Up to 20% of the US population has severe anxiety at the dentist's office. People who cannot help their gag reflex may unintentionally deprive themselves of the best dental care, write Giuseppa Bilello and Antonella Fregapane, both from the University of Palermo in Sicily.
Acupuncture may be one strategy to solve that problem, the pair suggests."It is a small study, and that is one weakness," Dr Palle Rosted told Reuters Health.
"But it is a good start."Rosted is a consultant acupuncturist with Weston Park Hospital in Sheffield, England. He was not involved with the current study.
The researchers recruited 20 people with a history of gag reflex in the dental chair to have upper and lower teeth impressions taken under normal circumstances and then immediately after acupuncture. Participants ranged in age from 19 to 80.
No comparison group
For the first round of upper teeth impressions, they reported an average gag reflex score of 7 on a 0-10 scale, with 10 representing the maximum nausea sensation. During the second round, the researchers applied acupuncture needles about 30 seconds before taking impressions and left the needles in until the procedure ended.
On average, gag reflex scores dropped to just 1.The pattern was similar for gag reflex scores during lower teeth impressions done with and without acupuncture, according to findings published in the journal Acupuncture in Medicine. The researchers point out that they can't be sure the improvements were due to the acupuncture needles themselves – in part because there was no comparison group that didn't get acupuncture.
Another possibility is that gag reflex scores improved because participants were more used to the impressions the second time around. Still, "It has certainly given us some more evidence that acupuncture may be effective," Rosted said.
The study's positive result "is something that we doctors definitely need exposure to and to keep in mind as a possible option," Dr. Preeti Nair said.
"We rarely think of acupuncture, and usually use local anaesthetics."Nair was not part of the current research. She has studied gag reflex at the People's College of Dental Sciences & Research Centre in Bhopal, India. One difference between a drug like local anaesthesia and acupuncture could be side effects.
"We haven't gotten all of the details in our hand, but with acupuncture, the side effects could be less," Nair said. Much more research is needed on the subject, she added. In order for a large, randomised controlled trial - the gold standard in medical research – to be done on this subject, dental offices and academic institutions may have to work together, said Chris Dickinson of King's College London Dental Institute at Guy's Hospital in England. In England, the British Dental Acupuncture Society offers training for dentists in certain dental applications of acupuncture, said Dickinson, who was not involved in the new study.
"There are very few contraindications associated with acupuncture and dental operations that we've experienced," Dickinson said. "But we don't use the technique in patients with metal allergies, pregnant women and those with needle phobias."
Dickinson noted that other acupuncture points could have been used for gag control such as ear points and LI4, also known as the Hegu point. Researchers in the current study placed needles in the PC6, EX 1 and CV24 acupuncture points on the face and wrist."The message to dentists is that it's a simple technique and easily learned," Dickinson said.
"It's also cost-effective. Even though it does not work in every case there's very little lost by trying it."In the US, acupuncture typically costs about $100 per session. One of the positive aspects of acupuncture is that after an operation, a patient may choose to drive home, which is not possible with other treatments, such as general anesthesia, Rosted said. "The risk of causing harm with this treatment is nearly non-existent," he said.