The role of acupuncture in controlling the gagging reflex using a review of ten cases

A Simple Technique to Manage Gag Reflex

Gagging poses a clinical difficulty to the dentist in all facets of therapy, from diagnostic techniques to active treatment. Various treatment methods to manage the gagging include behavioral techniques, acupressure, acupuncture, hypnosis, systemic desensitization, and pharmacological techniques. This article presents a straightforward method for getting rid of the gag reflex using an eye massager. Eye massagers can help reduce the stress and anxiety associated with dental procedures by providing an effective alternative to traditional methods. This technique can be a valuable aid in making short dental procedures more comfortable and successful.

A Simple Step-by-Step Technique for the Management of Gagging in Edentulous Patient

Gagging presents a clinical challenge to the dentist in all aspects of treatment starting from diagnostic procedures to active treatment. There is no single cause associated with gagging. For successful management, it is very important to find the cause and plan the treatment accordingly. This article describes a simple step-by-step technique for eliminating the gag reflex in an edentulous patient. This simple approach helped the patient to relax and eliminate the phobia of dental treatment. It also enhanced the patient’s ability to continue the dental procedure.

Comparative evaluation of effect of microcurrent electrical stimulation on acupoints to control gag reflex in patients receiving prosthodontic treatment: An in vivo study

Aims

The aim of this study is to see if microcurrent electrical stimulation on two acupoints, auricular and Hegus, can help patients prevent their gag reflex.

Settings and Design

This was an in vivo cross-sectional study.

Materials and Methods

Thirty patients were randomly assigned to three groups: A, B, or C, of ten patients present in each group. Group A and Group B undergone electroacupuncture (microcurrent electrical stimulation) using electroacupuncture device on auricular point and Hegus point (Li 4), respectively, for 1 min and Group C formed the placebo group, point Shou San Li (Li 10). The gag severity index and the gag prevention index were used to measure the gag reflex, which was done in two steps.

Statistical Analysis Used

SPSS (SPSS Inc., Chicago IL, USA) version 24 software was used for statistical analysis. Paired t-test, one-way analysis of variance test, post hoc Bonferroni test was used to analyse and compare the data.

Results

It was found that Point A and Point B were significantly effective in reducing the severity of gag reflex. Point C demonstrated insignificant results. In addition, Point B (Hegus [Li4]) is more effective than Point A (auricular) in controlling the gag reflex in patients within the set age group of 20-70 years of age.

Conclusions

Microcurrent electrical stimulation is a useful adjuvant in the treatment of unfavorable gag reflexes during routine dental procedures. Point Hegus and point auricular acupuncture are both useful in decreasing the severity of gag reflex, with point Hegus being more effective than point auricular.

Acupuncture and Transcutaneous Electrical Acupoint Stimulation Do Not Suppress Gag Reflex

Objective: Gagging is a problem for many dental patients, as well as patients undergoing medical procedures, such as intubation. Research to date on the gag reflex has been limited by a lack of objective measures for measuring this reflex. Materials and Methods: A validated quantitative method was used to measure if acupuncture or transcutaneous electrical acupoint stimulation (TEAS) at Pericardium 6 (PC 6) and Stomach 36 (ST 36) suppressed the gag reflex, compared with a sham placebo. The subjects were 60 healthy adults randomly chosen to receive acupuncture, TEAS, or sham-TEAS on PC 6, located on the forearm, and ST 36, located on the lower leg. The gag reflex was measured by inserting a saliva ejector slowly down each participant's throat to determine the maximum tolerance of the gag reflex; the insertion length was used as an index of this reflex. Results: There was a significant difference in pre- and postintervention insertion lengths in all groups (paired t-test; all groups; P < 0.001). The differences in the insertion length among the groups (P = 0.76) and the interaction effect (group × time) were not significant (P = 0.79; 2-way analysis of variance). Conclusions: This study suggested that PC 6 and ST 36 stimulation was no different than placebo for alleviating the gag reflex.

Predicting Gag, Discomfort, and Laryngeal Visualization in Patients Undergoing Flexible Laryngoscopy with Stroboscopy

OBJECTIVE

To investigate potential associations between the Predictive Gagging Survey (PGS) with patient experience of gag and discomfort as well as provider perception of patient gag and level of laryngeal visualization during flexible laryngoscopy with stroboscopy (FL-S).

