|Year : 2015 | Volume
| Issue : 3 | Page : 181-186
Ayurveda and holistic approach in oro-dental care: An overview
Vinay Kumar Bhardwaj
Department of Public Health Dentistry, H. P. Govt. Dental College and Hospital, Shimla, Himachal Pradesh, India
|Date of Web Publication||4-Aug-2015|
Vinay Kumar Bhardwaj
Department of Public Health Dentistry, H.P. Govt. Dental College and Hospital, Shimla, Himachal Pradesh - 171 001
Dentistry was not a well recognized specialized branch of Ayurveda, literature shows it was included in its Shalakya Tantra. Before the inception and regular use of modern allopathic system, problems related to the oral cavity, plaques and infections were managed in ancient India. Traditional medicine can treat various infectious and chronic conditions. Various researchers have revealed that all kinds of chewing sticks described in ancient Ayurveda literature have medicinal and anti-cariogenic properties. Its oil pulling (Kabla Graham, Kabla Gardoosa) practice is claimed to cure about 30 systemic diseases. Use of safe, quality products and practices should be ensured based on available evidence if traditional medicine is to be acknowledged as part of primary health care. Traditional medicine is the sum total of knowledge, skills and practices based on the theories, beliefs and experiences indigenous to different cultures that are used to maintain health, as well as to prevent, diagnose, improve or treat physical and mental illnesses. Traditional medicine that has been adopted by other populations (outside its indigenous culture) is often termed complementary or alternative medicine. Herbal medicines include herbs, herbal materials, herbal preparations, and finished herbal products that contain parts of plants or other plant materials as active ingredients. Scientific validations of the Ayurveda dental health practices could justify their incorporation into modern oro dental care. Publicity of these techniques using appropriate media would benefit the general population by giving more confidence in the ancient practices, thus preventing various oro dental problems
Keywords: Aloe vera, Ayurveda, oil pulling, oral health
|How to cite this article:|
Bhardwaj VK. Ayurveda and holistic approach in oro-dental care: An overview. SRM J Res Dent Sci 2015;6:181-6
| Introduction|| |
Ayurveda a holistic ethnic medical care system evolved in India 3000-5000 year ego. It is in practice in Indian subcontinent since preblical era, now practiced in other parts of the world as a form of complementary medicine.  The earliest literature on the practice of Indian system of medicine, appeared during the Vedic period in India. The Sushruta samhita and charak samhita are its earliest authoritative text.  The traditional system advocates predominantly life style approach to good health and disease prevention. When treating a disease, herbal mineral preparations are added to the latter approach after assessing an individual's constitution traits called as prakriti in Ayurveda.  With the passage of time, ayurvedic practitioners developed large numbers of medicinal preparations and surgical procedures for the treatment of various ailments and diseases. Dentistry was included in the shalya-chikitsa section of Ayurveda. 
Traditional medicine is the sum of total knowledge, skills and practices based on the theories believes and experiences indigenous to different cultures that are used to maintain health, as well as to prevent, diagnose, improve or treat physical and mental illness. Traditional medicine that has been adopted by other populations is often termed as alternative medicine. Herbal medicine includes herbs, herbal material, herbal preparation, and finished herbal products that contains plants or their constituents. 
Varieties of ayurvedic and herbal preparation such as chewing sticks, herbal brushes (Babool, miswalk, neem and mango), turmeric, amla, aloe vera, garlic and ginger are used for various oral hygiene procedures as well as for treatment of various gum and oral diseases. 
Dental health care professionals need to put home oral hygiene at the priority of their advice on preventive practice. There are umpteen numbers of indigenous natural medicinal products which deserve recognition for their contribution in the improvement of oro-dental health. 
