AYURVEDIC APPROACH IN ORAL HEALTH & HYGIENE: A REVIEW

Abstract

Oral diseases continue to be a major health problem worldwide with the incidence of oral cancer and other disorders are on the rise in developing countries. Oral health also reflects the body health. For prevention and the treatment of oral diseases, modern medicine has had only limited success. There is a global need for safe and effective alternative prevention and treatment. Ayurveda is good alternative for that and may lead to the development of novel preventive or therapeutic strategies for oral health. This 5000-year-old system of medicine not only recommends treatments with specific herbs and minerals to cure various oral diseases but also recommends some daily use therapeutic procedures for the prevention of and maintenance of oral health. Recently, there is renewed interest in use of Ayurvedic drugs for oral health. Various Ayurvedic herbs and natural products have been used for their pharmacological applications viz. antiulcer, wound healing, anti-inflammatory, antimicrobial and antioxidant properties and have been proven to be safe and effective for oral disease and hygiene including various therapeutic Ayurvedic procedures. Scientific validations of the Ayurveda oral health practices could justify their incorporation into modern oral care. In this paper, an attempt has been made to scientific evidence based review various therapeutic procedures for the prevention and maintenance of oral health and hygiene mentioned in Ayurveda.

Full text

ISSN: 2322 - 0902 (P)
ISSN: 2322 - 0910 (O)
IJAPR | May 2016 | Vol 4 | Issue 5 17
International Journal of Ayurveda
and Pharma Research
Review Article
AYURVEDIC APPROACH IN ORAL HEALTH & HYGIENE: A REVIEW
Gunjan Garg1*, Gopesh Mangal2, N.S. Chundawat3
*1Associate Professor, Department of Swasthavritta, Mahatma Jyotiba Fule Ayurveda College, Chomu, Jaipur, India.
2Assistant Professor, Post Graduate Department of Panchkarma, National Institute of Ayurveda, Jaipur, Rajasthan, India.
3Former Professor & Head, PG Department of Swasthavritta &Yoga, National Institute of Ayurveda, Jaipur, Rajasthan, India.
ABSTRACT
Oral diseases continue to be a major health problem world-wide with the incidence of oral cancer and other
disorders are on the rise in developing countries. Oral health also reflects the body health. For prevention and
the treatment of oral diseases, modern medicine has had only limited success. There is a global need for safe
and effective alternative prevention and treatment. Ayurveda is good alternative for that and may lead to the
development of novel preventive or therapeutic strategies for oral health. This 5000-year-old system of
medicine not only recommends treatments with specific herbs and minerals to cure various oral diseases but
also recommends some daily use therapeutic procedures for the prevention of and maintenance of oral
health.
Recently, there is renewed interest in use of Ayurvedic drugs for oral health. Various Ayurvedic herbs and
natural products have been used for their pharmacological applications viz. antiulcer, wound healing, anti-
inflammatory, antimicrobial and antioxidant properties and have been proven to be safe and effective for oral
disease and hygiene including various therapeutic Ayurvedic procedures. Scientific validations of the
Ayurveda oral health practices could justify their incorporation into modern oral care. In this paper, an
attempt has been made to scientific evidence based review various therapeutic procedures for the prevention
and maintenance of oral health and hygiene mentioned in Ayurveda.
KEYWORDS: Ayurveda, Oral health and hygiene, Dantapavan, Kavala, Gandoosha.
INTRODUCTION
Oral diseases are one of the most important
problems in public health and are on the rise in developing
countries. Oral health is integral to general well-being and
relates to the quality-of-life that extends beyond the
functions of the craniofacial complex. The link between
oral diseases and the activities of microbial species that
form part of the micro biota of the oral cavity is well-
established. Despite several chemical agents being
commercially available, these can alter oral micro biota
and have undesirable side-effects such as vomiting,
diarrhea and tooth staining.[1] Oral health also reflects the
body health.
