by Cathy Hester Seckman, RDH
Every hygienist in the country should know two things about complementary and alternative medicine, if they know nothing else, says Dr. David Shuch of Augusta, N.J.
1 If you have a patient with very loose, bleeding gingivitis, have the patient get a certain vitamin C powder called sodium ascorbate. It looks and tastes like salt. Have them put a little in their palm, wet it with water, and brush with that mixture for a week. The puffiness will be gone.
2 If you have patients with pockets — with or without gingivitis — the number one nutritional recommendation is coenzyme Q10. It makes a tremendous, tremendous difference in their gingival health. Typically I'll recommend 60 mg a day. If the patient is a diabetic or a smoker, double it. In three months, there will be a noticeable difference. Coenzyme Q10 isn't a magic bullet, but if the root surfaces are clean and the bite is okay, they will get remarkably tight healing.
However, don't forget Leslie Andrews' warning about stepping outside practice acts (see article) by diagnosing or prescribing without a license.
Because we work in dentistry every day, it is easy to become callous about our patients' feelings. Are they anxious? Are they afraid of sensitivity during a procedure? Do they worry about gagging? I tend to accept those things as unavoidable hazards.
"Remember to keep breathing through your nose," I'll say to a gagger, sliding an X-ray film into place. "If you hold your breath, that makes it worse." Then I zip out of the room and hope the patient's willpower lasts long enough.
Never mind if she is miserable for a few seconds; at least I got my X-ray. Those few seconds don't mean anything to me, but they're important to the patient. Add them to the time she spends dreading sensitivity, and the time she spends being anxious about the whole procedure, and it's no wonder people put off dental appointments.
Did you know there's a simple way to reduce gagging problems? Acupressure is not a guaranteed cure, but it works better than the patient's willpower. Acupressure is part of complementary and alternative medicine (CAM), which also includes acupuncture, herbal remedies and homeopathy — branches of medicine with which Americans are almost completely unfamiliar.
CAM is an integral part of Oriental medicine and is widely accepted in Europe. Britain's Queen Mother used a homeopathic hospital, and she lived to be 101. In the United States, however, we're still firmly entrenched in Western medicine. Well-known physician and author Dr. Isadore Rosenfeld has said he never heard the word "acupuncture" in medical school.
But CAM has come into the mainstream increasingly in the last few years as health consumers become more widely read and more accepting of alternative ideas. How many times in the past six months has a patient told you he's using St. John's wort or is seeing a massotherapist? Articles about naturopaths and homeopaths are turning up in consumer magazines, and Americans are beginning to understand how wide the field of CAM really is.
Even the medical establishment has begun exploring what they perceive as "new" philosophies. The National Institutes of Health spends millions of dollars every year through its National Center for Complementary and Alternative Medicine (www.nccam.nih.gov) to evaluate CAM procedures and ideas. Physicians now occasionally recommend herbal remedies, and even dentists are considering CAM ideas.
Dr. David Shuch of Augusta, N.J., has been lecturing on CAM for years. "I co-wrote the first article on CAM for Dentistry Today in 1995," he says. "I've been giving seminars ever since in the greater New York area." His favorite remedy for the gagging patient is to use acupressure — that is, acupuncture without needles. An acupuncture point called "Nei guan," or the P-6 point, is stimulated electrically or by applying continuous pressure.
"Our most severe gagger has neurofibromatosis, a condition that makes his nerves less stable electrically. He gags just with brushing, and it's very hard to treat him. We stimulate the P-6 point, and can do whatever we want with him."
To find the P-6 point, place your middle three fingers on the inside of the opposite wrist with the edge of the third finger on the first wrist crease that goes all the way across. The P-6 point is just under the edge of your index finger between the two central flexor tendons. Pressing those points on both wrists for five minutes relieves gagging and nausea.
Dr. Shuch uses a TENS (transcutaneous electrical neuro stimulation) machine, once popular in dentistry for lower anterior analgesia, to stimulate the points. "Doing that can virtually shut off nausea immediately," he says.
If your office doesn't have a TENS machine stuck in the back of a supply closet, Sea Bands (www.sea-bands.com) are an easy way to stimulate both points at once. You've probably seen Sea Bands in a drugstore — they are terrycloth wristbands with hard plastic buttons attached. The buttons are placed over the nei guan point to apply continuous pressure. The bands are marketed for travel and motion sickness, morning sickness and nausea related to anesthesia and chemotherapy.
A 1999 study published in the Journal of the Academy of General Dentistry looked at the effect of acupressure on gagging dental patients. The study concluded that stimulating the P-6 point has an anti-gagging effect, usually within three to five minutes. No adverse effects were observed, and the study called acupressure stimulation an effective, simple, reliable, and safe technique.
Acupressure has other applications in dentistry. Dr. Warren Morganstein is senior associate dean of the University of Maryland Dental School. He is also an acupuncturist and frequent lecturer. Dr. Morganstein says the hoku or LI-4 point can deal with pain in the upper part of the body, especially the mouth and face. "But it's very important to press on the right place."
To find the LI-4 point, hold your thumb and forefinger upright, pressed together. The point is at the base of the mound that forms below the junction of the fingers. Another locator is to line up the transverse crease of the interphalangeal joint of one thumb with the top of the web between the thumb and index finger of the opposite hand. The point is where the tip of the thumb touches.
