Ask an expert - body - head - mouth - dental

4 questions

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:  This may seem like a daft question but anyway  I had 7 teeth removed from my lower jaw and had a bone graft and dental implants on a bridge of 10 teeth. The thing is that I'm having great difficulty getting used to them and my tongue doesn't know where to go. Could acupuncture help in any way?

A: This is one of the more interesting questions we have been asked, if not intriguing!
 
We could, I suppose, make a case that acupuncture treatment is always seen as restoring natural balances, and that as such it might help the tongue to find its 'proper place', but ancient Chinese medicine was not familiar with bone grafts and dental implants, so this might be a bit of a stretch. There are certainly points on the body which were traditionally said to promote the healing of bone, and there is also good evidence for the use of acupuncture treatment to reduce inflammation. However, nothing we can find in the research literature suggests that it might be the answer to your problem.
 
The one thing which does occur to us, however, comes from our use of tongue diagnosis. The system depends on an understanding of changes in the colour, shape, size and coating of the tongue which reflect the changes in the internal Organs. There are a number of relatively common syndromes where the tongue can become quite swollen, many of which reflect a weakening of the Yang energy of the body which people might experience as tiredness or lethargy. It is just possible that your tongue is not so much confused by the additional hardware in your mouth but reflects the fact that you are a bit run down from the surgery. The feeling of a swollen tongue is one that people often experience whenthey are exhausted and can't quite seem to enunciate properly.
 
There would be no harm in asking a BAcC member local to you if they can see anything in your overall energy patterns which might be contributing to this feeling, but we suspect that it will settle down of its own accord eventually, irritating and uncomfortable as it must seem now.  
 

Q:  I had 2 lower wisdom teeth, both having formed cysts, removed from my lower jaw in January. I'm still experiencing discomfort which is aggravated by talking. The maxillo facial surgeon has told me that  there is nothing wrong and that I must be patient.  Would acupuncure help?

 

A:

While a great deal of the early research into acupuncture was about pain reduction, as our factsheet shows please click here

 

 

 

 

 

 

a great many of the studies target specific pains. There are a number of studies of dental pain please click here

 

 

 

 

which are of sufficient standard for us to be able to advertise that acupuncture can assist dental pain, but the kind of pain from which you suffer is not one which has been specifically described in the studies, and we would be reluctant to say, under the general rubric of 'dental pain' that acupuncture would be of benefit.

 

 

 

It would certainly do no harm to visit a BAcC member local to you and seek their advice on whether they think they may be able to help you. However, another option you may want to consider is cranial osteopathy. One feature of wisdom tooth surgery is that the jaw is often extended very fully while considerable pressure is applied, and the tempero-mandibular joint (TMJ) can easily be slightly dislocated. This might well generate the symptom you describe, and while it is possible that an acupuncturist can provide some relief if there has been displacement of the TMJ the use of gentle manipulation to correct a misalignment may be a good alternative option.   

 

 

 

 

Q:  I had dental surgery about 7/8 years ago and it has left me with continuous pain/discomfort. I have various and extensive treatment ranging from root canal - physiotherapy - anti depressants (for transgeminal? neuralgia) and a host of other. I am now waiting to see yet another consultant but would like to investigate alternatives myself. I really feel that the problem is nerve damage as the original extraction was very lengthy and tricky but I am reluctant to try the drugs again as I have already tried this for over a year and the side effects were unpleasant.
Any guidance would be appreciated

 

A:  We're sorry to hear about your problem. Dental pain, because it is too 'close in' to shut off, can cause long-term distress and depression.
 
Oddly enough, in spite of the much more severe restrictions now in force about what advertisers and marketers can say, dental pain is one of the small number of conditions for which acupuncture is accepted as a viable and evidence-based treatment. Ironically the main providers of dental acupuncture, the British Dental Acupuncture Society, use it less for pain and anxiety than to control the gagging reflex, but there is no doubt that acupuncture can reduce pain after dental work.
 
However, while not diverting you from treatment, one situation which we find quite often is that aggressive and lengthy dental work, where the mouth is held open for a long time and considerable force is applied to extract or to work on teeth, can cause all sorts of problems in the tempero-mandibular joints, and our colleagues in the osteopathy profession, especially those who practise cranial osteopathy, tell us that this is a condition which they deal with regularly. The joint is not a very fixed one, as you know from being able to move the jaw very freely, and it is easy for it to become dislocated. This can then put pressure on the trigeminal nerve and create extremely severe pain which is sometimes 'remedied' by further dental work which proves ineffective.
 
Even one of our great detractors concedes that acupuncture may have a role to play in sorting out the structural malfunctions associated with TMJ problems
 
http://www.ncbi.nlm.nih.gov/pubmed/10190797
 
and we would certainly be happy to recommend that you seek treatment with one of our members. However, in the view of this 'expert' if you were to present at my clinic I would almost certainly refer you to an osteopath in the first instance to ensure that I did not take half a dozen sessions to effect a change he might make in one. It would not be unusual to get a reciprocal referral after a session or two to encourage the musculature local to the problem to maintain the proper position to which the joint had reverted.
 
We would advise you to contact one of our members to discuss your problem with them. If they felt that there was a case for referral on they would know who locally to you would be best suited to your needs.   
 
 
 

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