Cássia Maria Grillo

Could Acupuncture Be Useful in the Treatment of Temporomandibular Dysfunction

In this study, the effects of acupuncture in comparison with flat occlusal plane appliance were evaluated in patient with myogenic temporomandibular dysfunction (TMD). The sample consisted of 40 women with TMD and unbalanced energy predominance of Yang Liver Ascension, selected using the Renying and Cunkou pulses, randomly divided into two groups: acupuncture and splint. The effect of treatments on the masseter and anterior temporal muscles was evaluated after 4 weeks of treatment, by means of electromyographic activity (root mean square) and pain pressure threshold. Pain intensity was measured using the visual analog scale, and range of mouth opening was evaluated using a millimeter ruler. All evaluations were performed at the beginning and end of the treatment. Visual analog scale score was reduced equally in the two groups (p < 0001), and the increase in range of mouth opening was significant in both groups. A significant difference was detected only in pain pressure threshold of the left masseter in the acupuncture group (p < 0.05). Only root mean square in the at rest position of the right temporal muscle diminished in the final stage of the splint group (p < 0.05). Both treatments reduced the pain intensity of myogenic TMD in the short term and may be considered strategies for control of chronic pain related to TMD.

Acupuncture in the Management of Acute Dental Pain

Acute dental pain is the main reason for seeking dental services to provide urgent dental care; there is consensus about the use of alternative therapies, such as acupuncture, to control dental pain in pre-dental care. This study aimed to evaluate the use of acupuncture in reducing the intensity of acute dental pain in pre-dental care in patients waiting for emergency dental care, and was conducted at the After-Hours Emergency Dental Clinic of Piracicaba Dental School, and at the Emergency Center Dental Specialties I in Piracicaba, São Paulo, Brazil. The sample consisted of 120 patients. The Visual Analog Scale (VAS) was used to measure pain intensity. All patients underwent one session of acupuncture; the points LI4, ST44 and CV23 were selected and were used alone or in combinations. Reduction in pain was observed in 120 patients (mean initial VAS=6.558±1.886, p<0; mean final VAS=0.962±2.163, p<0.00001). The results of this study indicate that acupuncture analgesia could be a technical adjunct to pain control in patients with acute dental pain, contributing to the restoration of health with social benefit.

A Case Report on the Effect of Sham Acupuncture

When nausea, an extremely unpleasant symptom, is experienced during dental treatment, it generates disorders and obstacles for both the patient and the professional, compromising the good quality of dental care. Clinical studies have confirmed the antiemetic action of acupuncture and shown its use for the treatment of nausea and vomiting. In the scientific literature there are several recent studies that address the placebo effect of acupuncture. The aim of this manuscript is to present a case report of a 46-year-old Caucasian male patient, who had severe symptoms of nausea while undergoing dental care. Treatment with sham acupuncture (acupuncture simulation) obtained a positive result of nausea prevention. We will discuss three possible hypotheses concerning this result: (1) there was action of Deqi; (2) high expectations of the patient; and (3) association with specific learned response. The patient in this case report received nonpenetrating sham acupuncture at acupoint Neiguan (PC6), which resulted in the complete remission of nausea during an intra-oral impression-taking procedure, but it is unclear whether the placebo effect was triggered by the action of Deqi, the high expectations of the patient, an association with a learned response, or by the interaction of all these factors.

Therapeutic effectiveness of a combined counseling plus stabilization appliance treatment for myofascial pain of the jaw muscles: A pilot study

Objective: This study aims to assess changes over time in pain intensity (VAS) and in pressure pain threshold (PPT) of the anterior temporalis and masseter muscles with a treatment protocol combining counseling and stabilization appliance as well as its effects on psychosocial factors. Methods: Twenty individuals with myofascial pain of jaw muscles lasting from at least six months were selected for an uncontrolled before-after study. Counseling was performed by giving information on myofascial pain and advice on self-management. Stabilization appliances were delivered one week after the first counseling session. A number of outcome variables (i.e. visual analogue scale [VAS], pain pressure threshold [PPT] and Research Diagnostic Criteria for Temporomandibular Disorders axis II [RDC/TMD]) were assessed at different evaluation points during a six-month follow-up. ANOVA for repeated measures and Pearson’s correlation test were used to evaluate changes in the outcome variables over time. Results: Compared to baseline data, a significant positive change was found at the 1st week, 1st, 3rd, and 6th month evaluations for VAS values (P < 0.0001) and at the 1st week, 3rd, and 6th month evaluations for PPT values (P < 0.05). RDC/TMD axis II values were significantly different (P < 0.05) from baseline to all evaluations points. Conclusion: The association of counseling and stabilization appliance is effective in the management of chronic myofascial pain of jaw muscles. Future controlled studies are required to get deeper into the assessment of the relative effectiveness of counseling and stabilization appliances.

