The effect of acupuncture on dental anxiety. A systematic review

Objective:

To evaluate the effectiveness of acupuncture in the treatment of dental anxiety. The last systematic review on the subject was done in 2002.

Methods:

We searched Medline, Embase, Cochrane and complementary medicine databases for 1990-2007 randomized controlled trials (RCT) using maximum blinding in the form of either placebo or another conventional treatment. The keywords used were: randomized controlled trials, acupuncture, dental anxiety, dentistry.

Results:

Sixteen RCT's were located. Six of them were systematic reviews of previous studies and only two were selected for meta-analysis. The rest were discarded because they were systematic reviews (n=6) or were either duplicate or irrelevant (n=8). No adverse events were reported in either of the two studies selected.

In the first RCT [Mathias et al, 2007] randomised 67 patients to:

a-Ear acupuncture (n=19).

b-Placebo ear acupuncture (n=19).

c-Nasal midazolam (n=19).

d-No-treatment (n=10).

On the Spielberger State-Trait Anxiety Inventory (STAI) score after 30min, the auricular acupuncture group (95% ci (-19,-2); P=0.01) and the midazolam (95% ci (-26.4,-9.4); P<0.001) group performed better than no treatment. On VAS only the difference between no treatment and midazolam was significant (95% c.i. (-3.9,-0.43); P=0.01). Acupuncture and midazolam performance were similar. Effect did not longer show after the tooth extraction.

In the second RCT (Wang & Kein) 55 patients were randomised to three groups.

a-Shenmen group-bilateral auricular acupuncture (n=22)

b-Bilateral auricular acupuncture at relaxation point (n=15)

c-Biletral acupuncture at sham point (n=18)

On the STAI scale, patients in the relaxation group were significantly less anxious at 30 minutes (P=0.007) and 24 hours (P=0.04) as compared to patients in in both the Shenmen and the Sham groups.

Conclusion: The suggested benefit of auricular acupuncture merits further investigation.