Summary of findings 1. Acupuncture with or without sedation for gagging in patients undergoing dental treatment.
| Acupuncture with or without sedation for gagging in patients undergoing dental treatment | ||||||
| Patient or population: patients undergoing dental treatment Setting: university hospital Intervention: acupuncture at P6 point with or without sedation Comparison: sham acupuncture with or without sedation | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | Number of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with sham acupuncture | Risk with acupuncture | |||||
| Acupuncture without sedation | ||||||
| Completion of dental procedure | Study population | RR 1.78 (1.05 to 3.01) |
59 (2 RCTs)a,b | ⊕⊝⊝⊝ VERY LOWc,d,e | ||
| 357 per 1000 | 636 per 1000 (375 to 1000) | |||||
| Reduction in gagging (patient‐reported, dichotomous data) |
Study population | RR 2.57 (1.12 to 5.89) |
26 (1 RCT)a | ⊕⊝⊝⊝ VERY LOWc,f,h | No clear difference found when outcome was assessor‐reported or patient‐reported (VAS) (1 RCTb, 33 participants) | |
| 333 per 1000 | 857 per 1000 (373 to 1000) | |||||
| Presence or absence of gagging | None of the trials reported this outcome | |||||
| Adverse effects | ‐ | ‐ | 33 (1 RCT)b | ⊕⊝⊝⊝ VERY LOWc,f,g |
The trial authors were unsure whether the reported adverse events were due to participant anxiety or due to intervention | |
| Acupuncture with sedation | ||||||
| Completion of dental procedure | Study population | RR 1.08 (0.91 to 1.28) |
34 (1 RCT)a |
⊕⊝⊝⊝ VERY LOWc,f,i |
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| 933 per 1000 | 1000 per 1000 (849 to 1000) |
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| Reduction in gagging (patient‐reported, dichotomous data) |
Study population | RR 1.09 (0.87 to 1.37) |
34 (1 RCT)a |
⊕⊝⊝⊝ VERY LOWc,f,i |
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| 867 per 1000 | 945 per 1000 (754 to 1000) |
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| Presence or absence of gagging | None of the trials reported this outcome | |||||
| Adverse effects | None of the trials reported this outcome | |||||
| *The risk in the intervention group (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI) CI: confidence interval; P6: point located 3‐finger breadths below the wrist on the inner forearm in between the 2 tendons; RR: risk ratio; RCT: randomised controlled trial; VAS: visual analogue scale | ||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect | ||||||
aLu 2000. bZotelli 2014. cDowngraded 1 level for unclear risk of bias. dDowngraded 1 level for indirectness: only 2 studies and done only in adults. eDowngraded 1 level, imprecision apparent from width of confidence interval (due to small sample size even after combining 2 studies (n = 59)). fDowngraded 1 level for indirectness: single study including adults only. gDowngraded 1 level, imprecision apparent from width of confidence interval (due to small sample size (n = 33)). hDowngraded 1 level, imprecision apparent from width of confidence interval (due to small sample size (n = 26)). iDowngraded 1 level, imprecision apparent from width of confidence interval (due to small sample size (n = 34)).