By Kelly Mondesire and Dr. Jeffrey R. Lemler

Nine years ago, I was told a story by one of my herbology professors. She grew up during the Cultural Revolution in China in a poor and rural section of the country. When she was a little girl, she experienced a toothache in one of her molars. Her grandmother mixed Shi Gao (gypsum) with a raw duck egg and gave the mixture to her for the toothache. The toothache being gone, the little girl realized that if she feigned another toothache, she would get another duck egg (eggs were very hard to come by in that area and were quite a treat!).

I have always remembered the story and the ‘take home message'... Shi Gao (Gypsum) is sweet, acrid, and very cold by nature and travels to the Stomach and Lung channels. It is in the Clear Heat, Drain Fire category. According to Bensky, it can: clear heat, drain fire, and clears blazing Stomach Fire. It is indicated for headache, toothache, and used for swollen and/or painful gums due to Stomach Fire. Hence, it can be quite effective in the treatment of pain, heat, and swelling of the gums for post-dental surgery. I remembered the duck egg and Shi Gao remedy because of the endearing story, but I never thought I would have the opportunity to use this traditional combination on one of my own patients.

 I was recently approached by a patient who has been seeing me regularly for his healthcare. The subject is a 58-year-old male in good health. He was to undergo dental surgery. The procedure scheduled was a vertical and horizontal augmentation of the mandibular posterior ridge utilizing guided bone regeneration. The main graft material was an allograft putty supported by tent poles and covered with a double collagen membrane for barrier function. The patient was informed that following this three hour operation (in which he would be under general anesthesia), he would experience excruciating pain for approximately 4 days, accompanied by swelling. Anti inflammatory drugs, antibiotics, and painkillers would be prescribed. The patient was advised to go home after the surgery and stay there for at least two days because of the severity of pain expected. My patient asked me to treat him pre and post procedure for the expected pain, swelling, and side effects of the anesthesia and antibiotics. I accepted the task (as I do make house calls in Manhattan) and after meeting with the surgeon, Dr. Jeffrey R. Lemler, I was also granted admission into the operating room to observe this amazing dental procedure.

My treatment of the patient and the stages of his recuperation are as follows:

Day 1 Pre-operation treatment approximately four hours prior to procedure:

Treatment Principle: Tonify Qi and Blood

LU7 (R) KI3 (L)

P6 (L) SP4 (R)

ST36 (R) SP6 (L)

LI4 (L) LV3 (R)

R17, R6, Yin Tang

The patient was anesthetized during surgery. Following the operation, he rapidly came to full consciousness. He was fairly talkative, coherent, and rather energetic. He reported having no pain (the anesthesia was wearing off at this time). The patient insisted on having his dental bridge placed back onto the lower left jaw, against the advice of his surgeon. The bridge, it was explained, would prevent the ease of healing and build pressure on the soft tissue as it would naturally swell during the healing process. The patient was advised that this could cause complications and greater pain, but, nevertheless, he was adamant to have his bridge adhered to the lower jaw. Approximately two hours following surgery, I whisked 30g of Shi Gao (gypsum) with two duck eggs (a wonderful source of protein and collagen) until the mixture was smooth. I then blended this with 30g of protein powder, one cup of whole Greek style yogurt, 8 oz whole milk and crushed ice. The patient drank the shake for dinner.

Present DX: Qi & BL Stagnation in ST Channel with Heat in St Channel

TX Principle: Clear Stagnation and Heat, relieve pain.

Acupuncture treatment was as follows: After his meal, I needled ear Shenmen bilaterally and added SuJok (Korean hand/foot) lower left jaw point on the left thumb (which was quite tender upon pointer palpation). The patient rested comfortably. Four hours later, I mixed another shake containing 30g Shi Gao, one duck egg, 30g protein powder, one cup fresh papaya, 8oz milk, and crushed ice. The patient still reported having no pain. Ice packs held to lower jaw every four hours for 5 to 10 minutes were also administered. Patient took one painkiller and (2) regular strength Tylenol as a preventive measure because of the warnings of the surgeon that there would be excruciating pain.

Day 2

The patient reported that he slept fairly well, but was tired. He stated that he had no pain. There was very little swelling of the lower left jaw (site of surgery) visible. He reported some diarrhea (possibly from the anesthesia and antibiotic). He had little appetite but this increased as he drank another protein shake made with 30g Shi Gao and two duck eggs (protein powder, milk, crushed ice and yogurt were standard ingredients in these shakes). The patient took two regular strength Tylenol as a ‘just in case' during the day and just prior to bedtime.

Present DX: Qi and Bl Stagnation and Heat Accumulation in ST Channel.

