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Adding acupuncture to nerve block
Acupuncture Adding acupuncture to nerve block Background.—It is especially difficult to obtain effective pain control during endodontic procedures involving mandibular posterior teeth with irreversible pulpitis. The usual method of anesthetizing the mandibular posterior teeth is an inferior alveolar nerve block (IANB), but satisfactory anesthesia levels are not always achieved. Acupuncture is an alternative therapeutic procedure using thin needles inserted at certain points on the surface of the body (acupoints). Point LI4 Hegu is an acupoint associated with dental and masticatory pain control. Accurate insertion will prompt an experience of De qi, which is felt as numbness, heaviness, or distention around the insertion point. Although acupuncture’s mechanism of action has not been clearly delineated, the insertion of the needles releases encephalin, which blocks substance P, a neurotransmitter for pain. This blunts the pain sensation. Serotonin release may also occur, which increases endorphin and adrenocortical hormone (ACTH) levels, related to cortisol release. Cortisol is helpful in controlling stress and anxiety. The effects of using acupuncture preoperatively on the success of IANB for teeth with symptomatic irreversible pulpitis were investigated. Methods.—Forty patients (age range 18 to 53 years, mean 29.1 years) with symptomatic irreversible pulpitis were divided into an acupuncture and a control group in a randomized, triple-blinded clinical trial. All patients had severe pretreatment pain.
For the acupuncture group, a disposable needle was inserted at the L14 Hegu acupoint. Patients who reported the De qi sensation were given an IANB 15 minutes later. Among the control group, the patients underwent a sham acupuncture procedure without inserting a needle 15 minutes before an IANB was initiated (Fig 1). Endodontic treatments were undertaken for patients who experienced lip numbness 15 minutes after the injection. If patients reported intolerable pain (more than 20 mm on a 100-mm scale), a supplemental injection was given and the IANB was considered unsuccessful. The data from both groups were analyzed statistically. Results.—All subjects reported lip numbness within 15 minutes of receiving the IANB injection. All the acupuncture group participants experienced De qi after needle insertion. No side effects developed within 48 hours of the procedure for either group. The acupuncture group had a success rate of 60% and the control group a rate of 20%. The addition of acupuncture produced a significantly higher success rate for anesthesia than IANB alone. Women’s success rates were lower than men’s rates, but the difference did not reach statistical significance. Discussion.—Acupuncture administered 15 minutes before commencing an IANB for mandibular molar teeth
Fig 1.—The position of the needle for patients in the (A) acupuncture and (B) control groups was similar in appearance. (Courtesy of Jalali S, Majd NM, Torabi S, et al: The effect of acupuncture on the success of inferior alveolar nerve block for teeth with symptomatic irreversible pulpitis: A triple-blind randomized clinical trial. J Endod 41:1397-1402, 2015.)
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with irreversible pulpitis provided a higher success rate than the use of IANB alone. Studies have indicated that most IANBs do not completely anesthetize teeth with irreversible pulpitis.
Clinical Significance.—Acupuncture is a natural, inexpensive option that is safe when done by well-trained professionals. It can be safer than some anti-inflammatory medications and helps to control pain when added to conventional techniques. Performing acupuncture before endodontic treatment of mandibular molars with irreversible pulpitis specifically may
increase the patient’s threshold of pain and improve the effectiveness of IANBs.
Jalali S, Majd NM, Torabi S, et al: The effect of acupuncture on the success of inferior alveolar nerve block for teeth with symptomatic irreversible pulpitis: A triple-blind randomized clinical trial. J Endod 41:1397-1402, 2015 Reprints available from NM Majd, Dental Research Lab, Howard Univ, College of Dentistry, 600 W St, NW, Washington, DC 20059; e-mail: [email protected]
E-cigarettes Vaping versus smoking Background.—Electronic cigarettes (e-cigs) constitute an emerging health concern, with few clinicians aware of their health effects on patients. In addition, legislation to license and regulate the sale and use of these products differs between various locales. Some ban them, some prohibit their use in specific settings, and some allow unfettered use of e-cigs. These battery-operated devices with cartridges containing flavors, preservatives, and nicotine create an ultrafine particle vapor that is inhaled by the user (Fig 1). Health professionals, policymakers, and the public need to understand the benefits and drawbacks associated with e-cigs.
men. Parent and peer use are highly influential in the use of these products. Some smokers also use e-cigs, but other persons prefer simply vaping or smoking.
Comparisons of Smoking and Vaping.—Over half of current or former smokers report having tried e-cigs, with increasing popularity among younger adults, especially
Advantages of E-Cigs.—Most studies conclude that the health risks of e-cig vapor are less than the risks associated with conventional smoking. Few adverse effects have
The appeal of e-cigs to conventional cigarette smokers lies in their belief that these products have fewer negative outcomes and may be a suitable substitute without the known dangers of smoking. Vapers find their e-cigs attractive for their accessibility, their claim of being healthier, and their more esthetically pleasing nature. Concerns about possible toxicity and the uncertain future legality of the devices bother some who vape.