In recent years complementary and alternative medicine is gaining popularity over conventional allopathic medicine. This may be due to the reason that products used are natural and safe. Provision of self-treatment, is cost effective and decreases the prevalence of chronic diseases such as diabetes as most of the allopathic preparations they contain sugars as a syrup base.  A PUBMED, MEDLINE, HINARI, Medknow search was conducted using keywords: Oil pulling, miswak, neem, mango tree extract, turmeric, aloe-vera, garlic, ginger, amla, tulsi and oral health. Apart from indexed journals, peer reviewed and non-indexed journals were also reviewed.
Oil hygiene or oil pulling
It is an ayurvedic practice that involves swishing of oil in the mouth for oral and systemic health benefits. The concept of oil pulling has been discussed in the Charak Samhita (around 3000 BC) where it is referred to as "Kabla graham" or "kabla gardoosa". It has been used extensively as a traditional Indian folk remedy for years to prevent dental decay, halitosis, bleeding gums, cracked lips and for strengthening teeth and gums. Dr. F. Karach refamiliarized the concept of oil pulling in 1990 in Russia. 
Sesame seed oil is used most commonly because of several medicinal properties and desirable health benefits. Occasionally sunflower oil is also used. Exact mechanism of the action of oil pulling is not known. It is claimed that swishing of oil in the mouth activates enzymes and draws the toxins out of blood. Sesame seed oil has a high concentration of polyunsaturated fatty acids which are good source of fat soluble vitamins. ,
Antioxidants present in the sesame are sesamin, sesamolin and sesaminol. These lignans have certain actions on the living tissues like detoxification of toxins, antioxidant effect, potentiates the action of Vitamin-E. Sesamin has found to inhibit the absorption of cholesterol as well as its production in the liver reduces lipogenesis and antibiotic effect in that it helps in the destruction of micro organisms. 
A few studies were found in the literature which highlights the role of oil pulling therapy in the maintenance of oral health. Amith et al. (2007)  have shown that oil pulling therapy with sunflower oil significantly reduced plaque scores after 45 days. Sharath et al. (2009)  revealed that oil pulling therapy was effective against plaque induced gingivitis both in microbiological and clinical assessment. The viscosity of the oil probably inhibits bacterial adhesion and plaque co-aggregation. Other possible mechanism may be saponification process that occurs as a result of alkali hydrolysis of fatty acids. Ashoken (2008)  had shown significant reduction in Streptococcus mutans count in saliva and plaque after oil pulling therapy which in turn will reduce the incidence of dental caries. It has also known to prevent halitosis, xerostomia and angular chelitis. Soaps are good cleansing agents because they are effective emulsifying agents. Emulsification greatly enhances the surface area of the oil, thereby increasing its cleansing action. Sesame oil is relatively high in unsaponifiable substances. The unsaponifiable fraction can probably protect the oral cavity from infection and inflammation by its antioxidant property. 
Herbal chewing sticks (Datun)
Ayurveda recommends and insist on the use of herbal brushes. Chewing sticks have been widely used in the Indian subcontinent, the Middle East and Africa since ancient times. Datun can be a good alternative to the toothbrush as a means of preventing oro-dental diseases. It is suitable for cleaning the teeth; costs little, possess various medicinal properties and are easily available in the rural areas of developing countries including India. It is also an oral hygiene tool that requires no expertise or special resources for its production and marketing.  Datun is approximately nine inch long and thickness of finger. One end of these twigs is chewed and made soft to be used as brush. After cleaning the teeth with datun it is torn into two parts and used to scrap the tongue coatings. 
It is recommended that chewing sticks be obtained from fresh stems of medicinal plants. The neem (Azadiroxtha indica) and babool are famous herbal chewing sticks. The twigs should be healthy, soft, without leaves or knots and taken from a healthy tree. Chewing on these stems is believed to facilitate salivary secretions which possibly help in oral cleansing and plaque control.
