Ask an expert - body - head - mouth

12 questions

Q: Can acupuncture help with Sjoegrens syndrome, immune disease affecting connective tissue, salivary glands, symptoms include dry mouth, reynauds tingling/burning hands and feet.

A: As you are probably fully aware Sjogrens can occur as either a primary or secondary condition whose origin is not entirely clear. Treatment is usually supportive and symptomatic rather than curative, and the wide array of potential symptoms which arise from the change in moisture producing cells means that research studies are not as common as would normally be the case.

 This is certainly the case with acupuncture trials and Sjogrens. We wouldn't want to quote specific studies because they tend to be small and methodologically 'under-powered' but if you use an open access database like NCBI by typing in 'ncbi acupuncture Sjogrens' you will find at least half a dozen studies which report significant changes from treatment, whether it be with acupuncture, auricular acupuncture, electroacupuncture or Chinese herbal medicine. What most conclude, however, is that the sample size is too small to make any firm recommendations other than that larger studies should be organised.

 Of course, from a Chinese medicine perspective the somewhat disparate nature of potential symptoms plays to one of its greatest strengths, the ability to make sense of what appear to be unconnected symptoms within a framework based on an entirely different conceptual structure. Chinese medicine is based on theories of energy, called 'qi', whose rhythm, flow and balance determine the overall health of the individual. Within this overarching picture are Organs which have specific functions within the flow. Organs are different from the western concept of an organ, being seen as functional units whose effects can be seen in several areas of the body. This can often mean that symptoms which would be treated separately in western medicine are treated as a part of one functional disturbance.

 This means that when a practitioner looks at each presentation within the Sjogrens pattern he or she will be analysing them across the range of functional disturbances which might show common roots, and this can often mean an individual treatment for the person as a unique presentation rather than a standard formula treatment.

 It is also fair to say that in many cases of connective tissue disorder the various symptoms are all assumed to be fruit of the same tree when in reality some of them may from a Chinese medicine perspective be consequences of weaknesses in the system caused by the Sjogrens. Some may well be amenable to constitutional treatment.

 The bottom line, therefore, is that acupuncture treatment may be able to offer some benefits, and will certainly do no harm. In order to say more, though, we would have to see your symptoms in their overall context, which online is not an option. The best advice that we can give is that you visit a BAcC member local to you and seek a brief face to face consultation to assess what might be going on. Most members are willing to give up some time without charge to give a better view of what may be possible, and this gives you a chance to meet them and see where they work.

Q: I am seeking help to treat dry mouth (xerostomia). I know there is some research demonstrating that acupuncture is effective in cancer patients. My dry mouth has been investigated, no obvious cause, salivary glands normal. None of the practitioners websites I have looked at specify that they treat dry mouth. Should I be looking for someone with specialist knowledge in this area or would any acupunturist be able to treat it (the research report does specify the areas to insert needles into). 

A:  As you say there has been research into the use of acupuncture for xerostomia arising from cancer treatments, and we touched on this in an answer we gave some time ago

We were asked this question once in relation to xerostomia induced by radiotherapy, and our answer was, taken from our factsheet on palliative care and further supplemented:

Dry mouth (xerostomia)

A systematic review found possible benefits with acupuncture for radiotherapy-induced xerostomia (O’Sullivan 2010). Not all the inter-group differences were significant but this is typical in trials comparing acupuncture with sham acupuncture, for the latter is commonly viewed as being an active treatment itself, not a placebo, and hence may underestimate the effects of the therapy (Lundeberg 2011; Sherman 2009; Paterson 2005).The RCTs to date are few in number and small in size. Although they have produced encouraging results, and are supported by observational studies (for example, Meidell 2009), larger trials are required to achieve more robust evidence. Acupuncture may also help with xerostomia dysphagia (swallowing difficulty) in late-stage palliative care (Filshie 2003).

There is some evidence for the value of acupuncture treatment for dry mouth after radiotherapy, and the two studies below certainly seem very positive.
 
http://www.ncbi.nlm.nih.gov/pubmed/23104718

 http://www.ncbi.nlm.nih.gov/pubmed/22072272
 
Clearly there is a considerable difference between the kinds of functional disturbances caused by disruption of the balance of the body's energies through normal wear and tear and the kinds of damaged brought on by injury or accident. This does mean that it is more difficult to predict whether acupuncture treatment might be of benefit. Treatment of the kind used in the studies tends to be localised or precisely targeted, and this can mean that it does not really conform to the patterns of treatment which a Chinese medicine practitioner would employ. In broad terms, however, acupuncture treatment is aimed at putting the whole system back in balance with the underlying belief that a body in balance tends to deal with symptoms itsef, and on this basis it may well be worth talking to a BAcC member local to you to see if a combination of systemic and local treatment may, in their view, be of benefit. Most BAcC members are more than happy to give up a little time without charge to give a face to face assessment of whether treatment would help.
 

