Clinical Oral Investigations

, Volume 16, Issue 6, pp 1517–1522 | Cite as

Auricular acupuncture effectively reduces state anxiety before dental treatment—a randomised controlled trial

  • Andrea Michalek-SaubererEmail author
  • Erich Gusenleitner
  • Andreas Gleiss
  • Gabor Tepper
  • Engelbert Deusch
Original Article



The objective of this study was to analyse whether auricular acupuncture, acupuncture at the outer ear, could reduce state anxiety before dental treatment.


This prospective, randomised patient-blinded study with 182 patients compared anxiety before dental treatment following auricular acupuncture at the relaxation-, tranquillizer- and master cerebral points (auricular acupuncture group) versus acupuncture at sham points (finger-, shoulder- and tonsil points; sham group) and a non-intervention control group. Anxiety was assessed using the Spielberger State Trait Anxiety Inventory (German version) before auricular acupuncture and 20 min thereafter, immediately before dental treatment.


Auricular acupuncture reduced state anxiety score more effectively from 54.7 ± 10.8 to 46.9 ± 10.4 (mean ± SD) than sham acupuncture from 51.9 ± 10.2 to 48.4 ± 10.0. In contrast, state anxiety in the control group increased from 51.0 ± 11.7 to 54.0 ± 11.6 (mean increase +3.0; CI +4.7 to +1.2). The decrease in state anxiety in both intervention groups was statistically significant (p < 0.001) when compared to the non-intervention control group. After correcting for group differences in baseline state anxiety, the reduction in anxiety was −7.3 score points (CI −9.0 to −5.6) in the auricular acupuncture group and −3.7 score points (CI −5.4 to −1.9) in the sham group (p = 0.008).


Auricular acupuncture, a minimally invasive method, effectively reduces state anxiety before dental treatment.

Clinical relevance

Auricular acupuncture could be an option for patients scheduled for dental treatment, who experience an uncomfortable degree of anxiety and request an acute intervention for their anxiety.


Acupuncture Ear Anxiety Dental Complementary therapy Therapy Alternative 



DIng. Silberbauer Vertriebsgesellschaft m.b.H. &Co. KG (Vienna, Austria) kindly provided the acupuncture needles.

