Dentistry and Ayurveda Classification and Management

88Indian J Dent Res, 19(1), 2008

C O N T E N T S

Indian Journal of Dental Research ISSN: 0970 - 9290Volume: 19 / Issue: 1 / January - March 2008

EditorialAuthorshipB Sivapathasundharam ........................................................................................................................................................................ 1

Original ResearchEffect of chemical surface treatments and repair material on transverse strength of repaired acrylic denture resinMahroo Vojdani, Sakineh Rezaei, Lila Zareeian ................................................................................................................................... 2

Intrusion in implant-tooth-supported fi xed prosthesis: An in vitro photoelastic stress analysisMurali Srinivasan, Padmanabhan TV .................................................................................................................................................... 6

Self-assessment of facial form oral function and psychosocial function before and after orthognathic surgery: A retrospective studyVinod Narayanan, Shankar Guhan, Sreekumar K, Ashok Ramadorai .................................................................................................. 12

The effect of post-core and ferrule on the fracture resistance of endodontically treated maxillary central incisorsSendhilnathan Dakshinamurthy, Sanjna Nayar .................................................................................................................................... 17

The effect of ibuprofen on bleeding duringperiodontal surgeryShiva Prasad BM, Vijaya M, Sridhara B Reddy, Sudhir R Patil, Nagaraj B Kalburgi ............................................................................. 22

In vitro evaluation of antibacterial activity of an herbal dentifrice against Streptococcus mutans and Lactobacillus acidophilusYogesh Kumar Vyas, Maheep Bhatnagar, Kanika Sharma ................................................................................................................... 26

Effect of three commercial mouth rinses on cultured human gingival fi broblast: An in vitro studyFlemingson, Emmadi Pamela, Ambalavanan N, Ramakrishnan T, Vijayalakshmi R ............................................................................ 29

The diagnostic and prognostic implications of silver-binding nucleolar organizer regions in periodontal lesionsMini Saluja, Vandana KL ...................................................................................................................................................................... 36

Review ArticlesPlatelet-rich fi brin: Evolution of a second-generation platelet concentrateSunitha Raja V, Munirathnam Naidu E ................................................................................................................................................. 42

Malignant melanoma of the oral cavity: A review of literatureMS Hashemi Pour ................................................................................................................................................................................ 47

Dentistry and Ayurveda - IV: Classifi cation and management of common oral diseasesSunita Amruthesh ............................................................................................................................................................................... 52

Case ReportsOdontogenic myxoma of maxillaSivakumar G, Kavitha B, Saraswathi TR, Sivapathasundharam B ........................................................................................................ 62

Ewings sarcoma of the maxillaVikas Prasad B, Ahmed Mujib BR, Bastian TS, David Tauro P ............................................................................................................. 66

Two-rooted mandibular second premolars: Case report and surveyPrakash R, Nandini S, Suma Ballal, Sowmya N Kumar, Kandaswamy D ............................................................................................. 70

Histochemical and polarization microscopic study of two cases of vegetable/pulse granulomaManjunatha BS, Kumar GS, Vandana Raghunath ................................................................................................................................ 74

Central giant cell granuloma of the anterior maxillaAmar A Sholapurkar, Keerthilatha M Pai, Auswaf Ahsan ..................................................................................................................... 78

Symposium ReportISDR International symposium on research priorities in Dental Science and technology in Asia and AfricaM Rahamatulla ..................................................................................................................................................................................... 83

Journal ReviewsEinstein A, Sathyakumar M .................................................................................................................................................................. 85

Book ReviewCopyright 2008 by Editor-in-chief, IJDR

................................................................................................................................................................................ 51

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PANCHAKARMA

PURVA KARMA PASHCHYAT KARMA(preparatory, viz, dipana, (i.e., special dietary regimenpacana, snehan, svedana) or samsarjana karma)

PRADHANA KARMA(Main therapies)

VAMANA VIRECANA VASTI SIROVIRECANA RAKTAMOKSANA(Emesis) (Purgation) (Enemata) (Insuflation) (Blood letting)

ANUVA SAN ASTHAPANA(Oily enema) (Decoction enema)

Figure 1: Panchakarma procedure

Dentistry and Ayurveda - IV: Classification and management of common oral diseases

Sunita Amruthesh

ABSTRACTABSTRACTThis article, the fourth in the series titled Dentistry and Ayurveda, describes in brief the panchakarma therapy, which is a distinctive feature of the Ayurvedic method of detoxifying the body. The various therapies and medicines used in Ayurveda have been elaborated. Further, an attempt has been made to correlate dental diseases in Ayurveda with the modern-day classification, clinical features, and management.

Key words: Alternate medicine, Ayurveda, complementary medicine, dental diseases, dentistry, integrated medicine

The introduction, basics of the entities of health, diagnosis, and principles of management of diseases in Ayurveda has already been discussed in Dentistry and Ayurveda sections I, II, and III, respectively.[1-3]

THERAPEUTIC PROCEDURES(KIRIYA KALPA)[1-6]

To preserve normal dental health, different methods are advised for regular practice, such as the following:1. Dantha dhavani (brushing)2. Mukha prakshalan3. Kavala (gargling)4. Gandoosha5. Abhyanga (oil massage)6. Vyayama (exercise)7. Pratimarsha nasya (errhine therapy)

PANCHAKARMA[2,6,8-14,16,22,25]

The Panchakarma therapy aims to purify the body at the gross and subtle levels as well as to clean the channels of the body to enable free ow of nutrients, medicaments, and metabolites. The living human body consists of innumerable channels called srotas. Ayurveda advocates that samsodhana is the way to clean these channels in order to enable the organism to heal itself spontaneously as well as to enable the medicaments reach the target sites more easily. Thus, samsodhana is considered a prerequisite before all kinds of medications and therapeutic interventions. There are two forms of samsodhana: (1) external puri cation by way of

oleation, fomentation, and massage, where a therapist uses oil bath, heat, and the physical pressure of massage as the tools of treatment to soften and mobilize the malas (impurities) and push them to kosthas, i.e., gross channels (excretory system), from where they get easily excreted or are expelled with the help of major internal puri catory procedures of samsodhana karma and (2) internal puri cation, which is the major intervention [Figure 1].

