Doi:10.1016/j.homp.2007.02.004

ORIGINAL PAPER
Outcomes from homeopathic prescribing in
dental practice: a prospective, research-targeted,
pilot study
Faculty of Homeopathy and British Homeopathic Association, Hahnemann House, 29 Park Street West,Luton LU1 3BE, UK Background and Aims: A base for targeted research development in dental homeop-
athy can be founded on systematic collection and analysis of relevant data obtained by
dentists in clinical practice. With these longer-term aims in mind, we conducted a pilot
data collection study, in which 14 homeopathic dentists collected clinical and outcome
data over a 6-month period in their practice setting.
Methods: A specifically designed Excel spreadsheet enabled recording of consecutive
dental appointments under the following main headings: date; patient identity
(anonymised), age and gender; dental condition/complaint treated; whether chronic
or acute, new or follow-up case; patient-assessed outcome (7-point Likert scale: À3 to
+3) compared with first appointment; homeopathic medicine/s prescribed; whether
any other medication/s being taken for the condition. Spreadsheets were submitted
monthly via e-mail to the project co-ordinator for data synthesis and analysis.
Results: Practitioners typically submitted data regularly and punctually, and most data
cells were completed as required, enabling substantial data analysis. The mean age of
patients was 46.2 years. A total of 726 individual patient conditions were treated
overall. There was opportunity to follow-up 496 individual cases (positive outcome in
90.1%; negative in 1.8%; no change in 7.9%; outcome not recorded in 0.2%). Sixty-four
of these 496 patients reported their outcome assessment before the end of the
homeopathic appointment. Strongly positive outcomes (scores of +2 or +3) were
achieved most notably in the frequently treated conditions of pericoronitis, periodontal
abscess, periodontal infection, reversible pulpitis, sensitive cementum, and toothache
with decay.
Conclusions: This multi-practitioner pilot study has indicated that systematic recording
of practice data in dental homeopathy is both feasible and capable of informing future
research. A refined version of the spreadsheet can be employed in larger-scale research-
targeted data collection in the dental practice setting.
Homeopathy (2007) 96, 74–81.
Keywords: systematic data collection; homeopathic dentists; clinical outcomes;
research targeting
Homeopathy in dentistry is considered useful in the treatment of a number of problems, including teething, Correspondence: Robert T Mathie, British Homeopathic Association, Hahnemann House, 29 Park Street West, Luton dental abscess, toothache, surgical trauma, and ner- vousness or anxiety.However, the research evidence base in dental homeopathy is minuscule: to our Received 18 September 2006; revised 5 February 2007;accepted 8 February 2007 knowledge, only four randomised controlled trials Clinical outcomes in dental homeopathyRT Mathie, S Farrer (RCTs) have been published. Three of these studies have investigated post-surgical complications, such aspain and bleeding, after tooth extraction; findings have Fourteen dentists contributed to the study: all were been positive,negativeand inconclusive.A trial of in primary care, six in an exclusively private practice homeopathy for oral dryness also reported results in setting. All were based in England. Five practitioners favour of homeopathy.Clearly a great deal more were DFHom (Dent) qualified, and nine were LFHom research is required. Such initiatives would benefit qualified. Recruitment took place from a pool of 35 from being firmly grounded in normal dental homeo- Faculty dentists who had replied to a survey on UK pathic practice, focusing on conditions/symptoms dental homeopathy practice, conducted in autumn where there is particularly promising case-based 2004. All 14 were given the opportunity to comment on a spreadsheet (Microsoft Excel), which was designed It is therefore important that clinical outcomes in the by the authors and approved by the Homeopathic ‘real world’ of dental homeopathic practice are Research Committee of the British Homeopathic characterised by conducting suitable systematic ob- servational studies. They have been strongly advocated The spreadsheet allowed the recording of consecu- in the medical homeopathy literature.Multi-practi- tive appointments, row by row, under the following tioner clinical data collection in the dental profession would make a significant contribution towards meetingthat principle. The Faculty of Homeopathy has recently carried out pilot studies of this nature within  Unique (anonymised) patient identity/number.
dental homeopathy, the only clinical observational study of this nature has been the single-practice audit  The condition/complaint treated. A separate page comprised a ‘pick-list’ containing 59 dental terms in The current pilot study was designed to lay the eight categories—see below. The list was not designed foundation for a larger-scale dental data collection to limit prescribing, but to ensure consistency of project in the Faculty of Homeopathy. The objectives nomenclature by using the ‘copy/paste’ facility in of such an initiative have been defined as follows: Excel. Practitioners were invited to add terms to thepick-list as required.
