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Toothache: a case study

Writer's picture: Stéphane PépinStéphane Pépin

Updated: Mar 27, 2022




Acupuncture and Chinese medicine are a very vast field of knowledge and techniques. There are many approaches within the field of acupuncture that, although often similar in appearance, vary in their application and effectiveness for specific cases.


I am passionate about acupuncture and Chinese medicine and I have worked hard over the past 15 years to broaden and deepen my knowledge and skills. I explored many facets of Chinese medicine and developed some expertise in various approaches.


In addition to so-called Traditional Chinese Medicine (TCM) acupuncture, I developed a rather orthopedic approach to acupuncture, working with trigger points, motor points, etc, along with training and mentoring with Whitfield Reaves, a leading expert in sports medicine acupuncture. I also learned the Balance Method, often called Dr. Tan’s method. This approach is remarkably effective for the quick relief of pain. I also explored Master Tung’s acupuncture, a traditional line that was handed down in the family and which escaped the Chinese medicine reform of Communist China. All this in addition to my many Tuina trainings and development internships at the TCM Provincial Hospital in Zhejiang in China.


Mastering these more advanced or specialized approaches can significantly improve clinical outcomes, and achieve much faster relief. However, sometimes you have to go back to the basics taught in the basic curriculum of acupuncture school.


 
A case study:

Recently, a young patient came to consult me ​​for irreversible pulpitis. Pulpitis is an inflammation of the dental pulp, which is the innermost part of the tooth and consists of nerves, blood vessels, and lymphatic vessels.

Having once successfully treated a patient with teeth loosening and gingivitis, it was with confidence that I gave an appointment to the patient.

My approach in the clinic is to never blindly rely on diagnoses made by other health professionals. It may happen that a diagnosis is inaccurate or that the pathology has changed, or that the problem diagnosed is not the true or sole cause of the patient’s pain.

In this case, I first considered the possibility of referred pain. Very few people know that Trigger Points in the temporal muscle can cause pain and / or sensitivity to cold or heat in the upper teeth. So I first treated the trigger points of the temporal muscle while treating the pain according to meridian balancing theory. During the same treatment, I also treated another unrelated pain that the patient was suffering from.

Following this treatment, the patient reported an improvement that was short-lived, the pain had returned as before after a few days. While I don’t expect a total relief in one treatment, the treatment should have provided more lasting relief.

During the second treatment, I modified my approach and treated according to Master Tung’s acupuncture. The following week the patient reported no noticeable improvement.

Having had no significant and lasting results, we decided, at our third meeting, to focus our attention on the second reason for consultation, the other pain the patient had, while also needling a couple acupuncture points related to the tooth. To limit the number of needles and not to interfere with the rest of the treatment, I chose points of the ear. Auriculotherapy is a technique that I learned during my studies in acupuncture more than 15 years ago but that I do not use very often clinically since I generally consider other approaches more effective.

At the following treatment a week later, the patient noted a significant improvement of her discomfort in the tooth. She no longer had the sensations of pressure and pulsing in the tooth, but remained hypersensitive to the cold. So we continued with ear acupuncture, leaving small beads in the ears on ShenMen and Dental Analgesia points so that the patient could stimulate the points herself. She did not feel discomfort until the beads fell. At the next treatment, we still placed these beads in the ears. And she came back a week later just to replace them, not because the pain had returned but rather in prevention.

At follow-up, more than a month later, the patient reported having had no pain in the teeth since her last treatment.


 


This episode serves to remind me that advanced techniques are not always the most appropriate. Sometimes it is necessary to go back to basics and a simple treatment is sometimes enough to reach the therapeutic objectives we set.


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