There is a chance, of course, that the xerostomia which you are asking about is not related to cancer treatment. From a Chinese medicine perspective this makes no difference. The understanding of the mechanics of the disruption of the physiology of salivation from within the Chinese medicine paradigm will be the same whatever the cause, although the cause, again seen from this perspective, may have a considerable impact on the treatment. By this we mean that radiotherapy might be seen as a cause of great heat and dryness within the system as a whole or locally, and this would almost certainly feed into the treatment strategy.
 
As we said above, speaking to a BAcC member local to you who can assess the problem face to face may well be the best option for you before committing to treatment.  

We have used bold highlighting for one paragraph because it emphasises the point that from a Chinese medicine perspective there is no single treatment for the problem, and it will be addressed as every other presenting symptom is within the overall context of the patient's health and balance. What this means, of course, is that there is unlikely to be an expert in treating the problem because there is no discrete body of knowledge about this condition alone. In Chinese medicine the relationship between generalist and specialist is the complete opposite of conventional medicine. In ancient times, specialists who only treated a few conditions were regarded as inferior!

The advice we gave before holds good. Our postcode search facility shows a number of members within easy reach, and most are willing to give up a few minutes without charge to assess whether your specific presentation would be likely to benefit from acupuncture treatment. All our members are equally well-trained and qualified, and the choice you finally make may well depend on the rapport you make with the ones you see. This can be quite a positive factor in treatment.

Q:  Can acupuncture help with burning tongue syndrome? I have suffered for many years with no physiological reason for this and the constant pain is driving me mad.

There is a very small amount of encouraging evidence from small-scale studies such as this

http://www.ncbi.nlm.nih.gov/pubmed/23336607

as well as a number of studies which involve the use of electro-acupuncture and laser treatment. However, to be able to make a whole-hearted recommendation we would need to have a great deal more to go on.

However, the human physiology involved in Chinese medicine is very different from that which underpins conventional medicine. The central concept of qi, or energy, is similar to concepts of ki and prana in other South East Asian medical traditions, a life force which constitutes everything and whose balance, flow and movement determine overall health. The Organs of the body, which are much wider in meaning that the equivalent organs of the same name in western medicine, and the flow in the channels which they govern contribute to all our functions. A Chinese medicine practitioner will try to make sense of the symptoms which someone has as either a local blockage or a systemic problem of which this is the tip of the iceberg. In many cases it is both; a system out of balance tends to let small problems arise elsewhere which are not on the surface directly related to each other.

This is a rather long-winded way of saying that when a symptom like yours starts and persists, the practitioner will look at the whole system to see how it has manifested and what can be done to correct it. It goes without saying that each person is unique and different from this perspective, but the appearance of heat anywhere in the body can usually be made sense of within Chinese medicine, where the patterns often use the language of heat, cold, damp and other climate factors to describe some of the manifestations of disharmony.

The best advice we can give is to visit a BAcC member local to you for a brief face to face assessment. They are much better placed than we to offer advice, and may well pick up a number of factors in the system which point to why this has started. If so, they will be able to give you a reasonable idea of how much treatment you may need.

In conditions like this we tend to the view that there will always be some improvement, and the key question is how much improvement and how sustainable it is. This can sometimes become an issue of cost effectiveness - is the expense worth it for three or four days of relief - but what we ask members to avoid is getting locked into a long course of treatment without clear outcomes or reviews, and without any clear sign of improvement. If nothing happens after three or four sessions it is important to consider whether it is worth continuing.

Q:  Do you know of a dentist in London who practices acupuncture and offers NHS treatment?  I don't mind where in London as long as I find one.

A: If you are looking for someone who incorporates the use of acupuncture into their dental work, the best bet is to contact the British Dental Acupuncture Society. However, we have had a few problems trying to locate them of late, their web address not seeming to work. It may be worthwhile contacting the British Medical Acupuncture Society with whom many dentists undertake training. This group can be contacted at www.medical-acupuncture.co.uk.

The majority of dental treatments are for calming the gag reflex rather than managing pain through the consultation. It is possible that anyone trained by the BMAS may have wider skills to hand, the only requirement for training being a registrant of a statutorily regulated healthcare profession, but whether they are entitled to treat conditions other than dental pain is something you would have to explore with them. The text on one of the dental insurers' sites is very useful in this respect:

Q. I am a dental hygienist with training in acupuncture. Am I allowed to use these techniques in the dental setting and do I need any additional indemnity?