1. Using a piloted spreadsheet ‘tool’, to gain insight into  System-based category of condition/complaint—En- the complaints that dentists treat using homeopathy dodontia (ENDO), Exodontia (EXO), Face & Jaw 2. For follow-up (FU) cases, to determine patient- assessed change in severity of the treated dental condition/complaint (comparing the last with the first  Whether the condition/complaint is ‘chronic’ or consultation in a defined study period), and thus ‘acute’. In the context of a 6-month study (see identify any specific patterns of disease, clinical below), this was defined as symptoms greater than responses and/or homeopathic medicines that may help to target future research projects in dental  Whether, in relation to the previous 12 months, this is a newly treated complaint or an FU appointment for 3. For FU cases, to note any change in patients’ use further treatment of the same complaint.
of conventional medication for their dental condi-  Patient-assessed change in the treated complaint at the current FU compared with the initial homeo- pathic consultation, using 7-point scale (‘no change’ The primary aims of this pilot study were thus: or ‘unsure’ [0] / ‘mild’ [71] / ‘moderate’ [72] /‘major’ [73]).
1. To test the use of a specially designed spreadsheet,  Homeopathic medicine/s prescribed, using a ‘pick- and to find how consistently practitioners complete list’ containing 61 remedies (including the option and then return spreadsheet data to a co-ordinating ‘none’). This was not designed to limit prescribing options, but to ensure consistency of nomenclature 2. To inform our approach to a larger-scale dental data using ‘copy/paste’ in Excel. Practitioners were invited collection project—in particular, to ascertain whether to add to the pick-list as required.
data can be analysed and interpreted in anticipation  Homeopathic medicine/s prescribed at previous of Aims 1–3 of such work (see above).
Secondary aims were: (1) to begin the process of  Any other (conventional) medication/s being taken engaging Faculty dental practitioners in clinical data collection/research; (2) to explore whether data of this  Notes/comments, especially those that qualify or kind might be useful for dentists in their own practice amplify other data for the same appointment. State ‘phone’ if FU information obtained by that means.
Detailed instructions on using the spreadsheet A new master copy of the complete appointments format, and how to ask patients questions about their page was then created, into which were added columns clinical outcome, were provided on separate pages of to indicate: (1) the appointment number per patient per the file. The following standard question sequence was condition/symptom (when this could be determined); recommended: ‘‘Are your symptoms better, worse or and (2) whether or not an appointment was the final exactly the same?’’ If the patient says he/she is better, one for a given condition/symptom in a given patient then ask: ‘‘Has there been what you would call a mild, during the 6 months of the study. These procedures moderate or major improvement?’’ Responses scored enabled convenient pivot-table analysis based on final as follows: mild improvement ¼ +1; moderate im- appointments only—ie on the number of individual provement ¼ +2; major improvement ¼ +3. If the patient conditions treated, irrespective of whether they patient says he/she is worse, then ask: ‘‘Has there were treated by the practitioner once, twice or more been what you would call a mild, moderate or often. (The phrase ‘individual patient condition’ is major deterioration?’’ Responses were scored: mild used because a given patient could present with deterioration ¼ À1; moderate deterioration ¼ À2; ma- different conditions on a different—or even the jor deterioration ¼ À3. Record ‘no change’ or ‘unsure’ same—occasion. Also, if a patient presented at one appointment with more than one condition—each of The duration of the study was 6 months: 1 which was treated separately with homeopathy—the February–31 July 2005. Practitioners were expected practitioner reported each on a different row of the to send data to one of us (RTM, the project spreadsheet. This approach was adopted because a key co-ordinator), via e-mail attachment, on a monthly purpose of the study was to catalogue the frequency basis (on the last day of each month); this allowed the and success rate of treating named conditions, even if a co-ordinator to oversee data generally, to point out given individual patient exhibited more than one.) obvious errors to practitioners, and generally to A blank cell usually characterised the ‘outcome’ maintain contact with those collecting the original column for a New appointment. However, there were a number of occasions in this study where patients End-of-study data analysis was by practice (with reported a change in symptoms immediately after individual feedback to each practitioner) as well as taking their first homeopathic medicine (ie before overall (reported in this paper). 2–3 weeks after leaving the dentist’s surgery)—see Results. Exception- the final despatch of their practice data, practitioners ally, therefore, a score was recorded in the ‘outcome’ were sent a brief questionnaire, designed to gauge column for a New appointment in such cases.