METHODS

A total of 53 adult patients undergoing FL-S were recruited for this prospective non-controlled study. PGS was completed before FL-S. Patients rated perceived level of gag and discomfort on a 10-point severity scale after FL-S. Additionally, providers completed a Gagging Severity Index (GSI) reflecting their impression of patient gag and level of laryngeal visualization following FL-S. Spearman rank correlation coefficients were used to assess associations.

RESULTS

There was a positive association with PGS score and patient perception of gagging (0.34; P = .013) and patient perception of discomfort (0.38; P = .005). No significant association was found between PGS score and provider GSI (-0.12; P = .39) or level of laryngeal visualization (0.15; P = .29). A negative association was found between level of laryngeal visualization and patient perception of gagging (-0.34; P = .012) and discomfort (-0.44; P = .001). No significant differences were found between current and former smokers compared to never smokers for GSI or patient-perceived gag or discomfort.

CONCLUSIONS

While not predictive of GSI or level of laryngeal visualization, the PGS was found to be a useful tool in predicting patient experience of gagging and discomfort during FL-S, further reinforcing the subjective experience of this procedure. Use of the PGS may be helpful in identifying specific candidates who may struggle with subjective discomfort or gagging during FL-S for future studies considering interventions to manage and meaningfully decrease discomfort. Having such an instrument is important given the low number of individuals who struggle with discomfort during the exam.

A New Concept for the Treatment and Rehabilitation of Patients with Pathologic Comorbidities Using Cutting-Edge Digital Technologies in Dental Orthopaedics

Objectives  This article investigates the specific aspects of overactive or exaggerated vomiting reflexes affecting the procedure of dental examination and impression in patients with complete secondary adentia, who need orthopaedic dental treatment.

Materials and Methods  The prevailing manifestation degree of exaggerated vomiting reflex was diagnosed among patients with complete secondary adentia and exaggerated vomiting reflex.

Statistical Analysis  Exaggerated vomiting reflexes occur when a patient suffers from dentophobia, the term, which is otherwise known as the fear of dentists. The study was performed using methods of mathematical statistics, including the Pearson χ ² criterion and the statistical probability criterion ( p ).

Results  The role of an exaggerated vomiting reflex was revealed in the development of patients’ dentophobic experiences, and the nature of such experiences was established. Variations in dentophobic reactions were distinguished and management strategies were studied for patients with complete secondary adentia and exaggerated vomiting reflex.

Conclusions  These studies were aimed at preventing the development of vomiting reflex during dental procedures and at identifying an optimal strategy for stopping exaggerated vomiting reflex. The role of the vomiting reflex in the orthopaedic treatment of dental patients was determined.

Acupuncture for Relief of Gag Reflex in Patients Undergoing Transoesophageal Echocardiography-A Protocol for a Randomized Placebo-Controlled Trial

Background: Gagging during transesophageal echocardiography examination (TEE) can be distressing and even dangerous for patients. The needling of acupuncture point CV24 was described to be effective in reducing the gag reflex during TEE in patients with ischemic stroke or transient ischemic attack. Methods: We describe a proposal for a prospective, randomized, patient, practitioner and assessor-blinded, single-center trial with two arms/groups; real acupuncture will be compared to placebo acupuncture. A total of 60 (30 per group) patients scheduled for elective TEE in order to exclude a cardiac embolic source, endocarditis or for valve failure evaluation will be recruited according to patients' selection criteria and receive either indwelling fixed intradermal needles at acupoints CV24 and bilateral PC6 or placebo needles at the same areas. Patients, the practitioners who will perform the TEE procedure, and the assessor of the outcome measures will be unaware of the group's (real or placebo) allocation. Results: The primary outcome is the intensity of gagging, measured using verbal rating scale (VRS-11) from 0 = no gagging to 10 = intolerable gagging. Secondary outcomes include the incidence of gagging, the use of rescue medication, patients' satisfaction with relief of unwanted side effects during TEE procedure, success of patients' blinding (patients' opinion to group allocation), heart rate and oxygen saturation measured by pulse oxymetry. Conclusions: To study the effects of acupuncture against gagging during TEE, we test the needling of acupoints CV24 and PC6 bilaterally. A placebo acupuncture is used for the control group. Trial registration number: NCT NCT0382142.