In principle, the samsodhana karma is followed by speci c samsamana or curative treatment, which consists of rationally planned diet, drugs, and life-style changes. While formulating a scheme of samsamana treatment, the physician keeps in mind the prakrti or nature of the patient and the components of his vikrti or morbidity, namely the pattern of vitiation of doshas, dhatus, agni, etc. He takes the help of pancabhautika composition of drugs and diets, including their rasa, guna, virya, vipaka, and prabhava

Corespondence:Dr. Sunita Amruthesh,E-mail: [email protected]

Received : 26-07-06Review completed : 01-07-07Accepted : 26-07-07PubMed ID :

Dept. of Oral Medicine and Radiology, K.L.Es Dental College and Hospital and Research Centre, Bangalore - 560022, India

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Indian J Dent Res, 19(1), 200853

and follows the law of samanya and visesa (homologous vs heterologous).

PURVAKARMA OR PREPARATORY MEASURES

The word panchakarma means ve actions. It is a curative line of treatment for all diseases that are not amenable to shamana chikitsa, i.e., the palliative line of treatment. The ve methods or procedures of elimination of vitiated doshas from the body are:l. Vamana karma (emesis therapy)2. Virechana karma (purgation therapy)3. Basti karma

a. Anuvasana vasti/basti karmab. Nirooha vasti karma

4. Rakthamokshana5. Nasyakarma (shirovirechana)

The main operative treatment of panchakarma (pradhana karmas) is always preceeded by preoperative eliminative procedures to bring vitiated morbid dosha from the shakhaas, which include rakthaadi dhatus and twak to the koshta. Due to aggravation, increased uidity, suppuration, removal of obstruction at the entrance of the channel of circulation, and reduced pressure, the vitiated doshas leave the periphery and come to the central part of the body (alimentary tract). By the application of preoperative measures like sudation and oleation, the vitiated dosha can be brought to the alimentary tract and eliminated through urdhwa marga (upper orifice/mouth) or through adho marga (lower ori ce/anus). Certain postoperative treatment procedures are necessary for a complete cure. Emesis therapy is advised for alleviating and curing diseases associated with kapha. Similarly, purgative and enema therapies alleviate diseases associated with pitta and vata, respectively. Errhine therapy is a speci c treatment for the diseases of the head.

FORMS OF MEDICINES

Powders, lambatives, decoctions, medicated oils (taila), medicated ghees (ghritas),[17-19] confections, and wines are the forms of medicines. Ingredients for the drugs such as roots, leaves, etc., should be culled in the appropriate seasons.

Illness management is a four-part procedure:1. Shodan: cleansing by panchakarma2. Shaman: palliation or reduction of intensity of the

disease; there are seven types of shaman:a. Dipan: kindling the digestive re for vata and kapha

disturbancesb. Pachana: burning the toxic wastec. Ksud-nigrah: fastingd. Trut-nigrah: observing thirste. Vyayam: yoga-exercisef. Aap-seva: sunbathing

g. Marut-seva: breathing, exercise, and meditation3. Rasayan: rejuvenation4. Satwajaya: mental and spiritual healing

AmaUndigested, unabsorbed, and unassimilated food particles are sticky and adhere to the tissues and clogging channels, interfering with the normal functioning of the body organs. Cleansing eliminates ama, dietary and life-style interventions are initiated according to the disturbed doshas (body materials and psychic abnormalities) and the prakriti (physical and mental constitution of a person) and are accompanied by spiritual nurturing, removing chinta (serious worry), physical exercise, and yoga practice.

Mercury is considered a yogavali or activator of other drugs. Metals and mineral preparations, called bhasm, are used extensively in Ayurvedic medicine, Gold, silver, copper, mercury, zinc, tin, arsenic, gypsum, lime, alum, borax, silica, diamond, ruby, emerald, sapphire, jade, moonstone, sunstone, turquoise, and mica are commonly used.

Bhasms have unique pharmacological properties that cannot be accomplished by the properties of a pure metal salt.

Rasayana[15,20-22]They are general tonics and have multipotent power for rejuvenating all body tissues. Drugs prescribed in Ayurveda primarily consist of herbs, bhasm, rasas, and medicated oils (for topical application, nasal instillation, and enemas). In Ayurveda, a single herb is rarely administered to a patient; it is usually a combination of several herbs.

And data on more than 5000 Indian medicinal plants have been compiled in the compendium of Indian plants.

Ayurvedic formulas are used to improve health and as adjuvants in conjunction with other methods of treatment. The most popular is chyavanprash. It can be taken daily with food. It promotes a healthy appetite and improves digestion and absorption of food; increases bowel tonicity; strengthens the colon and intestine; regulates bowel movements; and builds up good health by promoting the levels of minerals, vitamins, carbohydrates and proteins, and removing undesirable fats. It also assists natural immunity, maintains new tissues, increasea red blood cell count and haemoglobin synthesis, cleara toxic materials from the body, and improves blood ow. It helps with relaxation, sound sleep, and coping with stress, fatigue, and the mental strains of daily life. It also renews vital energy, strengthens mental and physical functions, alleviates nervous tension and anxiety due to stress, and supports creativity by increasing mental energy.

Moreover, rasayanas provide relief from morning stiffness at the joints and postexercise joint and muscle pain, and

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sprains; improve cartilage regeneration in joints; build healthy bones; clear impurities from the body; and improve vitality and stamina. They strengthen respiration and blood circulation, dispel excess mucus from respiratory system, build healthy lungs, and stimulate the male and female reproductive systems.

Yoga[4,5,7-9,11-14,16,20,22-25]Yoga is used as a therapy to improve general health and vitality. Yoga is de ned as the nirodha (inhibition) viritti ( uctuations) of chitt (consciousness). It is the restraint of the mental activity.

