Integrating Medical Acupuncture and Intraoral Dry Needling Protocol for Radiation-Induced Xerostomia

ABSTRACT

Clinical trials have shown that acupuncture may be effective in treating xerostomia.2 Acupuncture reduces symptoms related to xerostomia in patients who are refractory to current management such as pilocarpine.3 A 60-year old female patient presented with xerostomia after receiving radiation for adenoid cystic carcinoma. Patient reported attempting various treatment modalities to improve RIX that included but not limited to Pilocarpine prescription and over the counter saliva substitutes. After 3 months, patient decided to seek care at UCLA School of Dental Medicine’s Orofacial Pain Clinic for dental acupuncture treatment. We opted to utilize Dr Niemtzow’s protocol for this case study. Dr Richard Niemtzow, a colonel in the US Air Force, created an acupuncture protocol that is point precise to treat radiotherapy-induced xerostomia (RIX) for cancer patients.6 Per Dr Niemtzow’s medical acupuncture protocol, three auricular and four digital points were bilaterally placed for 45 minutes. Patient subsequently received intraoral dry needling protocol on two tongue and two palatal acupuncture points for two minutes. Treatment was repeated the next day. By including dental acupuncture after Dr Niemtzow’s protocol, saliva production increased by an average of two times more compared to Dr Niemtzow’s stand alone treatment. The intraoral acupuncture protocol may have additionally stimulated the parotid, submandibular, sublingual, and minor palatal salivary glands, resulting in an increase of salivary production. Studies have shown at least two neuropeptides, vasoactive intestinal peptide and calcitonin gene-related peptide, to be present in salivary glands that can stimulate salivary secretion.7 The intraoral dry needling protocol is an invaluable addition to provide relief from radiation-induced xerostomia. Further investigation with a larger patient population should be considered to standardize dental acupuncture.

KEYWORDS:

• Case report
• acupuncture
• dental acupuncture
• medical acupuncture
• xerostomia
• recalcitrant xerostomia
• radiation induced xerostomia
• dysgeusia
• dysphagia
• odynophagia

Acknowledgment

Dental acupuncture has been taught and practiced at UCLA School of Dental Medicine since the early 1980s for various orofacial pain conditions. UCLA Health Center for East-West Medicine has also educated their residents on medical acupuncture for the past 30 years. At the UCLA Health Center for East-West Medicine, Dr Richard Niemtzow’s lecture in 2021 taught us his updated protocols on how to treat recalcitrant RIX.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Notes on contributors

S. J. Lee

S. J. Lee (DMD) is a board certified orofacial pain and dental sleep medicine specialist. After earning her doctorate from Tufts University School of Dental Medicine, Dr. Lee went on to complete her residency at UCLA School of Dental Medicine. Her areas of interest include TMJ and jaw pain/dysfunction, nerve pain in the face, headaches, and obstructive sleep apnea. Dr. Lee provides comprehensive treatment approaches uniquely tailored to each patient. To ensure patients have a full understanding of their condition, Dr. Lee is committed to open communication and patient education.

C. P. Diep

C. P. Diep (DDS, LAc) is a licensed dentist who has successfully treated patients for more than 32 years. She is a graduate of the UCLA School of Dentistry in 1989 where she earned a Doctorate in Dental Surgery. Dr. Diep is a Diplomate of American Board of Orofacial Pain (ABOP) and Diplomate of Oriental Medicine (NCCAOM). She is also a California Licensed Acupuncturist. Dr. Diep is a teaching faculty of UCLA center for East-West Medicine and a clinical educator at the UCLA School of Dentistry.

S. Arman

S. Arman (DMD, MPH) is the director of the orofacial pain program and continuing dental education program at the UCLA School of Dentistry. He joined the faculty as a lecturer in 2012 and also had a practice limited to Orofacial Pain. He is involved with the American Academy of Orofacial Pain and the American Board of Orofacial Pain. His interest is to promote Orofacial Pain education to healthcare providers and students as well as the integration of Orofacial Pain education into dental education curricula.

D. V. Messadi

D. V. Messadi (DDS, MMSC, DMSC) is a professor and Chair of the Section of Oral Medicine, Oral Pathology, and Orofacial Pain at the UCLA School of Dentistry. She previously served as the Associate Dean for Academic Affairs.

F. S. Younai

F. S. Younai (DDS) is a Professor of Clinical Dentistry in the Section of Oral Medicine and Orofacial Pain in the Division of Oral Biology and Medicine. In 1997 she joined the faculty of UCLA School of Dentistry, where she currently serves as Chair of the Division of Diagnostic and Surgical Sciences. Dr. Younai obtained her dental degree from the School of Dental Medicine at State University of New York at Stony Brook in 1985. After completing her training in Hospital Dentistry at Long Island Jewish Medical Center in New York, she joined the faculty of New York University (NYU) College of Dentistry in the Division of Basic Sciences. There, she was appointed as an Assistant Professor (1990–1996) and then an Associate Professor of Basic Sciences (1996–1997) and served as the Director of Hospital Dentistry, Special Patient Care and Oral Medicine from 1990 to 1997. Dr. Younai’s teaching portfolio includes courses that focus on the interplay between systemic diseases and oral health, oral diseases and their pharmacological management, and patient assessment. She chairs and teaches in a number of courses in the predoctoral curriculum in the Oral and Systemic Diseases Track.