Νευροινιδιακη εκφυλιση και δενδριτικεσ αλλοιωσεισ

The Use of Acupunture in Dentistry

YEHIEL ALPERN D.M.D A.C

פניה לרפואה משלימה

ב וכלל"בסקר מקיף שנערך בארהנמצא כי , אלף מרואיינים30 מעל

18 מהמשתתפים מעל גיל אחוז 36פנו לשירותי הרפואה האלטרנטיבית

.בזמן מחלה

?ומה קורה בישראל

1993 משתתפים בשנת - 2000 בסקר עם יותר מעליה שלנמצא כי בשנים אלה היתה 2000, ובשנת במספר הפונים לרפואה משלימה - 70%קרוב ל

הגישות הטיפוליות הפופולריות ביותר היו הומאופתיהאקופונקטורהו

נשים ותושבי ערים גדולות נטו יותר לטיפולים 75% דווחו 2000 כ בשנת "אלטרנטיביים וסה

מהמטופלים שהטיפול עזר להם

107. Acupuncture

National Institutes of HealthConsensus Development Conference Statement

3-5,1997November

Ample clinical experience, supported by someresearch data, suggests that acupuncture may be a reasonableoption for a number of clinical conditions. Examples arepostoperative painand myofascial and low back pain.

The History of Acupuncture

Acupuncture, or needle puncture, is a European term invented by Willem Ten Rhyne, a Dutch physician who visited Nagasaki in Japan in the early part of the seventeenth century.

The Chinese describe acupuncture by the character 'Chen', which literally means 'to prick with a needle', a graphic description of this therapeutic technique.

Early History

Acupuncture has a clearly recorded history of about 2,000 years, but some authorities claim that it has been practiced in China for some 4,000 years. The Chinese believe that the practice of acupuncture began during the Stone Age when stone knives or sharp edged tools, described by the character 'Bian', were used to puncture and drain abscesses..

APPLICATION IN DENTISTRY

SEDATION-PREOPERATIVE PAIN CONTROL-POSOPERATIVE GAG REFLEX CONTROL CONDITIONS in oral medicine: TMJ DIS -FUNCTION,BRUXISM

RECURENT APHTOUS STOMATITIS

Facial paralysis ,Trigeminal neuralgia Modified taste sensation, Burning mouth

syndrome,xerostomia…….

YIN &YANG

The Yellow Emperor said ''The principle of Yin and Yang is the foundation of the entire universe. It underlies everything in creation. It brings about the development of parenthood; it is the root and source of life and death it is found with the temples of the gods In order to treat and cure diseases one must search for their origins.

CHINESE PHYLOSOPHY

YANG=YANG=LIGHTLIGHTSUNSUNACTIVITYACTIVITYEASTEASTENERGYENERGYWARMWARMUPPERUPPEREXTERNALEXTERNALMINDMIND

YIN=DARKNESSMOONRESTWESTMATTERCOLDLOWERINTERNALBODY

PHYSIOLOGY

THE VITAL SUBSTANCES :

THE VITAL ENERGY ,LIFE FORCE : “CHI” =MOVEMENT, WARMTH, SPIRIT,ORGAN FUNCTION, WEI –

PROTECTION(IMMUNITY) JING -life essence (genetics)

BLOOD BODY FLUIDS YIN AND YANG ORGANS

PATHOLOGY

THE EIGHT PRINCIPLESDEFICIENCY YINEXCESS YANGINTERIOR HOTEXTERIOR COLD TCM’S SYNDROMES

ToothacheKey Diagnostic Points:Toothache is a common symptom. It can be involved in acute or chronic pulpitis (inflammationof the dental pulp), dental caries (tooth decay), periodontal abscess and pericoronitis(inflammation of the gingiva, surrounding the tooth).Differential Diagnosis:1) Toothache due to Stomach fire.Severe toothache accompanied by foul breath, thirst, constipation.Tongue: Yellow coatPulse: Rapid, flooding2) Toothache due to wind-fire.Acute toothache with gingival swelling accompanied by chills and fever.Tongue: Thin white coatPulse: Superficial and rapid3) Toothache due to Kidney Yin deficiencyDull pain on and off. Loose teeth.Tongue: Red bodyPulse: Thready and rapid

Treatment Principle:Clear away fire, stop pain.Point and Technique Prescription:

L.I. 4: One of the four key points, this one for face and mouth. It's also the YuanSource point for the L.I. channel. L.I. goes into the lower gums.St 6 and 7: (reduce) Local points found on the stomach channel. Stomach channelenters the upper gums.

