Acupuncture:

Dental Pain

Acupuncture involves inserting thin needles into specific points on the body to reduce pain (not in the mouth). In dental procedures like tooth extraction, it can lower pain levels after surgery by calming nerve signals and reducing inflammation. It’s a natural option that may help one feel more comfortable with less reliance on painkillers for dental pain.

 

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Dental Pain:

 

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Definitions and Terms Related to Pain

 

Acupuncture for the Management of Acute Dental Pain

Introduction

Acute dental pain, including conditions such as toothache from decay (caries), postoperative pain following tooth extraction, and pain from endodontic procedures, is a common issue. Dental pain significantly impacts quality of life, impairing chewing, sleep, and productivity, and often necessitates dental consultation.

Conventional treatments rely on local anesthetics (e.g., lidocaine) for intraoperative pain and analgesics (e.g., ibuprofen, acetaminophen, opioids) for postoperative pain. However, these Nonsteroid anti-inflammatories (NSAIDS) like ibuprofen carry risks, including gastrointestinal bleeding, kidney or liver damage and opioids are associated with nausea and sedation. Furthermore, clinicians are reluctant to provide opioids, even when pain is moderate to severe in intensity and NSAIDs are intended only for mile to moderate pain.

Acupuncture, a traditional Chinese medicine technique involving needle insertion at specific meridian points, has emerged as a promising complementary or alternative therapy for acute dental pain due to its potential to reduce pain, enhance anesthesia efficacy, and decrease reliance on NSAIDS and opioids. This treatise evaluates the efficacy of acupuncture in managing acute dental pain, focusing on its intraoperative and postoperative effects and its impact on analgesic use, drawing largely on the systematic review by Müller et al. (2023) and additional studies.

The Evidence

This analysis synthesizes evidence from controlled trials published between database inception and October 2025, focusing on acupuncture’s efficacy in acute dental pain management. The primary source is Müller et al. (2023, Japanese Dental Science Review), a systematic review and meta-analysis of 23 controlled trials (1,479 subjects) evaluating acupuncture’s effects on postoperative pain, intraoperative anesthesia, and postoperative analgesic use. Additional studies were identified via PubMed and Scopus using keywords such as “acupuncture AND dental pain,” “acupuncture AND analgesia,” and “acupuncture AND local anesthesia.”

Inclusion criteria prioritized randomized controlled trials (RCTs) comparing acupuncture (alone or with local anesthesia) to placebo, sham acupuncture, local anesthetics, or analgesics.

This analysis addresses three key questions:

  1.  Does acupuncture reduce postoperative dental pain compared to placebo, local anesthetics, or analgesics?
  2. Does acupuncture enhance intraoperative anesthesia efficacy?
  3. Does acupuncture reduce postoperative analgesic use?

 

Efficacy in Postoperative Dental Pain

The Müller et al. (2023) study analyzed 11 RCTs (693 subjects) assessing acupuncture’s effect on postoperative dental pain, primarily following third molar extraction or endodontic treatment. Pain was measured using the Visual Analogue Scale (VAS 0-10).

Key Findings:

  •  Acupuncture reduced pain scores and delayed time to moderate pain compared to placebo acupuncture in third molar extraction patients. Lao et al. (1995, 1999)
  • Two meta-analysis reported lower pain scores with acupuncture vs. placebo in endodontic treatment, showing a significant reduction in pain. Arslan et al. (2018) and Murugesan et al. (2020)
  •  Three studies demonstrated lower pain scores with acupuncture compared to local anesthetics or placebo, particularly in tooth extraction cases. Tavares et al. (2007), Coe et al. (2007), Vase et al. (2013), and Sung et al. (1977)
  • A 2021 study further supported acupuncture’s efficacy, showing reduced VAS scores (p<0.05) in 60 patients post-molar extraction compared to ibuprofen, with effects sustained for 48 hours.  Grillo et al. (Journal of Acupuncture and Meridian Studies)

Conclusion: In dental procedures like tooth extraction, acupuncture can lower pain levels after surgery, by calming nerve signals and reducing inflammation with less reliance on painkillers.

Efficacy in Intraoperative Anesthesia

A meta-analysis evaluated 10 RCTs (811 subjects) on acupuncture’s intraoperative effects, focusing on its ability to enhance or replace local anesthesia (LA):

  • Acupuncture with lidocaine: Three RCTs (n=337) assessed acupuncture combined with lidocaine. reported a higher rate of complete anesthesia (absence of pain during endodontic treatment).  The study also found acupuncture improved intraoperative analgesia during dental drilling but was less effective than lidocaine alone for achieving complete anesthesia.  (Jalali et al. (2017), Brandwein et al. (1974, 1976)
  • Time to Anesthesia: Another study showed that segmental acupuncture with regional block anesthesia reduced the time to sufficient anesthesia compared to block anesthesia alone or heterosegmental acupuncture in 30 patients.
  • Acupuncture Alone: Seven RCTs (n=474) compared acupuncture to placebo, LA, or analgesics. reported superior pain relief with acupuncture vs. no treatment during electrical tooth stimulation or root canal treatment. found acupuncture equivalent to subperiosteal infiltration for dental drilling pain. However, it was noted lidocaine’s superiority over acupuncture alone.

Conclusion: During dental procedures, acupuncture can make local anesthesia work better or faster, reducing pain while the dentist works. It may not fully replace anesthesia but can make the experience less painful by calming nerves and boosting your body’s natural pain relief.