Fig 1.—The basic components of an e-cig. Reproduced with permission from the Brazilian Journal of Pulmonology (Knorst MM, Benedetto IG, Hoffmeister MC, Gazzana MB. The electronic cigarette: the new cigarette of the 21st century? J Bras Pneumol 2014;40:564-573). (Courtesy of Alawsi F, Nour R, Prabhu S: Are e-cigarettes a gateway to smoking or a pathway to quitting? Br Dent J 219:111-115, 2015.)
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Dental Abstracts
For the acupuncture group, a disposable needle was inserted at the L14 Hegu acupoint. Patients who reported the De qi sensation were given an IANB 15 minutes later. Among the control group, the patients underwent a sham acupuncture procedure without inserting a needle 15 minutes before an IANB was initiated (Fig 1). Endodontic treatments were undertaken for patients who experienced lip numbness 15 minutes after the injection. If patients reported intolerable pain (more than 20 mm on a 100-mm scale), a supplemental injection was given and the IANB was considered unsuccessful. The data from both groups were analyzed statistically. Results.—All subjects reported lip numbness within 15 minutes of receiving the IANB injection. All the acupuncture group participants experienced De qi after needle insertion. No side effects developed within 48 hours of the procedure for either group. The acupuncture group had a success rate of 60% and the control group a rate of 20%. The addition of acupuncture produced a significantly higher success rate for anesthesia than IANB alone. Women’s success rates were lower than men’s rates, but the difference did not reach statistical significance. Discussion.—Acupuncture administered 15 minutes before commencing an IANB for mandibular molar teeth
Fig 1.—The position of the needle for patients in the (A) acupuncture and (B) control groups was similar in appearance. (Courtesy of Jalali S, Majd NM, Torabi S, et al: The effect of acupuncture on the success of inferior alveolar nerve block for teeth with symptomatic irreversible pulpitis: A triple-blind randomized clinical trial. J Endod 41:1397-1402, 2015.)
Volume 61
Issue 1
2016
29
with irreversible pulpitis provided a higher success rate than the use of IANB alone. Studies have indicated that most IANBs do not completely anesthetize teeth with irreversible pulpitis.
Clinical Significance.—Acupuncture is a natural, inexpensive option that is safe when done by well-trained professionals. It can be safer than some anti-inflammatory medications and helps to control pain when added to conventional techniques. Performing acupuncture before endodontic treatment of mandibular molars with irreversible pulpitis specifically may
increase the patient’s threshold of pain and improve the effectiveness of IANBs.
Jalali S, Majd NM, Torabi S, et al: The effect of acupuncture on the success of inferior alveolar nerve block for teeth with symptomatic irreversible pulpitis: A triple-blind randomized clinical trial. J Endod 41:1397-1402, 2015 Reprints available from NM Majd, Dental Research Lab, Howard Univ, College of Dentistry, 600 W St, NW, Washington, DC 20059; e-mail: [email protected]
E-cigarettes Vaping versus smoking Background.—Electronic cigarettes (e-cigs) constitute an emerging health concern, with few clinicians aware of their health effects on patients. In addition, legislation to license and regulate the sale and use of these products differs between various locales. Some ban them, some prohibit their use in specific settings, and some allow unfettered use of e-cigs. These battery-operated devices with cartridges containing flavors, preservatives, and nicotine create an ultrafine particle vapor that is inhaled by the user (Fig 1). Health professionals, policymakers, and the public need to understand the benefits and drawbacks associated with e-cigs.
men. Parent and peer use are highly influential in the use of these products. Some smokers also use e-cigs, but other persons prefer simply vaping or smoking.
Comparisons of Smoking and Vaping.—Over half of current or former smokers report having tried e-cigs, with increasing popularity among younger adults, especially
Advantages of E-Cigs.—Most studies conclude that the health risks of e-cig vapor are less than the risks associated with conventional smoking. Few adverse effects have
The appeal of e-cigs to conventional cigarette smokers lies in their belief that these products have fewer negative outcomes and may be a suitable substitute without the known dangers of smoking. Vapers find their e-cigs attractive for their accessibility, their claim of being healthier, and their more esthetically pleasing nature. Concerns about possible toxicity and the uncertain future legality of the devices bother some who vape.
Fig 1.—The basic components of an e-cig. Reproduced with permission from the Brazilian Journal of Pulmonology (Knorst MM, Benedetto IG, Hoffmeister MC, Gazzana MB. The electronic cigarette: the new cigarette of the 21st century? J Bras Pneumol 2014;40:564-573). (Courtesy of Alawsi F, Nour R, Prabhu S: Are e-cigarettes a gateway to smoking or a pathway to quitting? Br Dent J 219:111-115, 2015.)
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Dental Abstracts