Periodontal Holistic Therapies: Acupuncture & Aromatherapy

 

Abstract

Periodontal diseasescontinue to be most commonly occurring oral diseasesin modern times. Many therapeutic modalitieshave been tried and tested to relieve these problems. The conventional therapy—scaling and root planing (SRP)—stands out to be the most used mode of treatment, and other treatments remain applicable as adjuncts to SRP, including acupuncture, acupressure, and aromatherapy. The present article discusses the applications of the abovementioned therapeutic modes and their relevance in current scenarios. Alternative medicine may be preferred as an adjunct to conventional periodontal therapy to relieve pain, bad breath, gingival inflammation, mouth ulcers, and mouth sores.

1. Introduction

The term ‘‘periodontal disease,’’ in its strictest sense, refers to both gingivitisand periodontitis. Gingivitis is an inflammatory condition of the soft tissues surrounding the teeth and is a direct immune response to dental microbial plaque that builds up on teeth. Gingivitis is influenced by several factors, including smoking, certain drugs, and hormonal changes that occur in puberty and pregnancy.

Periodontitis follows gingivitis and is influenced by the individual’s immunoinflammatory response. It is initiated by microbial plaque and manifests in only a subset of the population. It involves the destruction of the supporting structures of the teeth, including periodontal ligaments, bones, and soft tissues. Clearly, periodontitis demands serious concern because it is a direct cause of tooth mortality [1].

Alternative medicine is used across the world for the holistic management of diseases and the maintenance of good general health and includes acupressure, acupuncture, and aromatherapy. Acupuncture involves the insertion of specialized needles into trigger points (acupuncture points) that are situated along channels called “meridians” that run throughout the body [2]. Acupressure follows the same principles as acupuncture, but it involves stimulation of the points with gentle finger pressure instead of fine needles [3]. Aromatherapy utilizes the aromatic and therapeutic properties of essential oils and is used to treat different ailments.

2. Acupuncture

The word acupunctureis derived from the Latin “acus,” meaning a needle, and “puncture,” meaning “to prick” with a needle (According to Complementary Medicine & the National Health Service, 1996). Acupuncture uses very fine needles to gently prick specific points of the body to promote healing, relieve stress and anxiety, and reduce pain [4]. It can also be used to treat people with a wide range of illness because it focuses on improving overall wellbeing rather than specific symptoms [5].

2.1. Historical background

During the early 20thcentury, it was the law of the emperor of China that Western-style medical research not be practiced. Evidence of acupuncture therapy was noticed when a mummified body was recovered from a glacier in Switzerland that showed tattoo-like markings corresponding to trigger points [6].

The first examination performed under acupuncture anesthesiawas reported in China in 1960. In Japan, Masayoshi Hyodo pioneered 30 cases of acupuncture anesthesia in 1972 at Osaka Medical College and became one of the more experienced persons using acupuncture anesthesia [7]. Acupuncture has been used successfully for over 17 years as an alternative form of analgesia in dentistry.

2.2. Mechanism of action

According to Chinese philosophy, our health is dependent on the body’s motivational energy, qi [8], that moves smoothly through the series of meridians or channels that lie beneath the skin. Qi is comprised of equal and opposite energies called yin and yang, and illness can result when these forces become unbalanced. The flow of qi can be disturbed by factors such as anxiety, stress, anger, fear, grief, poor nutrition, hereditary conditions, infections, poisons, and trauma. The needle is pricked at trigger points to induce transcutaneous electrical nerve stimulation (TENS) at a low frequency (2–4 Hz), but with high intensity, in order to balance qi. Thus, the aim of acupuncture is to treat the person as a whole and strike equilibrium between physical, emotional, and spiritual needs.

Cun, or t-sun [9], is a unit of measurement used by the acupuncturist to locate trigger points. One unit is defined as the distance between the palmer creases over the proximal and distal interphalangeal jointsof the middle finger of the patient.

