Complementary and Alternative Medicines in Oral Health Care: An Integrative Review.

Complementary and alternative medicine (CAM) uses a holistic approach that finds natural solutions that help the immune system to fight off infection and diseases. In conventional medicine, the diseases are treated as a series of symptoms developed and not its actual cause or etiology, but CAM commonly targets the exact cause of the disorder thereby stimulating the body's healing process. This is based on an integrative literature review of methods and techniques used as complementary and alternative approaches for oral health care. A comprehensive electronic database search was conducted in PubMed, CINAHL, MEDLINE, EMBASE, Google, Google Scholar, and SCOPUS. Medicinal plants such as Medicago Sativa, Aloe Barbadensis Miller (Aloe Vera), and Trifolium Pratense (Red Clover) have excellent applications in treating gum disorders, prevent tooth decay, and have demonstrated good antifungal activity in the oral cavity. Homeopathic medicines such as Belladonna, Antimonium crudum, and Chamomilla have useful applications in relieving toothache. In Chinese medicine, various acupressure points (Acupuncture) have been used to relieve pain related to tooth, head-and-neck region, sinusitis, etc. Dental professionals can utilize these treatment modalities in their practice along with other conventional procedures as an integrative treatment approach to achieve better outcomes. Copyright:

INTRODUCTION

Complementary and alternative medicine (CAM) is one type of health-care system which includes diverse practices and products that conventional medicine does not use.[1] These treatment modalities are efficient, economical, and safe to be adopted as an alternative health-care approach in dentistry. As CAM is more widely discussed by the media and in mainstream medicine, patients feel more comfortable in the use of these therapies.[2]

CAM system includes domains such as Ayurveda, Naturopathy, Homeopathy, Chinese Medicine (acupuncture), and other interventions such as meditation, massage therapy, music therapy, and biofield therapies (Reiki). This study is aimed to discuss the possibilities of application of these alternative systems in dentistry.[1345]

MATERIALS AND METHODS

An integrative literature search was conducted on various Internet-based search engines (Google and Google Scholar) and bibliographic databases (PubMed, PubMed Central, MEDLINE, Medknow, EMBASE, SCOPUS, CINAHL, and AMED) for articles published from the year 1975 to 2017 using the keywords and phrases: “Dentistry” OR “Oral health care” AND “Complementary medicine” OR “Alternative medicine” OR “Holistic Dentistry” OR “Traditional medicine” OR “Ayurveda” OR “Chinese Medicine” OR “Homeopathy,” OR “Naturopathy.” The search was limited to articles published in English.

A bibliographic management software “EndNote” (Thomson Reuters, New York, NY, USA) was used for importing the search results. Articles published only in English language were included. The contents with duplicity were removed, and the remaining articles were screened and assessed by the titles and abstracts. The initial search identified 287 articles. A total of 55 articles were finally considered for the review after thoroughly examining the quality and content of each one [Figure 1]. Two authors were assigned to assess the quality of all the selected articles. The article does not intend to be a systematic review, rather a narrative review that illustrates the application of holistic or complementary medicines in the field of oral care.

Figure 1

Flowchart of literature search.

AYURVEDA

Ayurveda is one of the ancient Indian health-care systems which still has a high acceptance worldwide. Ayurvedic treatments are based on a comprehensive knowledge base about physical, spiritual, mental, and social health of an individual.[6] The fundamentals of Ayurveda are fully documented in the ancient holistic books “Charaka Samhita” and “Sushruta Samhita. According to the principles of Ayurveda, the human body is made up the three doshas: Vata (wind, air); Pitta (Bile, fire); and Kapha (mucus, water); these “tridoshas” are physiological entities which play a vital role in performing all the metabolic functions of the body.[67]

The structure and functions of teeth and gums, various toothpaste available and how to select the tooth powder depending on the constitution and character of the gums, various teething disorders, beneficial and harmful diet, congenital anomalies, traumatic injuries, ANUG, gingivitis, periodontitis, dental caries and toothache, alveolar abscess, malignancies of jaw bones, and dislocation of TMJs along with their treatment are all described in Ayurveda.[8] Some of the commonly used medicinal plants for problems associated with oral health are illustrated in Table 1. Evidence suggests that Ayurvedic treatments received much attention worldwide in the field of prevention and cure compared to the western medicinal system. Ayurveda treatments cannot completely substitute conventional dental therapies but could be used as adjunctive methods.[8]

Table 1

Medicinal plants and its applications in dentistry

Medicinal plants	Indications in dentistry/oral health
Medicago sativa (Alfalfa)[9]	Useful in treating minor hemorrhages and fungal infections
	Excellent choice as a mineral supplement (makes tooth more resistant to decay)
Aloe Barbadensis Miller (aloe vera), Eucalyptus camaldulensis, Panax ginseng, Trifolium pratense (red clover), Matricaria chamomilla (used as mouth wash)[10111213141516]	Healing and soothing effect on inflamed gums and sores in the mouth Antifungal effect Antioxidants

HOMEOPATHY

Homeopathy medicine is gaining acceptance worldwide for the treatment of various diseases. Dr. Samuel Hahnemann propounded the principles of homeopathy. Homeopathy utilizes the body's healing capacity to cure the diseases, and Hahnemann was of the view that the symptoms of the diseases are nothing but the struggle to overcome the illness.[17] Homeopathy explores the essence of disease through the symptom syndrome. Homeopathy can be unified into the practice of dentistry by replacing the conventional drugs or as a treatment for conditions for which there is no other alternative. However, it cannot replace the mechanical arts of dentistry. Some of the commonly used homeopathy medicines for oral health care and treatment are depicted below [Table 2].