There are some aspects of the provision of dental treatment that the General Dental Council's Scope of Practice simply does not cover. Acupuncture would be a good example. In the past the GDC has been a little cautious about its use in dentistry, presumably because they are not quite sure where it fits in. The use of holistic medicine and hypnosis would be other good examples. This lack of clarity from the GDC is not helpful, although they would probably argue that there does have to be a point where the scope of practice has to be at the registrant's discretion.

If a registrant is to consider using these techniques, they would need to demonstrate that they are competent to do so and have acquired the necessary training. A training course run for DCPs by a UK dental hospital would probably be regarded as appropriate training.

The difficulty would be how you might decide to use this additional skill in the dental surgery. As a hygienist, using acupuncture as some form of relaxation technique would not seem unreasonable. If you intended using acupuncture for the treatment of TMJ dysfunction this would be quite a different matter. For obvious reasons this type of treatment is a long way outside the scope of practice for a hygienist.

The use of acupuncture for a condition that was unrelated to dentistry would also be unacceptable. Indeed it would be necessary to ensure that a clear distinction was made between this alternative practice and the practice of dentistry. You could not, for example, advertise yourself as being a hygienist and in some way give additional credence to the treatment you provide from your GDC registration. On these occasions you would need to obtain additional indemnity from another provider.

There are overlaps which tend to complicate matters even further. It is, for example, the duty of all clinicians to provide advice on smoking cessation and to encourage patients to give up the habit. In the past, acupuncture (rather like hypnosis) has been shown to be quite successful in this respect. It is debatable whether the use of acupuncture in such a way is part of the practice of dentistry, or outside the dental field.

From Dental Protection's point of view, provided you are using acupuncture as part of dental treatment, there is no particular difficulty in relation to recieving an indemnity as a benefit of dental membership. This may change in the future if the GDC should decide that it falls outside the scope of practice for a hygienist.

Any DCP members finding themselves in a similar situation are invited to contact Dental Protection for advice.

We have done a brief web search for a dentist using acupuncture on the NHS in London and come up with nothing,so it may well be only through direct enquiry that you manage to locate someone. In this context it may well be worth contacting Guy's dental school http://www.guysandstthomas.nhs.uk/our-services/dental/overview.aspx. They offer emergency cover at all times and often seem to be in the forefront of new dental services. It may well be that someone there could advise you.

Q:  Please could you forward details of an acupuncturist qualified to treat lingual nerve damage. The nerve was severed during a routine wisdom tooth operation.  I subsequently had microsurgery to rejoin the nerve.  Although the nerve was rejoined I still suffer continual chronic pain on the left side of my tongue

A:  We are afraid that we cannot give specific recommendations for individual practitioners, although using our postcode search function on our home page www.acupuncture.org.uk will generate a significant number of names. The more important point, though, is that from a Chinese medicine perspective, there are very few areas where we acknowledge specialist practice. At the moment the three categories of patient for which we believe it may be possible to define expert practice are children, pregnant women and people with mental health problems. For all other patients, every BAcC member is equally well qualified to treat any patient because the skills of Chinese medicine rest in treating the person, not the named conditon. Indeed, ancient China the generalist practitioner was held in much greater esteem than the specialist who was seen as markedly inferior in the narrowness of the focus of their practice.

As far as your specific problem is concerned, there are many studies for the use of acupuncture in the treatment of chronic pain, as our factsheet shows:

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/chronic-pain.html

but very few studies which we can trace for the use of acupuncture in the treatment of lingual nerve damage. There are a number of studies which look at sensory deficit after dental surgery, but only one which were able to trace which appeared to indicate that acupuncture has been used for this specific problem but with unclear results.

However, it is fair to say that much of the research into conditions like this is conducted within conventional medical research facilities which use a far less sophisticated form of acupuncture than that used by Chinese medicine practitioners. There are a number of different ways of addressing problems such as yours, from a local problem caused by energetic disruption inherent in any surgery through to level of shock caused by the procedure through to a more widespread weakness in the system which impairs healing throughout. The skill of the Chinese medicine practitioner lies in making sense of the complex pattern which each individual represents, and treating with the best focus for achieving sustainable change.

The best advice that we can give is that you visit a BAcC member local to you and ask for a brief face to face assessment of what they think they might be able to achieve. In cases like yours which are quite rare it would be sensible, if you did decide to go ahead with treatment, to set some very clear review stages at set points to assess progress, and also to try to set measurable outcomes. This avoids the course of treatment meandering on without apparent benefit, which in our experience invariably leads to bad feeling.

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