There is evidence that oral biofilm-associated
diseases may affect systemic health by mechanisms such
as spreading infections to adjacent tissues and spaces,
hematogenous dissemination of oral biofilm organisms or
inflammatory mechanisms.[2] Further, evidence suggests
that oral biofilm-associated chronic periodontitis enhances
the risk of coronary heart disease and cerebrovascular
disease and that poor glycaemic control in diabetic
patients with periodontitis is a concern for clinicians. [3-5]
Hence the prevention and treatment of oral
diseases is not only important for maintenance of good
oral health but also for general health. For prevention and
the treatment of oral diseases, modern medicine has had
only limited success. Oral hygiene is the practice of
keeping the mouth and teeth clean for dental health and to
avoid bad breath. Tooth brushing, dental floss, toothpicks
and gargling are main techniques for oral hygiene in
modern science.
Oral 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.[6] Various plants and natural products have been
used for their pharmacological applications viz. antiulcer,
wound healing, anti-inflammatory, antimicrobial and
antioxidant properties etc.[7]
Ayurveda is good alternative for that and may lead
to the development of novel preventive or therapeutic
strategies for oral health. This 5000-year-old system of
medicine not only recommends treatments with specific
herbs and minerals to cure various oral diseases but also
recommends some daily therapeutic procedures for the
prevention and maintenance of oral health and these have
been proven to be safe and effective. Recently, there is
renewed interest in use of various Ayurvedic drugs and
therapeutic procedures for oral and dental health.
Bacterial infections are considered as causative
factors in most of the dental diseases and it has been well-
documented that Ayurvedic medicament produce
considerable antibacterial activity against microorganisms,
including bacteria responsible for periodontitis and dental
caries.[8]

Gunjan Garg et al. Ayurvedic Approach in Oral Health & Hygiene
Available online at: http://ijapr.in 18
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. Dattuna 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.[9]
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 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.[10]
Ayurveda and Orofacial diseases
Among the eight branches of Ayurveda, Salakya-
tantra branch explains the treatment of ailments affecting
eyes, ear, nose, mouth, etc. and mentioned 65 varieties of
oral diseases can arise in seven anatomic locations-eight
on the lips, 15 on the alveolar margin, eight in connection
with the teeth, five on the tongue, nine on the palate, 17 in
the oropharynx and three in a generalized form.[11]
Ayurveda recognizes nine openings of physical
body and oral cavity as one of them.
It suggests cleaning these openings frequently and
regularly. Hygiene of oral cavity is more important due to
the chief entrance and digestion process begins in the
mouth itself. Oral cavity includes the Oshtha (lips),
Dantamoola (gingiva and tooth supporting structures),
Danta (teeth), Jihva (tongue), Talu (palate), Kantha
(throat) and Sarvasara (oral mucosa). For the treatment of
these diseases Ayurveda advocates procedures such as
oral cleansing, extractions, excisions, flap surgeries etc.
Ayurveda and Oral hygiene
Ayurveda emphasis upon the maintenance and
promotion of positive health which is its primary objective
whereas cure of diseases are only secondary. Ayurveda
includes the preventive health care in “Swasthya
Samrakshana”. It well explains the importance of hygiene.
For the maintenance and promotion of positive health,
several regimens are prescribed in Ayurveda which
include, Dinacharya (daily routines), Ratricharya (night
regimen), Ritucharya (seasonal regimen), Sadvritta (right
conduct of life), Achara Rasayana (behavioral conducts).
The regimens which should be followed every day is
known as Dinacharya in Ayurveda which includes oral
hygiene, food hygiene, personal hygiene etc. Under the
Dinacharya (daily routines) various procedures for
maintaining oral hygiene are well explained in all classical
texts of Ayurveda. These include procedures like Danta-
dhavana (brushing the tooth), Pratisarana (Massaging the
teeth and gums), Jivha nirlekhana (tongue cleaning),
Gandoosha and Kavala (gargling) etc.