Because the degree of imbalance is unique to each individual, an acupuncturist needs to diagnose the complex pattern of this harmony and customize each treatment plan.

When a needle is inserted, the sensation is often described as that of a tingling or dull ache. An acupuncturist might insert a needle for a few seconds or leave it in place for 30 minutes or more depending on the needs of the patient. During therapy, patients commonly experience a pleasant feeling of relaxation.

The benefits of one or more session of acupuncture include more than just pain relief or the alleviation of symptoms, as reported by the British Acupuncture Council. Many people also experience increased energy levels, better appetite, improved sleep patterns, and an overall feeling of well-being [5].

Indications for acupuncture/acupressure in periodonticsand their corresponding trigger points include the following [Fig. 1]:

1.

Severe gingival redness and inflammation of the mandibular region [10].

a)

Stomach (ST) 6 (Jiache): located over the masseter muscle anterior to the angle of the mandible.

b)

ST 7 (Xiaguan): located in the center of the depression of the lower margin of the zygomatic arch, anterior to the TMJ. A finger is placed infront of the ear & simultaneously palpating for the TMJ movement while allowing the opening & closing of the jaw or by taking 0.1 t-sun above ST 6.

2.

Anxiety [11].

a)

Governing vessel (GV) 20 (Baihui): located on the midline of the scalp, 7 t-sun above the posterior hair line, 5 t-sun behind the anterior hair line, and midway between the line connecting the apex of both auricles.

b)

Extra ordinary 6 (Sishencong): these are group of four points situated 1 t-sun anterior, posterior, right lateral, and left lateral of GV20 on the scalp.

3.

Quitting drinking and smoking 10, 12.

a)

H 7 (Shenman Point): located on the medial side of the wrist, just proximal to the pisiform bone in a groove lateral to the tendon of the muscle flexor carpi ulnaris (the medial end of the most distal wrist crease on the anterior aspect).

4.

Dental anesthesia [13].

a)

Upper incisors and aphthous ulcers.

i.

GV 26 (Renzhong): located at the junction of the upper one-third and lower two-thirds of the philtrum of the upper lip.

i.

Large Intestine (LI) 20 (Yingxiang): located at the midpoint on the line drawn horizontally from the highest point of the ala nasitowards the nasolabial groove on the opposite side.

b)

Upper Canine:

i.

Small intestine (SI) 18 (Quanliao): located just below the inferior border of the zygomatic bone at a level vertically below the outer canthusof the eye.

c)

Premolar:

i.

ST 6

d)

Molar:

i.

ST 7

e)

Lower incisor, canine, premolar, and molars and the gag reflex:

a)

CV 24 (Chengjiang): located 0.5 t-sun inside the anterior natural hair line at the midline.

5.

To relieve periodontal/gingival pain and postoperative pain [14].

a)

Large intestine (LI) 4 (Hegu): located on the highest point of the bulge made by the first dorsal interosseus muscle when the thumb and index finger are held close together in adduction.

b)

LI 11(Quchi): Semiflex the elbow and take the lateral end of the elbow crease.

6.

Bad breath [14],

a)

Pericardium (Per) 7 (Daling): located at midpoint of the distal transverse wrist crease between the tendons of the flexor carpi radialis and palmaris longus muscles.

b)

Per 8 (Laogong): located at the middle of the palm. The fingers at metacarpophalangeal and interphalangeal joints should be flexed and be touching the center of the palm. This point lies between the tip of the middle and ring fingers, which is close to the third metacarpal bone.

7.

Gingival inflammation [15].

a)

ST 45 (Lidui): located 0.1 t-sun proximal to the lateral side of the corner of the nail of the second toe.

b)

Kidney (KI) 3 (Taixi): located midway between the tip of medial malleolus and Achilles tendon, just opposite the Urinary bladder (UB 60).

8.

Periodontitisof the maxillary teeth [16].

a)

ST 44 (Neiting): located on the dorsal aspect of the foot 0.5 t-sun proximal to the web space between the second and third toes.

