Case Description. This case report describes the use of acupuncture as a treatment for periodontal disease as prescribed and administered by a Korean practitioner. The patient was treated in 1991 by the insertion of multiple acupuncture needles in response to a diagnosis of "gum pain." Chronic, low-grade discomfort, diagnosed as a symptom of the disease, disappeared after the acupuncture treatment. The patient had minimal professional care in this country since the acupuncture therapy. She had experienced low-grade, but persistent, discomfort over the previous two years.

Clinical Implications. The oral diagnosis is moderate to advanced generalized chronic periodontitis with primary occlusal trauma. The present findings tend to implicate parafunction as the etiology for the current pain and perhaps the etiology for the discomfort experienced 10 years ago.

Although acupuncture initially was used for disease management, its use has evolved as a pain control modality. In 1958, acupuncture was used to produce surgical anesthesia during a tonsillectomy in Shanghai, China. In 1960, the visiting anesthesia faculty from Jefferson University College of Medicine filmed a pneumonectomy procedure in China, in which the only anesthetic employed was gold-needle acupuncture.³ The female patient was awake throughout the surgery and responded to questions asked of her by the surgeons and spectators.

	CASE REPORT

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A 78-year-old Korean woman came to New York University College of Dentistry for routine dental treatment. On a radiograph, 0.1-millimeter–diameter radiopaque lines of varying lengths were noted. These lines appeared to be fine metallic wire filaments and were scattered throughout the maxilla and mandible in random fashion from the canine teeth to the second molars. A subsequent panoramic radiograph confirmed the presence of 24 embedded wire filaments that were approximately 1 centimeter long, unequal in shape and randomly placed in the facial mucosae and soft tissues of the lip (Figure 1). Individual periapical radiographs demonstrate that several of the wire filaments were superimposed over the teeth’s roots (Figure 2). A subsequent radiograph of the patient’s lip showed the actual location of the inserted wires in the labial and facial soft tissues (Figure 3).

View larger version (86K): [in this window] [in a new window]   Figure 1. Panoramic radiograph showing two dozen wires throughout the oral cavity.

View larger version (88K): [in this window] [in a new window]   Figure 2. Two periapical radiographs of the maxillary anterior segment with multiple linear opacities superimposed over the right canine and lateral and central incisors.

View larger version (112K): [in this window] [in a new window]   Figure 3. Radiograph of lip area over maxillary right canine that shows the haphazard arrangement of nine filamentous wires.

The patient’s daughter, interpreting for her mother, explained that a Korean acupuncturist in New York City treated the patient in 1991 for "gum pain." The acupuncturist placed thin gold wires into the buccal and lip mucosae, without anesthesia. The patient recalled that her therapy was successful at that time. However, within the past year, vague, intermittent, low-grade gingival discomfort had intensified, prompting her visit to the New York University College of Dentistry.

Our examination discovered occlusal trauma as being concomitant to periodontal infection; the temporomandibular disease was one source of the discomfort. The patient understood the results of a thorough baseline dental examination, and she elected to undergo traditional therapy for advanced generalized chronic periodontitis, through interpretation and advice from her daughter.

	CONCLUSIONS

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In critical reviews of acupuncture in dentistry, its use for pain control is equivocal, as control groups are unobtainable and the few available studies are largely anecdotal.^4,5 In dentistry, acupuncture has been used to control pain and decrease salivary flow.^6,7 It has been studied during endodontic therapy and operative dentistry.^8–10 Investigators have studied acupuncture for relief of postoperative pain after tooth extraction, and the results have been less than satisfactory.^11–14

Since the United States is a multicultural society, general practitioners should be cognizant of therapies used in other parts of the world.

View larger version (153K): [in this window] [in a new window]   Dr. Schoor is the director, Advanced Training in Periodontics, New York University College of Dentistry, 345 East 24th St., Room 413, New York, N.Y. 10010-4086, e-mail, "NYUGUMS{at}aol.com". Address reprint requests to Dr. Schoor.

View larger version (145K): [in this window] [in a new window]   Dr. Sussman is an associate clinical professor, Department of Periodontics, New York University College of Dentistry, New York.

View larger version (120K): [in this window] [in a new window]   Dr. Kazandjian is the director, periodontal residency program, VA Medical Center, New York; and an assistant clinical professor, Department of Periodontics, New York University, College of Dentistry, New York.