TX Principle: Clear Stagnation and Heat, prevent and reduce any soreness and pain.

His acupuncture treatment for the day was as follows: LI4 and ST3, ST44, and LI11. These points were attached to strong e-stim, continuous pulse. It has been in my experience that the ST44, LI4, and LI11 clear heat from the channel, thus preventing inflammation of the gums and jaw and relieving pain and any impending headache. Ear Shenmen P6 (L), HT3 (R) (for pain and to calm the Spirit) Patient still states that he has no pain and is feeling much better after his acupuncture treatment. I advised the use the cold packs as needed for five minutes on and 20 minutes off.

Day 3

Bruising (dark dusky blue) is now coming to the general surface of the lower left jaw. The patient is now ingesting fish, soft meat and vegetables. He is drinking his two shakes per day. Dosage of Shi Gao is 30g per serving with two duck eggs added. He is up and about and is performing most of his normal daily activities. There is no pain reported, just a dull soreness that comes and goes from time to time. The application of cold packs as needed is being applied. The patient took only two Tylenol before bedtime the prior evening.

Present Dx:  Qi & BL Stagnation in ST channel

TX Principle: clear heat and stagnation/relieve soreness

Acupuncture treatment was as follows: LI4, ST36, ST44, LI11. These points were augmented with strong continuous e-stim. Ear Shenmen SuJok left thumb at lower left jaw position.

Day 4

The patient reports that he still has not experienced any pain, just some soreness in the jaw area. He believes he slept on his left side the night before. He is eating soft meats and fish, and is now including salad, rolls, and green vegetables (green beans and asparagus) to his meals. Patient is still ingesting his two shakes per day. The dosage of Shi Gao has been reduced to 15G per serving with one duck egg. Fruits are added to shakes for variety of flavor. There have been no digestive issues since the first day of surgery. Bowel movements have been normal and his energy level is much better. Sleep is good. Soreness and bruising of jaw area are very minimal. No over the counter pain killers or anti-inflammatory medications were taken. He is experiencing some stress for unrelated issues.

Present DX: Qi and BL Stagnation in ST Channel

Treatment Principle: Clear Stagnation, relieve pain, and calm Shen.

Acupuncture treatment as follows: SuJok Left thumb (three lower left jaw points needled to correspond to entire left jaw) and Ear Shenmen bilaterally. Patient reported feeling much calmer, relaxed, and pain free after treatment.

Day 5

The patient skipped a day of treatment. He reports feeling ‘heat' in the jaw and a dull ache. There was some pus around the lower jaw and I advised the patient to notify his surgeon, because of the possibility of infection.

Present Diagnosis: Qi Stagnation and Heat accumulation in the ST Channel

Treatment Principle: Clear Stagnation and heat, relieve pain, and tonify Qi

Acupuncture Tx as follows: Yin Tang SJ17, ST7-ST5 (L) threaded downward along the jawline, R17, R6, LI4 (R), LV3 (L), LI11 (L), ST 36 (R), Ear Shenmen.

Note: On a normal basis, I use 30 gauge needles on this patient. Today he was very sensitive. With the exception of SJ17, LI4 and ST7-ST5, I used 38 gauge needles for today's treatment. As of this point in time, the patient has not needed to take the pain killers except for the one tablet he ingested the first day following his surgery. He has taken regular Tylenol or Advil, and has not reported having any pain whatsoever.

He returned to the surgeon today. The bridge was removed. A root that had been left as a conservative measure to hold the structure was infected. The root was removed with a local anesthetic, and the bridge once again reset. Another 3 days dosage of antibiotics was prescribed and the patient is scheduled to return to the surgeon's office in five days to have all the stitches removed.

Two Weeks Post Surgery

At this point in time, the patient is doing very well. He is eating normally and examination by the surgeon proves that the gums have healed completely. It will take another two months before it can be determined if the bone graft has taken. If so, at that point in time groundwork will begin for the implantation process. The patient is very pleased with the results of his treatment. The healthcare providers involved are quite impressed that this gentleman experienced no pain during his recuperation period.

Conclusion

This course of treatment required the trust and participation of the patient. Without his full cooperation and willingness to have treatments and herbal drinks every day, I surmise that I might not have had such a positive end result. His implant surgeries will begin in another four months after the grafts have matured. He has already signed me on to the task of seeing him through the next series of surgeries with acupuncture and any other herbal remedies that might be appropriate at that time.