2.3. Advantages

Electroacupuncture can be considered noninvasive because the effects are mediated via TENS, without the need for incisions [17].

Almost all patients in discomfort can undergo acupuncture treatment.

Acupuncture provides relief from both physical and mental problems.

In principle, acupuncture therapy aims to reestablish the harmony between the body and its surrounding environment in an attempt to eliminate the cause and not just the symptoms.

Acupuncture stimulates the release of endorphins into the blood stream; these constitute the body’s natural pain control system [18].

Acupuncture employs what is referred to as “the gate theory” to decrease aches and pain [19]. During acupuncture, the nerves in the spinal cord are stimulated, which in turn facilitate the release of certain pain-reducing neurotransmittersthat are the body’s natural and drug-free pain relief mechanisms.

Acupuncture might be responsible for increased blood flow due to the insertion of needles, thereby resulting in increased supply of essential nutrients to the affected area. This could also help remove toxins and facilitate healing.

2.4. Disadvantages

Acupuncture is safe only if the procedure is performed by a licensed acupuncturist (practitioner) and the needles that are used are sterile and nontoxic. The U.S. Food and Drug Administration (FDA) has set certain guidelines designed to ensure that cross contamination does not occur [20].

Patients report varying responses to acupuncture therapy, making it difficult to specify the dose or duration of acupuncture therapy. Some patients may require more than 10 sessions in order to obtain long-lasting benefits.

Although complications are rare, there have been reports of infections, rupture of organs, bleeding, swelling, and soreness at the treatment site.

3. Acupressure

Acupressureis the ancient Chinese healing method of applying pressure to certain points on the body in order to relieve pain. Acupressure is often used during anesthesiainjections in order to reduce anxiety and minimize pain [4].

3.1. Mechanism of action

Practitioners use their fingers, palms, knuckles, fist, elbows, or feet, or special devices to apply pressure over the acupointson the body’s meridians. Acupressure may also involve stretching or massage. During an acupressure session, one lies fully clothed on a soft massage table. The acupressurist gently presses or massages the acupressure points on the body. A session typically lasts for about 1 hour. One may need several sessions to obtain the best results. Some proponents claim acupressure not only treats the energy fields and body but also the mind, emotions, and spirit. Some even believe that the therapist transmits their vital energy (external qi) to the patient.

Not all Western practitioners believe that this is possible or even that meridians exist. Instead, they attribute the results of acupressure massage to other factors, such as reduced muscle tension, improved circulation, and the stimulation of endorphins[21].

3.2. Applications in periodontics

1.

Gingival/periodontal pain.

2.

Postoperative pain.

3.

Pain due to occlusal trauma.

4.

Relieves tension and anxiety before surgery.

5.

Relieves shock during surgery.

6.

Helps increase blood circulation after surgery [22].

3.3. Advantages

Acupressure can be carried out without any special equipment and, thus, offers easier means of treatment.

3.4. Disadvantages

Because only one acupressure point can be treated at a time, a patient with multiple problems may require multiple sittings.

Acupressure is time consuming because each trigger point needs to be stimulated for at least 5–10 minutes. The acupressurist is, thus, obliged to stay with the patient throughout treatment, whereas in acupuncture, after the insertion of the needles, the patient may be left alone until the effects manifest.

It can be employed only when the acupressure point lies over a bone. Pressure points that lie over soft areas, like the abdomen, are not therapeutic [23].

4. Aromatherapy

The art and science of using volatile oils for psychological and physical well-being is called aromatherapy. These volatile oils are derived from plants. Essential oils are used the most in aromatherapy due to the innumerable benefits they have on the mind-body system [24].

4.1. History of aromatherapy

Even though the term aromatherapy was not used until the 20thcentury, the foundations of aromatherapy date back thousands of years. In particular, the use of essential oils dates back nearly 1000 years. The Chinese may have been one of the first cultures to use aromatic plants for well-being. Their practices involved burning incense to help create mental/physical harmony and balance.