their experience of using the spreadsheet and their The following three principal pivot-table analyses opinions of the value they attributed to the data it were then carried out: (1) ‘final’ outcome score by dental category and condition; (2) ‘final’ outcome score The Chair of the South Bedfordshire Research by dental category and homeopathic medicine used at Ethics Committee (REC) advised that the study did previous appointment; (3) ‘final’ outcome score by Upon receipt of practitioners’ final spreadsheets at the end of the project, the original data were re- checked and scrutinised for obvious missing data and Dentists submitted data reliably to the project co- typographical errors. These were flagged up, and ordinator. Each practitioner sent an updated spread- rectified where possible. A particular note was made sheet for every consecutive month, and most were of whether the condition/symptom treated and the punctual in their communication (3 days early to 28 homeopathic medicine prescribed seemed to have been days late; average 5 days late per month per dentist).
copy/pasted from the pick-lists provided—absence of All practitioners returned data for the entire 6-month capital letters, for example, made it certain that copy/ study period, except for three practitioners who pasting had not been used. Appointments data from all discontinued data collection after 3 or 4 months, due 14 dentists were combined together into a master to either communication difficulties or ill health.
spreadsheet. Pivot-table analysis (one each for condi- Technical problems, such as failure of e-mail or of tions and homeopathic medicines) allowed a conveni- attaching a file, occurred relatively rarely. Most ent count of the total number of pick-list items and appointments appeared to be recorded meaningfully, their transfer to the appointments page by copy/paste.
with misunderstanding over the detailed use of the Near-duplicate descriptions of what were clearly spreadsheet occurring infrequently. One early difficulty identical conditions or medicines were reconciled into was in cases where a patient presented with two single unique terms. Any conditions not on the pick- discrete conditions that were treated separately with list were ascribed category headings. One new category two different homeopathic medicines: it took a month was added as a result of this approach: viz. ‘Poly- or so of taking part in the project before all practitioners adopted the recommended use of two Clinical outcomes in dental homeopathyRT Mathie, S Farrer separate rows to describe two independent dental complaints of this kind. These early errors were The 1143 homeopathy appointments represented Some patients reported an effect of homeopathic data from 726 individual patient conditions. Inspection treatment during the first appointment; giving an of the data revealed that 73 of those were recorded in outcome score in a ‘New appointment’ row became patients who had also been recorded for another the agreed means of identifying such cases. In all but treated condition—ie there were actually 653 indivi- two of those occasions, no subsequent appointment dual patients in the study overall: 414 (63.4%) of these were female, 239 (36.6%) were male. The correspond- Where homeopathy had been used following in- vasive dental surgery, ie iatrogenic injury, patients had The mean of the 651 known ages was 46.2 years.
no point of reference against which to compare change.