Classifications of management [Figure 2]I. A. Urjaskara: promotion of health and vigour

1. Rasayana (rejuvenation)2. Vajikarna (virili cation)

B. Rogaghna (cure of diseases)1. Prasamana (mitigating disease)2. Apunarbhavakara (preventing recurrence) Dravya (with use of drugs); There are three kinds

of drugs:a. Bhauma (mineral) - from gold to saltb. Audbida (vegetable)

i. Vanaspati - bears fruitsii. Vanaspatya - bears owers and then

fruitsiii. Virudh - creepers and bushesiv. Osadhi - perishes after the fruit

matures Adravya (without use of drugs): The various

methods include:i. Fastingii. Exposure to breezeiii. Sunlightiv. Shadev. Sacred spellsvi. Appeasing Godsvii. Charityviii. Threateningix. Terrorisingx. Shockxi. Creating happiness

xii. Tormentingxiii. Laughingxiv. Sleepxv. Avoidance of sleepxvi. Ridingxvii. Music, dance etc.

II. Trividha chikitsa A. Daivavyapasraya (invoking grace of Gods)

1. Chanting hymns2. Wearing of plants, gems3. Auspicious ceremonies, oblations, sacri ce, vows4. Expiatory rites, fasting, reciting holy chants5. Surrendering to Gods6. Pilgrimages

B. Yuktivyashrays: administation of food and drugs C. Satvarajaya (controlling mind): control mind,

keeping it away from unhealthy thoughtsIII. A. Apakarsana (elimination)

1. Bahya (external) - tumors, infections, foreign bodies

2. Abhyantara (internal) emesis, purgation, etc. B. Prakrutivighata samsamana (mitigational allevia-

tion of diseases)1. Use of oil massage2. Sudation (fomentation)3. Applying poultices4. Pouring decoction or other liquids5. Mild massage

C. Nidanatyaga (avoidance of cause): avoidance of cold, heat, food, exercise; using things that are unctuous, dry, etc., in accordance with the doshas

IV. A. Hetuviparita (opposite of cause): using materials that are light, dry, and hot to keep away diseases caused by materials that are heavy, unctuous, and cold

B. Vyadhiviparita (opposite of disease)1. Mulopakrama (chief method) a. Langhana (thinning) b. Brhmana (fattening/stoutening)2. Panchakarmas: ve puri catory therapies

THERAPEUTIC PROCEDURES[4-6,8-16]

I. Dhoomapana[4,9,10,12-15]Dhoomapana is an important therapy, consisting of the inhalation of medicated smoke through mouth or nose and releasing it through the mouth. It is commonly indicated in head, throat, nose, ear, and dental disorders.

The different types are prayogika, virechanika, snehika, kasaghna, and vamaneeya dhoomapana.

a. Prayogika/shaman dhoomapana: Eladigana dravyas except kusta and tagaru is pasted on 12-inch long shara kanda, which is then covered with silk cloth upto 8 inches of its length; it is dried in shade; then shara kanda is removed; and the 8-inch medicated varthi is

Dentistry and Ayurveda - IV Amruthesh

Chikitsa (treatment)

LanghanFasting

BrahmnNourishing

Figure 2: Types of treatment



used for dhoomapana.b. Virechanika dhoomapana: Varthi prepared with shiro

virechana drugs like vidangac. Snehika dhoomapana: Varthi prepared with eranda,

devadaru, madooschista, sarja ras, and guggulud. Kasanghana dhoomapana: Varthi prepared with

bruhati, kantakari, trikatu, kasamarda, hingu, guduchi, karkataka, and shrungi

e. Vamaneeya dhoomapana: Varthi prepared with snayu, twak, horns, bones, dried sh, meat, and insects, or with vamaka dravyas

f. Vrana dhoomapana: Varthi prepared with vrana ropana dravyas

The indications of dhoomapana in mukha rogas include mukha paka, dysgeusia, hanugraha, upajihwa, and halitosis. Contraindications have also been described.

The procedure is as follows: The selected drugs are ground into a ne paste and smeared over a hollow reed made of gold, silver, copper, or brass. Four more coatings are made after drying of each layer and then smeared with ghee or oil. One end is lit and the smoke is inhaled.

II. Raktha mokshana (bloodletting)This procedure is indicated in raktha and pitta disorders. Raktha mokshana is done by using shrunga (cowhorn for aspiration), jalauka (leeches), ghati (cupping glass), alaabu (white gourd), and venesection (siravyadana). This procedure is indicated in some mukha rogas.

III. Nasya karmaNasya karma is an important therapy in panchakarma for the management of the diseases of shalakya tantra (ENT, eye, and dental diseases) and other systemic disorders like vata vyadhi-unmada, apamara, moorcha, kesha vikara, and pumsamana karma. It is the last step in panchakarma therapy.

It is a special and important therapy, in which the medicine is administered through the nose in the form of a power, liquid, oil, or smoke.

Drugs may be used for nasya in the following forms: chuma nasya, kalka nasya, swarasa nasya, ksheera nasya, kwatha nasya, saara nasya, udaka nasya, dhooma nasya, mamasarasa nasya, taila nasya, ghritha nasya, madya nasya, and raktha nasya.

Charaka classified nasya into two broad types, with subcategories in each, as follows:A. 1. Navana: sneha nasya, shodhana nasya

2. Avapeedana: shodhana nasya, stambana nasya3. Dmapana nasya4. Dhooma nasya: prayogika dhooma nasya, virechanika

dhooma nasya, snehika dhooma nasya5. Pratimarsha nasya: snehan nasya, rechan nasya

B. 1. Rechana nasya2. Tarpana nasya

3. Shamana nasya

Drugs used for nasyaCharaka prescribed the following drugs for nasya: apamarga, pippali, maricha vidanga, shigru, sarshapa, tumburu, jeerak, ajamoda, pilu, harenuka, pruthweeka, surasa, swetha, kutheruka, phaninjaka, shireesha, lashun, haridra, daruharidra, sauvarchalavana, saindhavalavana, jyothishmathi, shunthi, gandeera, shallaki, tejovathi, ingudi, dalcini, varthaki, ela, sumukha, gandeeraka, kalmalaka, parnasa, ghrungver, mulak, tarkari, arka, alerka, kusta, nagadanthi, vacha, bhargee, gavakashea, awakpushpee, vruchcnikali, brahmes, ativisha, lodhra madanphala, sapthaparna, nimba, devadaru, agaru, sarela, hingu, guduchi, bruhati, ikshavak, trikatu, gomaya, gomutra, lavana, and ela.

