Exactly which tooth is sore. Version 1
Research type
Research Study
Full title
An investigation into the effect of acupressure on the localisation of ill-defined intraoral pain
IRAS ID
238593
Contact name
Mark Hector
Contact email
Sponsor organisation
University of Dundee
Duration of Study in the UK
0 years, 11 months, 13 days
Research summary
Patients often report with orofacial pain to a dental hospital or surgery. The history of the presenting complaint together with a clinical examination and special investigations may allow the dentist to reach a diagnosis and to determine exactly which tooth (+/- surrounding tissues) requires treatment (if the pain is of odontogenic origin). However, the localisation of the painful tooth is not always so easy for the patient or the dentist as dental pain can be referred between different teeth and different orofacial structure. (Mardani et al., 2008)
As a result, a dentist may often use a “wait and see” approach to treatment which is not ideal for either parties. (Bender, 2000)
One of the biggest challenges for the dentist in this situation is to identify the offending tooth in a heavily restored mouth or when there are few identified carious lesions present. In addition to this the available diagnostic methods have limitations (Alghaithy and Qualtrough, 2017) (Gopikrishna et al., 2009) see table 1.This could affect the accuracy of the final diagnosis and the treatment delivered. Ultimately, in extreme circumstances, inappropriate dental care might end up in a life threatening complication as previously reported (R. W. J. Porter, 2007)
The problem of poor localisation ability for dental pain have been addressed by many studies previously (Friend and Glenwright, 1968) (Bishop, 2001). In our laboratory we have studied the ability to localise experimentally, electrically evoked dental sensations. The results showed that whether the electrical stimulus was applied to the anterior or posterior teeth, the subjects could correctly identify the stimulated tooth approximately 58-64% of the time. This is in agreement with previously reported studies using slightly different methodologies (e.g Brodison (1995) ,Bishop (2001)).
Another study in our laboratory examined the effect of applying a remote noxious conditioning stimulus (volunteer’s hand in a cold (x3˚C) water bath) on the accuracy of locating electrically evoked dental pain. We found that using the cold water conditioning procedure improved the localisation ability significantly P<.008(Wilicoxon signed-rank test) name of statistical test). It was concluded that the noxious conditioning stimulus significantly improved the localisation accuracy of experimentally evoked dental pain and this may be due to activation of a well know physiological phenomena called Diffuse Noxious Inhibitory Controls (DNIC) (Le Bars et al., 1979). This was in agreement with Brodison (1995)
As the use of a cold water bath is not clinically appropriate for many reasons, acupressure was chosen to be evaluated as a condition to trigger DNIC for this purpose.
Acupressure is a non-pharmacological method often used to control pain. It is a modification of acupuncture (Chen and Wang, 2014). Instead of using a needle insertion technique, a firm finger pressure is applied on specific points called acupuncture / acupressure points. It is a safe, non-invasive technique that is inexpensive.
Research studies have been carried out using an acupressure technique as a form of pain relief for orofacial pain (Kong et al., 2015). Our interest was to evaluate any effect that can be brought about by manipulating a specific acupoint on the hand (called LI4) on the accuracy of localising dental pain.
The LI4 acupoint (Hegu or HoKu) is one of the most important acupoints on the human body and has been found to be effective in managing pain in the head and neck regions as well as acute dental pain. (Ca´ssia Maria Grillo, 2013). (Shen et al., 2009). The position can be identified on the hand by squeezing the thumb and index finger together thus producing an elevation between the thumb and index finger. At the centre of this elevation LI4 is located .
In order to evaluate the magnitude of LI4 manipulation experimentally, we areconducting a study in our laboratory investigatingthe effect of acupressure on the localisation ability of electrically evoked dental pain of by volunteers.. The preliminary results indicate that the activation of the LI4 acupoint improves the localisation accuracy of the electrically evoked dental pain (See graph 1).
Therefore, the aim of this study is to evaluate the effect of acupressure on the localisation of the poorly localised clinically presenting intraoral pain of dental patients.REC name
South East Scotland REC 02
REC reference
19/SS/0030
Date of REC Opinion
28 Feb 2019
REC opinion
Unfavourable Opinion