Research has shown that chewing sticks described in ancient Ayurveda literature, have medicinal and anticariogenic property. Saimbi et al. (1994)  have reported that neem extract had significant and higher antiplaque efficacy as compared to ayurvedic tooth powder and commercial toothpastes. Venugopal et al. had found that the children (1-4 year of age) using neem datum were less affected with dental caries. Neem contains the alkaloids margosine, resins, gum, chloride, fluoride, silica, sulfer, tannins, oils, saponins, flavonoids, sterols and calcium. Khalid (1999)  conducted a study in Saudi Arabia, examined the antimicrobial activity of aqueous extract of neem at various concentration and found antimicrobial activity at all the concentrations. Vanka et al. (2000) conducted a study to know the effect of indigenous Neem (Azadirachta indica) mouthwash on S. mutans and lactobacillus growth. Initial data of the study revealed that it has inhibiting effect on S. mutans which has reversed incipient carious lesions.  Baswa et al. (2000) conducted a study which revealed that neem oil have bactericidal activity independent of the temperature and energy. The activity was mainly due to the inhibition of cell-membrane synthesis in the bacteria. 
Mango leaves are widely used for cleaning teeth in rural areas of southern India. Summant et al. (1992)  evaluated the efficacy of mango leaf as an oral hygiene aid and obtained significant findings. Caries experience in the group using mango leaf was similar to that using tooth brush which shows the effectiveness of mango leaves. Mango leaves contain mangiferin a compound which had significant antibacterial property against certain stains of streptococci, staphylococci, pneumococci and lactobacillus acidophilus.
Mangifera indica contains tannins, bitter gum and resins. At higher concentration extract of mango chewing sticks showed more antimicrobial activity which could be due to the contents in mango extract. Tannins and resins supposedly have an astringent effect on the mucous membrane forming a layer over enamel thus providing protection against dental caries. 
Literature in Islamic hygiene jurisprudence reveals the use of miswak a teeth cleaning twig obtained from Salvadora persica tree. Use of miswak is predominant in Muslim countries and predates the inception of Islam. Almas and Zeid (2004) conducted a study to assess antimicrobial efficacy of miswak chewing sticks in vivo, especially on S. mutans and lactobacillus which revealed that miswak had an immediate antimicrobial effect. S. mutans were more susceptible to miswak than lactobacilli. 
Results of a study conducted by Al-Otaibi et al. (2003) to compare the use of miswak with ordinary toothpaste concluded that using miswalk was more effective than ordinary tooth brush provided that proper instructions had been given to use it. 
Turmeric (Curcumin longa, Haldi)
In Sanskrit, turmeric is called as sarvoshadhi, meaning medicine for all diseases. Turmeric is used historically as an antiseptic, antibacterial, anti-inflammatory, pain killer, and hepatoprotector. It has been used for over 2500 years in India. It is a perennial plant with orange, oblong tubers 2 or 3 inch in length and 1 inch in diameter, pointed or tapering at one end. Indeed, recent research shows that turmeric extract and turmeric oil may even reverse precancerous changes in oral submucous fibrosis in humans. 
Benefits of turmeric
Curcumin an active constituent of turmeric have a wide range of therapeutic action as follows:
- It protects against free radical damage because it is a strong antioxidant. It reduces inflammation by lowering histamine levels and possibly by increasing the production of natural cortisone by the adrenal glands.  It effectively inhibits metastasis of melanoma cells. It also deactivates the carcinogens in cigarette smoke.  A double blind clinical trial revealed that curcumin was superior to placebo or phenylbutazone for alleviating post-surgical inflammation. 
Dental application of turmeric
Turmeric contains approximately 3-4% curcumin by dry weight. Turmeric can be used in the following ways to offer relief from dental problems 
- Rinsing the mouth with turmeric water (5 g of turmeric powder, two cloves and two dried leaves of guava in 200 gm of water) gives an instant relief from pain.
- Applying the powder of burnt turmeric pieces and Bishop's weed seed on teeth and cleaning them makes teeth and gums strong.