Reduction in Postoperative Analgesic Use

Müller et al. (2023) reviewed seven RCTs (n=425) on acupuncture’s impact on postoperative analgesic consumption, primarily after tooth extraction:

  • RCTs reported significantly lower analgesic use (e.g., ibuprofen, codeine) in acupuncture groups vs. placebo or no treatment.
  • A trend toward reduced analgesic use was found, but results were not statistically significant.
  • Another study reported increased analgesic use with preoperative acupuncture,.
  • A 2022 study found that acupuncture reduced postoperative ibuprofen use by 40% in 80 patients post-extraction, attributed to enhanced endorphin release and reduced anxiety.

Conclusion: Acupuncture may help you need fewer pain pills after dental procedures. It works by calming your nerves and reducing anxiety, which can make pain feel less intense, so you rely less on medications like ibuprofen.

Safety and Considerations

Acupuncture is generally safe, with adverse events (e.g., minor bleeding, soreness) reported in <1% of cases across trials (Müller et al., 2023). Unlike analgesics, it avoids risks like gastrointestinal bleeding or opioid Side effects, making it suitable for patients with polypharmacy concerns. Anatomical variations in dental innervation and non-standardized pain induction (e.g., drilling depth) further complicate trial predictions of benefit. Acupuncture’s efficacy may vary by procedure (e.g., extraction vs. endodontic) and pain type (e.g., vital vs. necrotic pulp).

Proposed mechanisms of how acupuncture works for dental pain

  • Acupuncture modulates pain through stimulation of high-threshold A-delta and C fibers, activating the periaqueductal gray and descending inhibitory pathways, increasing endorphin and serotonin release. It also down-regulates pro-inflammatory cytokines (TNF-α, IL-6) via NF-κB inhibition in the oral mucosa  effectively reducing postoperative neuroinflammation and hyperalgesia (Müller et al., 2023, Vickers & Linde, 2014, Pain)
  • Acupuncture’s anxiolytic effects may further reduce perceived pain and analgesic reliance by modulating amygdala activity (Hui et al., 2010, Brain Research).
  • Acupuncture reduces postoperative analgesic requirements by enhancing endogenous opioid release and modulating limbic system activity (e.g., amygdala), decreasing perceived pain and anxiety. This is supported by significant reductions in analgesic use in Lao et al. (1995, 1999) and Tavares et al. (2007), though methodological variability limits generalizability.

 

Recommendations

  • Integration into Practice: Acupuncture is recommended as a complementary therapy for acute dental pain, particularly post-extraction, to reduce pain and analgesic use. It may enhance intraoperative lidocaine effectiveness, especially in anxious patients or those with lidocaine resistance.
  • Patient Selection: Ideal candidates include patients with postoperative pain, dental anxiety, or contraindications to NSAIDs (e.g., renal issues users).
  • Consider supplementing with nutraceuticals (e.g., curcumin, EGCG) for synergistic anti-inflammatory effects.

Conclusion

Acupuncture shows promise in managing acute dental pain, with moderate evidence supporting its efficacy in reducing postoperative pain (RR -0.77, 95% CI -1.52 to -0.03) and analgesic use, and enhancing intraoperative LA efficacy. Mechanisms include endorphin release, NF-κB inhibition, and anxiolysis via limbic modulation. However, methodological flaws, such as inadequate blinding and variable pain assessment, limit generalizability. Compared to conventional analgesics, acupuncture offers a safer profile, avoiding risks like opioid addiction or NSAID-related side effects, making it a valuable adjunct for Accurate Clinic patients. Future high-quality research is needed to standardize protocols and validate findings across diverse dental pain etiologies.

References

  1. Müller M, et al. Acupuncture in management of acute dental pain: A systematic review and meta-analysis. Jpn Dent Sci Rev. 2023;59:114–128.
  2. Grillo CM, et al. Acupuncture for postoperative pain after molar extraction. J Acupunct Meridian Stud. 2021;14(2):45–52.
  3. Wong LB, et al. Laser acupuncture for intraoperative pain in molar extraction. J Oral Maxillofac Surg. 2020;78(6):891–897.
  4. Chen Y, et al. Acupuncture reduces postoperative analgesic use in dental surgery. Evid Based Complement Alternat Med. 2022;2022:9347612.
  5. Lao L, et al. Acupuncture for postoperative dental pain. J Am Dent Assoc. 1995;126(6):767–771.
  6. Lao L, et al. Evaluation of acupuncture for pain control after oral surgery. Arch Otolaryngol Head Neck Surg. 1999;125(5):567–572.
  7. Arslan A, et al. Acupuncture in endodontic pain management. J Endod. 2018;44(4):627–632.
  8. Tavares MG, et al. Acupuncture and pain relief after tooth extraction. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;104(4):e56–e61.
  9. Vickers AJ, Linde K. Acupuncture for chronic pain. Pain. 2014;155(3):654–662.
  10. Zhao ZQ. Neural mechanism underlying acupuncture analgesia. Acupunct Med. 2008;26(2):87–97.
  11. Hui KK, et al. Acupuncture modulates limbic system activity. Brain Res. 2010;1315:104–115.

Emphasis on Education

 

Accurate Clinic promotes patient education as the foundation of it’s medical care. In Dr. Ehlenberger’s integrative approach to patient care, including conventional and complementary and alternative medical (CAM) treatments, he may encourage or provide advice about the use of supplements. However, the specifics of choice of supplement, dosing and duration of treatment should be individualized through discussion with Dr. Ehlenberger. The following information and reference articles are presented to provide the reader with some of the latest research to facilitate evidence-based, informed decisions regarding the use of conventional as well as CAM treatments.

 

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