings suggest moderate evidence for ac- upuncture as an effective inter- vention for the reduction of TMD symptoms, although more stud- ies of larger sample sizes are needed to investigate the long- term effectiveness of acupunc- ture. Trigeminal neuralgia is a sud- den, unilateral, brief, stabbing, re- current pain in the distribution of one or more branches of the trigeminal nerve. Carbamazepine is often the irst-line treatment for this condition and is considered the gold standard, but it also has various side-effects, including drowsiness, dizziness and consti- pation. There are several case re- ports and case series in the Chi- nese literature on the success of acupuncture treatment on pa- tients with trigeminal neuralgia. Acupuncture points GB14 (yang- bai) and EX-HN5 (taiyang) are used if the ophthalmic branch is af- fected, ST2 (sibai) and ST3 (juliao) if the maxillary branch is affected, and ST6 (jiache) and ST7 (xiaguan) if the mandibular branch is af- fected. The choice of acupuncture points coincides with the distribu- tion of the nerve branches. There is however, a paucity of reports in the Western literature and a lack of randomised controlled trials to verify its effectiveness in treating trigeminal neuralgia. Editorial note: A list of references is available from the publisher. Dr Wong Li Beng is a consultant periodontist at Ng Teng Fong General Hospi- tal and Jurong Medical Centre in Singapore and Director of Preventive Dentistry at the centre. In 2011, he obtained a graduate diploma in acupuncture from the Singapore College of Traditional Chinese Medi- cine and is now a registered acupunc- turist with the Traditional Chinese Medicine Practitioners Board. He can be contacted at Li_Beng_Wong@ juronghealth.com.sg.

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