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12 SCIENCE & PRACTICE Dental Tribune Asia Pacific Edition | 5/2017 procedures, an anxious patient may hinder the operator from ex- ecuting procedures properly. Traditionally, medications like benzodiazepines and midazolam have been used to manage dental anxiety. The use of acupuncture may provide an alternative treat- ment modality without possible adverse drug reactions. Several re- ports on the use of auricular acu- puncture for treating chronic and acute anxiety have shown promis- AD ing results. A randomised con- trolled trial comparing auricular acupuncture with intranasal mi- dazolam for managing dental anxiety suggested that both treat- ment methods were similarly ef- fective.6 More large-scale studies are needed to verify this finding. The gag reflex is a normal pro- tective, physiological mechanism that occurs to prevent foreign ob- jects or noxious material from en- tering the pharynx, larynx or tra- chea. Its causes may be somatic, that is brought about by stimulat- ing certain trigger areas in the oral cavity, or psychogenic, that is in- duced by thought stimulus modu- lated by the higher brain centres. A hyperactive gag reflex can be a hin- drance to dental procedures, such as during taking of alginate im- pressions for denture fabrication. The use of certain acupoints like PC6 (neiguan) and CV24 (cheng- jiang) have been reported to reduce the gag reflex significantly.7 Auricu- lar acupuncture too has been sug- gested for treating a severe gag re- flex.8 According to the TCM theory, the acupoint PC6 (neiguan), located on the palmar side of the forearm 2 in. (50.8 mm) above the transverse crease of the wrist, falls on the peri- cardium meridian, which has the effect of “calming the heart which houses the spirit”. It is often used to treat heart palpitation, nausea and vomiting. In providing an explana- tion in the context of Western med- icine, it has been proposed that ac- upuncture may trigger an increase in circulating endorphin, which binds to the opioid receptor, exert- ing an antiemetic effect.9 The an- ti-gagging point located on the ear corresponds with the area of the skin innervated by the auricular branch of the vagus nerve and adja- cent to the area innervated by the auriculotemporal branch of the mandibular division of the trigemi- nal nerve, both are responsible for the sensory and motor function of the larynx, pharynx and palatal re- gion. It can be postulated that stim- ulation of the auricular acupoint may inhibit the muscular function in the gag reflex. More studies to verify the effectiveness of acu- puncture in controlling the gag re- flex should be carried out. Growing interest among medical and dental professionals A recent press report in Singa- pore indicated that there are an increasing number of medical and dental professionals also trained in providing acupuncture treat- ment.10 Based on the official figure at the end of 2015, there were 249 registered acupuncturists in Sin- gapore, of which 134 were medical doctors and dentists, constituting 54 per cent of the group. In addi- tion, acupuncture treatment for pain management is currently being offered in four major public hospitals in the country, a major step towards its recognition as a treatment modality in the main- stream health care sector. Conclusion The use of acupuncture has a long history and has been proven to be an effective treatment mo- dality in TCM. The scientific evi- dence for its role in pain manage- ment is strong, although more large-scale studies with better ex- perimental designs should be car- ried out to verify its application in other areas. The use of acupunc- ture in dentistry may provide an added dimension to the patient- orientated holistic treatment ap- proach that all health care provid- ers should strive to achieve. 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.