7.4% of the patients of known age were children or Consequently they were asked to assess change in adolescents (aged 19 years or less).
comparison to their expectation. Cases of this type Analysis of the data from the 726 patient conditions were highlighted in the Notes/Comments column.
treated shows the most frequently treated were apical The total number of appointments per practitioner abscess, tooth extraction, anxiety, sensitive cementum, for the 6-month period varied from 5 to 224 (mean, 82).
periodontal abscess, post-surgery pain, gum swelling, The large majority of data cells were completed as and reversible pulpitis. A longer list of conditions required, though 15.8% of those specified for homeo- pathic medicine had missing information. Entries for Additional analysis of the data from the 726 patient ‘homeopathic medicine prescribed at previous appoint- conditions shows the homeopathic medicines (single, ment’ had 26.2% missing data; these were rectified, complex or combined remedies) most frequently used where possible, before final analysis. The greatest at the penultimate appointmenty were as follows: amount of missing data occurred in the first month or Hepar sulph, 66; Arnica, 50; Aconite, 40; Traumeel, two, while practitioners became used to working with 31; Hypericum, 30; Plantago tincture, 30; Silicea, 18; the spreadsheet. The presence or absence of other Hepar sulph+Silicea, 15; Rhus tox, 10. Individualised (conventional) medication/s taken for the condition/ prescribing was the general rule, though within a complaint was noted on just 20.2% of appointments.
relatively narrow range of medicines per condition.
Two-thirds of those notes (ie 13.6% of the total There were several instances of matching between a appointments) explicitly stated ‘none’, while the other specific dental condition and a particular homeopathic third (6.6% of the total) stated a conventional medica- medicine, the following being most apparent: Aconite tion that had been prescribed. The Notes/Comments for anxiety (34 of 56 anxiety patients at last appoint- column was used in 27.5% of appointments; some ment where the medicine was noted); Arnica for tooth practitioners made ready use of this column for extraction (31 of 50); Plantago tincture for sensitive additional notes, while others used it sparingly.
cementum (30 of 33); Arnica+Hypericum for post- A total of 1143 homeopathy appointments was surgery pain (23 of 27); Hepar sulph for apical abscess recorded. Nine hundred and eighteen (80.3%) of the appointments were for conditions present in the pick-list. Of those 918 appointments, it was estimated that copy/pasting of the condition took place in 90.8% of There was opportunity to follow up 496 individual occasions. Practitioners treated 95 different dental cases—68.3% of those treated. This includes 64 cases conditions in total; 49 of these appeared in the original where the final outcome score was recorded during the pick-list. Of the total 1143 appointments, 741 (64.8%) first appointment. Of these 496 FUs, there was a used homeopathic medicines present in the pick-list; positive outcome in 90.1%, no change in 7.9% and 276 (24.1%) used remedies (or combinations) not in deterioration in 1.8%; failure to record outcome the pick-list; the remaining appointments had no occurred in 0.2% of cases. For the same 496, a score entries in this column. Of the 741 appointments where of +2 or +3 was recorded in 79.0% of cases; a score a listed remedy was used, copy/pasting of the remedy of À2 or À3 was recorded in 1.2% of patients. For the occurred in an estimated 64.2% of occasions. In total subset of 64 patients who reported an immediate 113 different homeopathic medicines (or combinations response, a score of +2 or +3 was recorded in 76.6% of medicines) were reported; 42 of these appeared inthe original pick-list; 18 single remedies and 53 remedy yThis includes medicines used in the appointment at which the combinations were not in the pick-list.
outcome in 64 patients was recorded — see subsequent text.
Most frequently treated dental conditions/complaints Summary of outcome scores of follow-up patients by ÃOutcome not recorded in one of these 23.
Summary of +2/+3 outcomes of follow-up cases by dental A total of 96 different conditions was reported overall; thetabulation lists only those 18 comprising at least 10 cases in each.
Outcome scores by percentage of 496 follow-ups—acute Conditions with 10 or more follow-up patients only are listed.
Final outcome scores in terms of the homeopathic medicines most frequently used at the penultimateappointment (see previous footnote y) were as follows of cases; a score of À2 or À3 was recorded in 1.6%.
(score of +2 or +3): Plantago tincture, 96.7%; 368 FUs were for ‘acute’ conditions; 128 were Traumeel, 87.1%; Arnica, 80.0%; Hypericum, 80.0%; ‘chronic’. Further details of these data are illustrated Hepar sulph, 78.5%; Aconite, 77.5%; Rhus tox, 70.0%; Hepar sulph+Silicea, 66.7%; Silicea, 61.1%.