IV. Gandoosha and kavalagrahAccording to them, the difference between the two is only in the dosage and procedure of using the drug.

In gandoosha, a medicated uid is held mouthful for a speci c period until there is lacrimation and nasal discharge, and then the patient spits it out.

In kavalagra, the mouth is only three-fourths lled with the medicated uid; the uid is swished in the mouth for a speci c time and then spat out.

According to Sarangadhara, kalka (medicated bolus) drugs are used in kavala, and liquids are used in gandoosha.

Classi cation of kavala or gandooshaThese are of four types according to Vagbhata: (1) snigda gandoosha, (2) shaman, (3) shodhan, and (4) ropan.

1. Snehan or snigda gandoosha: The drugs used are snigda-ushna, madura, and lavana in vata prakopa. The medicine is mixed with other vata hara sneha, mamsaras, etc.

2. Shaman gandoosha: Drugs are prepared with tiktha, kashya, and madura rasa for pitta shaman, but in prasadan gandoosha of Sushrutha, the drugs should be prepared with madura, sheetha for pitta shaman.

3. Shodhan gandoosha: Drugs are prepared with teekshna, ushna, ruksha, katu, amla, and lavan rasa for kapha shaman. Gomutra, madya, shuktha, madu, dhanyamala, etc., should be used along with the drugs.

4. Ropan gandoosha: Drugs are prepared with ushna, kashaya, katu, madura, and rasa for vrana ropana. Ghritha, ksheera, and sneha dravya are used along with the drugs.

Gandoosha vidhi (procedure)The correct procedure must be followed, which is of utmost



importance in the managament of mukha rogas. It is a special process as well as pashchyath karma to nasya karma, vaman karma, etc., to save the body from complications of kapha dosha. The steps are as follows:1. Preparation of the patient for gandoosha.2. Preparation of the medicine according to the conditions

of the patient. For example,a. Triphala-trikatu, pancha, valkala, dashamoola,

vacha,[17,18] etc., should be ground to prepare kalka (bolus or paste) to keep in the mouth or to swish in the mouth.

b. Liquid medicines: like grhitha, taila, madhu, water, madya, mamsa rasa, gomutra, decoctions of medicines, shuktha, kanji, etc.

c. According to the vitiation of doshas, either kalka or kashaya, or both, should be selected for the therapy.

3. Gentle massage.4. Light fomentation at neck, cheek, face, head, shoulders,

etc.5. The patient is seated comfortably in a chair; the medicine

is held in the mouth, or swished, up to the speci c time (till kapha collects in mouth or there is lacrimation), after which it is spat out. Pashchyath karma or other gandoosha is performed.

6. Gentle massage and light fomention at neck, face, cheeks, shoulders, head etc.

Indications for gandoosha are: (1) shira shoola (headache), (2) mukha roga (diseases of osta, dantha moola, dantha, jihwa, talu, gala, etc.), (3) lala srava (salivation), (4) mukha sdsha (vataj disorders of mouth), (5) hrullasa (nausea), and (6) aruchi (tastelessness).

Regular gandoosha vidhi achieves the following bene ts: (1) swara balam (strength to voice), (2) hanubalam (strength to jaws), (3) strength to face, (4) ruchyam (better taste perception), (5) druda dantha (strong and healthy teeth), and (6) resistance against doshaja or aaganthuja mukha rogas, shiro rogas, karna rogas, nasa roga, and netra roga.

Schedule for gandoosha: The medicated uid is kept in mouth till (1) collection of kapham in the mouth, (2) nasa srava, (3) karna srava, and (4) netra srava. The uid is then spat out. The procedure may be repeated with another drug, or pashchyath karma (next procedure) is performed, depending on the condition of the patient.

Samyak yoga lakshanas of gandoosha: Symptoms of adequate gandoosha include: (1) relief from the disease or symptoms, (2) freshness of all indriyas, face, and mind, (3) lightness of body, (4) sound sleep, and (5) normal taste, appetite, digestion capacity, and general health.

Atiyoga lakshanas of gandoosha: Symptoms of excessive gandoosha include: (1) shosha (dryness of mukha, srotas,

etc.), (2) daha (burning sensation), (3) paka (ulceration), (4) trushna (thirst), (5) aruchi (loss of taste), and (6) kiam (debility).

Asamyak yoga lakshanas of gandoosha: Symptoms of inadequate gandoosha include: (1) alastwa (laziness), (2) aggravation of the disease, (3) kapha vitiation, (4) aruchi (tastelessness), (5) hrullasa (nausea), and (6) tandra (inactive state or sleepy mood).

Some important yogas of gandooshaThese include (1) hot water gandoosha in general kapha disorders of mukha; (2) gandoosha with kanji or dhanyamla in aruchi; (3) daruharidr-rasa kriya or triphala kashaya gandoosha in mukhapak; (4) trikatu sarshapa hareetaki kalkam + ksharaj ala gandoosha in kaphaj mukha roga; (5) tila kalka + water gandoosha in dantha harsha; (6) ghritha or ksheera gandoosha in pittaja mukha rogas; (7) ksheeri vruksha kashaya gandoosham in bleeding gums; (8) decoction of kaseesa, lodra, pippali, manahshall, priyang, tejohwa + honey, gandoosha in pyorrhea (pus discharge from gums); (9) pancha pallava kashaya + ghitha + mada + sugar gandoosha in (gingivitis) upakusha; (10) gandoosha with frimedadi taila or sahacharadi taila or sarshapa taila or narayan taila or prasarini taila in gum disorders (dantha moola vyadhies); (11) decoction of lodra, musta, jatamamsi, rasanjan, patanga + honey, gandoosha in saushira (dantha moola vydhi); (12) patola-nimba, triphala kashaya gandoosha in gum disorders; (13) dashamoola kashaya + tila taila gandoosha in dantha rogas; (14) trikatu, sarshapa, saindhava lavana, gandoosha in kaphaja jihwa roga; (15) kshara jala gandoosha in kaphaj mukha roga); (16) tila taila gandoosha is best done daily to prevent mukha roga; (17) yastimadu kashaya gandoosha in mukha paka; and (18) kakolyadi or vidarigandhadi ghritha gandoosha in pittaj mukha rogas.