- Applying a paste made from 1 tsp of turmeric with ½ tsp of salt and ½ tsp of mustard oil provides relief from periodontitis and gingivitis. Rub the gums and teeth with the paste twice daily.
- Massaging the aching teeth with roasted, ground turmeric eliminates pain and swelling.
- Pit and fissure sealants.
It has been found that tinted pit and fissure sealant is useful for applying to the tooth surface for the prevention and reduction of dental caries. This sealant can be produced from a composition comprising a polymerizing resin system containing acrylic monomer and minimally one colorant selected from the group consisting of Annatto extract, turmeric extract and β-Apo-8-Carotenal. 
- Dental Plaque detection system.
The dental-plaque detection system includes a dental-plaque staining agent, which contains at least one from the yellow pigment of beni-koji, turmeric extract, curcummin and a light emitting apparatus which emits light exhibiting a wavelength with on a range of 250-500 nm to an object in the oral cavity where the dental-plaque staining agent is attached. A yellow pigment of beni-koji and turmeric are known as staining agent. 
Ginger (Adraka, Sunti, Zingiber officinale,)
In Ayurveda, ginger is commonly prescribed for nausea, vomiting, motion sickness, sore throat, respiratory congestion, hypoglycemia and vertigo. Study by Bone et al. have revealed that ginger is used in elevating toothache. It is partially burnt, mixed with common salt and placed in close vicinity of aching tooth. It is also having mild anti-inflammatory property. 
Garlic (Allium sativum L, Lahsun)
Garlic is used as a natural antibiotic. It is prescribed as antitussive, expectorant, diuretic, lipid and blood pressure lowering drug. Garlic by strengthening the immune system, helps the body fight against diseases such as cancer. Garlic has blood thinning property. They can also block cyclooxygenase pathways and prevent formation of inflammatory prostaglandis. Garlic can enhance the effects of NSAIDs, aspirine, warfarin, heparin and other antiplatelet drugs. Garlic has been found to be a powerful natural antibiotic to use against a variety of infections. In in vitro studies, garlic has been found to have antibacterial, antiviral and antifungal activity. It is effective against most dental infections. Unlike drug oriented antibiotics, one cannot build a tolerance or resistance to garlic and will not have to worry about a limitation of its intake. 
Amla (Emblica officinalis, Amalaki, Phyllanthus emblica, Indian gooseberry, Dhatriphala)
Amla is a well-known rasayana herb in Ayurveda and considered as general rebuilder of the oral health.1/2 Gms of amla extract can be taken orally per day for long term benefits for the teeth and gums. Vitamin-C present in amla, acts as a cofactor in the conversion of proline into hydroxyproline which is one of the essential constituent of connective tissue. 
Ayurveda believes that amla can maintain balance between all the three doshas (vat, pit and kuff). It is used in two most commonly consumed ayurvedic preparation, namely chyawanprash and triphala. Amla is the richest natural source of Vitamin C and a good tonic for the maintenance of the health of the gums.  Amla is one of the constituent of triphla which is among the most common formula, used in traditional Ayurvedic medicine. Maurya et al. supports the use of triphala for the cure of periodontal diseases. Jagtap and Karkara  tested the efficacy of triphala mouthwash in the inhibition of Streptococcal counts. Bajaj and Tandon  had conducted a study to know the effect of triphala mouthwash on dental plaque, gingival inflammation and microbial growth. The study revealed that there was a progressive decrease in plaque scores from the baseline to the end of nine months, improvement in the gingival status and inhibition of microbial flora.
There are two health benefits from aloe vera. Gel from the aloe leaf has been used for centuries as a topical remedy for minor burns, cuts, and other skin infections. The second benefit is laxative effects from the use of Aloe juice or encapsulated powder.
