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Background The authors compiled information on the prevalence of complementary and alternative medicine, or CAM, use, as well as on reports of randomized clinical trials of CAM modalities used to treat chronic facial pain. Types of Studies Reviewed The authors searched several databases for reports of clinical trials randomizing patients who had facial pain to a CAM intervention or to a control or comparison group. Search terms included “complementary,” “alternative,” “acupuncture,” “biofeedback,” “relaxation,” “herbal,” “meditation,” “massage,” “yoga,” “chiropractic,” “homeopathic” and “naturopathic.” Results Three acupuncture trials, eight biofeedback trials and three relaxation trials met the authors' inclusion criteria. Across studies, results suggested that acupuncture, biofeedback and relaxation were comparable to conservative treatment (for example, an intraoral appliance) and warranted further study. The authors did not locate any randomized clinical trials that tested the effects of homeopathy, naturopathy, chiropractic, massage, meditation, yoga or herbal remedies for chronic facial pain. Clinical Implications Significant gaps in the scientific knowledge base limit the accuracy with which dental professionals can guide their patients regarding CAM approaches used to treat chronic facial pain.

Background Periodically, Congress considers expanding Medicare coverage to include some currently excluded health care services. In 1999 and 2000, an Institute of Medicine committee studied the issues related to coverage for certain services, including “medically necessary dental services.” Methods The committee conducted a literature search for dental care studies in five areas: head and neck cancer, leukemia, lymphoma, organ transplantation, and heart valve repair or replacement. The committee examined evidence to support Medicare coverage for dental services related to these conditions and estimated the cost to Medicare of such coverage. Results Evidence supported Medicare coverage for preventive dental care before jaw radiation therapy for head or neck cancer and coverage for treatment to prevent or eliminate acute oral infections for patients with leukemia before chemotherapy. Insufficient evidence supported dental coverage for patients with lymphoma or organ transplants and for patients who had undergone heart valve repair or replacement. Conclusions The committee suggested that Congress update statutory language to permit Medicare coverage of effective dental services needed in conjunction with surgery, chemotherapy, radiation therapy or pharmacological treatment for life-threatening medical conditions. Practice Implications Dental care is important for members of all age groups. More direct, research-based evidence on the efficacy of medically necessary dental care is needed both to guide treatment and to support Medicare payment policy.