Pratisarana (mouth pastes): There are three types, based on use, viz., rasakriya, kalka, and churna.

Mukhalepa (face pastes): There are three types, viz., doshaghna (for mitigating the dosha), visaghna (antipoisonous), and varnya (for improving color and complexion).

Mukha rogas (diseases of the face and oralcavity)[4,6,9,10,12-16,21,22]

These are classi ed as follows:I. Osta roga (diseases of lips)II. Danta moola roga (diseases of gums)III. Danta roga (diseases of teeth)IV. Jihwa roga (diseases of tongue)V. Talu roga (diseases of palate)VI. Gala roga (diseases of throat)VII. Mukha dhi (sarvaj)VIII. Ganda roga



I. Osta roga 1. Vataj osta roga 2. Pittaja osta roga 3. Kaphaja osta prakopa 4. Sannipathaja osta prakopa 5. Rakthaja osta prakopa 6. Mamsaja osta prakopa 7. Medoja osta prakopa 8. Kshathaja osta prakopa 9. Khandausta (harelip)10. Grandhi (cyst)11. Jalaarbuda (mucocele)12. Gandalaji (cellulitis)Vataj osta prakopa: Vata doshas vitiate, and osta (lip) is stony hard, rough, stiff, blackish, painful, and has ssures. A typical treatment for the condition consists of: (1) abhyanga with chatur snehas and madooschista (beeswax) or yastimadu + lodra + sariba + shravani + neelothphala + patola + kaka machi + tailam (til oil); (2) nadi sweda (sweating therapy using a tube) with vata haradravya kashaya (medicine/decoction that corrects vitiated vata, e.g., eranda patr (castor leaves), ksheera pakwa kashaya; (3) upanaha sweda (poultices); (4) shirovasti (anointing the head) with vata harataila, e.g., bala taila; (5) nasya with vataharataila, e.g., balataila; (6) pratisarana with (a) sarala niryasa, sarjarasa, devadaru, and guggulu, yastimadu, (b) taila + ghritha + sarjarasa + rasna + guda + saindhav lavana + gyrica pakwataila + madooschistam for local application; and(7) internal yogas ghrithapan (ghee), mamarasa sewana (meat soup), shothahara, shoolahara (analgesic), and krimighna (antibiotic) vranaropana yogas (preparation of medicines that promote healing), e.g., tiiphalaguggulu, gangakrasayan, and maharasnadi quatha (a decoction).

Clinical treatments have been described for all the other diseases of the lips.

II. Diseases of the gums (dantha moola vyadhis) 1. Sheethada (scurvy, gingivitis) 2. Dantha pupputaka (gingival abscess) 3. Dantha vestak (periodontal abscess) 4. Upakusha (periodontitis) 5. Dantha vydarbha (allergic gingivitis) 6. Vardana (supernumerary tooth) 7. Adhimamsa (pericoronitis) 8. Saushira (ANUG) 9. Mahashushira (cancrum oris)10. Paridhara11. Vataj dantanadi12. Pittaj dantha nadi13. Kaphaj dantha nadi14. Sannipathaj dantha nadi15. Dantha vidradi

1. Sheetada (scurvy gingivitis): The general principles of treatment include: (1) swedana (sweating therapy);

(2) rakthamokshana (blood letting) with alabu, gati, or jalauka (leech application); rubbed with coarse powder (dantha gharshana choorna); (3) pratisarana yogas (preparations): (a) priyangu triphala and musta, (b) musta, arjuna twacha, triphala, priyangu, shunti, rasanjan + madhu, (c) kaseesa lodra pippali, mahashila, (d) dadima twacha, triphala, rasanjan, shunti, saindhava, lavana, musta + honey, (e) lavana and sarshapa taila as toothpowder; (4) gandoosha or kavalagraha (gargle, mouthwash) with: (a) musta, arjuna twacha, triphala, priyangu, rasanjan and shunti, (b) shunti and parapataka, (c) vataghna taila and ghritha, (d) ksheeri vriksha kashaya, (e) shunti, sarshapa, triphala, musta rasanjan, (f) babbula twacha (decoction of the bark of babbula); (5) nasya snehana nasya: (a) if vata is associated, (b) madukadi triphala taila nasya if kapha dosha persists (yasti, madhu, utpala, padmaka triphala + taila), (c) nasya with triphala ghritha if raktha is associated; (6) internal yogas (medicine preparation): (a) shoola hara, shotha hara, vrana ropana preprations are to be administered, e.g., triphala guggulu, kanchanara guggulu, lakshadi, guggulu, (b) lagusuthasekara ras, and (c) sarivadi vati, tr athakadivati or khadiradivati. Avoid brushing; add ne powder or tiktha kashaya ras for massaging and cleaning teeth (dantha dhavana).

2. Dantha pupputaka (periapical or dento-alveolar abscess): kapha and raktha dosha. Treatment involves: (1) raktha mokshana, (2) application of kshara, (3) pancha lavana preparation in salt and madhu (honey) for massaging over the gums, (4) kavala (gargle), (5) snigda bhojan, and (6) ghee.

3. Dantha vestak (periodontal abscess): The treatment consists of: (1) raktha mokshana, (2) prathisarana with medicated powder prepared with lodra, yastimadu laksha chandan + honey, (3) arogyavardhini vati with cows milk for local application, (4) gandoosha: ksheeri vruksha kashya + honey + ghee, (5) nasya with medicated ghee prepared with kakolyadi dravya, dashaguna ksheera, (6) swetha manjan and dashan samskar choorna for brushing, (7) khadiradivati for chewing, (8) irimedadi taila or sarshapa taila applied to the gums; gargling with lukewarm water, and (9) raktha and pittahara chikitsa (administer medicines that treat raktha and pitta dosha).

4. Upakusha: (periodontitis): Treatment principle includes: (1) vaman (emetic therapy); (2) virechan (purgation); (3) shirovirechana; (4) raktha mokshana with gojihwa patra or mandalagrashastra; (5) pratisarana: (a) trikatu, lavana + madhu, (b) laksha, priyangu, patanga, kusta, shunti, maricha, yastimadhu rasanjan, ghrithamanda, or madhu; (6) (a) pippali, swetha, sarshapa shunti, vetasa with hot water, (b) gbritha prepared with kakolyadi madhura dravya, (c) ksheeri pallava kashaya + madhu, (d) pancha pallava kashaya + madhu + ghritha + sharkara (sugar), (e) sahacharadi taila, and (f) irimedadi taila.