The active constituent for aloe's laxative effect are known as anthraquinone glycosides, which are converted by intestinal bacteria into aglycones. Aloe's wound healing properties are likely due to several saccharide molecules. Overall roll of aloe- vera on well-being of a person is as follows: 
- Aloesin and aloemannan constituents in Aloe species are anti-inflammatory.
- The neutral polysaccharide, aloemannan and acemannan show antitumor, anti-inflammatory and immunosuppressive activities.
- An aloe glycoprotein faction is involved in the wound healing effect of aloe vera via cell proliferation and migration.
- Aloe vera influences the wound healing by enhancing collagen turnover in the wound tissue.
- Both topical and oral treatments with Aloe vera were found to have a positive influence on the synthesis of glycosaminoglycans (GAGs), thereby beneficially modulate wound healing.
Hall and Poor (2002)  conducted a study to see the variation in the incidence of alveolar osteitis in the patients treated with clindamycin soaked Gelfoam or Salicept patches, a freeze dried pledget that contains Acemannan hydrogel obtained from the clear inner gel of Aloe Vera. The study revealed that the Salicept patch significantly reduces the incidence of alveolar osteitis compared with clindamycin soaked gel foam.
Wound healing is a fundamental response to tissue injury that results in the restoration of tissue integrity. This is achieved mainly by the synthesis of the connective tissue matrix. Collagen is the major portion of the extracellular matrix and is the component which ultimately contributes to the wound strength.  Chitra et al. (1998)  in their study had revealed that Aloe Vera had a significant influence on the collagen content and its characteristics in healing wound. It was observed that Aloe vera increased the collagen content of the granulation tissue as well as its degree of crosslinking as marked by increase aldehyde content and decreased acid solubility.
Guggul (Commiphora mukul, Indian Bdellium gum, guggulipid)
Guggul, the sticky gum resin from the mukul myrrh tree, plays a major role in Ayurveda, the traditional herbal medicine of India. It was traditionally combined with other herbs for the treatment of arthritis, skin diseases, and pains in the nervous system, obesity, digestive problems, infections in the mouth, and menstrual problems. Guggul has been used for the treatment of heart diseases since historic times. It is found in Northern India, Rajasthan and Gujarat. G. V. Satyavanti in 1966 published the first study of the effects of guggul on rabbits. After the mid-1990s, there was a considerable interest shown by the western world in guggul as a hypocholesterolaemic drug. In ayurveda it is considered as an antioxidant, anti-inflammatory, hypolipidemic, antiobesity herb. The Z and E isomers of guggulosteron are biologically active constituents of guggul and are responsible for its therapeutic effects.  Guggul has been shown to decrease high-sensitivity C-reactive protein (hs-CRP), an index of inflammation, by 29% which depicts it as a good anti-inflammatory agent. 
Ayurveda and oral health care in India
Over the centuries, India has used its rich knowledge of traditional medicine to prevent and treat diseases. This knowledge has generally been passed by word of mouth from generation to generation, described in ancient classical and other literature, often accessible to common man. In the past decade there has been renewed attention and interest in the use of traditional medicine in India. It is estimated that 65% of the population in rural India use ayurveda and medicinal plants to help meet primary health care needs. Ayurveda has never been practiced as a commercial service like modern medicine and patients pay according to their ability and financial status.
The cost of Ayurveda is much lower, it is closer to the community, and patients get personal attention or the healing touch of the practitioner who speaks the same language. According to World health Organization (WHO) 75% of the world's population uses herbs for basic health care needs. WHO has recommended for the incorporation of the traditional systems of medicine like Ayurveda into the primary health care system, for those communities where it is accepted. All the ayurvedic medicines and local remedies discussed above (oil pulling, herbal chewing sticks, turmeric, amla, ginger, garlic and guggul) are easily available in the rural areas where socioeconomic condition of the people is not good enough to buy costly toothpaste or curative medicines. Ayurveda must be reinterpreted in the light of our new knowledge and it must be incorporated in modern medicine along with other forms of traditional medicine.
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