Tuesday March 30 2010
Acupuncture needs more research as an anxiety treatment
“Acupuncture can help cure patients of a fear of the dentist's drill,” according to The Daily Telegraph. The newspaper says that research shows that just one five-minute session of acupuncture can reduce anxiety and enable people who have previously avoided the dentist to have treatment.
This study looked at 20 people whose fear of the dentist had previously hampered or prevented the completion of their dental treatment. It found that their pretreatment level of anxiety reduced after acupuncture and they were all able to receive their dental treatment. However, this study did not compare people receiving acupuncture with people receiving no anxiety treatment. This means we cannot rule out the possibility that their fear naturally reduced over time. Also, the dental procedures performed in this study were minor (cleaning or examination), and this study cannot tell us whether acupuncture would provide anxiety relief for major procedures such as drilling.
Overall, the study suggests that further investigation into the use of brief acupuncture sessions for reducing dental anxiety is warranted, but larger, blinded, randomised controlled studies will be needed to confirm acupuncture’s effects.
Where did the story come from?
Dr Palle Rosted and colleagues from Weston Park Hospital in Sheffield and other centres in the UK and Denmark carried out this research. No specific sources of funding were reported for the study. The study was published in the peer-reviewed journal Acupuncture Medicine.
The Daily Telegraph, BBC News and Metro have covered this story. They report the research accurately, and The Daily Telegraph and BBC News have, importantly, noted that larger studies will be needed to confirm the findings. It is not possible to say whether acupuncture can “help cure patients of a fear of the dentist's drill”, as is suggested in The Daily Telegraph, as the patients did not receive any drilling during their treatment.
What kind of research was this?
This was a case series looking at the use of acupuncture to relieve anxiety in people afraid of receiving dental treatment.
This type of study does not include a control group of people not receiving acupuncture to compare against. This makes it difficult to determine whether any reduction in fear seen in the treated individuals would have occurred naturally over time. As no other anxiety treatment was compared, it is also not possible to say whether acupuncture would be any better than other approaches, such as hypnotism.
A further limitation of this research is that such a small number of cases may not be representative of the many members of the general population who have some degree of anxiety about dental treatment. Equally, it may be too small to give a good idea of the different levels of anxiety for which such a treatment may be more or less effective.
What did the research involve?
The study looked at whether acupuncture reduced anxiety in 20 people who were afraid of receiving dental treatment, as rated by the patients themselves and the dentists.
To be eligible for inclusion, patients had to have previously shown signs of severe anxiety about receiving dental treatment that had made treatment impossible or difficult. They also had to show moderate-to-severe anxiety on a standard self-reported questionnaire measure called the Beck Anxiety Inventory (BAI). A higher score on this scale indicates greater anxiety, with a maximum score of 63.
The patients reported having had dental anxiety for between 2 and 30 years, with an average of about 10 years. The study reports that in 14 patients, planned dental treatment had previously been cancelled due to their dental anxiety. In addition, six patients had required sedatives such as diazepam or midazolam in order to undergo dental treatment in the past, and another three had required a general anaesthetic. The exact types of dental treatment associated with these instances were not reported.
Eight dentists reported on twenty patients who received acupuncture over eighteen months. These dentists had been trained in using acupuncture to treat dental anxiety. They carried out the acupuncture five minutes before starting treatment, applying needles to two points on the top of the head that reportedly have a relaxing effect. The needles were inserted and rotated anticlockwise and clockwise for five seconds, and then left in place during the dental treatment. During dental treatment patients received minor procedures, mainly dental examination (13 patients) or cleaning of the teeth (7 patients). The dentists also used their standard procedures for easing patient anxiety.
The patients’ anxiety levels were assessed using the BAI questionnaire before the acupuncture treatment and after the acupuncture and dental treatment. The dentists rated their patients’ anxiety on a scale of zero to five, where zero indicated no anxiety and five severe anxiety. The patients also used this scale to rate their anxiety in the 24 hours before their treatment, when they entered the clinic, and during their past and current treatments. The study did not blind the patients or the dentists to the anxiety treatment received.
What were the basic results?
The patients were less anxious in the 24 hours before their current treatment than they had been in the past, with an average (median) score of three for current treatment compared with a score of four during previous treatment.
Before acupuncture the patients reported moderate-to-severe anxiety (average BAI questionnaire score of 26.5). After acupuncture and dental treatment, the patients’ anxiety had reduced significantly, and they only showed mild anxiety (average BAI score of 11.5). They also rated their anxiety as lower during current treatment than in past treatments (average score of two for current treatment compared with four for previous treatment on a scale from zero to five). The dentists also rated their patients as less anxious in the current treatment than in past treatments (average score of four for previous treatment and two for current treatment).
Twelve of the twenty patients (60%) were reported to have responded positively to acupuncture, based on the BAI scale. Current dental treatment could be completed by all twenty patients, of whom only six had previously been treated successfully without acupuncture. There were no serious side effects of the acupuncture, although two patients reported sleepiness.
How did the researchers interpret the results?
The researchers conclude that “acupuncture prior to dental treatment has a beneficial effect on the level of anxiety in patients with dental anxiety”. They say that the technique is easy to learn and inexpensive, but that any recommendations regarding its use “should not be made until a controlled trial has been performed”.
There are a number of points to note when interpreting this study:
- As there was no control group we cannot tell whether the reduction in the patients’ anxiety levels was because their fears naturally subsided over time or was due to the acupuncture. The dentists also used their standard techniques for anxious patients, and these could have contributed to the results seen.
- The study was small, and could only include people who agreed to have acupuncture. It is not clear how many people had been asked to take part but declined, or the reasons why people may have declined. The small study size and lack of information on those who declined means results of the study may not be representative of the average individual who is afraid of the dentist. For example, some people who are afraid of dental treatment may have a fear of needles, which could reasonably be extended to a fear of acupuncture needles.
- The individuals in this study were only receiving minor dental procedures (cleaning or examination). The study cannot tell us what effect acupuncture could have on anxiety relating to more major dental treatment, such as fillings or the use of the drill.
- It is not possible to say what effect the treatment would have on children who are afraid of the dentist, as only adults were included.
- The study cannot tell us whether acupuncture would have been any better than other possible approaches to reducing fear, such as a brief counselling session or hypnosis, or the dentists’ standard anxiety-relief techniques.
- The study was not blinded, therefore it is not clear how much of the effect was due to the acupuncture itself and how much was due to the fact that the patients knew they were receiving acupuncture aimed at reducing their anxiety. This also applies to the dentists’ ratings of patient anxiety.
Overall, the study suggests that using a brief acupuncture session for reducing anxiety in people afraid of the dentist could be worth further investigation, but larger, blinded, randomised controlled studies will be needed to confirm its effects.