For use with Stomach fire and wind fire, the above three points should be reduced. For KidneyYin Deficiency, the above three points should receive even stimulation.For Stomach fire, add:

St 44: (reduce) Ying spring point of Stomach channel is used to reduce the stomach fireas Ying spring points are used for heat/fire.

For Wind-fire, add:SJ 2 (reduce) The Ying spring point of the San Jiao. Ying Spring for heat/fire, This pointclears fire and dispels wind.SJ 5 (reduce) Luo connecting point of San Jiao, and the confluent point for the YangWei Mai especially effective for exterior syndromes. Dispels wind and heat.Du 14: (reduce) Clears away fire because its the meeting point of all yang channels anda nape location, many of which are effective on wind attacks.

For Kidney Yin deficiency, add:Kid 3: (reinforce) Nourishes Kidney Yin. Tai Xi, "Great River" the deep and lowcollecting point of water on the body.

LI 4

Chinese Name: He GuEnglish Name: Union Valley

Description: In the middle of the 2nd metacarpal bone on the radial side.Any problem on the face - sense organs, mouth, teeth, jaw, toothache, allergies, rhinitis, hay fever, acne, eye problems, etc. Tootache use both LI 4 & ST 44 - LI for the

lower jaw & ST for the upper jaw. Headache, especially frontal a/or sinus

(yangming area).

ST7 • XiaguanStomach 7 • Meeting point of the Stomach and Gall Bladder ChannelsLocation: With mouth closed, in the depression at the lower border of the zygomatic arch, anterior to the condyloid process of the mandible.Benefits The Ears, Jaw And TeethActivates The Channel And Alleviates PainCheek And Facial Pain • Cheek Pain And Swelling • Deafness • Ear Pain • Jaw Dislocation • Jaw Lower And Gums Swollen • Mouth And Eye Deviation • Purulent Discharge And Itching • upper Teeth And Lower Jaw • Tetany Facial • Tinnitus • Toothache • Visual Dizziness • Yawning •

ST5 • DayingStomach 5 • Great WelcomeLocation: Anterior to the angle of the mandible, on the anterior border of masseter muscle, in the depression that appears when the cheek is bulged. CautionAvoid the Artery!Eliminates Wind And Reduces SwellingAdenopathy • Chills • Edema Face And Lower Cheek • Eye Pain With Inability To Close Eyes • Facial Swelling Wind Obstruction • Fever And Chills With Neck Pain • Frequent Yawning • Lips Twitching • Mouth Deviation • Mumps • Stiff Tongue With Inability To Speak • Toothache Lower Jaw • Wind Tetany With Lockjaw •

THEORETICAL EXPLANATIONS FOR ACUPUNCTURE

TRADITIONAL THE

MERIDIANS

14 MAJOR 8 EXTRA

SCIENTIFIC “ GATE CONTROL” Melzack and wall

1965“NEURAL

MECHANISMS” Stux and Pomerants

1987

Gate control theory Melzack &Wall 1965

Small diameter nerve fibers carry pain stimuli through a gate but large diameter nerve fibers going through the same gate can inhibit transmission of those pain impulses

The brain also appears to influence whether the gate is open or closed

Acupuncture excites the pain inhibitory nerve fibers for a short period of time, thereby blocking pain, but the effects of acupuncture can last for some months after the acupuncture needle has been removed, and nothing in the Gate Theory really explains this prolonged effect. Acupuncture is a valuable treatment in a variety of non-painful diseases and the Gate Theory makes no attempt to explain the mechanism of acupuncture in the treatment of these diseases.

NEURAL MECHANISMS OF ACUPUNCTURE ANALGESIA STUX & POMERANTZ

AA is initiated by stimulation of small diameter AA is initiated by stimulation of small diameter nerves in muscles which sends impulses to:nerves in muscles which sends impulses to:

Endorphins and Monoamines Endorphins and Monoamines

Spinal cordSpinal cord midbrainmidbrain

ANALGESIAANALGESIA

Pitutary & hypotalamusPitutary & hypotalamus

Endorphins

Endorphins are released into the nervous system by the action of acupuncture and the effects of acupuncture anaesthesia can be reversed by the use of anti-morphine drugs.

*From some recent research work it would seem that not all types of acupuncture are blocked by anti-morphines

*The endorphin theory again only deals with pain and makes little attempt to explain the use and effects of

acupuncture in non-painful diseases.