5. Dantha vydarbha 6. Vardhan/adhidantha: Removal of tooth followed

by agnikarma (cautery) and vrana chikitsa (wound healing).

7. Adhimamsa (pericoronitis): Treatment includes: (1) adhimamsa chedan (excision of excessive tissue), pratisarana with vacha, chavya, patha, sarjakshara, and yavakshara + madhu; (2) kavala: pippali + madhu; (3) mukhadhavana (wash, gargle with decoction of patola, triphala, and nimbatwak); (4) shirovirechan; and (5) virechana dhooma.

8. Saushira (ANUG): kapha, pitta, and raktha doshas. Treatment includes: (1) raktha mokshana; (2) chedan and lekhan; (3) pratisarana with lodra, musta, shatapushpi, triphala, rasanjan, patong, phalapushpa, and katphala + madhu; (4) (a) gandoosha: decoction of above drugs, (b) with ksheeri vruksha kashaya; (5) nasya: with medicated ghritha pepared with sariva, neelakamala yastimadhu, lodra, agara, and chandan (for kalka) + 10 times the volume of milk, ghritha.

9. Maha saushira (noma): Treatment is a more vigorous application of that given for saushira.

10. Paridhara11. Dantha naadi (sinuses/ stula osteomyelitis): (1) vataja,

(2) pittaja, (3) kaphaja, (4) sharyaja, dantha nadi, and (5) tridoshaja. Treatment consists of: (1) upanaha swedam (hot application), (2) nadividarana (incision of sinus), (3) puyanirharana (drainage of abscess), (4) prakshalana (currettage), (5) purana or pratisarana, (6) nadivrana chikista, (7) dantha nirharana, (8) lekhana (saucerization), (9) kshara (alkali) or agnikarma (cauterization), and (10) pratisarana.

III. Dantha rogas (diseases of the teeth)[20]1. Dalana2. Krimi dantha (dental caries)3. Dantha harsha (hypersensitivity)4. Bhanjaka5. Dantha shaykara (calculus)6. Dantha kapalika7. Shyavadantha (pigmentation)8. Hanumoksha (mandibular dislocation)9. Danthavidradi10. Karala11. Chaladantha12. Adidanth (supernumerary tooth)

1. Dalana (focal reversible pulpitis): Treatment includes: (a) sweda with hot water (warm water gargles); (b) dantha pali lekhan (scraping/lekhan of carious lesion/calculus with vreehimukha shastra); (c) agnikarma with hot oils; (d) pratisaran with powders of musta, saindhava lavana, salt, dadima twacha, triphala, rasanjan, priyangu, jambausti, shunti, madhu; (e) kavala with ksheeri vruksha kashaya; (f) nasya with anutaila.

2. Krimi dantha (dental caries): The treatment can vary

with the condition of the tooth. a. If tooth is not mobile: (1) swedana, (2) raktha

mokshana, (3) vataghna avapeedana nasya, (4) sneha gandoosha, (5) bhadra daarvadi lepam, and (6) snigdha bhojan.

b. If tooth is mobile: extraction and cauterization (agnikarma).

c. For relieving pain due to caries: (1) dhoopana with seeds of kantakari; (2) keeping the vati (tablet) in the mouth (hingu, katphala, kaseesa, sarjakshara, and kusta vidanga; (3) sariva kalka, mukhadharana (chewing) as krimighana (antimicrobial); (4) ardhrakat krishna lavaria, mukhadharana (chewing) as antimicrobial; (5) vataghna taila, e.g., narayanataila for gandoosha; (6) brahatyadi gandoosha; (7) gandoosha with medicated oil prepared from hingu katphala, vidanga, kaseesa, sarjakshara, and kusta; (8) application of clove oil; (9) nasya with sarshapa taila (oil); (10) nasya with medicated oil prepared from vidari, yastimadu, kasheruk, and shrungatak mixed in 10 times its volume of milk.

3. Dantia harsha (hypersensitivity due to attrition or abrasion): The vata is vitiated. Treatment includes: (1) kavala gandoosha with (a) lukewarm oils (chatur sneha sarpi taila vasa, and majja), (b) trivruth ghritha or with vataghna aushadas, (c) yastimadu, tila, and ksheera (ksheera pala aushada), (d) sarshapataila or narayanl vishnu prasarini taila; (2) nasya: sneha nasya; (3) dhoomapana: snehika dhoomapana; (4) shirovasti: vataghna taila; (5) snigdhabhojan mamsarasa, navaneetha, and ghritha, (6) vatahara chikitsa.

4. Bhanjaka (enamel hypoplasia): Treatment consists of: (1) kapha vataghna chikitsa (correct kapha and vata), (2) ardhitha vata chikitsa, (3) abhyanga with narayan taila, (4) swedan, (5) vasti, (6) gandhoosha with yastimadhu, tilaksheerapaka, (7) kavala with aakara karavadi yoga, (8) erandataila panam.

5. Dantha sharkara (calculus): Treatment inclues: (1) nidana parivarjana (proper brushing and gargling); (2) shareera shodhana (vamana, virechana); (3) danthamala lekhana (scaling); (4) pratisarana with kshara + mdhu; (5) poorana with laksha + madhu (restoration); (6) kavala or gandoosha as in dantha harsha.

6. Kapalika dantha 7. Shyava dantha 8. Hanu moksha (dislocation of mandible): Treatment

includes: (1) arditha vata chikitsa, (2) shiro vasti, (3) nasya, (4) dhooma, (5) upanaha sweda

9. Dantavidradi10. Karala (ill-formed teeth)11. Chaladantha (mobile teeth/periodontitis): Treatment

includes: (1) sneha (oleation) and gandoosha with dashamoola quatha; (2) gharshana with tutha, lodra,



pippali, triphala, rakthachandan, and saindava lavana; (3) snigda nasya; (4) snigda kavala; and (5) snigda bhojan.

