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| Title |
More Evidence Is Needed to Determine the Efficacy of Auricular Acupuncture for Treatment of Dental Pain |
| Clinical Question |
For a patient experiencing post-operative dental pain, does auricular acupuncture reduce pain in comparison to medication? |
| Clinical Bottom Line |
There is sparse evidence regarding auricular acupuncture for dental pain, but there is evidence that acupuncture may be beneficial for acute pain episodes. This indicates a need for further research instead of treating using assumptions about acupuncture efficacy. |
| Best Evidence |
(you may view more info by clicking on the PubMed ID link) |
| PubMed ID |
Author / Year |
Patient Group |
Study type
(level of evidence) |
| #1) 30139712 | Armond/2019 | 16 patients needing bilateral third molar extractions | Randomized Controlled Trial | | Key results | There were no differences in pain, trismus, and anxiety in patients when they received acupuncture or sham acupuncture up to 72h after surgery. There was a statistically significant but clinically insignificant increase in edema for extraction sites that received acupuncture. | | #2) 28395101 | Murakami/2017 | 10 RCTs and 684 patients/9 RCTs and 636 patients | Meta-Analysis | | Key results | Ear acupuncture reduces pain intensity and decreases the need for further analgesia within 48h of treatment for treatments including orthopedic surgery, abdominal surgery, migraines, and reproductive surgeries. Studies that reported pain intensity indicate that acupuncture is protective in comparison to the control (SMD -0.96, 95% CI -1.82, -0.11) and studies that reported a need for analgesia supplement after acupuncture report less medications needed (SMD -1.08, 95% CI -1.78, -0.38). There is moderate heterogeneity with this meta-analysis (I^2=64%, Chi^2=5.54 for pain intensity and I^2=77%, Chi^2=22.06 for analgesia requirement). This heterogeneity is likely due to how the outcomes are reported.
| | #3) 35018808 | Sng/2022 | Patient with symptomatic irreversible pulpitis | Case report | | Key results | A patient experiencing symptomatic irreversible pulpitis had acupuncture needles placed prior to endodontic treatment. The patient reported a reduction in pain after the procedure and no consumption of pain medications after endodontic therapy. | |
| Evidence Search |
“auricular acupuncture” AND “acute”. Second search: “acupuncture and molar”. Third search: “acupuncture” AND “dental pain” |
Comments on
The Evidence |
Armond’s study is one of the only RCTs available studying auricular acupuncture and dental pain. Each patient acted as their own control, receiving acupuncture for pain control after one third molar extraction and at a subsequent surgery for the contralateral tooth receiving sham acupuncture. Although the study found no significant difference in pain between, this may be attributed to the small sample size.
Murakami’s meta-analysis reviewed all available literature until March 2015 with clear inclusion and exclusion criteria. This study’s biggest advantage is the author’s decision to combine RCTs from different acupuncture treatments, indicating that acupuncture is applicable to many different pain conditions. However, this contributed to a higher heterogeneity score.
The Sng article should be treated with caution as it is a case report with a low level of evidence, but it is one of the only case reports available regarding acupuncture for an acute dental need. By demonstrating that acupuncture was effective this article makes an argument for further research into using acupuncture for dental pain.
|
| Applicability |
There is an impetus to explore complementary medicine alternatives for pain management. Acupuncture is cheap, non-invasive, and non-addictive, all desirable qualities for pain management techniques. Studies demonstrate that acupuncture is effective for pain control in other medical specialties, but the evidence for dentistry is lacking. There has been one case report demonstrating its efficacy with concomitant endodontic treatment to control pain from symptomatic apical periodontitis. The only RCT available demonstrates no effect in comparing acupuncture to sham acupuncture, but a limited number of patients makes it hard to generalize these findings. |
| Specialty/Discipline |
(Endodontics) (General Dentistry) (Oral Surgery) (Periodontics) (Restorative Dentistry) |
| Keywords |
Acupuncture, dental, pain, medication
|
| ID# |
3515 |
| Date of submission: |
12/01/2022 |
| E-mail |
melch@livemail.uthscsa.edu |
| Author |
Christine Melch, DDS |
| Co-author(s) |
Dr. Mina Morcos |
| Co-author(s) e-mail |
morcos@livemail.uthscsa.edu |
| Faculty mentor/Co-author |
Angela Palaiologou Gallis, DDS, MS |
| Faculty mentor/Co-author e-mail |
palaiologouA@uthscsa.edu |
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) |
post a rationale |
| None available | |
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Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) |
post a comment |
| None available | |
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