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Acute Pain | Chronic Pain | General

Acupuncture for dental pain

Clinical bottom line:

Based on a very small number of trials, there is no convincing evidence for the effectiveness of acupuncture in relieving clinical dental pain. There is no evidence that acupuncture relieves pain during drilling into the dentine, and there is a very preliminary suggestion (based on 20 patients) that acupuncture may be beneficial in relieving postoperative pain.


Acupuncture for dental pain

It is traditionally believed that acupuncture works to relieve pain by restoring energy flow through meridians in the body. Western theories of the mechanism include activation of endogenous substances inhibiting nociceptive transmission, and theories of diffuse noxious inhibitory control. Acupuncture analgesia is a modern concept, dating perhaps to 1958. Currently, the most frequent indication of acupuncture is for pain control.

Systematic review

Smith LA, Oldman AD. Acupuncture and dental pain. British Dental Journal 1999; 186:158-159

Ernst E, Pittler MH. The effectiveness of acupuncture in treating acute dental pain. British Dental Journal 1998; 184:443-447

Inclusion criteria were randomised, double blind, placebo-controlled trials of acupuncture; dental pain; group size at least 10; pain outcome; pain from clinical interventions.

Where possible, data were extracted from each trial, and a relative benefit with 95% confidence interval was calculated. Where data extraction was not possible, conclusions from original authors were used.

Findings

Acupuncture for postoperative dental pain

One of one trials (in 20 patients) reported significantly better pain relief over three hours with 15 minutes of Ho-Ku acupuncture administered after tooth extraction compared with sham acupuncture.

Acupuncture during restorative surgery

Two trials with 90 patients looked at pain caused by drilling into the dentine, comparing 30 minutes of Ho-Ku electroacupuncture carried out during surgery with placebo. For these two trials data pooling was possible. We did not find any significant differences between groups on any measure, including pain reduction — relative benefit 1.2 (0.96 to 1.4).

However, it should be noted that both trials had a design flaw: insufficient power to demonstrate a pre-emptive effect, resulting in a very high placebo response rate.

Table: Analgesic effectiveness of acupuncture compared with placebo during dental restoration

Efficacy Measure No. of Trials No. of acupuncture patients with successful outcome No. of placebo patients with successful outcome Relative Benefit (95% CI) NNT (95% CI)
Pain reduction - patient rating* 2 40/46 33/44 1.2 (0.96 to 1.4) 8.4 (3.6 to -24)
Local anaesthetic required** 2 45/46 42/44 1.0 (0.94 to 1.1) 42 (10 to -20)
Dentist rating of procedure as successful 2 44/46 39/44 1.1 (0.96 to 1.2) 14 (5.5 to -25)
Patient rating of no pain 1 13/26 11/25 1.1 (0.63 to 2.1) 17 (3.0 to -4.7)
Pain reduction - dentist rating* 1 18/26 20/25 0.87 ( 0.63 to 1.2) -9.3 (7.8 to -2.9)
*success = pain reduction excellent or good
**success = no anaesthetic required

Adverse effects

Not stated by reviewers

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