Dantha shoola (tooth ache/odontodynia)Treatment includes: (1) hingu, katphala, kaseesa, sarjakshara, kusta, vidanga pratisaran; (2) gandoosha with hugwadi taila; (3) eranda, bruhati dwaya, mundi, siddha taila, gandoosha; (4) dhoopana with kantakari seeds; and (5) clove oil application.

If extraction is indicated and done, (1) yastimadu + taila to be applied, (2) vidari, yastimadu, shrungataka, kasheru, and ksheera siddha taila nasya.

IV. Jihwa gatha rogas (diseases of the tongue)1. Vataja jihwa kantaka2. Pittaja jihwa kantaka3. Kaphaja jihwa kantaka4. Alasa5. Upajihwaka6. Adh ihwaka

1. Vataja jihwa kantaka (acute glossitis): Treatment includes: (1) abhyanga with chatursnehas, (2) nadi or upanaha sweda, (3) sneha pratisarana, (4) sneha nasya (vatahara, vrana ropana, shothahara chikitsa).

2. Pittaja jihwa kantaka (chronic glossitis): Treatment includes: (1) rakthamokshana: rubbing surface of tongue with leaves of gojihwa or shephalika; (2) sira vyadana (venesection); (3) pratisarana with kakolyadi madhura sheetha dravyas; (4) kakolyadi dravya kwatha gandoosha; (5) kakolyadi dravya milk + sneha siddha, sneha narayam; (6) pittahara ahara and vihara.

3. Kaphaja jihwa kantaka: Treatment includes: (l) lekhana or gharshana with the leaves of gojihwa or shephalika to remove impure blood, (2) raktha mokshana, (3) pratisarana:trikatu, sarshapa and saindhava lavana, (4) kavalagraha with swetha sarshapa + saindhava lavana, (5) yusha sevana:yusha + food.

4. Alasa (Ludwigs angina): Treatment includes: (1) virechana, (2) rakthamokshana, (3) kavala, (4) shirovirechan, (5) dhooma, (6) vamana, (7) nasya.

5. Upajihwak (ranula): Treatment includes: (1) raktha mokshana, lekhana, pratisarana, nasya, dhoomapana; (2) chedan and teekshana dravya pratisaran with katuki, pippali, nimba.

V. Talurogas (diseases of the palate)1. Gala shundi2. Tundikeri3. Adrusha4. Kacchapa5. Talu arbuda6. Mamsa sanghata

7. Talu pupputa8. Talu sosha9. Talu paka

1. Gala shundi: Treatment includes: (1) shaman chikista: kavala, gandoosha, nasya, and dhoomapana; (2) chedan karma with samdamshayantra and with mandalagra shastra; (3) pashchyat karma (post chedan therapy) -(a) pratisarana with maricha, ateesha, patha, vacha, kusta, shyonak, rasna, saindhava lavana + madhu, (b) kavala with the decoction of vacha, ativisha, patha, rasna, katuki, and nimba, (c) dhoomapana with panchangee varthi prepared by ingudi, kimihe, danthi, trivruth, and devadaru, (d) kshara, siddha, mugda, yusha, and bhojan.

2. Tundikeri (tonsillitis): Treatment includes: (1) shamana chikitsa: kavala, gandoosha, dhooma, and nasya; (2) shastra chikitsa (gala shundi); (3) pratisarana with gruha dhooma + katuvarga dravyas; (4) nasya with taila prepared from apamarga beeja (seeds), vishnukrantha, dhanthi, vidanga; (5) saindhava lavana and tila kalka.

3. Adrusha (palatitis): Treatment includes: (1) shaman chikitsa: (a) abhyanga, (b) pratisarana, (c) kavala, (d) gandoosha and (2) shastra chikitsa.

4. Talu kacchapa (adenoma of palate): Treatment includes: (1) shamana chikitsa: (a) abhyanga, (b) pratisrana, (c) kavala, (d) gandoosha, (e) dhooma, (f) nasya; (2) shastra chikitsa: chedana.

5. Talu arbuda (epithelioma of palate): It is due to vitiated raktha dosha. There is no treatment since it is asadhya vyadhi (incurable). Palliative measures include: (1) chedana; (2) pratisarana with sarj akshara + shunti + honey; (3) gandoosha with taila + madhu; (4) nasya with teekshana (intensive) taila nasya.

6. Mamsa sanghata ( broma of patate): It is caused by kapha + raktha doshas. Treatment includes: (1) shaman chikitsa; (2) chedan chikitsa as for galashundi.

7. Talu pupputa (cyst): Kapa dosha, medodhatu causes a painless xed swelling. Treatment includes: (1) chedana, lekhana; (2) pratisarana, kavala, nasya.

8. Talu sosha (atrophy/cleft palate): Vata and pitta vitiation, vatapitta jwara. Treatment includes: (1) Treat the cause (nidana parivarjanam); (2) vata pitta hara chikitsa; (3) ghee taken after meals; (4) pippali shunti pakwajala panam (boil decoction of pippali and shunti); (5) pippali shunti ghritha panam (preparation of pippali and shunti in ghee); (6) gandoosha with amla dravya or sneha dravya; (7) drink snigda jangola mamsarasa; (8) nasya with ksheeri sarpi.

9. Talu paka (palatal ulcers): Treatment includes: (1) nidana parivarjanam; (2) pitta visarpa hara chikitsa; (3) if there is no suppuration, kavala with sheetha kashaya, madhura dravyas like kakolyadi; (4) if there is suppuration, (a) asta pada vatha bhedan (eight-legged incision), (b) teekshana ushna pratisarana, (c) kavala with vasa, nimba twak, patola, etc.



