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Treatment
of Dry Mouth
Doctor's Thesis from Karolinska Institutet: Blom, Maria
Studies on acupuncture treatment of xerostomia
Friday, October 15, 1999ISBN: 91-628-3637-4 Diss: 99:533
Abstract: Xerostomia (dry mouth) is most often associated with Sj”gren's
Syndrome (SS), medication, endocrinological
disorders, or irradiation treatment to the head- and neck region. There
is no effective treatment of xerostomia at the
present. Only alleviating methods are used, such as saliva substitutes, saliva
stimulating agents, chewing gum, pilocarpine, and
electrical stimulation; however, these methods give only a short-term relief.
Acupuncture, one of many methods of sensory stimulation, has been used to treat
various diseases for over 3000 years.
Five studies were performed in order to elucidate the
effects of acupuncture on xerostomic patients. In the
first two studies the effects of acupuncture stimulation on 59 patients with xerostomia caused by irradiation, SS, hypothyroidism, Raynaud's disease, or unknown etiology
were investigated. The results of these studies indicate that
acupuncture may be a useful method of treatment for inflammation- and
irradiation-induced xerostomia.
In the third study the effects of four different
stimulatory modes of acupuncture on blood flux were investigated using Laser
Doppler flowmetry. 21 patients with primary or
secondary SS were treated with four different modes of acupuncture on different
occasions: manual stimulation, low frequency (2 Hz) and high frequency (80 Hz)
electrical stimulation, and with superficial needle insertion. The results show
that the local blood flux in the skin of the cheek increased significantly
(p<0.05) during acupuncture with low and high frequency electrical
stimulation, and both during and after treatment using manual stimulation. The
results of this study indicate that increases in the peripheral blood flux of xerostomic patients may be one of the underlying mechanisms
of acupuncture, and that superficial acupuncture results in a change in blood
flux, suggesting it should not be used as a placebo intervention.
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The fourth study determined the prognostic value of a Pilocarpine Test, aimed at identifying xerostomic
patients who may benefit from acupuncture treatment. The study included 32
patients with xerostomia caused by radiation
treatment (n=21) or SS (n=11). Salivary secretion was determined before and
after a Pilocarpine Test, and subsequently, all
patients were given 24 acupuncture treatments and followed up at I and 6 months. The effects of acupuncture treatment on
salivary flow rates (SFR) were compared to the results of the Pilocarpine Test. The Pilocarpine
Test was found to have a high sensitivity (0.89) and a good positive predictive
value (0.74) in identifying patients who may respond to acupuncture treatment of xerostomia.
The fifth study was a retrospective investigation,
determining the long-term effects up to 3 years of acupuncture in 70 patients
with xerostomia of different etiologies and the
influence of additional treatment. This study shows that acupuncture treatment
results in statistically significant improvements in SFR in patients with xerostomia up to 6 months.
The main findings of these five studies were: Acupuncture
treatment can improve salivary flow rates in patients with xerostomia
of different etiology. The Pilocarpine Test is a good
prognostic tool for predicting if acupuncture treatment may successfully treat
patients with xerostomia. It is suggested that
patients should be treated with at least 24 initial sessions over a period of
approximately four months. The results indicate that 10-12 additional
treatments every year can maintain and in some cases give further improvements.
No serious negative side effects were observed.
Acupuncture can be recommended as a valuable treatment
method with long-term effect for patients with xerostomia.
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