Dental Analgesia

I have been performing dental analgesia for the past several years. Many dental patients are allergic or hypersensitive to lidocaine and other local anesthetics. These patients commonly resist dental treatment because they are unaware of their options. The clients range from young and robust to fairly elderly individuals. I have participated in many dental procedures where the patient was given neither lidocaine nor an anti-inflammatory drug; rather, they relied on acupuncture alone for their analgesia.

Much to the surprise of many dentists and dental surgeons with whom I have worked, this rather simple procedure renders very good results. I have witnessed many a wisdom tooth extracted, molars drilled, cavities filled, and groundwork laid for root canal; acupuncture being the only analgesic utilized. I always tell my patients to give me a hand signal if they feel any discomfort during their time in the dental chair and after; not observing such a sign, I have repeatedly asked if they have pain. They always shake their heads ‘no'. I find this to be quite fascinating - our medicine never ceases to impress me!

Basic Protocol

Because electrical stimulation is crucial to the efficacy of my treatments, I do not treat clients who have pacemakers, nor will I treat individuals who have frail health conditions. There are a few physical factors to be considered if one is to take on dental analgesia. Firstly, a typical dental room is rather small. There is usually very little space to move around the operating chair and there is always a dentist, dental assistant, and sometimes a second dentist or surgeon present in the room. The application of needles to the patient's body from the torso to the head is out of the question, because of the suction tubes, drills, lights, and constant maneuvering of the person's upper body and head during the procedure.

I set up both clean and dirty fields near the foot-end of the dental chair. I have all my necessary materials on hand, so I am never a physical interference to the other practitioners. Just five minutes prior to any dental procedure, I request the dental assistant to set up the patient so that there will be no repositioning of the chair after the needles are applied. I needle LI4 (HeGu) and ST36 (ZuSan- Li) bilaterally, and slowly drive the qi upward until the patient tells me when he or she can feel a tingling or numbing sensation in the gums. When the qi is felt in the gums, I apply electrical stimulation to all four points with strong and continuous pulsation. The strength of the e-stim should be strong enough to keep the gums numb, but not too strong as to cause the patient pain. This step must be performed expediently, because the procedure is scheduled for a limited time and the dentist cannot wait for me. I have also discovered that after 30 minutes, the efficacy of the level of e-stim begins to wear off. As soon as the e-stim is applied, the procedure begins. Careful monitoring of the patient's response to drilling, cutterage, and extraction is necessary. If any discomfort is observed, I increase the force of the electrical stimulation. If there is an extraction and stitches are involved, adding ST44 bilaterally with e-stim just prior to the application of the stitches will ensure there is no pain during this stage of the operation.

These points help to reduce the swelling and heat associated with extraction. Once all drilling, extraction, cutterage or stitching is complete, I slowly turn down the e-stim. I retain the needles for another five minutes after removing the electrodes. It is usually during this time that dental gauze packs are being applied to the gums and the dentist gives the patient last minute instructions. It is common that dentists who have never worked with an acupuncturist in this manner will have some sort of local anesthetic on hand, even if the patient requests no such treatment. I am always very proud of my profession when (after another successful procedure and the unused lidocaine is put back into storage) a dentist will state how amazing it is to witness a patient's painless surgery with only the use of four to six thin needles. These healthcare professionals develops a newfound respect for traditional Chinese medicine. They transcend from being a skeptic to sometimes becoming new patients themselves in my clinic.

Many a professional relationship and patient referral develop from these experiences. From my point of view, at the foot of the dental chair, I have a clear view into the mouth of the patient. To be privy to dental surgery is quite an education. Acupuncture analgesia is an old form of our medicine. I am honored to continue our tradition in this manner.

Rationale of Points Used

ST36 (ZuSanLi) is the He Sea and Earth Point of the Stomach channel. It clears fire, calms the Spirit, activates the channel, and relieves pain. ST44 (Neiting) is the Ying Spring and Water Point of the Stomach channel. This point clears heat and damp heat from the channel, calms the Spirit, and alleviates pain. It is a very effective point to add to treat toothaches of the upper and lower teeth and face in general. LI4 (HeGu) is the Yuan Source point of the Large Intestine channel. It is also the Command point of the head and face. This point activates the channel and alleviates pain of the teeth and jaw. It is quite effective for swelling of the face. OM

Kelley Mondesiré, MSTOM, L.Ac., is a

graduate of Pacific College of Oriental Medicine.

She has a private practice in Manhattan,

New York. She can be reached for questions

or comments at k@kmondesire.com or

refer to her website at www.kmondesire.com

Dr. Jeffrey R. Lemler has a private practice

in Manhattan, New York and Westport,

Connecticut. For inquiries about receiving

bone regeneration surgery, please contact

his office at 212-983-1080.