Oral hygiene is not described as a separate
chapter in Ayurveda but it comes under the different
chapters of Ayurvedic literature. Acharya Charak described
it under the topic “Swasthyavrata” which means personal
hygiene in “Mattrashitiyaadhyaye”. Acharya Sushruta had
told about oral hygiene in the “Anagatabhadapratished”
chapter, while Acharya Vagbhatta described it in
“Dincharya” chapter. All the authors have given emphasis
on personal hygiene which should be followed by each
individual strictly.[12]
Dantapavan/ Dattuna (Chewing sticks/brushing teeth)
Brushing of teeth helps to remove dental plaque
and tartar from teeth to prevent cavities, gingivitis, and
gum disease.
According to Ayurvedic texts, it is recommended
that Dattuna (Chewing Sticks) in the morning as well as
after every meal prevents oral diseases. The method of use
is to crush one end, chew it and brush with it slowly. It is
better to take from fresh plant. The stems used for
Dantapavan should be healthy, soft, without leaves and
knots. After cleaning the teeth with Dattuna it is torn into
two parts and used to scrap the tongue coatings. According
to Acharya Sushruta, Dantapavan should be fresh and
straight. Its length should be 12 Angul (9 inches), while
thickness should be equal to Kanshtika anguli (little
finger).[14] These herb sticks should be either Kashaya
(astringent), Katu (pungent), or Tikta (bitter) in Rasa.[ 15]
Acharya Sushruta also includes Madhura rasa.[16]
Various recommended plants are Neem (margosa
or Azadirachta indica), Fresh stems of Yastimadhu
(Glycyrrhiza glabra), Arjuna tree (Termmalia arjuna), Vata
(Ficus bengalensis), Vijaysara (Pterocarpus marsupium),
Arka (Calotropis gigantia), Khadira (Acacia catechu),
Karanja (Pongamia glabra), Karaveera (Nerium indica),
Arimeda (Acacia farnesiana), Apamarga (Achyranthus
aspera), Malathi (Jasminum grandiflorum) or such other
known herbs which posses the above mentioned tastes
should be used. [17] Acharya Susrutha suggested that Nimba
(Azadiracta indica A.juss) is better among bitter ones,
Khadira (Acacia catechu Linn.f) among Astringent ones,
Karanja (Pongamia glabra Vent) among pungent ones and
Madhuka (Bassia longifolia Koen) among sweet ones. [18]
Various plants those are not suitable for brushing
are also mentioned in Ayurveda as follows.
Twigs of Sleshmathaka (Cordia dichotoma), Arishta
(Sapindus trifoliatus), Bibhithaka (Terminalia bellereca),
Dhava (Anogeissus latifolia), Dhanwan (Grewia tiliifolia),
Bilwa (Aegle marmelos), Nirgundi (Vitex negundo), Sigru
(Moringa oleifera), Tilwaka (Simplocus racemosus),
Tinduka (Diospyros melanoxylon), Kovidara (Bauhinia
variegata), Sami (Accacia suma), Pilu (Salvadora persica),
Pippali (Piper longum), Ingudi (Puthranjiva roxburgh),
Guggulu (Commiphora mukul), Paribhadraka (Erythryna
indica), Amlika (Tamarindus indica), Salmali (Bombax
ceiba), Palasa (Butea monosperma) and Sana (Crotalaria
retusa) should not be used as Dattuna (Chewing Sticks).
Dattuna is contraindicated in pathological conditions like
facial paralysis, mouth ulcers, heart diseases, some eye and

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IJAPR | May 2016 | Vol 4 | Issue 5 19
ENT disorders. For these conditions Ayurveda
recommends the use of soft and fine powders of drugs for
cleaning the teeth.
The benefit of Dantpavan is to get rid from bad
odour of mouth along with increase interest towards food
due to removal of Mala from tooth, tongue and mouth.[19]
Research has shown that Dattuna (chewing sticks)
described in ancient Ayurveda literature, have medicinal
properties and have the role in the maintenance of oral
health.
Chewing on these stems is believed to cause
attrition and levelling of biting surfaces, facilitate salivary
secretion and possibly help in plaque control while some
stems have an anti-bacterial action.[20] Present day
research has shown that all the chewing sticks described in
ancient Avurveda have medicinal and anti-cariogenic
properties. [21]
Neem (Azadiracta indica) is most commonly used
herb for Dattuna all over the India. Some studies are done
on Neem (Azadiracta indica) related to tooth brushing are
as follows.