Reliability, validity, and sex differences in a quantitative gag reflex measurement method

A reliable assessment method is required to manage the gag reflex. We tested the inter- and intra-examiner reliability and validity of a quantitative measurement method and evaluated the differences between sexes. This study included 21 healthy adults (10 women, 11 men; mean age, 27.1 ± 9.9 years). An examiner inserted a standard saliva ejector slowly down the participant's throat to determine the maximum tolerance of the gag reflex; the insertion depth was used as an index of gag reflex. The reflex was measured by one examiner during two sessions (S1 and S3) and by a second examiner during one session (S2) under the same conditions. The galvanic skin response (GSR) and heart rate (HR) were recorded during each session to test the method validity. Data were analysed using the intraclass correlation coefficient (ICC), paired t test, and two-way repeated-measures analysis of variance. The ICC of the gag reflex measurements was 0.91 between S1 and S2, and 0.93 between S1 and S3. The GSR and HR increased significantly after the maximum tolerance of the reflex in S1, S2, and S3 (GSR: P < 0.001, P = 0.004, P = 0.001, respectively; HR: all, P < 0.001). Differences in the measurements according to sex and session were not significant. Our method exhibited excellent inter- and intra-examiner reliability and was unaffected by the participants' sex. Measurement revealed significant autonomic reactivity, which is common for this reflex. Consequently, this method may be used in clinical and laboratory-based applications.

The Greek version of the Gagging Assessment Scale in children and adolescents: psychometric properties, prevalence of gagging, and the association between gagging and dental fear

BACKGROUND

No studies assessing the association between gagging and dental fear are available in pediatric samples.

AIM

To assess the psychometric properties of the Greek version of the Gagging Assessment Scale (GAS), to explore the prevalence of gagging, and to evaluate the relationship between gagging and dental fear in a pediatric sample.

DESIGN

A total of 849 8- and 14-year-old children filled out a questionnaire consisting of demographic items, the Greek version of the GAS, and the Greek Children's Fear Survey Schedule Dental Subscale (CFSS-DS); the older children also completed the Greek version of the Modified Dental Anxiety Scale (MDAS). The short form of dentist part of the Gagging Problem Assessment (GPA-de-c/SF) was used to objectively assess gagging.

RESULTS

A total of 51 children (6.0%) demonstrated gagging on the GPA-de-c/SF. Children rated as gaggers on the GPA-de-c/SF had significantly higher GAS scores. There were no relationships between GPA-de-c/SF and the CFSS-DS or MDAS. The GAS ratings were significantly correlated with the CFSS-DS (rho = 0.420, P < 0.001) and MDAS (rho = 0.429, P < 0.001). The internal consistency was good (Cronbach's alpha = 0.697).

CONCLUSIONS

The GAS demonstrated good psychometric properties. Dental fear was correlated with the self-report gagging assessment, but not with the objective gagging assessment.

Management of exaggerated gag reflex in dental patients using intravenous sedation with dexmedetomidine

Pharmacological sedation is one of the effective ways of prevention of gag reflex development in patients experiencing anxiety and fright before dental treatment. We are reporting a case where we could successfully eliminate exaggerated gag reflex (intravenous [IV] Gagging Severity Index) in a dental patient using IV sedation with dexmedetomidine. IV administration of dexmedetomidine provided elimination of gag reflex at a depth of sedation for the patient with the Richmond Agitation-Sedation Scale score of −2 and −1. The patient received dexmedetomidine 1.0 μg/kg for 10 min and then a continuous infusion of dexmedetomidine 0.4 μg/kg/h. The use of dexmedetomidine for sedation may be an alternative to other pharmacological agents in patients with dental anxiety accompanied by exaggerated gag reflex.

