ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Efficacy of acupuncture treatment in patient with xerostomia
Clinical Question Is acupuncture an effective treatment option for patients with xerostomia?
Clinical Bottom Line There is weak evidence that acupuncture is an effective treatment in patients with xerostomia. (See Comments on the CAT below)
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) 15899016Jedel/2005 Three articles of controlled clinical trials evaluating the efficacy of acupuncture in the management of xerostomiaSystematic Review
Key resultsThis systematic review showed that there is no evidence for the efficacy of acupuncture in the management of xerostomia. This conclusion was based on reviewing three articles/studies. One study was high quality of assessment in accordance with the criteria list by Jadad et al., which has previously been tested for its reliability. This high quality study showed indifferent results about efficacy of acupuncture treatments in the management of xerostomia. One out of these three studies with low quality assessment showed indifferent results, while the other with low quality showed positive results.
#2) 12436835Brennan MT, Shariff G, Lockhart PB, Fox PC. / 2002 Review of randomized trials published in peer-reviewed journal Systematic Review
Key resultsThis systemic review shows that the existing literature on xerostomia treatments present biases and weaknesses. Thus, in order to get a meaningful statistically significant efficacy on an outcome measurement of xerostomia intervention, it is necessary to design and conduct a clinical trial in a well-controlled and minimized bias setting.
#3) 18532895Cho JH, Chung WK, Kang W, Choi SM, Cho CK, Son CG. /200812 patients with radiation-induced xerostomiaRandomized Controlled Trial
Key resultsPatients receiving real acupuncture treatment have significantly increased their un-stimulated salivary flow rates. Both patients receiving placebo acupuncture treatment and those receiving real acupuncture treatments showed slight increase in their whole stimulated salivary flow rate, with no significance difference between them. In addition, subjective symptom changes using the simple patient-reported questionnaire have examined. The results of the subjective examination did not show significant difference between the two groups at any point, except after 6 weeks with a p value of < 0.05. However, this statistical significance is not powerful due to the small number of subjects and nonuniform severity of xerostomia.
#4) 15899016Blom M, Dawidson I, Angmar-MÃ¥nsson B./ 199221 patients with severe xerostomiaRandomized Controlled Trial
Key resultsPatients who received acupuncture treatment have increased their salivary flow rates throughout and after the treatment for a year. Those who received placebo treatment only showrd improvement of their salivary flow rates during the treatment. However, many factors can influence the salivary production, thus influence the results of the study. These factors include positive expectations prior to the treatment, lowered dosage of hypnotic medication, and the philosophy of traditional Chinese medicine, which said that “There is always some positive effect of an acupuncture needle, even when the needle is not placed accurately.”(8) Therefore, this study indicates that acupuncture treatment may be a useful adjunct for the stimulation of salivary secretion in some patients with xerostomia.
#5) 18606019Deng G, Hou BL, Holodny AI, Cassileth BR. /2008 20 healthy volunteers Randomized Controlled Trial
Key resultsTrue acupuncture induced more saliva production than sham acupuncture. This conclusion is obtained by looking at the cortical regions that were activated or deactivated during the interventions evaluated by functional magnetic resonance imaging (fMRI). Changes in neuroimaging signal appear correlated to saliva production. This study showed that acupuncture point LI-2 that is commonly used to treat xerostomia was associated with activation of the insula and adjacent operculi at the cortical regions. However, no activation or deactivation was detected during sham acupuncture. Several limitations were noted in this study: only one type of control intervention, and no subjective inputs about the sensation or “deqi” sensations. Furthermore, although the data in this study indicated that areas activated by acupuncture at LI-2 overlap with those involved in gustation or salivation, this study was descriptive in nature. Therefore, it cannot be concluded that there is a casual relationship such as activation led to increased salivation.
Evidence Search Search "Xerostomia"Mesh]Search "Acupuncture Therapy"[Mesh]
Comments on
The Evidence
Applicability According to current evidences reviewed above, acupuncture treatment does have some efficacy in relieving patients with symptoms of xerostomia. It also showed some improvement of objective salivary flow rates during and after the treatment. However, problems regarding the experimental methods made these studies and reviews weak evidences. Large sample size randomized clinical trails with standardized acupoints and acupuncture methods will be necessary to be incorporated into the study design. Until more reliable studies and reviews are published, acupuncture should not be considered as a adjunctive treatment for patients with xerostomia.
Specialty/Discipline (Oral Medicine/Pathology/Radiology)
Keywords Xerostomia and acupuncture
ID# 559
Date of submission: 03/31/2010spacer
E-mail hsucl@livemail.uthscsa.edu
Author Chia-ling Hsu
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Chih-ko Yeh, BDS, PhD
Faculty mentor/Co-author e-mail YEH@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 on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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by Veronique Smith (San Antonio, TX) on 04/18/2012
A PubMed search done in April of 2012 using the same MeSH terms, brought up a more recent systematic review out of Ireland, which came to a similar conclusion as that stated in this CAT. PubMed ID: 21062848
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