TERMS OF GLOSSARY

Abhyanga: Oil massage.Aakara Karavadi yoga: a formulationAgaru: Aquillaria agallocha.Agikarma: Cauterisation. Ardraka: Ginger.Alabu : Lagenera avulgaria ser(white gourd).Apamarga:Achyranthus aspera.Arjuna: Terminalia arjuna.Arka:Calotropis procera.Amala: Sour, Embelica of cinalis.Asoka:Saraka Indica.Ativisha: Aconilum hetophylum.Anutaila: Oil preparation.Babbula: Acacia arobica wild.Bedana: Incision.Bhadra darvadi lepam: A preparation for external application.Brahatyadi Kashaya: A preparation for external application.Chandana: Santalum album linn.Chatur sneha: Oleation with 4 oils.Chavya: Piper chaba hunter.Chedana: To excise.Dadima twacha: Bark of pomegranate, Punicagranatum.Dravya: Liquid.Dantamanjan: Tooth powder.Danthi: Baliospermum montanum.Dashagunaksheera: Milk preparation.Dashamoola quatha: a decoction.Devdaru: Cedrus deodara.Ela:Elettarria cardamomum.Eranda: Ricinus communis linn.Ghrita: Ghee.Gojihwa: Onosma bracteatum wall.Gokshura:TribulusTerresrnas.Guduci :Tinospora cordifolia.Guggulu: Commiphera mukul.Gandak rasayan: Sulphur preparation.Gyrica:Ferrous pyrate.Hingu: Asofoetida:Ferula foetida regal.Hingwadi taila: An oil preparation.Iremedadi taila: Oil preparation.Ingudi: Balanites aegyptiaca.Jaati: Jasminum grandi orum.Jaatiphala: Nutmeg.Ja1auka: LeachJambausti: Nut of Syzigium jambolana:Jangola: A dry areaJwara: Fever.Jyotismati :Celeusterus paniculatus.Kadira: Acacia arabica.Kakamachi: Solanum nigrum.Kakolayadi:Kalka: Paste/ bolus.Karanja :Pangomia glabra.Krimighna: Antimicrobial.Katphala : Myrica nagi.

Kantakari: Solanum xanthocarpum.Katuki: Picrorrhiza curroaKaseesa: Ferrous sulphate.Kshara: Alkali.Kashaya: Decoction.Katuvarga: Group of pungent drugs.Khadiradi vati: A tablet preparation.Krishna lavana: Blacksalt.Ksheera: Milk.Ksheeri vruksha kashaya: A decoction of ve trees (Barks) in milk.Kusta: Saursurea lappa.Lagusuthasekara: A preparation (tablets).Laksha: Laccifer lacca (Lac).Lakshadi guggulu: A tablet preparation.Lekhana: To scrape.Lepa: External application.Lodra: Symplocos racemosus.Madhu: Honey.Madhuschistam: Bees wax.Maharasnadi quatha: an anti in ammatory analgesic decoction.Mahashila: Arsenic trisuiphate.Maricha: Piper nigrum.Mundi: Speranthus indica.Musta: Cyprus rotundus.Narayana/ Vishnu/ prasarini taila: An oil preparation.Navaneetha: Butter.Neelotphala: Lotus.Nimba: Azaridacta indica.Panam/sevana: To drink/eat.Pancha lavana(5 salts):( 1 )Saindhavana (rock salt), 2)Samudralavana(commomsalt) 3)Bida, 4)Sowarcha, 5)Udbida lavana.Pancha pallava kashaya: A decoction of inflorescence of 5 owers.Parpataka : Mollugo stricta.Patanga: Caesalpinia sappan.Patha: Cissompelios pareire.Patola: Trichosanthes dioica.Phalasha pushpa: Butea monosperma.Pippali: Piper longum.Pratisarana: Massage with dry power.Priyangu: Callicarpa macrothylla.Rasanjan: Extract of beriberis aristrata.Rasna : Vanda rosaftinghii.Rodhra: Symplocus racemosa.Sahacharadi thaila: An oil preparation.Saindhava lavana: Rock salt.Saralaniryasa: Oleoresina of Pinns longifolin.Sariba: Hemidesmus indicus.Sarivadi vati: A tablet.Sarja:Dipiroecarpus alaus.Sarjarasa: An extract.Sarshapa: Mustard- Brassica Alba.Shaman: Mitigation.Sharkara: Sugar candy.Shata pushpi: (saunf/fennel), Anethum sowa.Shephalika: Nyctanthes arbortristis.



Dentistry and Ayurveda - IV Amruthesh

Shirovasti: Oleation to the head.Shodhan: Puri cation \ detoxi cation.Shoolahara: Analgesic.Shotahara: That which controls swelling.Sharavani: Sparantus Indicus.Shrungataka: Trapa bispinosa.Shunti: Zingiberus of cinalia.Shyonak: Oroxylum indicum.Siddha taila: Oil preparation.Sneha: Oleation.Snigdha: With ghee/ oil.Sweda: Sweating.Swetha manjan: a tooth powder.Tejohwa: Zanthoxylum armatum.Thaila: oil.Tila: thill, Sesamum indicum.Tiktha kashaya ras: a preparation of bitter drugs.Tr atakadivati: a tablet.Triphala: Three fruits.Trivruth: Operculina terpethum.Tulasi (Surasa) Ocimum sanctum.Twak: Bark of Cinnamomum zeylanium.Tutha: Copper sulphate.Utphala: A variety of lotus.Usheera: Vettiveria zizanoides.Vacha: Acorus calamus.Varthaka: Solanum melongena.Vetasa: Salix caprea.Vidanga: Embilia ribes.Vidari: Puraria tuberosa.Vishnukrantha:Vranaropana: wound! Ulcer healing.Yastimadu: Glyceriza glabra.Yavakshara: an alkali.Yogas: preparations/formulations.Yusha: A thick soup

ACKNOWLEDGEMENTS

I would like to dedicate this article in the fond memory of my parents Mr. K. Kadadi and late Mrs. Shobha K. Kadadi for being role models and instilling right values.

I would like to express my gratitude to Dr. B. A. Venkatesh, Professor and H.O.D. of Shalakyatantra for his guidance; Dr. P. K. Dayal, former Professor and Head, Department of O.M.R, A. J. Shetty Institute of Dental Sciences, Mangalore, and Editor, DR; and Dr. D. Bailoor, Vice Principal, Yenopoya Dental College and Hospital for their timely help and sincere encouragement. I

would also like to thank all those who have helped me directly and indirectly in this endeavour.

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How to cite this article: Amruthesh S. Dentistry and ayurveda - IV: Classifi cation and management of common oral diseases. Indian J Dent Res 2008;19:52-61.Source of Support: Nil, Confl ict of Interest: None declared.


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Dentistry and Ayurveda Classification and Management