A global summary of +2/+3 outcomes by dental category is presented in the greatest percen- tage of high positive scores was most apparent in Completed questionnaires were received from 12 of patients presenting with toothache or periodontal the 14 practitioners who took part. Four of the 12 complaints; the fewest such scores were reported by dentists entered the clinical data during the homeo- patients treated for F&J conditions. An equivalent pathic appointment itself. All but one found the summary of À2/À3 outcomes by dental category is spreadsheet practical to use; only two had used Excel previously. Nearly all found it easy to copy/paste data negative outcome scores of this magnitude, and there from the pick-lists. The outcome question sequence was no particular dental complaint that typically seemed to be understood by all dentists’ patients, seemed to respond adversely. also contains whose stated outcome proved easy to score on the 7- summarised data of +1/0/À1 outcomes (ie patients point scale. Seven of the dentists felt the scores had a who reported little or no change): patients with F&J positive bias. All the dentists found it convenient to conditions were prominent in this category. A sum- return data on a monthly basis, though one found the mary of +2/+3 outcome scores by dental condition/ use of e-mail inconvenient. A large majority found it a complaint is given in . High positive scores were worthwhile exercise, and derived useful factual infor- achieved in many cases, most notably in the frequently mation from the analysis of their own practice treated conditions of pericoronitis, periodontal ab- data. Most of the 12 dentists would take part in a scess, periodontal infection, reversible pulpitis, sensi- larger-scale clinical data collection study, and about tive cementum, and toothache with decay, as well as in half would probably take part in future controlled Clinical outcomes in dental homeopathyRT Mathie, S Farrer The following is a sample of specific comments/ Several other characteristics of the data are worth highlighting. Not surprisingly, many of the polychrestremedies were frequently prescribed, and on an ‘‘I have enjoyed taking part in this study and this has individualised basis. It is equally apparent that a given me confidence in using homeopathy [more] in my number of remedies tended to be selectively used for particular dental conditions. The several clear matches ‘‘I mainly used local prescribing for acute conditions in (eg Aconite for anxiety, Arnica for tooth extraction, this study, which may explain the very positive results.’’ Hepar sulph for abscess) are consistent with standard ‘‘Those participating are inevitably positively inclined teaching of the homeopathic Materia Medica. It is a toward homeopathy. On the other hand, I saw definite matter of debate whether the penultimate prescription clear-cut clinical reactions, some of which were is actually the most appropriate or representative, but we have used it in this study as a single description of a ‘‘It reduces my stress levels dealing with less anxious patient’s homeopathic treatment. Individual practi- patients [who had received homeopathy].’’ tioners adopt differing prescribing profiles dependenton their level of expertise.
The outcome score used was a generic 7-point Likert scale. It has three levels of severity both for improve- These 14 Faculty of Homeopathy dentists were ment and for deterioration, as well as a zero value clearly capable of recording homeopathic cases system- expressing no change. Although not strictly validated atically in a spreadsheet and communicating the data for the purpose adopted here, such scales have been reliably to a co-ordinating centre. The Excel format validated in other research settingand have been appeared to allow most appointments to be recorded in used in homeopathy outcome audits in the past.
a meaningful way. The complaints that were treated The scale was chosen here for its simplicity and frequently and with greatest apparent success were convenience, given that in a study aiming to provide readily ascertained: pericoronitis, periodontal abscess, trends of outcome information for any condition or periodontal infection, reversible pulpitis, sensitive ce- symptoms, it is neither necessary nor appropriate to mentum, toothache with decay. In a previous data have a greater apparent degree of precision. Identifying collection study in UK dental homeopathy,data on patients with scores 72 or 73 was sufficient for the specific conditions were not reported. There is therefore purpose intended. For targeted research in named no previous report of dental homeopathy with which to dental conditions, however, it would be much more compare our overall rate of positive outcome (90.1% of important to have validated outcome scales. Such FU patients). Similar studies of homeopathy in medical research would also typically attribute a clear baseline practice settings typically achieve positive outcome in reference assessment against which to gauge any 70–80% of FUs overallA high score (+2 or +3) symptom changes that may be due to homeopathy.