Saimbi et al. (1994) have reported that Neem
extract had significant and higher antiplaque efficacy as
compared to Ayurvedic tooth powder and commercial
toothpastes.[22] Venugopal et al. had found that the
children (1-4 year of age) using Neem were less affected
with dental caries. Neem contains the alkaloids margosine,
resins, gum, chloride, fluoride, silica, Sulphur, tannins, oils,
saponins, flavonoids, sterols and calcium.[23] Khalid (1999)
examined the antimicrobial activity of aqueous extract of
Neem at various concentration and found antimicrobial
activity at all the concentrations.[24] 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.[25] 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. [26]
Another study done on mango leaves as an oral
hygiene aid done by Summant et al. (1992) and found
higher soft deposit score compared to toothbrush with
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.[27]
Jivha nirlekhana (tongue scrapping)
It is to be done after Danta pavana (brushing
tooth) using soft tongue scraper or massages over tongue.
Tongue scrapping is done gently with a metal scrapper
from root to tip. It is ideal to use gold, silver, copper,
stainless steel or branches of the tree for the scrapping of
the tongue. Its length should be ten fingers. Its margin
should be blunt so that it will not damage the tongue and
should be curved so can be use easily. [28] This stimulates
the whole digestive tract and increases the Agni (digestive
fire).[29]
It removes millions of bacterial growth
(approximately 500 varieties). Clinical evidences show
that use of tongue scrapers on a regular basis, has a
significant improvement on eliminating anaerobic bacteria
and decreases bad odour. Tongue scrapping stimulates the
reflex points of the tongue, removes bad odour (halitosis),
improves the sense of taste and stimulate the secretion of
digestive enzymes.[30-32]
Pratisarana (Massaging the teeth and gums)
Pratisarana is done with paste or powder of herbs
or by honey/oil with herbal powder. It can be apply with
fingers and rubbed gently on teeth and gums with fine
powder of Vapya or Kushta and three groups of three
drugs - Triphala, Trikatu and Trijata mixed with honey.
This process removes the food debris and plaque and
helps to maintain the periodontal health. According to
Acharya Sushruta Dattuna dipped in Madhu, Trikathu,
Trivargha, oil and Saindhavlavana can be used as tooth
powder. Recent researches has proved gum massage is
good for dental and oral hygiene. some of the studies on
this are as follows.
Suchetha et al. (2013) conducted a study for the
effectiveness of Periocare® gum massage powder
containing C. zeylanicum, Piper nigrum, E. caryophyllata, G.
glabra, and R. cordifoliac in Ayurvedic formulae shows
reduction in plaque scores, gingival score, aerobic CFUs,
and anaerobic CFUs, revels significant result with
mechanical plaque control.[33]
Indeed, recent research shows that turmeric
extract and turmeric oil may even reverse precancerous
changes in oral submucous fibrosis in humans.[34] The
active constituent of turmeric is known as curcumin, which
has been shown to have a wide range of therapeutic
effects,[35] Another study (done by cikrikci et.al.