Table 2

Homeopathic medicines commonly used in dentistry

Oro-facial disorders/problems	Homeopathic medicines
Toothache[1819]	Belladonna, Antimonium crudum, Aranea diadema, Calcarea carbonica, Chamomilla, Aconitum napellus, Coffea cruda, Ferrum metallicum, Magnesia carbonica, Magnesia phosphorica, Magnesia Phosphorica, Pulsatilla, Staphysagria
Periodontal diseases[2021]	Arsenicum album, China, Ferrum phosphoricum, Hypericum, Kali chloricum, Naturiummuriaticum, Hepar sulphuris, Silicea, Staphysagria, Symphytum, Mercurius solubilis, Nux vomica, phosphorus, Ruta graveolens
Halitosis[22]	Calendula mouth tincture
Temporomandibular joint disorders and trismus[232425]	Arum triphyllum, Calcarea phosphorica, Chamomilla, Granatum, Hypericum perforatum, Phytolacca
Dental abscess[2526]	Belladonna, Hepar sulphuris calcareum, Silicea, Myristica Sebifera, Calendula
Bleeding[1827]	Phosphorous, Arnica, Ferrum phosphoricum
Oral ulcers and sores[2428]	Antimonium crudum, Kali chloricum, borax, Natrum muriaticum, Nitircumacidum
Early childhood caries[19]	Kreosotum
Bruxism[232530]	Belladonna, Podophyllum, Tuberculinum
Salivary gland disorders and problems related to salivation[2930]	Baryta carbonica, Bryonia alba, Ignatia, phosphorous, Pulsatilla
Dental anxiety (apprehensions related to dental visit)[31]	Aconite, Coffea cruda, Chamomilla, Gelsemium, Kreosotum

NATUROPATHY

It is a system of curative science that takes advantage of the body's natural or instinctive capabilities to restore the health. Naturopathy can be seen as integrative science which includes healing practices applied in Homeopathy, Herbal Medicines, etc. It is a drugless system which utilizes some of the environmental forces such as air, temperature, and water to cure the disease. The treatment model in Naturopathy is based on the principles similar to Ayurveda and Homeopathy.[32] Some nontraditional techniques used consist of electrodermal screening, Contact Reflex Analysis, hypnosis, magnets, herbal plants, magnets, Homeopathy, therapies that utilize heat and cold, kinesiology, hydrotherapy, etc., Some of these techniques are being applied in dental practice such as hypnosis, kinesiology, and craniosacral interventions (used in orofacial orthopedics). Hypnosis is widely practiced in dental sleep medicine to treat bruxism, obstructive sleep apnea, pain control of orofacial structures, etc., Kinesiology is utilized for TMJ-related disorders, chronic and acute orofacial pain, and neck problems.[32]

TRADITIONAL CHINESE MEDICINE AND DENTISTRY

Chinese medicine has a long history and has been in practice for >2500 years and includes treatment modalities such as Acupuncture, Herbal Medicine, and Tai Chi and qigong exercises.[3334] In Acupuncture, practitioners make use of very thin needles to activate certain points on the body which controls the flow vital energy (Qi), stimulates the body's healing response, and restores the natural balance bringing relief to the patient thereby correcting the disturbed flow of Qi to the Zang-Fu. Studies have proved that Acupuncture is proved to be effective in managing certain pain such as postoperative dental pain, myofascial pain, headache, musculoskeletal disorders associated with dental practice such as carpal tunnel syndrome, lumbar pain, cramps, and tennis elbow.[3435] Herbal medicines act as Zang-Fu organs internally.[34] Qigong is a stretching exercise commonly used in Chinese medicine.[36] This technique helps to restore the flow of vital energy (Qi) which can be useful in relieving pain associated with maxillofacial region.[35] Different applications of acupuncture points are depicted in [Table 3].