Suggestibility

Acupuncture has been criticized for being no more than a complex form of 'hypnotic suggestion'. Available research work shows that those gaining benefit from acupuncture treatment are no more or less suggestible than those for whom acupuncture does not work. It would therefore seem that acupuncture does not depend on suggestibility. At the same time, acupuncture does have a certain amount of 'magic and mystery' surrounding it. Almost certainly this creates a small amount of benefit although it does not fully explain the dramatic and significant therapeutic effects of acupuncture.

Other Ideas

Some research workers, particularly in Russia, have suggested that fields of biological activity exist around all living objects. The concept of 'biofields' has little hard scientific evidence to support it, but there are people in both Russia and America who are suggesting that acupuncture may work through these 'fields. At present there are no good grounds for accepting or rejecting these theories.

Dr. Nogier's pulse reflex may possibly be part of the effect

of such 'biofields'

Auriculotherapy is a therapeutic Auriculotherapy is a therapeutic intervention in which the auricle intervention in which the auricle of the external ear is utilized to of the external ear is utilized to alleviate pain, dysfunction and alleviate pain, dysfunction and

disease as represented and disease as represented and manifest throughout the bodymanifest throughout the body

KIRLIAN PHOTOGRAPHYKIRLIAN PHOTOGRAPHY Kirlian Kirlian Photography is a process that Photography is a process that uses high frequencies and uses high frequencies and electron streams to take a electron streams to take a picture of invisible radiating picture of invisible radiating energy fields that surrounds energy fields that surrounds all living things all living things

Graphically illustrate the difference in

presents of CHI (Life) energy

level before and after

acupuncture, massage, raiky,

Qi Ging, exercise, polarity, or any

other body work.

No Real Answer?

The fact of the matter is that acupuncture does work, and has been shown to do so, but the exact answer as to how it works is unclear. The current scientific explanations give a logical and supportable basis for stating that it does have an effect on the nervous system, but it is difficult to draw any more definite conclusions.

MethodsTRADITIONAL AND MODERN

ACUPUNCTURE MOXIBUSTION HERBS

ELECTRO ACUPUNCTURE SOFT LASER BIORESONANCE AND HOMEOPATHY

AACUPUNCTURE NEEDLESCUPUNCTURE NEEDLES

Moxa

Modern Acupuncture Techniques

Both Chinese and European firms has produced small electrical stimulators that allow small amplitude pulsed electrical currents to pass between sets of paired acupuncture needles. In China these electrical machines are used to replace prolonged manual stimulation of acupuncture needle in activities such as acupuncture anaesthesia. In the West electrical stimulation is often used as part of standard acupuncture therapy. The voltage used is small and painless and passed between acupuncture needles that have already been inserted into the skin.

ToothacheKey Diagnostic Points:Toothache is a common symptom. It can be involved in acute or chronic pulpitis (inflammationof the dental pulp), dental caries (tooth decay), periodontal abscess and pericoronitis(inflammation of the gingiva, surrounding the tooth).Differential Diagnosis:1) Toothache due to Stomach fire.Severe toothache accompanied by foul breath, thirst, constipation.Tongue: Yellow coatPulse: Rapid, flooding2) Toothache due to wind-fire.Acute toothache with gingival swelling accompanied by chills and fever.Tongue: Thin white coatPulse: Superficial and rapid3) Toothache due to Kidney Yin deficiencyDull pain on and off. Loose teeth.Tongue: Red bodyPulse: Thready and rapid

Treatment Principle:Clear away fire, stop pain.Point and Technique Prescription:

L.I. 4: One of the four key points, this one for face and mouth. It's also the YuanSource point for the L.I. channel. L.I. goes into the lower gums.St 6 and 7: (reduce) Local points found on the stomach channel. Stomach channelenters the upper gums.

For use with Stomach fire and wind fire, the above three points should be reduced. For KidneyYin Deficiency, the above three points should receive even stimulation.For Stomach fire, add:

St 44: (reduce) Ying spring point of Stomach channel is used to reduce the stomach fireas Ying spring points are used for heat/fire.

For Wind-fire, add:SJ 2 (reduce) The Ying spring point of the San Jiao. Ying Spring for heat/fire, This pointclears fire and dispels wind.SJ 5 (reduce) Luo connecting point of San Jiao, and the confluent point for the YangWei Mai especially effective for exterior syndromes. Dispels wind and heat.Du 14: (reduce) Clears away fire because its the meeting point of all yang channels anda nape location, many of which are effective on wind attacks.