Is acupuncturing effective in controlling the gag reflex during dental procedures? A review of literature

Traditional acupuncture has been introduced more than 2500 years ago which provides an alternative and complementary option during clinical practices. Its main mechanism is based on stimulating the nerves by altering the processes and perception of pain transmitters. It facilitates releasing natural pain relievers such as endorphins and serotonin. Its success for various dental procedures has been proved earlier. However, its effects on controlling the gag reflex seem to be overlooked. The gag reflex is recognized as a protective reaction for stopping the entrance of any foreign bodies into the oropharynx. Pronounced gag reflexes can have negative impacts on the quality of dental procedures. Many techniques have been suggested for managing this reflex and acupuncturing is one of those which seems to be overlooked recently. The aim of this paper is reviewing the published high-quality researches about the efficacy of this technique for eliminating the gag reflex during dental procedures.

Influence of gag reflex on removable prosthetic restoration tolerance according to the patient section of the short form of the Gagging Problem Assessment Questionnaire

PURPOSE

To assess removable prosthetic restoration tolerance according to the patient section of the short form of the Gagging Problem Assessment Questionnaire (GPA-pa SF) and the influence of gender, education level and prosthesis type and denture-related mucosal irritation on the GPA-pa SF scores before treatment and over a period of two months after prosthesis insertion.

MATERIALS AND METHODS

130 participants who required removable prosthesis were surveyed with a standard form that included questions regarding age, gender, education level, dental attendance, and prosthetic restoration type. Participants answered the GPA-pa SF before restoration (T0) and 1 day (T1), 2 days (T2), 15 days (T3), 1 month (T4), and 2 months (T5) after prosthesis insertion.

RESULTS

Of the 130 participants, 110 participants completed the prosthetic restoration procedure, but only 93 of these were able to use the prosthesis over the two-month period. The mean GPA-pa SF score obtained at T0 was higher than the scores obtained at the other periods in the total of the sample. Significant difference was present between mean scores obtained at T0-T1 and T2-T3 than scores obtained at other periods (P<.05). Female participants and participants with denture-related mucosal irritation had higher GPA-pa SF scores at all time points analysed. Significant difference was present between mean GPA-pa SF scores obtained at T2-T3 than scores obtained at other periods for females and participants with denture-related mucosal irritation (P<.05). Education level and prosthesis type did not significantly influence the GPA-pa SF score at any time point analysed (P>.05).

CONCLUSION

GPA-pa SF scores were higher before the restoration procedure began, and decreased over time with the use of prosthesis. Gender and denture-related mucosal irritation affected the GPA-pa SF scores.

Managing endodontic patients with severe gag reflex by glossopharyngeal nerve block technique

INTRODUCTION

Gagging is a protective reflex, but when the gag reflex becomes abnormally active, it poses a difficulty for the dentist because it hinders all aspects of dental procedures including diagnosis, radiography, and any form of active procedure.

METHODS

In this case report, to overcome this difficulty the authors used a glossopharyngeal nerve block technique that is used by anesthetists and otolaryngologists, but its endodontic use has gone previously unreported.

RESULTS

Response to gag reflex decreases after successful glossopharyngeal nerve block.

CONCLUSIONS

The glossopharyngeal nerve block technique is a relatively safe, simple, and easy to master technique as compared with general anesthesia for treating a patient with an exaggerated gag reflex. The glossopharyngeal nerve block technique may be used in dental procedures in patients with an exaggerated gag reflex or when performing procedures in the posterior aspect of the mouth. Due caution should be exercised to prevent inadvertent intravascular administration of local anesthetic when using this procedure.

A Reliable and Valid Survey to Predict a Patient's Gagging Intensity

Objectives

The aim of this study was to devise a reliable and valid survey to predict the intensity of someone’s gag reflex.

Material and Methods

A 10-question Predictive Gagging Survey was created, refined, and tested on 59 undergraduate participants. The questions focused on risk factors and experiences that would indicate the presence and strength of someone’s gag reflex. Reliability was assessed by administering the survey to a group of 17 participants twice, with 3 weeks separating the two administrations. Finally, the survey was given to 25 dental patients. In these cases, patients completed an informed consent form, filled out the survey, and then had a maxillary impression taken while their gagging response was quantified from 1 to 5 on the Fiske and Dickinson Gagging Intensity Index.

