Complementary Therapies in Oral Medicine
The aim of this chapter is to describe complementary therapies that may be used in oral medicine.
After reading this chapter you should have an understanding of the range and value of the various complementary therapies possibly of use in oral medicine.
Western medicine has made significant advances, particularly over the past 60 years, into the treatment of many disorders. However, these tend to only constitute around 20% of all disease, leaving some 80% at best being controlled. This applies particularly to those conditions that are chronic or have an emotional basis. In addition, modern medicine has tended to place emphasis on treatment of disease rather than its prevention including lifestyle issues. This apparent failure has resulted in a growing interest among both the general public and some health care professionals to look to alternative or complementary forms of therapy. Reasons frequently given include:
orthodox treatments have failed
concern over side-effects of drugs
religious, cultural or philosophical reasons
some people just like to protest against orthodoxy
experiment with often exotic forms of therapy.
The difficulty for many conventional western-trained practitioners is that the mechanisms suggested as to how these therapies work do not always fit with accepted concepts of pathophysiology. In some instances reasons can be found as to why some methods such as acupuncture or hypnotherapy may be effective. In addition, the gold standard of evidence-based medicine – the double-blind randomised controlled trial – is difficult to undertake with many complementary therapies, given the individualistic nature of the treatment, such as in homoeopathy. These apparent deficits have led to a virtual rejection by many orthodox practitioners. Despite this, there are increasing numbers of patients seeking such treatment and in practitioners willing to provide it. There is also a trend in many orthodox circles towards being more open-minded and to facilitate research to determine what role these therapies may play. In addition, many medical schools, and to a lesser extent dental schools, are starting to incorporate courses covering complementary therapies within their curricula. Indeed, some therapies, such as hypnotherapy and acupuncture, are becoming accepted as routine therapeutic measures for certain conditions.
On the whole, dentistry has been slow to investigate the role of complementary medicine, with the exception of hypnotherapy. Some of the more popular therapies are discussed in this chapter. It is not all-inclusive, and interested readers are referred to the literature for more detail of the individual therapies. Those keen to pursue them further with a view to practice are recommended to seek out courses run through the various professional organisations, which are regulated, have proper codes of practice and training facilities. It is also essential to check with the medical defence organisations that they would be prepared to indemnify such therapies.
Acupuncture involves the insertion of fine needles into or pressing on (acupressure) defined points within the subcutaneous tissues. It has been practiced in China for at least 3000-4000 years and probably arose from careful observation that when areas of the body were traumatised symptoms at distant points were relieved. As such, acupuncture became an important component of traditional Chinese medicine with concepts such as the five elements, Yin and Yang, the circulation of a life force Qi through meridians or channels around the body taking a well-described course. These hypotheses are difficult to understand in terms of modern science, as there is little or no evidence to support their existence. Despite this, there is clear evidence as to the effectiveness of acupuncture for a whole range of disease processes. More recent work on acupuncture has given some indication as to its mechanisms of action. These include a segmental effect, blocking the spinal gate and thereby inhibiting pain modulation. In addition, there are more generalised central effects through the raphe magnus nucleus, which is the main producer of serotonin in the brain. This may explain the beneficial effect of acupuncture on stress and anxiety. There is also an increased release of endorphins, which again could have an effect on pain perception. Acupuncture has also been demonstrated to deactivate trigger points. These are small, well-defined areas located within muscles that can become activated through stress or strain to the muscle, giving rise to chronic pain often referred to an anatomically unrelated area. Matching these trigger points, which are relatively consistent between individuals, there is a remarkabl/>