Table 3

Application of acupuncture in dentistry

Acupressure points	Applications
P-6 (located between the two central tendons, along the inner forearm)[37]	Used for suppressing gag reflex and nausea
GB-20 (Feng Chi points)[38]	Effective for headaches, migraine, flu/cold symptoms, fatigue, low energy, etc., that works for stress and anxiety
GB-21 (Jian Jing)[39]	Recommended for headaches, pain, neck stiffness, shoulder tensions, etc.
BL-10 (Tianzhu)[40]	Indicated for headaches, cervical rigidity, fever, pain or red of the eyes, lacrimation, loss of olfaction, etc.
GV-16 (Wind mansion or “Fengfu”)	Effective in relieving pain in the neck region, mental stress, nosebleeds, dizziness, and also headaches
GV-24[4041]	Useful in chronic sinusitis, frontal headache, nosebleeds, nasal discharge, excessive tearing
LI-4 or “He Gu” (located between thumb and index finger)[40]	Used for treating dental pain of maxillary and mandibular teeth, facial pain, migraine etc.
ST-6 or “Jiache” (located in the inferior-posterior border of masseter muscle at the mandibular angle)[41]	Effective in treating dental pain, gingival diseases, jaw pain, masticatory problems etc.
ST-3 or “Juliao” (situated below the pupil at the level of the border of ala nasi)[42]	Used for treating trigeminal neuralgia, bells palsy, facial paralysis, dental pain etc.
ST-4 (point in the foot between second and third toe)[42]	Used effectively for jaw pain, tooth pain, tinnitus etc.

AROMATHERAPY

Aromatherapy is a complementary technique that makes use of essential oils obtained from medicinal plants or trees. It is efficiently used as ailments in stress or anxiety-related disorders, migraine, muscular, and jaw pain.[43] The essential oils are either inhaled or topically applied on the skin. When the oils are inhaled, the nerve cells in the nasal cavity get stimulated by the scents and activate the limbic system. Thus, it is responsible for the dominant effect on moods and the general state of mind and plays a vital role in controlling the heart rate and blood pressure by interacting with the kidney.[4445] Dental anxiety is considered as one of the obstacles to avoid dental treatment. Anxiety in patients may cause stress and irritation in dental health professionals and could result in reduced performance considerably affecting the treatment outcomes. Aromatherapy has been found effective in reducing fear and stress during conventional dental treatments.[46] Commonly used essential oils for managing some of the dental problems are shown in Table 4.

Table 4

Essential oils used in dentistry

Action	Essential oils
Antidepressants, anxiolytic, induces calmness, improves the mood[4347]	Lavender, chamomile, lemon, orange, ylang, melissa, neroli
Anti-inflammatory[44]	Lavender, marjoram, bergamot, geranium
Antispasmodic[48]	Lavender, chamomile, marjoram, rosemary, lemongrass
Arthritis and body pain[49]	Rosemary, grapefruit, juniper, Helichrysum
Antibacterial[50]	Tea tree oil, lavender
Astringent[47]	Cypress
Decongestant[47]	Eucalyptus, peppermint oil
Teething problems[47]	Chamomile

MIND BODY INTERVENTIONS

Mind and body interventional techniques such as Hypnosis, Yoga, and Biofeed training can be used to reduce pain associated with the orofacial region.[51] Biofeedback training is the process that enables an individual to learn control over his/her body functions that involuntary. Because mind and body are made of the same basic substance, and that if we can regulate mind, we can regulate the body. This technique is used to prevent or treat a migraine, headaches, chronic pain, high blood pressure, etc., Studies have proved that relaxation techniques such as yoga and deep breathing and visualization techniques can be helpful for pain control.[52] The dental health professionals can make utilize of these mind and body intervention techniques such as yoga and relaxation techniques to encounter problems such as musculoskeletal pain (associated with dental ergonomics) and also reduce stress.[53]

SPA DENTISTRY

Spa Dentistry is an emerging practice in dentistry where they offer some traditional and nontraditional techniques that are usually not associated with dental care. Therapies such as hand massage, head massage, or spa-like amenities seemed to provide relaxing environments for the patients that ease their fear and anxiety which are often associated with dental visits. The facility runs under the supervision of a practicing dentist. It combines the routine restorative, cosmetic, and holistic treatment.[54] Spa facilities in a dental clinic could help the patients to overcome dental fear or anxiety and make the visit a pleasant and sweet experience.[55]

Some of the ideas to incorporate Spa-style dental clinic includes:

i. At the waiting area:

Remote-controlled massage mats to set kneading pattern and heat intensity

Refreshments such as coffee, tea, juice assortments, and bottled water.

Cascading water fountains, salt aquarium to distract patient

Hotel-style concierge services: while the patient is receiving treatment, the staff attends cell-phone calls, babysits, orders the food, or does just about anything the patient asks

Pain treatment from an acupuncturist.

i. Within the operatory

Use of nitrous oxide for which can make the patient relaxed helping the dentist to perform the procedures efficiently

Virtual reality glasses or devices to watch a movie during dental treatment

Use of headphones with music could help in reducing the shriek of the drill

Dental chair with a cushion system for neck and back can be used to give the patient pleasant effect

Hot stone massages, hot paraffin-wax hand treatment, herbal eye masks, foot massages, during invasive procedures to keep the patient relaxed.

CONCLUSION

CAM brings together the best of all traditions emphasizing disease prevention, general well-being, and holistic approach to health. Most of these holistic approaches are found to be relatively nontoxic and biocompatible. Understanding each of these methods and its applications in oral health care is still an ongoing process. By use of these CAM therapies, dental practitioners can better meet their patient needs, establish a patient-centered, prevention oriented, and a class apart dental practice.

Financial support and sponsorship

This study was carried out without any funding.

Conflicts of interest

There are no conflicts of interest.