was recorded in 79.0% of FUs in our study. It is Our scale assessed only changes from a recalled notable, however, that a large majority of those high baseline. Controlled research would also normally positive scores was in patients whose condition was ascribe specific and relevant time-points for FU reported as acute (self-limiting), and this has probably assessment, and which would take into account the exaggerated the findings. It should also be noted that temporal relationship between homeopathic treatment medical practitioners spend the majority of their time as and any dental surgical intervention. In a non- physicians prescribing medicines and giving advice. By controlled data collection study such as the current contrast, dental practitioners spend much of their time one, patients are assessed opportunistically when they as surgeons doing physical intervention supported by return to the dentist for further treatment or if they are prescribed medicine (whether homeopathic or conven- in contact by telephone. This inevitably means that the tional). Related issues are discussed below.
FU intervals—even for a single named dental con- It is important to comment that data analysis was dition—are highly variable. The issue of iatrogenic not carried out on an intention-to-treat basis. Thus, the injury (see Results) might be addressed in future work outcome statistics refer only to patients who were re- by adding a column to the spreadsheet headed ‘dental assessed at FU, as per the prospective design of the treatment undertaken’ so it can be seen what took study. Any controlled research that is informed by place at each appointment, with ‘no surgical interven- such outcome findings would properly involve inten- tion’ being the clearest result for homeopathic data tion-to-treat analysis (where statistics would include patients with no recorded outcome), but the purpose Relying on patient recall over time is one of the here was to establish the basis for trends in homeo- several potential sources of outcome bias in studies of pathic prescribing and outcomes and thus begin to this kind. Additional sources of bias (probably positive inform future research. It should also be noted that a in nature) include: (a) the ‘dentist-with-patient’ dialo- control group was inappropriate to the study design of gue in identifying the outcome score; (b) the fact that the current project; comparison from baseline per dentists may have selected, unwittingly, some of their patient was sufficient for our needs.
most promising cases for homeopathy instead of conventional treatment; (c) patients attending a homeopathic dentist may have more confidence oroptimism about the therapy and empathy with its Clinical outcome studies of this type and other practitioners. Empathy has been shown to have a non-randomised designs are fundamental in informing positive association with outcome (enablement) from well-targeted future research in dental homeopathy.
homeopathic treatmenand targeted research would The current study has successfully piloted a spread- usefully address issues such as this. Half the dentists in sheet that, with some revision, can be used effectively the current study expressed the opinion that outcome in larger-scale systematic data collection in the dental practice setting. This work has indicated the apparent Another limitation of a study such as this is the swiftness of some homeopathic treatment effects, rather brief 6-month duration of systematic recording.
but also the difficulty of interpreting results in This means that a full course of homeopathy appoint- cases of iatrogenic injury. Controlled research already ments per patient condition will be registered in a seems indicated, particularly in patients with pericor- limited number of cases only. This would be the onitis, periodontal abscess, periodontal infection, situation particularly for long-term chronic cases, reversible pulpitis, sensitive cementum, or toothache where the start and/or end of homeopathic treatment would lie outside the 6-month ‘window’ of recordings.
Data might be distorted also by seasonal factors (thestudy took place mainly in spring and summer months) and by the unequal number of cases treated by each ofthe 14 practitioners (5–224 appointments). It was Practitioners taking part in data collection: Mark obvious too that, because of some practitioners’ base Cronshaw; Peter Darby; Peter Galgut; Ludwig Gedah; in private practice, there was a wide range of consultation characteristics from the long case to the Maddox; Louise Nash; Chris Norman; Carol Somer- shorter appointment. None of these issues is of major ville Roberts; Lesley Trivett; Philip Wander; Wendy concern in a pilot study, but they would be important considerations in designing a more definitive datacollection project. Such a project would be informedimportantly by the practical aspects of the current work, and would benefit from having more compre-hensive lists of named dental conditions/complaints 1 Bhat SS, Sargod SS, George D. Dentistry and homeopathy: an and homeopathic medicines which could be copied and overview. Dent Update 2005; 32: 486–491.
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