Results

There was a moderate positive correlation between the Predictive Gagging Survey and Fiske and Dickinson’s Gagging Severity Index, r = +0.64, demonstrating the survey’s validity. Furthermore, the test-retest reliability was r = +0.96, demonstrating the survey’s reliability.

Conclusions

The Predictive Gagging Survey is a 10-question survey about gag-related experiences and behaviours. We established that it is a reliable and valid method to assess the strength of someone’s gag reflex.

Nausea control by needling at acupuncture point Neiguan (PC6) during an intraoral impression-taking procedure

The objective of this study was to evaluate the effectiveness of acupuncture point PC6 (Neiguan) in controlling nausea during intraoral impression taking. This study was conducted in Piracicaba, São Paulo, Brazil. The sample consisted of 33 adult volunteers with nausea, who were randomly divided into control and study groups, and treated with nonpenetrating sham acupuncture and real acupuncture, respectively, at acupoint PC6. The two groups had two maxillary impressions taken, one prior to acupuncture and the other after acupuncture. The nausea assessment was made using the visual analog scale, Gagging Severity Index (GSI), and Gagging Prevention Index. Volunteers' expectation that nausea would be reduced through acupuncture was also assessed. For statistical analysis, we used the t test and the Spearman correlation (p < 0.05). When assessed by Gagging Severity Index/Gagging Prevention Index, nausea was reduced in the real acupuncture group (p < 0.01). In the visual analog scale assessment, similar reductions of nausea were noted in both groups (p > 0.05). No correlation existed between the expected and the actual reductions in nausea. Our results indicate that acupoint PC6 was effective for controlling nausea during the maxillary impression-taking procedure. Patients' expectation did not influence the results.

Intranasal midazolam may prevent gagging reflex: a case report

Background

Gagging can become a conditioned response that makes dental treatment difficult or impossible for both the individual and the dentist. The aim of this study is to report a 50 year old female and two children (15 and 11 years old) with exaggerated gag reflex referred to Faculty of Dentistry of Selçuk University.

Methods

During obtaining records, taking impression procedure was elicited the patients’ hypersensitive gagging reflex. Therefore, it was decided to administer intranasal midazolam to facilitate the taking of accurate dental impressions. After given verbal information about the procedure, 2.5 mg intranasal midazolam (Demizolam, Dem Medikal, Istanbul) were applied incrementally in both nostrils.

Results

Five minutes later; patients had no gagging reflex and allowed the clinician to take satisfying impressions. No serious adverse effects were observed and the patients remained cooperative during the entire procedure which was completed to the full satisfaction of all involved. The short absorption time and the fast relief process of anaesthetics transferred to the systemic circulatory system are important advantages of nasal application.

Conclusions

Intranasal midazolam may be very useful for the treatment of gag reflex probably effecting on the depression of upper airway reflex sensitivity.

Gag reflex control through acupuncture: a case series

BACKGROUND

Many patients avoid dental appointments because of severe gagging when they have work performed, such as taking impressions. There are several methods known to alleviate gagging, and some studies have suggested that acupuncture may be effective in reducing gag reflex. The aim of the present study therefore was to evaluate whether acupuncture can produce a reduction of the gag reflex.

METHODS

A total of 20 patients, aged between 19 and 80 years, with history of gag reflex on taking dental impressions, were recruited. All patients fulfilling the inclusion criteria had an upper and lower dental alginate impression taken without acupuncture, and a second upper and lower alginate impression taken immediately after acupuncture based on traditional Chinese medicine. After each impression, the patients recorded their emetic sensation using a visual analogue scale (VAS).

RESULTS

The results showed a significant (p<0.05) reduction in the gag reflex scores after acupuncture. For upper impressions, they fell from 6.8 (1.1) to 1.1 (1.1); and for lower impressions, from 5.45 (1.0) to 0.4 (0.7) (mean (SD)).

CONCLUSIONS

The findings from our study suggest that acupuncture may be useful for preventing and treating gag reflex, and justifies further study.