For Kidney Yin deficiency, add:Kid 3: (reinforce) Nourishes Kidney Yin. Tai Xi, "Great River" the deep and lowcollecting point of water on the body.

LI 4

Chinese Name: He GuEnglish Name: Union Valley

Description: In the middle of the 2nd metacarpal bone on the radial side.Any problem on the face - sense organs, mouth, teeth, jaw, toothache, allergies, rhinitis, hay fever, acne, eye problems, etc. Tootache use both LI 4 & ST 44 - LI for the

lower jaw & ST for the upper jaw. Headache, especially frontal a/or sinus

(yangming area).

ST7 • XiaguanStomach 7 • Meeting point of the Stomach and Gall Bladder ChannelsLocation: With mouth closed, in the depression at the lower border of the zygomatic arch, anterior to the condyloid process of the mandible.Benefits The Ears, Jaw And TeethActivates The Channel And Alleviates PainCheek And Facial Pain • Cheek Pain And Swelling • Deafness • Ear Pain • Jaw Dislocation • Jaw Lower And Gums Swollen • Mouth And Eye Deviation • Purulent Discharge And Itching • upper Teeth And Lower Jaw • Tetany Facial • Tinnitus • Toothache • Visual Dizziness • Yawning •

ST5 • DayingStomach 5 • Great WelcomeLocation: Anterior to the angle of the mandible, on the anterior border of masseter muscle, in the depression that appears when the cheek is bulged. CautionAvoid the Artery!Eliminates Wind And Reduces SwellingAdenopathy • Chills • Edema Face And Lower Cheek • Eye Pain With Inability To Close Eyes • Facial Swelling Wind Obstruction • Fever And Chills With Neck Pain • Frequent Yawning • Lips Twitching • Mouth Deviation • Mumps • Stiff Tongue With Inability To Speak • Toothache Lower Jaw • Wind Tetany With Lockjaw •

Effects of Electro AcupunctureLOW FREQUENCY(2-4 hz)HIGH INTENSITY= LOW FREQUENCY(2-4 hz)HIGH INTENSITY=

ENDORPHIN SYSTEM---THREE CENTERS ENDORPHIN SYSTEM---THREE CENTERS ---slower onset and long duration ---slower onset and long duration --- cumulative --- cumulative ---called “acupuncture like TENS” =produce “CHI”---called “acupuncture like TENS” =produce “CHI” ---given frequently (more than daily)=tolerance ---given frequently (more than daily)=tolerance ( morphine like) ( morphine like)

))HIGH FREQUENCY (50-200HZ), LOW INTESITY HIGH FREQUENCY (50-200HZ), LOW INTESITY SPINAL CORD AND MIDBRAIN (by pass endorphinSPINAL CORD AND MIDBRAIN (by pass endorphin

---conventional “TENS” (gate theory) ---conventional “TENS” (gate theory) system)- system)- ---rapid onset and short duration ---rapid onset and short duration

---no cumulative effects ---no cumulative effects TREATMENT FAILURE= deficiency of endorphines or TREATMENT FAILURE= deficiency of endorphines or

deficiency of opiate receptorsdeficiency of opiate receptors

Electrical stimulation on periodontal regeneration in

experimental 4wall bony defects in dogs

Kaynak ,JP 2005 ,2194

Quality of new bone fill and Quality of new bone fill and mean value of cementum were mean value of cementum were

significantly higher than controlsignificantly higher than control

Herbal Remedies

Herbal medicine is itself a powerful method of healing. Western drugs often control symptoms, but do not alter the disease process ( antibiotics eliminate bacteria but do not improve a person's resistance to infection; diuretics fid excess fluid without improving kidney function). Chinese herbs treat the underlying condition as defined by traditional diagnosis, and rarely cause unwanted side-effects.

Literature of effects in dentistry

Acupuncture induces an increase in the local blood and salivary flux in xerostomia patients j.oral rehab.1993 Blom et al.

Trigeminal neuralgia

ACUPUNCTURE treatment is useful in management of trigeminal neuralgia j .of anest.and pain in density Beppu et al 1992

TMJ

Acupuncture is useful in Tmj disorders psychological related but not due to occlusal interference . Raustia et al

J.prosthet.dent 1986 nov ,56(5)

Bacteria

Shimura et al., (1980) showed that acupuncture reduced the number of cavity-causing bacteria in rats even after the rats were fed a sugary diet

Gag reflex

PC6 an efficient acupoint for dealing with gag reflex .Yugin. Special care in dentistry jan-feb 1989

The use of acupuncture in dentistry: a review of the scientific

validity of published paper Oral Dis. 1998 Jun;4(2):100-4

Acupuncture in 11 out of 15 studies proved effective in the treatment of temperomandibular dysfunction (TMD) and as analgesia

A Randomized Controlled Trial of Tai Chi for Tension Headaches Ryan B

Tai Chi seems to directly affect stress and tension that contribute to the pain associated .In addition, Tai Chi may affect other symptoms that arise from

stress such as tachycardia,fatigue,anxiety, insomnia,

etc..