2008)revealed that applying a paste made from 1 tsp of
turmeric with ½ tsp of salt and ½ tsp of mustard oil
provides relief from gingivitis and periodontitis. It is
recommended to rub the teeth and gums with this paste
twice daily.[36] A pilot study (done by Suhag et.al, 2007)
conclude that 1% curcumin solution causes resolution of
inflammatory signs better than Chlorhexidine and saline
irrigation as a subgingival irrigant. [37]
Kavala and Gandoosha (Oil pulling)
The difference between the two is only in the
dosage and procedure of using the drug. In Gandoosha, the
oral cavity is filled completely with liquid medicine, held
for specific period until there is lacrimation and nasal
discharge and then spit out. Normally it is about 3-5
minutes. In Kavala Graha, a comfortable amount (three-
fourths filled) of medicated fluid is retained with the
mouth closed for a specific time (about 3 minutes), gargled
and then spit out.[38]
Four types of Kavala is mentioned in Ayurveda
according to their effect as Snaihika (lubricating effect),

Gunjan Garg et al. Ayurvedic Approach in Oral Health & Hygiene
Available online at: http://ijapr.in 20
Samana (mitigating effect), Sodhana (purificatory) and
Ropana (healing effect). The benefits of regular Gandoosha
are Swarabalam (strength to voice), Hanubalam (strength
to jaws), strength to face, Ruchyam (better taste
perception), Drudadantha (strong and healthy teeth), and
resistance against Doshaja or Aaganthuja mukharogas. [39]
Kavala and Gandoosha (Oil pulling) help in removing the
odour, stimulates the taste buds, strengthens the gums and
teeth and increases the appetite.[40]
It can be used to clean the oral cavity in those
cases where brushing is contraindicated e.g. mouth ulcer,
fever, indigestion, those who have tendency to vomit,
asthma, cough, thirst.[41]
Scientific evidences show that the Kavala and
Gandoosha (Oil pulling) have significant role in the
maintenance of oral health. New researches have proved
that the oral mucosa does not act as a semi-permeable
membrane to allow toxins to pass through. The medicated
oil and fluid used in Kavala and Gandoosha probably
protect the oral cavity from infection and inflammation by
its antioxidant property. These mechanisms could be
probable mode of action for the reduction of plaque scores
and colony count of the microorganisms in the oral cavity.
The viscosity of used medicated oil probably inhibits
bacterial adhesion and plaque co-aggregation.[12] Oil
pulling therapy is very effective against plaque induced
gingivitis both in the clinical and microbiological
assessment.[42,43] Study showed that oil-pulling therapy
could reduce the plaque index, modify gingival scores and
the total oral bacteria count in gingivitis patients.
A study done by Asokan S et al (2009) to evaluate
the effect of oil pulling with sesame oil on plaque induce
gingivitis, and to compare its efficacy with a chlorhexidine
containing mouthwash Significant reduction of the pre-
and post-values of the plaque and modified gingival index
scores in both the study and control groups (p<0.001) was
achieved. Total colony count of aerobic microorganisms in
the plaque of adolescents also decreases.[42] According to
Prakash et al 2014, Trifala mouth rinse shows significant
result in anti-cariogenic property and reduction in
gingivitis and periodontitis.[44]
CONCLUSION
Ayurveda is a holistic health system which also
recommends some daily therapeutic procedures for the
prevention and maintenance of oral health. The review of
above Ayurveda oral health practices and scientific
researches indicates that Ayurveda health promotive,
modalities have sound scientific base and these scientific
validation could justify their incorporation into modern
oral health care. Most of the oral diseases are due to the
bacterial infections. Material used in daily oral health care
modalities of Ayurveda including medicinal plants have
anti-bacterial activity against various microorganisms due
to the presence of potential bioactive compounds. These
helps to reduce bacterial load in the oral cavity and thus
prevent the formation of plaque, dental caries, ulcers and
other problems. Many Ayurvedic herbal plants also
possess anti-inflammatory, analgesic, anti ulcerative
properties. Ayurveda recommends and insist on the use of
herbal brushes. Dattuna can be a good alternative to the
toothbrush as a means of preventing oro-dental diseases.
Research has shown that all kinds of Dattuna (chewing
sticks) described in ancient Ayurveda texts have medicinal
and anti-cariogenic properties. Kavala and Gandoosh
procedures are claimed to cure several systemic diseases.
These procedures and herbs costs little, possess various
medicinal properties and are easily available.
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Cite this article as:
Gunjan Garg, Gopesh Mangal, N.S. Chundawat. Ayurvedic Approach in Oral
Health & Hygiene: A Review. International Journal of Ayurveda and Pharma
Research. 2016;4(5):17-21.
Source of support: Nil, Conflict of interest: None Declared
*Address for correspondence
Dr. Gunjan Garg
Associate Professor
Dept. of Swasthavritta & Yoga
Mahatma Jyotiba Fule Ayurveda
Mahavidhalaya
Chomu, Jaipur, India
Email: ayurvedshala@gmail.com