Edentulous Maxillary Arch Fixed Implant Rehabilitation Using a Hybrid Prosthesis Made of Micro-Ceramic-Composite: Case Report

The prosthetic treatment of patients with an edentulous maxilla opposing mandibular natural teeth is one of the most challenging endeavors that face clinicians. Occlusal forces from the opposing natural teeth may cause fractures in the maxillary prosthesis and also result in advanced bone loss of the edentulous maxilla. With the presence of extreme gagging reflex, the treatment may become more complicated. This article describes and illustrates the 2-stage surgical and prosthetic treatment of a patient with an edentulous maxilla opposing natural teeth. In the beginning, the patient was treated with 4 implants and a maxillary implant-supported overdenture. The extreme gagging reflex and the occlusal forces from the mandibular natural teeth obligated the team a second stage surgical and prosthetic treatment, which included increasing the number of implants after bilateral sinus lifting in the posterior maxilla and fabricating a maxillary fixed hybrid prosthesis made of micro-ceramic composite that yielded a satisfactory result.

Utility of the gagging problem assessment questionnaire in assessing patient sensitivity to dental treatments

Although the Gagging Problem Assessment Questionnaire (GPA) can be used to identify patients with gag reflex, it does not provide information about patient sensitivity to dental procedures. The aim of this study was to assess the utility of GPA in determining patient sensitivity (i.e. gag reflex) in response to intra-oral radiography and impression-taking procedures. The study included 95 patients (65 women; mean age, 44·2 ± 13·4 years) undergoing dental treatment at a Turkish dental school. Patients completed the patient section of the GPA before their dental examination. An observing dentist monitored and scored the gag reflex of patients during each step of intra-oral radiographic examination and impression taking. The overall sensitivity of the patient to the entire process was also recorded. Descriptive statistics, one-way analysis of variance and the Tukey's test were used for statistical analysis. Patients with GPA scores of 1·00-1·74 did not show any gagging or displayed only mild discomfort during the procedures. Patients with GPA scores of 1·75-3·24 showed moderate gagging, which was managed with prophylactic and suppressive precautions. Patients with GPA scores of 3·25-4·00 were unable to complete the procedures because of gagging. Differences (all P < 0·001) were found between the three groups for the observed responses of patients during radiography (F, 203·343), impression (F, 175·035) and radiography + impression procedures (F, 228·319), with no significant difference between women and men. In conclusion, GPA may be helpful for the prediction of patient sensitivity to dental treatments.

Acupuncture in Dentistry: Its Possible Role and Application

This article reviews the possible role and application of acupuncture in dentistry. The use of acupuncture in Traditional Chinese Medicine (TCM) has a long history and for the past forty years, many studies have been conducted to understand the scientific basis behind its therapeutic effects in Western medicine. The possible application of acupuncture in the dental field like managing post-operative pain, orofacial pain, xerostomia, Bell's palsy and dental anxiety will be discussed in detail. The inherent challenges in conducting clinical trials in acupuncture using the evidence-based medicine model will also be covered. It is envisioned that acupuncture may play a promising role in complementing conventional treatment in certain dental conditions and more studies with improved methodology should be carried out to verify its application.

The use of acupuncture in controlling the gag reflex in patients requiring an upper alginate impression: an audit

BACKGROUND

A pronounced gag reflex (GR) can be a problem to both the acceptance and delivery of dental treatment. Despite a range of management strategies, some patients cannot accept even simple dental treatment. The aim of this study was to evaluate the use of acupuncture point CV-24 in controlling a profound gag reflex during dental treatment requiring an upper alginate impression.

METHOD

Members of the British Dental Acupuncture Society were invited to take part in an audit of the role of acupuncture point CV-24 in controlling the gag reflex. They were issued with patient inclusion criteria, a standardised procedure instruction sheet and a recording form. All patients fulfilling the inclusion criteria had an upper dental alginate impression taken (or an attempt made at it) before acupuncture, and a second upper alginate impression taken immediately after acupuncture of point CV-24. The GR assessment was undertaken prior to insertion of the acupuncture needle using the Gagging Severity Index (GSI); and after the acupuncture and impression taking using the Gagging Prevention Index (GPI). Both the GSI and GPI were recorded at three stages of the dental impression taking procedure, ie, when the empty impression tray was tried in the mouth, when the loaded tray was inserted into the mouth, and on completion of the impression taking.

