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Dental Tribune Asia Pacific Edition | 5/2017 SCIENCE & PRACTICE 11 Acupuncture: Probing its way into dentistry—Part II Dental applications of acupuncture in managing xerostomia, dental anxiety and gag reflex By Dr Wong Li Beng, Singapore After a general introduction to acu- puncture and its practical applica- tions in contemporary dental prac- tice, this second part of the article will discuss the use of the method in managing oral conditions such as xerostomia and its effect in reduc- ing dental phobia and the gag reflex before illustrating the recent uptake of acupuncture in the mainstream health care sector in Singapore. Management of xerostomia Xerostomia may be medica- tion-induced and other common causes are autoimmune condi- tions like Sjögren’s syndrome and irradiation of the head or neck re- gion. Conventional management of xerostomia includes palliative treatment, such as a saliva substi- tute or chewing gum, and systemic medication, like pilocarpine. The use of acupuncture as an alternative treatment modality for xerostomia has been documented in Western medicine since the 1980s. Observational studies have demonstrated that acupuncture treatment may increase salivary flow in healthy volunteers, patients with Sjögren’s syndrome and pa- tients who have undergone radio- therapy of the head or neck region. In a long-term retrospective study involving 70 patients with xerosto- mia due to primary and secondary Sjögren’s syndrome, irradiation and other causes,1 the patients re- ceived a course of 24 acupuncture treatment sessions over the first six months. The salivary flow rate (SFR) for stimulated and unstimulated saliva was measured six months after the baseline acupuncture treatment and according to subjec- tive changes observed by the pa- tients. Data for up to three years was also analysed, comparing those who chose to receive addi- tional acupuncture treatment with those who did not. The results showed that the SFR in both stimu- lated and unstimulated saliva was significantly higher after six months compared with the base- line and this was consistent with the subjective improvement de- scribed by the patients. In addition, patients who received additional acupuncture treatment after six months had a consistently higher median SFR in both stimulated and unstimulated saliva compared with those who did not, suggesting that supportive acupuncture treat- ment given over a long period may help to maintain its therapeutic ef- fect. This finding is in accordance with the traditional Chinese medi- cine (TCM) concept that the treat- ment effect of acupuncture may be accumulative after repeated ses- sions. Acupuncture treatment may provide relief for pilocarpine-re- sistant xerostomic patients after radiotherapy for head or neck ma- lignancies.2 However, the treat- ment outcome for the study cited was only based on the Xerostomia Inventory score, which is a self-re- port questionnaire. Acupuncture seems to be able to increase the SFR, provided that the salivary glands are still functional. For those patients whose salivary glands have been structurally af- fected by radiotherapy and be- come resistant even to pilocar- pine, acupuncture may provide subjective relief to a limited ex- tent, although the patients should be advised on realistic expecta- tions of acupuncture therapy. The mechanism behind how acupuncture can increase the SFR is still not fully understood. It can be a placebo effect as shown in Pav- lovian conditioning, in which ex- “...scientific evidence for [acupuncture's] role in pain management is strong.” pectation alone of those receiving treatment can induce saliva pro- duction. Local acupoints in the head and neck region may also di- rectly stimulate the nerves inner- vating the salivary glands. Some authors have suggested that acu- puncture treatment triggers the release of neuropeptides and this can affect blood flow, have anti-in- flammatory properties and exert a trophic effect on the salivary glands.3 Another possibility may be related to neuronal activation. In a descriptive study, cortical re- gions were evaluated using func- tional magnetic resonance imag- ing of volunteers undergoing acu- puncture treatment.4 It was ob- served that acupuncture treatment activated the parietal, Rolandic and frontal opercula, as well as the insula, overlapping with the re- gions involved in gestation and sal- ivation. The authors proposed that acupuncture treatment may tap into the neuronal circuit that acti- vates the salivary nuclei in the pons and subsequently the sali- vary glands via the cranial nerves. More studies are needed to investi- gate how acupuncture therapy may increase salivary flow. Management of dental anxiety and gag reflex A recent Cochrane review showed that 31 per cent of adults are fearful of dental treatment.5 A phobic patient may develop reluc- tance towards or avoidance of dental treatment and thus not seek dental care. During dental