ToothacheKey Diagnostic Points:Toothache is a common symptom. It can be involved in acute or chronic pulpitis (inflammationof the dental pulp), dental caries (tooth decay), periodontal abscess and pericoronitis(inflammation of the gingiva, surrounding the tooth).Differential Diagnosis:1) Toothache due to Stomach fire.Severe toothache accompanied by foul breath, thirst, constipation.Tongue: Yellow coatPulse: Rapid, flooding2) Toothache due to wind-fire.Acute toothache with gingival swelling accompanied by chills and fever.Tongue: Thin white coatPulse: Superficial and rapid3) Toothache due to Kidney Yin deficiencyDull pain on and off. Loose teeth.Tongue: Red bodyPulse: Thready and rapid

Treatment Principle:Clear away fire, stop pain.Point and Technique Prescription:

L.I. 4: One of the four key points, this one for face and mouth. It's also the YuanSource point for the L.I. channel. L.I. goes into the lower gums.St 6 and 7: (reduce) Local points found on the stomach channel. Stomach channelenters the upper gums.

For use with Stomach fire and wind fire, the above three points should be reduced. For KidneyYin Deficiency, the above three points should receive even stimulation.For Stomach fire, add:

St 44: (reduce) Ying spring point of Stomach channel is used to reduce the stomach fireas Ying spring points are used for heat/fire.

For Wind-fire, add:SJ 2 (reduce) The Ying spring point of the San Jiao. Ying Spring for heat/fire, This pointclears fire and dispels wind.SJ 5 (reduce) Luo connecting point of San Jiao, and the confluent point for the YangWei Mai especially effective for exterior syndromes. Dispels wind and heat.Du 14: (reduce) Clears away fire because its the meeting point of all yang channels anda nape location, many of which are effective on wind attacks.

For Kidney Yin deficiency, add:Kid 3: (reinforce) Nourishes Kidney Yin. Tai Xi, "Great River" the deep and lowcollecting point of water on the body.

LI 4

Chinese Name: He GuEnglish Name: Union Valley

Description: In the middle of the 2nd metacarpal bone on the radial side.Any problem on the face - sense organs, mouth, teeth, jaw, toothache, allergies, rhinitis, hay fever, acne, eye problems, etc. Tootache use both LI 4 & ST 44 - LI for the

lower jaw & ST for the upper jaw. Headache, especially frontal a/or sinus

(yangming area).

ST7 • XiaguanStomach 7 • Meeting point of the Stomach and Gall Bladder ChannelsLocation: With mouth closed, in the depression at the lower border of the zygomatic arch, anterior to the condyloid process of the mandible.Benefits The Ears, Jaw And TeethActivates The Channel And Alleviates PainCheek And Facial Pain • Cheek Pain And Swelling • Deafness • Ear Pain • Jaw Dislocation • Jaw Lower And Gums Swollen • Mouth And Eye Deviation • Purulent Discharge And Itching • upper Teeth And Lower Jaw • Tetany Facial • Tinnitus • Toothache • Visual Dizziness • Yawning •

ST5 • DayingStomach 5 • Great WelcomeLocation: Anterior to the angle of the mandible, on the anterior border of masseter muscle, in the depression that appears when the cheek is bulged. CautionAvoid the Artery!Eliminates Wind And Reduces SwellingAdenopathy • Chills • Edema Face And Lower Cheek • Eye Pain With Inability To Close Eyes • Facial Swelling Wind Obstruction • Fever And Chills With Neck Pain • Frequent Yawning • Lips Twitching • Mouth Deviation • Mumps • Stiff Tongue With Inability To Speak • Toothache Lower Jaw • Wind Tetany With Lockjaw •

THE ODONTOMES

PAIN may be associated with health disturbances in areas remote from the teeth and periodontium . Clin.prev.dent nov-dec 1991 Horowitz et.al

Eastern cultures base health upon meridians in the human body. Everything that passes along these meridians affects the major organs of the body, such as the liver, heart or kidneys. All of the meridians run through the teeth. Dr.Voll