If a patient correctly stimulates the LI-4 point on one hand for a few minutes, then the opposite hand for a few more, then repeats, it should produce analgesia.
Acupressure points that work for stress and anxiety include:
• GB-20 (below the occipital bone in the depression between the sternocleidomastoid muscle and trapezius muscle)
• GB-21 (at the highest point of the back of the shoulder)
• BL-10 (within the posterior hairline on the lateral side of the trapezius muscle)
• GV-16 (one inch above the hairline at the back of the neck, between the attachments of the trapezius muscle)
• GV-24 (directly above the nose, half an inch within the anterior hairline).
More precise locations for these points can be found in any book on acupressure or acupuncture.
Dr. Morganstein cautions that LI-4 and GB-21 points should not be stimulated on a pregnant woman, because of a risk of premature contractions.
Leslie Andrews, RDH, MBA, of Norwalk, Conn., has been aware of CAM most of her life, but didn't get serious about it until her husband, Gary, suffered food poisoning 11 years ago. "We finally tried naturopathy when the problem just wouldn't go away, and he was stabilized." Since then she has studied CAM disciplines. "When I started, I hadn't a clue in the world there was so much out there." She now lectures on several topics, including CAM, across the northeast United States for Philips Oral Healthcare.
"When I first developed the CAM lecture," she says, "I saw a gap in dental professional knowledge. I've given the course many times, and I've seen tremendous interest. The course introduces dental professionals to homeopathy, naturopathy, acupuncture, yoga, meditation, chiropractic, and herbs."
Andrews says she believes a turning point is coming in dentistry. "The first step is to get dentists to refer to CAM practitioners. As an example, what about TMD? If a patient has been through the soft diet, the NSAIDs, the moist heat, the nightguard, and still doesn't get any relief, why not try acupuncture, or biofeedback, or chiropractic, or even physical therapy? Physical therapists are starting to cross that line into CAM — it's a very natural progression for them."
Andrews says a hygienist must step carefully because of practice laws. "It violates our practice acts to diagnose or prescribe anything, but if you work for a dentist who is trained in CAM, you can assist in the administration. For example, a dentist prescribes the homeopathic remedy and the hygienist teaches the patient how it is used. I suppose a hygienist could become a trained homeopath, but I don't think it's appropriate (for the hygienist) to practice it unless the dentist employer is also trained.
"If nothing else, we can always say to a patient, 'Have you ever considered a holistic approach? There's an acupuncturist who several of our patients have seen.' It's our job to be aware of other avenues, and to open those doors for our patients."Cathy Hester Seckman, RDH, is a frequent contributor who is based in Calcutta, Ohio. She can be contacted at cseckman @raex.com.
What is homeopathy, anyway?
Everyone has heard or read that word by now, but what exactly is homeopathy? The term comes from two Greek words, homoios and pathos, which translate as "similar suffering." An 18th century German physician named Samuel Hahnemann developed the discipline as a reaction against the primitive and sometimes brutal medicine practiced in his time.
Using his own body as a testing field, he learned that infinitesimal amounts of an agent that causes a disease would also cure it. As an easy example, Dr. David Shuch uses hay fever.
"When a substance in large quantities can induce a certain set of symptoms, you attenuate the substance down to an ultradiluted state and create a homeopathic remedy from it. Attenuated samples of onion are often used to treat hay fever because the symptoms are red, runny eyes and nose. You get those symptoms from an onion, also."
Hygienist Leslie Andrews, quoting well-known homeopath David Reilly, describes homeopathic remedies this way: "The remedy says to the body, 'I am your enemy. Defend yourself.' Then the body brings on its own defenses to fight the disease."
Hahnemann, in his research, stated that the more diluted an agent is, the more effective it is. Using distilled water and alcohol, he made weaker and weaker solutions of his remedies until no active ingredient remained. Though the remedies are pharmacologically inert, they are biologically active enough to stimulate the body's immune system to fight disease.
Homeopathic remedies are widely available in European pharmacies, but harder to find in the United States. Health food stores are a common source for such remedies. Most are sold as small white pellets that can be put under the tongue, while others are available as liquids direct from the manufacturer.
"Homeopathic products are FDA-approved and non-prescription," Dr. Shuch says. "They're easy, safe, effective and mainstream peer-reviewed. Scientific journals have done double-blind clinical trials that show unmistakably that homeopathic remedies have efficacy far above placebos. There has been good science done to show they work.
"They're not widely used, though, because they fly in the face of conventional science and chemistry. They create an energetic imprint on a water-alcohol mixture. That's not easily understood in terms of how conventional chemistry is understood."
Dr. Shuch uses homeopathic remedies regularly in his dental practice. "I match the specific remedy to the specific type of anxiety," he says. "If a patient has anticipatory anxiety, gets more nervous thinking about dentistry than about being here, I use gelsemium, a flower-based remedy, the night before. For young children who are shy and sensitive, who hide behind a parent and won't open their mouth, I use pulsatilla."
Dr. Shuch cautions against casual use, though. "There's no liability — no one can be allergic to a homeopathic remedy because there are no molecules there. But someone who knows only a little and tries to handle more deep-seated conditions won't do his patient much good. It takes years of training."