RESULTS

Twenty-one dentists submitted 64 case reports of which 37 fulfilled the inclusion criteria. Prior to acupuncture all 37 patients (20 females and 17 males with a mean age of 46.8 years) were unable to accept the impression taking. After acupuncture of point CV-24, an improvement of between 51-55% (mean 53%) for the three stages of impression taking was noticed. Thirty patients (81%) were able to accept the impression taking, whereas seven (19%) remained unable to tolerate the procedure. Assessed by the GSI and GPI, there was a significant decrease in GR scores at all three stages of the impression taking procedure (median 3 vs 1; 4 vs 2; 4 vs 2; p < 0.0001). Thus before acupuncture, the patients had moderate to severe GR and after acupuncture the GR had reduced to a level which only complicated dental treatment slightly.

CONCLUSION

Our results indicate that acupuncture of point CV-24 is an effective method of controlling severe GR during dental treatment including impression taking. However, the results of the current audit need to be tested in a randomised controlled study in order to substantiate the effectiveness of this method.

The use of Traditional Chinese Medicine in managing oral health — Hong Kong: one country, two systems

OBJECTIVES

To determine knowledge, use, and interest in traditional methods to manage oral health among Hong Kong adults.

DESIGN

A cross sectional epidemiological survey.

PARTICIPANTS

A random sample of 500 Hong Kong adults.

METHODS

Telephone interviews about Traditional Chinese Medicine (TCM) approaches to mange oral health, employing a battery of 50 questions over a one month period in 2002.

RESULTS

Most completed the interview (96%, 481/500). Over half (52%, 250/481) had some knowledge about using TCM to manage oral health. Approximately a third (32%, 155/481) reported using TCM to manage their oral health in the past, most frequently for oral mucosal lesions (65%, 101/155) or for periodontal reasons (62%, 96/155). TCM was used predominately in combination with western dentistry or as a last resort (55%, 86/155). Most (89%, 428/481) expressed an interest in TCM approaches to managing oral health, particularly if administered by their dentist (54%, 259/481), and expressed many reasons for such interest. Socio-demographic variations in knowledge, use and interest in the use of TCM to manage oral health were apparent (p<0.05).

CONCLUSION

Knowledge, use and interest in traditional based approaches to managing oral health is widespread in Hong Kong, and is associated with age and educational attainment.

Conscious sedation services provided in secondary care for restorative dentistry in the UK: a survey

OBJECTIVES

To assess the views of consultants in restorative dentistry on sedation services in secondary care for restorative dentistry and their involvement in the provision of this.

DESIGN

Postal questionnaire survey in the UK.

SETTING

Consultants in restorative dentistry.

RESULTS

There was an 80% response rate from 179 consultants. Among consultants in restorative dentistry there was a perceived need for sedation services in restorative dentistry within NHS hospitals other than for teaching purposes. Anxiety and level of trauma of dental treatment affected whether consultants felt it appropriate for patients to have such treatment under sedation. One third (48) of consultants treated patients under conscious sedation, a significant number of these held NHS posts and had graduated more recently. Of those (41) who provided treatment under conscious sedation in an NHS setting, most (38, 93%) provided treatment under intravenous sedation of whom only eight (21%) acted as operator/sedationist. Nearly all consultants (135, 94%) felt that specialist registrars in restorative dentistry should undergo some form of training in sedation.

CONCLUSIONS

Although consultants in restorative dentistry recognise the need for training in and the provision of sedation in secondary care for restorative dentistry, only one third of respondents currently provide this service.

A survey on the uses of acupuncture by a group of UK dentists

A small number of fully trained Chinese doctors practise Traditional Chinese Medicine (TCM) in western cities. Use of these services by British citizens is extremely limited, mostly due to lack of any knowledge on the effectiveness of acupuncture or exposure to complementary medicine in this country. Common situations where British patients seek the help of TCM are when medical therapy has failed; in relapsing chronic diseases like asthma, rheumatoid arthritis; and in pain management (mostly headache, migraine and back pain). Patients often appreciate that only limited interventions are available for treatment of these conditions in western medicine. At least one in 10 UK specialist physicians are actively involved in complementary and alternative medicine treatments.(1) A large number of westerners offer acupuncture therapy but lack basic medical training. It is likely that people are reluctant to use these services largely because of hygiene and safety reasons. Moreover, it has been demonstrated that the serious side effects reported are five times more frequent when treatments are provided by non-medically trained therapists compared with professionally registered health care providers.(2).