Psychological aspects of temporomandibular disorder patients: evaluations after acupuncture treatment

BACKGROUND AND OBJECTIVES: Depression and somatization are emotional features present in chronic temporomandibular disorder pain patients. This study aimed at evaluating results after acupuncture on psychological aspects of females with chronic muscle temporomandibular disorder pain. METHODS: Sample was made up of 40 females, aged between 18 and 45 years, submitted to two procedures: acupuncture and splint. Patients were evaluated for one month by the Research Diagnostic Criteria for Temporomandibular Disorders questionnaire Axis II before and after treatment. Treatment expectation before treatment was also evaluated by a visual analog scale with verbal anchors: negative expectation and positive expectation. RESULTS: There has been chronic pain improvement in 53.3% of acupuncture patients and in 60% of splint patients. For severe depression, 11.1% of acupuncture and 50% of splint patients have improved. Patients with severe somatization had 16.7% improvement with acupuncture and 44.4% with splint. There has been negative correlation (p<0.05) between treatment expectation and somatization (including and excluding pain items) for the acupuncture group. CONCLUSION: Both groups have improved some psychological aspects (depression and somatization) after a short period of treatment.

Temporomandibular disorder pain improvement with acupuncture: preliminary longitudinal descriptive study

JUSTIFICATIVA E OBJETIVOS:Acupuntura e um metodo terapeutico e seu uso e amplo para o tratamento da dor. As disfuncoes temporomandibulares apresentam sintomas como dores na face, na regiao da articulacao temporomandibular, nos musculos mastigatorios. O objetivo deste estudo foi descrever os resultados obtidos na reducao da intensidade de dor na disfuncao temporomandibular em pacientes atendidos no servico publico com um numero minimo de tres sessoes de acupuntura.METODOS:Trata-se de estudo descritivo de pacientes com disfuncao temporomandibular tratados com acupuntura no Centro de Especialidades Odontologicas I do municipio de Piracicaba (SP), no periodo de setembro de 2010 a outubro de 2011. A amostra foi de 31 pacientes, de ambos os generos, com idade entre 14 e 68 anos. A dor foi mensurada atraves da escala analogica visual (EAV), denominada EAV inicial (pre-tratamento) e EAV final (pos-tratamento), respectivamente no inicio e ao final da sessao de acupuntura. Cada paciente recebeu tres sessoes de acupuntura, uma vez por semana com a duracao de 20 minutos.RESULTADOS:A dor cessou (EAV=0) em 67,7% dos pacientes que apresentaram reducao na intensidade de dor, com EAVi da 1a sessao maior (6,10±2,64) do que a EAVf da 3a sessao (1,16±1,98).CONCLUSAO:Com um numero minimo de tres sessoes semanais de acupuntura foi possivel o controle da dor em pacientes com disfuncao temporomandibular independentemente do grau de dor inicial. Sua utilizacao poderia contribuir para ampliar o atendimento a esses pacientes no servico publico por ser uma pratica terapeutica de baixo custo e facil aplicacao.

Acupuntura no manuseio da dor orofacial e do tinido: Relato de caso

BACKGROUND AND OBJECTIVES: Orofacial pain is associated to soft and mineralized oral cavity and facial tissues. In dentistry, it may have or not odontogenic origin. Temporomandibular disorder (TMD) is the most common musculoskeletal orofacial pain and presents characteristic symptoms such as masticatory muscles pain, jaw movement limitation, joint noises, earache and tinnitus. Tinnitus is a term describing the perception of sound by human ears in the absence of external sounds and causes discomfort impairing quality of life. It may be a symptom indicating TMD especially when other symptoms are present, such as facial muscles pain. Due to etiologic variability, there are several therapeutic modalities, including acupuncture. This study aimed at reporting a case of a patient with orofacial pain and tinnitus treated with acupuncture and the results after treatment. CASE REPORT: Female patient, 32 years old, came to the Acupuncture Clinic of the School of Dentistry of Piracicaba (FOP/UNICAMP) complaining of facial muscle pain and pricking at the same side, acute right ear tinnitus, already with diagnosis of left ear hearing loss and with sleep disorders and stress. Patient was treated according to her energetic unbalance with 6 sessions of traditional acupuncture, for one week, lasting 20 minutes. To evaluate orofacial pain and tinnitus intensity, the visual analog scale (VAS) was used and was called initial VAS (pre-treatment) and final VAS (post-treatment). After the second session there has been improvement in orofacial pain and tinnitus symptoms. After the sixth session tinnitus had resolved. CONCLUSION: Acupuncture has induced muscle relaxation with benefits for masticatory and middle ear (tensor tympani) muscles, as well as levator palate muscle decreasing orofacial pain and tinnitus intensity.