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Rodríguez Vázquez LM, Rubiños López E, Varela Centelles A, Blanco Otero AI, Varela Otero F, Varela Centelles P (2008) Stress amongst primary dental care patients. Med Oral Patol Oral Cir Bucal 13:E253–E256PubMedGoogle Scholar
  2. 2.
    Hill KB, Hainsworth JM, Burke FJ, Fairbrother KJ (2008) Evaluation of dentists' perceived needs regarding treatment of the anxious patient. Br Dent J 204:E13, 442-443Google Scholar
  3. 3.
    Oosterink FM, de Jongh A, Aartman IH (2008) What are people afraid of during dental treatment? Anxiety-provoking capacity of 67 stimuli characteristic of the dental setting. Eur J Oral Sci 116:44–51PubMedCrossRefGoogle Scholar
  4. 4.
    Enkling N, Marwinski G, Jöhren P (2006) Dental anxiety in a representative sample of residents of a large German City. Clin Oral Investig 10:84–91PubMedCrossRefGoogle Scholar
  5. 5.
    Armfield JM, Slade GD, Spencer AJ (2009) Dental fear and adult oral health in Australia. Community Dent Oral Epidemiol 37:220–230PubMedCrossRefGoogle Scholar
  6. 6.
    Vermaire JH, de Jongh A, Aartman IH (2008) Dental anxiety and quality of life: the effect of dental treatment. Community Dent Oral Epidemiol 36:409–416PubMedCrossRefGoogle Scholar
  7. 7.
    Lahmann C, Schoen R, Henningsen P, Ronel J, Muehlbacher M, Loew T, Tritt K, Nickel M, Doering S (2008) Brief relaxation versus music distraction in the treatment of dental anxiety: a randomized controlled clinical trial. J Am Dent Assoc 139:317–324PubMedGoogle Scholar
  8. 8.
    Pilkington K, Kirkwood G, Rampes H, Cummings M, Richardson J (2007) Acupuncture for anxiety and anxiety disorders—a systematic literature review. Acupunct Med 25:1–10PubMedCrossRefGoogle Scholar
  9. 9.
    Wang SM, Kain ZN (2001) Auricular acupuncture: a potential treatment for anxiety. Anesth Analg 92:548–553PubMedCrossRefGoogle Scholar
  10. 10.
    Wang SM, Peloquin C, Kain ZN (2001) The use of auricular acupuncture to reduce preoperative anxiety. Anesth Analg 93:1178–1180PubMedCrossRefGoogle Scholar
  11. 11.
    Karst M, Winterhalter M, Munte S, Francki B, Hondronikos A, Eckardt A, Hoy L, Buhck H, Bernateck M, Fink M (2007) Auricular acupuncture for dental anxiety: a randomized controlled trial. Anesth Analg 104:295–300PubMedCrossRefGoogle Scholar
  12. 12.
    Wang SM, Maranets I, Weinberg ME, Caldwell-Andrews AA, Kain ZN (2004) Parental auricular acupuncture as an adjunct for parental presence during induction of anesthesia. Anesthesiology 100:1399–1404PubMedCrossRefGoogle Scholar
  13. 13.
    Laux L, Glanzmann P, Schaffner P, Spielberger CD, State Trait-Angstinventar (STAI) (1981) Beltz Testgesellschaft, Weinheim, Deutschland (German version) from: Spielberger Charles D, Porsuch RL, Lushene RH. State-Trait Anxiety Inventory. Consulting Psychologists Press Inc., Palo Alto, CA, USAGoogle Scholar
  14. 14.
    Hermes D, Matthes M, Saka B (2007) Treatment anxiety in oral and maxillofacial surgery. Results of a German multi-centre trial. J Craniomaxillofac Surg 35:316–321PubMedCrossRefGoogle Scholar
  15. 15.
    Vickers AJ, Altman DG (2001) Statistics notes: analysing controlled trials with baseline and follow up measurements. BMJ 323(7321):1123–1124PubMedCrossRefGoogle Scholar
  16. 16.
    Fisher PL, Durham RC (1999) Recovery rates in generalized anxiety disorder following psychological therapy: an analysis of clinically significant change in the STAI-T across outcome studies since 1990. Psychol Med 29:1425–1434PubMedCrossRefGoogle Scholar
  17. 17.
    Weisenberg M, Kreindler ML, Schachat R (1974) Relationship of the dental anxiety scale to the state-trait anxiety inventory. J Dent Res 53:946PubMedCrossRefGoogle Scholar
  18. 18.
    Linde K, Niemann K, Meissner K (2010) Are sham acupuncture interventions more effective than (other) placebos? A re-analysis of data from the Cochrane review on placebo effects. Forsch Komplementmed 17:259–264PubMedCrossRefGoogle Scholar
  19. 19.
    Usichenko TI, Lehmann C, Ernst E (2008) Auricular acupuncture for postoperative pain control: a systematic review of randomised clinical trials. Anaesthesia 63:1343–1348PubMedCrossRefGoogle Scholar
  20. 20.
    Halvorsen B, Willumsen T (2004) Willingness to pay for dental fear treatment. Is supplying dental fear treatment socially beneficial? Eur J Health Econ 5:299–308PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Andrea Michalek-Sauberer
    • 1
    Email author
  • Erich Gusenleitner
    • 2
  • Andreas Gleiss
    • 3
  • Gabor Tepper
    • 2
  • Engelbert Deusch
    • 1
    • 4
  1. 1.Department of Special Anaesthesia and Pain TherapyMedical University of Vienna, AustriaViennaAustria
  2. 2.Bernhard Gottlieb Department of Oral SurgeryMedical University of Vienna, AustriaViennaAustria
  3. 3.Center for Medical Statistics, Informatics and Intelligent SystemsMedical University of Vienna, AustriaViennaAustria
  4. 4.Department of AnaesthesiaSozialmedizinisches Zentrum Baumgartner Höhe–Otto Wagner SpitalViennaAustria

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