A long-term therapeutic treatment for patients with a severe gag reflex

"Hypnopuncture," a combination treatment of hypnosis and acupuncture, provides a therapeutic treatment plan for long-term therapy for patients with a distinctive gag reflex. The treatment is applied independently of the cause. In cases of emergency treatment in dentistry, the immediate compliance of a patient is of utmost importance. The long-term goal of any therapeutic measure is control of the gag reflex. A new treatment protocol is illustrated in the case of a 50-year-old patient with a severe gag reflex. After only 5 visits, dental treatment could be conducted without any auxiliary means. Hypnosis is applied in the form of hypnosedation (not as psychotherapy), while stereognosis occupies a central position for desensitization.

"Hypnopuncture"--a dental-emergency treatment concept for patients with a distinctive gag reflex

The present case report describes a newly developed dental treatment concept for patients with a distinctive gag reflex. "Hypnopuncture" is a combination therapy of hypnosis and acupuncture. Its simple, fast, and effective application autonomous of the cause makes it a valuable tool for dental-emergency treatment procedures. Physiologic and psychological aspects of gagging are influenced at the same time. The protocol is illustrated in the case of a 76-year-old patient with a severe gag reflex who was successfully treated by this combination approach. Necessary and effective therapeutic measures from both acupuncture and hypnosis are portrayed.

Can acupuncture reduce the induction time of a local anaesthetic?--A pilot study

We report on a pilot study we undertook to investigate if segmental acupuncture treatment, given two minutes prior to a regional inferior dental block (ID) with Prilocaine Hydrochloride, would reduce the onset time of a local anaesthetic. Thirty healthy people, who needed a regional inferior dental block (ID) as part of dental treatment in the lower jaw, were randomly allocated to three groups. They received segmental acupuncture, heterosegmental superficial acupuncture, or standard treatment (regional inferior dental block) without acupuncture. In the segmental acupuncture group, acupuncture was given within the innervation of the trigeminal nerve. The needles were left in for two minutes, followed by a regional inferior dental block (ID). In the second group, acupuncture needles were inserted superficially in extra-segmental points and left in for two minutes without stimulation, followed by the regional inferior dental block. A control group received standard treatment only, of a regional inferior dental block. The concept 'pain free for dental work' was defined as 'patients reporting pins and needles in the lower lip' and measured by a drilling test. Patients who reported no pain during the drilling test were included in the study. The time from administration of the injection to the patients' reporting pins and needles was recorded by an independent dental nurse. All tested patients reported sufficient anaesthesia during the drilling test. In the segmental acupuncture group, anaesthesia was achieved after 62 seconds, compared to the heterosegmental superficial acupuncture group, who took 115 seconds and the control group, who received standard treatment only, and took 119 seconds. The difference between the segmental acupuncture group and the heterosegmental superficial acupuncture group was statistically significant (p < 0.015); the difference between the segmental acupuncture group and the control, who received a regional inferior dental block only, was also significant (p < 0.032). No significant difference was found between the heterosegmental superficial acupuncture group and the control group who received a regional inferior dental block only (p < 0.84). It appears from this pilot study that the onset time of local anaesthesia is reduced if segmentally administered acupuncture is given prior to the regional inferior dental block. However, it needs to be reproduced including objective measurements.

The Use of Acupuncture in Implant Dentistry

This article aims to review how acupuncture can provide complimentary treatments to patients through implant rehabilitation. The following topics are discussed: control of gagging reflex, control of postoperative vomiting, control of postoperative pain, enhance anesthetic effects, control of anxiety, increase saliva production, enhance immune responses, management of temporomandibular dysfunction, smoking cessation, control diabetic mellitus, stimulation of peripheral nerve regeneration, and adverse effects.