The ancient Egyptians used essential oils in incense and massage oil to heal and to promote a desired mood or atmosphere. Later, the Egyptians invented a rudimentary distillation machine that allowed for the crude extraction of cedarwood oil. It is also thought by some that Persia and India may have also invented crude distillation machines, but very little is known about this.

During the earlier part of the 20thcentury, a French chemist René-Maurice Gattefossé became interested in the use of essential oils for their medicinal uses. Gattefossé is credited with coining the term aromatherapy in 1928. In 1937, Gattefossé wrote a book called Aromathérapie: Les Huiles essentielles hormones végétalesthat was later translated into English and named Gattefossé’s Aromatherapy[25].

4.2. Mechanism of action

Theories about the mechanism of action of aromatherapy and essential oils differ, depending on the community studying them. Proponents of aromatherapy often cite the connection between olfactionand the limbic systemin the brain as the basis for the effects of aromatherapy on mood and emotions. Most of the aromatherapy literature, however, lacks in-depth neurophysiological studies on the nature of olfaction and its link to the limbic system, and it generally does not cite research that shows these links. Proponents of aromatherapy also believe that the effects of these treatments are based on the special nature of the essential oils used. Some authors propose that the extraction of essential oils from whole aromatic plants causes them to contain a life force or vitality that allegedly sets essential oils apart from other (i.e., synthetic) fragrances[26].

This neurobiological view, which focuses mostly on the emotional and psychological effects of fragrances (as opposed to the other symptomatic effects claimed by aromatherapists), takes into account what is known about olfactory transductionand the connections between the olfactory system and other central nervous system functions; however, it is primarily theoretical because of the lack of significant research that addresses this topic [27].

4.3. Applications in periodontics

1.

Clove oil (90% eugenol): acts as a mild oral anaesthetic and cures mouth sores, ulcers, and sore gums. It has a “strong activity” against bacteria associated with plaque formation and helps to reduce bad breath. It also helps to numb tooth painand combat bacterial infections and inflammation 28, 29, 30.

2.

Lemon essential oil: acts as a good stimulant of the body’s own immune system and helps to cure gingivitis, gingival herpetic stomatitis, and mouth ulcers[31].

3.

Orange oil: as an anti-depressant, it is also an anti-inflammatory and antiseptic and supports the healing process in cases of inflamed gums and periodontal disease 32, 33.

4.

Basiloil: the antibacterial propertiesof basil can prevent plaque formation, dental caries, and bad breath.

5.

Eucalyptus oil: appears to inhibit the formation of dental plaque and effectively kills several strains of Staphylococcusbacteriato help heal mouth sores and gum disorders 34, 35.

6.

Tea-tree oil: halts halitosis and helps cure severe and chronic gingivitis [36].

7.

Myrrh essential oil: helpful for treating gingivitis and mouth ulcers [37].

4.4. Mode of application

Aromatic oils are incorporated into incenses and massage oils to promote healing and desired moods and atmospheres. For the aforementioned periodontal ailments, aromatic oils are delivered in the form of massage oils.

4.5. Advantages

Inexpensive, compact, and easy to handle. Reaches the afflicted sites directly and leaves the body quickly without any residues.

4.6. Disadvantages

Lack of regulation and can cause skin irritation, hormonal effects, and harmful drug interactions in young babies and asthmatics.

5. Conclusion

There is significant and growing interest in the use of alternative medicine in periodontal therapies across the world. Acupuncture, as an adjunctive therapy, has gained popularity due to its safe and effective applications that fulfill the objectives of public health initiatives. Although acupuncture has been studied and shows promising results as an adjunct to conventional treatments, other alternative approaches, like acupressureand aromatherapy, remain relatively and/or incompletely studied. No clinical trials have been conducted so far regarding the use of these therapies. There is a paucity of high-quality studies in the field. Until a reasonable number of methodologically sound studies are completed on these varied treatment modalities, it will remain difficult to draw any substantive conclusions regarding their usefulness to clinicians.